Gotowa bibliografia na temat „Georges Leven High-Tech Management School”

<p><strong>Abstract</strong></p><p class="yiv9127107781msonormal">Nejmi Sagıp Bodamyalızade, who was originally from Paphos in the south-west of Cyprus, completed his education at Oxford University. Then he returned to the island and established the Shakespeare School, which is one of the first private schools of the island. He has undertaken both teaching and school management roles here. Many Turkish Cypriots have been educated in this private school which offers English education. Nejmi Sagıp, which has a high level of general culture, has been nicknamed Feylosof (philosopher) by the community. During World War II, Nejmi Sagıp declared himself as a deputy of Cypriot Muslims by the signing of thousands of people in Nicosia. By using this title, Mr. Nejmi sent letters to the presidents and deputies of several countries, mainly the United Kingdom, defending the rights of Turkish Cypriots against the Enosis requests of Greek Cypriots. Mr. Nejmi has literary works besides education and political activities. One of his literary was the Quran which he translates to English. He also translated some of the classics of Turkish literature into English. Many people, especially the Irish writer George Bernard Shaw, Nobel Peace Prize-winning, have already begun to appreciate him for his translations. As a result, Mr. Nejmi has an important value for the Turkish Cypriot Political, Cultural and Educational history. </p><p><strong>Öz</strong></p><p>Aslen Kıbrıs’ın güney batısında bulunan Baf Kazasından olan Nejmi Sagıp Bodamyalızade, Oxford Üniversitesi’ndeki eğitimini tamamladıktan sonra adaya dönerek adanın ilk özel okullarından olan Shakespeare Okulu’nu kurmuştur. Burada hem öğretmenlik hem de okul müdürlüğü görevlerini üstlenmiştir. İngilizce eğitim veren bu özel okulda birçok Kıbrıslı Türk eğitim almıştır. Genel kültür düzeyi yüksek olan Nejmi Sagıp’a halk tarafından Feylosof (Filozof) lakabı takılmıştır. Nejmi Sagıp, II. Dünya Savaşı sırasında Lefkoşa’da binlerce kişiden imza toplayarak kendisini Kıbrıslı Müslümanların vekili ilan etmiştir. Nejmi Bey bu unvanı kullanarak başta İngiltere olmak üzere birçok ülkenin başkan ve elçilerine Kıbrıslı Rumların Enosis taleplerine karşı Kıbrıs Türklerinin haklarını savunan mektuplar göndermiştir. Nejmi Bey’in eğitim ve siyasi faaliyetlerinin yanında edebi çalışmaları da bulunmaktadır. Kaleme aldığı edebi eserlerinden birisi de İngilizceye çevirdiği manzum Kur’an-ı Kerim’dir. Ayrıca Türk Edebiyatının klasiklerinin bazılarını da İngilizceye tercüme etmiştir. Yaptığı bu çeviriler sayesinde başta Nobel Barış ödülü sahibi İrlandalı yazar George Bernard Shaw olmak üzere birçok kişinin takdirini toplamayı başarmıştır. Sonuç olarak Nejmi Bey Kıbrıs Türk Siyasi, Kültürel ve Eğitim tarihinin bir dönemine damgasını vurmuştur denilebilir.</p>

e24193 Background: This study had two objectives: To assess the impact of the COVID-19 pandemic on cancer patients’ management. To determine the impact of cancer types and anti-cancer medications on the immune response to COVID-19 vaccinations. Methods: Cancer patients at the Moncton Hospital, Oncology/Hematology Clinic, were invited to voluntarily complete a survey about the date of their cancer diagnosis, treatment, the impact of the COVID-19 pandemic on their health, and to complete a prepared list of possible side effects that they experienced after receiving any of the COVID-19 vaccines. Participants, who had received at least two doses of any COVID-19 vaccine, were given the option to consent to a sub-study to provide a blood sample to check their antibody response to the COVID-19 vaccination. Blood samples were collected at least 4 weeks after the second dose of a primary vaccine series, or at least 2 weeks after any booster dose. Samples were sent to the Dr. Georges-L.-Dumont University Hospital lab to be analyzed. Data was collected regarding the type of treatment (chemotherapy, immunotherapy, targeted therapy, hormonal therapy, radiation therapy, or a combination of these therapies). Analysis of the data was done using SPSS program. Results: 178 patients completed the survey. 117 patients had solid tumors, and 61 had a hematological malignancy. The mean age was 65.75 (range 31-90) years and 45.5% were males. 62.3% either had a high school diploma or a graduate degree. When asked if their anxiety about their health increased due to the pandemic, 57.8% reported that their anxiety level has moderately or somewhat increased. Similarly, around 70% responded that their stress levels moderately or somewhat increased due to the pandemic. Only 7.3% of patients mentioned that they had delays in diagnosis, and only 2.8% had changes in their treatment, however, around 30% had their appointments changed into phone appointments as a result of the pandemic. Only 4% reported a loss of job due to the pandemic, and 11.2% reported financial stress. Cross tabulations were done between type of cancer and results of the COVID-19 antibody test and type of treatment and results of the COVID-19 antibody test. Results showed that the type of treatment that the patient was receiving has no impact on the production of COVID-19 antibodies. However, antibodies after COVID-19 vaccination were not detected in 20.5% (10/49) of patients with hematological malignancies compared to 3.6% (3/82) of patients with solid tumors. This difference was statistically significant (p = 0.001). Conclusions: The pandemic affected Cancer patients in terms of increasing their anxiety and stress levels. The production of antibodies after COVID-19 vaccinations was significantly decreased in patients with hematological malignancies.

Abstract Aims/hypothesis Impaired awareness of hypoglycaemia (IAH) in type 1 diabetes may develop through a process referred to as habituation. Consistent with this, a single bout of high intensity interval exercise as a novel stress stimulus improves counterregulatory responses (CRR) to next-day hypoglycaemia, referred to as dishabituation. This longitudinal pilot study investigated whether 4 weeks of high intensity interval training (HIIT) has sustained effects on counterregulatory and symptom responses to hypoglycaemia in adults with type 1 diabetes and IAH. Methods HIT4HYPOS was a single-centre, randomised, parallel-group study. Participants were identified using the Scottish Diabetes Research Network (SDRN) and from diabetes outpatient clinics in NHS Tayside, UK. The study took place at the Clinical Research Centre, Ninewells Hospital and Medical School, Dundee, UK. Participants were aged 18–55 years with type 1 diabetes of at least 5 years’ duration and HbA1c levels <75 mmol/mol (<9%). They had IAH confirmed by a Gold score ≥4, modified Clarke score ≥4 or Dose Adjustment For Normal Eating [DAFNE] hypoglycaemia awareness rating of 2 or 3, and/or evidence of recurrent hypoglycaemia on flash glucose monitoring. Participants were randomly allocated using a web-based system to either 4 weeks of real-time continuous glucose monitoring (RT-CGM) or RT-CGM+HIIT. Participants and investigators were not masked to group assignment. The HIIT programme was performed for 20 min on a stationary exercise bike three times a week. Hyperinsulinaemic–hypoglycaemic (2.5 mmol/l) clamp studies with assessment of symptoms, hormones and cognitive function were performed at baseline and after 4 weeks of the study intervention. The predefined primary outcome was the difference in hypoglycaemia-induced adrenaline (epinephrine) responses from baseline following RT-CGM or RT-CGM+HIIT. Results Eighteen participants (nine men and nine women) with type 1 diabetes (median [IQR] duration 27 [18.75–32] years) and IAH were included, with nine participants randomised to each group. Data from all study participants were included in the analysis. During the 4 week intervention there were no significant mean (SEM) differences between RT-CGM and RT-CGM+HIIT in exposure to level 1 (28 [7] vs 22 [4] episodes, p=0.45) or level 2 (9 [3] vs 4 [1] episodes, p=0.29) hypoglycaemia. The CGM-derived mean glucose level, SD of glucose and glucose management indicator (GMI) did not differ between groups. During the hyperinsulinaemic–hypoglycaemic clamp studies, mean (SEM) change from baseline was greater for the noradrenergic responses (RT-CGM vs RT-CGM+HIIT: −988 [447] vs 514 [732] pmol/l, p=0.02) but not the adrenergic responses (–298 [687] vs 1130 [747] pmol/l, p=0.11) in those participants who had undergone RT-CGM+HIIT. There was a benefit of RT-CGM+HIIT for mean (SEM) change from baseline in the glucagon CRR to hypoglycaemia (RT-CGM vs RT-CGM+HIIT: 1 [4] vs 16 [6] ng/l, p=0.01). Consistent with the hormone response, the mean (SEM) symptomatic response to hypoglycaemia (adjusted for baseline) was greater following RT-CGM+HIIT (RT-CGM vs RT-CGM+HIIT: −4 [2] vs 0 [2], p<0.05). Conclusions/interpretation In this pilot clinical trial in people with type 1 diabetes and IAH, we found continuing benefits of HIIT for overall hormonal and symptomatic CRR to subsequent hypoglycaemia. Our findings also suggest that HIIT may improve the glucagon response to insulin-induced hypoglycaemia. Trial registration ISRCTN15373978. Funding Sir George Alberti Fellowship from Diabetes UK (CMF) and the Juvenile Diabetes Research Foundation. Graphical Abstract

Dear Colleagues, In the previous editorial paper published by Balat et al. [1] as an Early View Article a few months ago, it was reported that there were changes in the Editorial Team of the European Journal of Therapeutics (Eur J Ther). During these few months, while the preparations for the new issue (June 2023, volume 29, Issue 2) continued, the editorial board also was revised. We would like to inform you that the Editorial Board has been strengthened by academics who are competent in their fields from many countries of the world and will continue to be strengthened in the future. As it is known, Eur J Ther started broadcasting in 1990 as a Journal of the Faculty of Medicine University of Gaziantep (In Turkish: Gaziantep Üniversitesi Tıp Fakültesi Dergisi). In the first paper titled “While Starting” (In Turkish: Başlarken) of the first issue, Prof. Sabri Güngör, who was the first Editor-in-Chief, stated that the aim of the journal is to have an influential place in the field of science [2]. Over the past three decades, the journal has continued to advance. At the present time, it is inevitable to reorganise the editorial board of the journal and enrich it with leading international editors in order to move the journal to better places. This editorial will explain essential developments in the journal in the last few months, and the new Editorial Board Members of the Eur J Ther will be introduced. Changes are inevitable, and we are delighted to announce that this issue marks several significant improvements. Specifically, we bolstered our editorial team with esteemed international academics and expanded our pool of referees. Consequently, the evaluation period for the submitted articles was significantly reduced. In the last two months, the journal metrics are as follows: Acceptance rate: %29 Average time until the final decision: 24.4 days Average time to publish as Accepted/Early View Article, after acceptance: 4.8 days. Thanks to these improvements, as you will notice, there are 25 articles in this issue. In this way, this issue has been the issue in which most articles have been published so far. In addition, applications were made to DOAJ (Directory of Open Access Journals) and BASE (Bielefeld Academic Search Engine), among the most essential open-access databases in the world, in May 2023. Moreover, cited references to the previous and/or alternative names of the journal (Gaziantep Medical Journal, Gaziantep Med J, Gaziantep Tıp Dergisi and Gaziantep Üniversitesi Tıp Fakültesi Dergisi) in Web of Science that were not reflected in the journal metrics were identified and reported to the Web of Science. Some of these correction requests have been finalized and corrected, and thus the total number of citations and the H-index of the journal increased [3]. After all these data are updated, it will be seen that the citation values of the Eur J Ther will increase even more. We will also update the guidelines for the authors and reviewers with respect to the ICMJE [4] and EQUATOR Network [5], which will enhance the quality of research in the medical fraternity. Additionally, the use of DOI for articles published in the journal started in 2011 (2011, volume 17, Issue 2). In order to facilitate the recognition and access of the articles, DOIs have also been defined for all articles published in previous issues. Editors Ayşe Balat, MD, became the new Editor-in-Chief of Eur J Ther for the second time, the first between 2007-2010. She is a Professor in Pediatrics and a specialist in Pediatric Nephrology and Rheumatology. She has been working as Vice President of Gaziantep University since October 2020. She was the Dean of Gaziantep University Medical Faculty (2007-2010), President of the Mediterranean Kidney Society (MKS) between 2015 to 2018, and Secretary beginning in 2018. She is also President of the International Association for the History of Nephrology (IAHN) since 2022. In Gaziantep, she first established Pediatric Nephrology and Pediatric Rheumatology Units, and the first peritoneal dialysis was performed by her. She has several studies published in international and national peer-reviewed scientific journals (H-Index: 26, i10-index: 59 and approximately 2500 citations). She was the Guest Editor of the International Journal of Nephrology in 2012 (special issue titled “Devil’s Triangle in Kidney Diseases: Oxidative Stress, Mediators, and Inflammation”). She is a member of many national and international associations related to her field, including membership in the Turkish Pediatric Nephrology Association board in the past. She has several scientific presentation awards at national and international congresses. She has been joined as an “invited speaker” at 20 International Meetings. As of 2007, she organizes World Kidney Day activities within the scope of the “Survival is not Enough” program (in the first rank among European pediatric nephrologists as an organizer of those activities). Recently, she was elected as a “lifelong member of the Academy of Medicine and Surgical Sciences” of the University of Naples, which is one of the four important academies in Naples. Şevki Hakan Eren, MD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr Eren graduated from the Medical School, University of Gaziantep, Turkey and completed Emergency training at Cumhuriyet University. He has been working as a Professor at Gaziantep University, Department of Emergency Medicine, Gaziantep, Turkey. He is interested in traumatology, and toxicology. Mehmet Sait Menzilcioğlu, MD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr. Menzilcioğlu graduated from the Medical School, University of Gaziantep, Turkey and completed Radiology training at the same University. He has been working as an Associate Professor at Gaziantep University, Department of Radiology, Gaziantep, Turkey. He is interested in neuroradiology, ultrasonography, doppler Ultrasonography, Computerized Tomography, Magnetic Resonance Imaging, interventional radiology, and obstetric sonography. İlhan Bahşi, MD, PhD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr Bahşi is also on the Editorial Board of the Journal of Craniofacial Surgery, Frontiers in Neuroanatomy, and Mersin University School of Medicine Lokman Hekim Journal of History of Medicine and Folk Medicine. In addition, he has published more than 80 articles (H-index: 12 and i10-index: 15) and has been a referee for more than 600 academic papers in many internationally indexed journals. Dr Bahşi, who has been working in the Department of Anatomy at the Gaziantep University Faculty of Medicine since 2012, completed his doctorate education in 2017 and obtained the title of PhD. Besides anatomy, he is particularly interested in the history of medicine, medical ethics, and education. İlkay Doğan, PhD, is the new Editorial Board member of the Eur J Ther for Statistics and Methodology. He is in the Department of Biostatistics at the Gaziantep University Faculty of Medicine. His professional focus lies in research about Structural Equation Modeling, Multivariate Analysis. With a wealth of experience spanning over 15 years across multiple disciplines, including veterinary, nursing, sport and medicine, Dr Doğan has held various notable articles. He is a member of the Turkish Biostatistics Association. Ahmet Acıduman, MD, PhD, graduated from Ege University Faculty of Medicine in 1987 and later specialized in Neurosurgery in 1997. Dr Acıduman further expanded his academic credentials by completing a PhD in the History of Medicine and Ethics in 2005. Currently, he is a Professor in the Department of History of Medicine and Ethics at Ankara University Faculty of Medicine. With a notable record of over 200 academic publications, Dr Acıduman’s contributions to the field continue. Bilal Çiğ, PhD, is a new Editorial board member of the Eur J Ther. Associate Prof Bilal Çiğ is a Postdoctoral researcher at King's College London Wolfson Card. He has been investigating the roles of ion channels in neurological diseases using the patch clamp technique for nearly 15 years. For the past few years, he has focused on the interactions of TRPA1 and Kir 4.1 channels in demyelination. He has 40 SCI-E and international publications, with about 1300 citations. Tsvetoslav Georgiev, MD, PhD, holds an esteemed position as an associate professor at the First Department of Internal Medicine in Varna, Bulgaria, while also working as a clinician at the University Hospital St. Marina. He has successfully defended his doctoral dissertation in 2018 at the Medical University in Sofia. Having obtained a specialization in rheumatology that same year, Dr Georgiev has extensive expertise in this intricate field of medicine. He further expanded his knowledge and skills by attending comprehensive courses on imaging diagnostics and musculoskeletal ultrasound in rheumatology held in various locations. Dr Georgiev has been involved in formulating the Bulgarian consensus on osteoarthritis and EULAR recommendations for the non-pharmacological core management of osteoarthritis. Notably, Dr Georgiev has received recognition for his outstanding contributions as a reviewer, earning awards in 2019 and 2021 from the Korean Academy of Medical Sciences. Davut Sinan Kaplan, PhD, is a new Editorial Board Member of the Eur J Ther. Dr Kaplan is an Associate Professor in the Department of Physiology at Gaziantep University Faculty of Medicine. He is also the Graduate School of Health Sciences’ Director. He has taken involved in a wide variety of research with animal models. His research generally focuses on Endocrinology, Metabolism, Physical Activity, and Breast Milk. He has mentored a large group of master’s and PhD students. He has served for many years as a member of the local animal experiments ethics committee. Mehmet Karadağ, MD, is a new Editorial Board Member of the Eur J Ther for Psychiatry. Dr. Karadag is an Associate Professor of Child and Adolescent Psychiatry. He is in the Department of Child and Adolescent Psychiatry at the Gaziantep University School of Medicine. He has experience on Posttraumatic Stress, Attention Deficit Hyperactivity, Autism Spectrum, Anxiety, Depressive Disorders and EMDR Therapy. He is also EMDRIA accredited EMDR Consultant. Murat Karaoglan, MD, is a new Editorial Board Member of the Eur J Ther for Endocrinology. Dr. Karaoglan is an Associate Professor of Pediatric Endocrinology. He is in the Department of Pediatric Endocrinology at the Gaziantep University School of Medicine. He has experience on growth disorder, diabetology and disorder of sexual development. Waqar M. Naqvi, PhD, is a faculty in the Department of Physiotherapy at the College of Health Sciences, Gulf Medical University, Ajman, UAE. His professional focus lies in the development of the research ecosystem within healthcare education, with a particular interest in AI, AR, VR, Sensors, and innovation in health sciences. With a wealth of experience spanning over 14 years across multiple countries, including India, Canada, Cameroon, Hong Kong, and Saudi Arabia, Dr Naqvi has held various notable positions. These include his roles as the Associate Director of Research at the NKP Salve Institute of Medical Sciences, Acting Dean and Vice Dean of the Physiotherapy College, Convener for the International Admission Office, International Accreditation and Quality Assurance Wing, Staff Selection Committee, and Coordinator for a Staff-Student Exchange Program. In recognition of his outstanding contributions, Dr Naqvi was honored with the Distinguished Service Award and Young Achiever Award from the Indian Association of Physiotherapy. Dr Naqvi is widely recognized for his expertise in conducting seminars and workshops on research, publications, and intellectual property rights. Specializing as a research trainer in the fields of medicine, dentistry, physiotherapy, and health sciences, Dr Naqvi's unwavering commitment to research excellence and his genuine passion for mentoring aspiring researchers are instrumental in shaping the future of healthcare. He firmly believes in the power of evidence-based practice and actively advocates for its implementation. Ali Nasimi is a neuroscientist in the field of central regulation of the cardiovascular system. Victor Nedzvetsky, PhD, DrSc is a full professor of Physiology, Biochemistry and Lab Diagnostics, where coordinates courses on Neurochemistry, Molecular and Cell Biology. Additionally, he is a vice-director of “The Biosafety Center” research and development company (Ukraine). He obtained PhD in biochemistry at Dnipropetrovsk University, Ukraine (1990). After postdoctoral training, he received a degree of Doctor Science at Kyiv National University (2006). Since 2015 he was involved as an invited professor of Bingol University, Turkey as a supervisor of PhD projects on genetic and molecular biology. He has participated in both the education and research work of the Dept. Art and Science of Bingol University from 2015 to 2021. His current research interests are focused on intestinal barrier function, brain blood barrier, astrocytes, cognitive deficits, bioactive compounds as anticancer agents, nanomaterials, and neuroprotection. He is the author of over 230 research publications and ten patents. He is a member of the editorial board of the journal “Regulatory Mechanisms of Biosystems”. Raphael Olszewski, DDS, MD, PhD, DrSc is a full professor of oral surgery and dentomaxillofacial radiology at the Université Catholique de Louvain (UCLouvain), Brussels, Belgium. Professor Olszewski is an oral surgeon and member of the Department of Oral and Maxillofacial Surgery at Cliniques Universitaires Saint Luc, UCLouvan, Brussels, Belgium. Prof Olszewski is the Editor-in-Chief of NEMESIS: Negative effects in medical sciences: oral and maxillofacial surgery. Janusz Ostrowski, MD, PhD. Internal medicine, nephrology, and public health specialist. Former Head of the Department of Internal Medicine and Nephrology at the Provincial Hospital in Wloclawek, Poland. Director for Peritoneal Dialysis in Diaverum Company Poland. Secretary of the Historical Section of the Polish Society of Nephrology. Former President of the International Association for the History of Nephrology. Professor, Vice Dean of the School of Public Health and Head of the Department of the History of Medicine in the Centre of Postgraduate Medical Education in Warsaw, Poland. Ayşe Aysima Özçelik, MD, is a new Editorial Board member of Eur J Ther for Neurology. She is the head of the pediatric neurology department and works at Gaziantep University Faculty of Medicine. She is the regional manager for the treatment of spinal muscular atrophy disease. She is an experienced physician in the treatment and follow-up of genetic neurological disorders, epilepsy, and neuromuscular diseases. Maria Piagkou, DDS, MD, MSc, PhD is a new Editorial Board member of Eur J Ther for Neurology. She is an associate professor at the Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens. She is a Deputy Vice-President of the Hellenic Association of Public Health in Greece and a President of the printed material handling committee of the National Organization for Medicines. She has twenty-one years of teaching activity in the field of anatomy, focused on head and neck, oral and maxillofacial area, as well as on skull base anatomy and anatomical variants. Her main areas of interest are head and neck anatomy and surgery, skull base anatomy, oral surgery, maxillofacial and dental trauma, rehabilitation, intraoral fixation after condylar fractures, and teeth replantation. She is an associate editor in 2 journals of Anatomy and acts as Editorial Board Member in six other journals. She authored six chapters in neuroanatomy and oral and maxillofacial surgery and thoracic surgery books, two monographs, and edited the translation of 9 books. She is a reviewer in 30 international scientific journals. She authored 156 publications in PubMed, 91 abstracts in 26 international congresses, and 318 abstracts in Greek scientific meetings. She is General Secretary of the Sports Medicine Association of Greece and treasurer of the Hellenic Association of Anatomy. Halima Resić, MD, PhD is a Professor of Internal medicine – nephrology in Sarajevo. Professor Resić studied medicine at the University of Belgrade where she also undertook a clinical fellowship in nephrology. She finished her postgraduate studies also at the University of Belgrade in 1987. Professor Resić worked at the Clinical Centre of Belgrade from 1972. to 1992. In 1993. She worked at the Marmara University of Istanbul. Also, in the period from 1994. to 1996. she took part in projects for refugees in Munich with the support of the Ministry of Health of the city of Munich. From 1996. till 2019. professor Resić worked at the Clinical Center University of Sarajevo, where she was head of the Clinic of Hemodialysis. In 2001. She obtained her PhD degree in Nephrology. She became a professor at the Medical Faculty of the University of Sarajevo in 2013. Professor Resić published about 180 professional and scientific papers in relevant journals. She has been a president of organizations of a few national congress and nephrology schools, and also an active participant of ERA congress and WCN congress. She has also been invited lecturer in over 60 different international and national congresses. Professor Resić was President of the BANTAO Society (2017-2019), and President of the Mediterian Kidney Society. She has been President of the Society of Nephrology, Dialysis and Kidney Transplantation in Bosnia and Herzegovina (2010-2020) and also, she is President of Donor’s network of Bosnia and Herzegovina. She is a member of ERA EDTA and ISN, and also a member of the Committee of SRC by ISN. She is a member of the Council of EAPE (European Association of Professor Emerita). She is also vice president of IANUBIH (International Academy of Science and Arts in Bosnia and Herzegovina) and a member of the board of South Eastern Europe by ISN. In her carrier, she obtains many international awards for her work in the field of Nephrology. Aldo Rogelis Aquiles Rodrigues is a new Editorial Board member of Eur J Ther for Neurology. Currently, he is an associate professor in physiology at the Federal University of Triângulo Mineiro, MG, Brazil since 2006. Before that, he worked as a research associate at the Department of Neurophysiology, Madison, USA from 2002 to 2005. He has experience in auditory neurons electrophysiology, enteric neurons and ion channels in general. Domenico Santoro is a Full Professor of Nephrology, Director of the Division of Nephrology and Coordinator of the Nephrology Fellowship Program University of Messina, AOU G. Martino – Messina. He is s a clinical expert in glomerular disorders with a scientific formation at the section of renal Pathology of the CSMC UCLA Los Angeles. He collaborated in genetic studies in glomerular disease. He coordinates as principal investigators several studies in glomerular disease both in clinical/therapeutical as well genetic aspects. He is the Associate Editor of the Journal of Nephrology and MBC Nephrology. Author of more than 270 scientific publications indexed on Scopus, H-index in Scopus: 38; H-index in Google Scholar: 46. Onur Taydaş, MD, is a new Editorial Board Member of the Eur J Ther for Radiology. Dr Taydas is an Associate Professor in the Department of Radiology at the Sakarya University School of Medicine. He has a Turkish Society of Radiology Proficiency Certificate, a European Diploma in Radiology, and a Turkish Interventional Radiology Diploma. He has experience in neuroradiology, musculoskeletal radiology, and interventional radiology. Gregory Tsoucalas (or Tsoukalas), born in 1974 and originated from the Island of Skopelos in the center of the Aegean Sea, he had studied Medicine in the University of Saint Kliment Ohridski in Sofia Bulgaria. He had then continued his studies in Lyon France and Athens Greece. He had been a Nuclear Medicine-Oncology-End stage physician in Saint Savvas Anticancer Hospital of Athens. He had after that moved to the city of Volos where he had been a physician in the Saint George Clinic for Alzheimer and Related Dementia Syndromes-End stage. He had finally moved to the General Clinic Anassa of Volos in the Internal Pathology Department. He currently holds the position of the Assistant professor of the History of Medicine, and head of the Department of History of Medicine and Medical Deontology, Medical School, University of Crete, Heraklion, Greece. Specialized in Nuclear Medicine, MSc in Palliative Medicine and PhD in the History of Medicine from National and Kapodistrian University of Athens, History of Medicine Diploma from Claude Bernard Lyon 1 University, post-doc in Anatomy from Democritus University of Thrace, Anthropology Course Diploma from Leiden University. He holds diplomas in Mastology and Clinical Nutrition for the related European Societies. He is the General Secretary of the Hellenic Branch of the Balkan Medical Union. Interested in the fields of History of Medicine, Deontology, Bioethics, Anatomy and Humanities, he is the writer of more than 200 articles in the PubMed database and more than 200 in other bases. He loves books and had published 10, while he had participated with chapters in various publications. Member of the International Society of the History of Medicine he had presented more than 130 speeches and 50 lectures in international level. Member of DELTOS (Hellenic Society) he had presented more than 400 speeches in local level. He enjoys more than 2500 citations, H-index: 17, and i10-index: 41. Hamit Yıldız, MD, PhD, is the new editorial Board member for Internal Medicine. Dr Yildiz is an internal medicine specialist and practices in Gaziantep University Hospital. He is Board Certified in Internal Medicine. He completed his internship at Gaziantep University in Gaziantep and also graduated with a PhD in molecular biology. He has more than ten years of experience as a specialist who focuses on patients with diabetes, hypertension and thyroid diseases. His special interest is recombinant DNA technologies and the development of biotechnological drugs. Betül Yılmaz Furtun, MD, FASE, FAAP, is a new Editorial Board Member for the Eur J Ther. She is an Associate Professor of Pediatrics at the Texas Children's Hospital, Baylor College of Medicine and Associate Medical Director of the Fetal Cardiology/Fetal Cardiac Intervention Program at Texas Children's Hospital. Dr Yilmaz Furtun is also a Course Director of Fetal Cardiology Education/Curriculum Development for advanced and categorical cardiology fellows and an Associate Director of the Fetal Care Center Steering Committee for fetal cardiology at Texas Children's Hospital. Dr Yilmaz Furtun is a pediatric cardiologist with expertise in advanced imaging modalities including fetal echocardiography, transthoracic and transesophageal echocardiography. Dr Yilmaz Furtun completed her pediatrics training at Washington University in St. Louis, pediatric cardiology training at Columbia University Medical Center, New York Presbyterian Hospital, and fetal cardiology/advanced imaging training at Cincinnati Children's Hospital. Dr Yilmaz Furtun actively participates in fetal and pediatric echocardiography laboratory protocol development and fetal and echocardiography lab and Fetal Care Center quality and improvement initiatives. Dr Yilmaz Furtun has been a member of the American Society of Echocardiography, the International Society of Ultrasound in Obstetrics and Gynecology, the Fetal Heart Society as well as American College of Cardiology. Dr Yilmaz Furtun’s clinical and research focus relates to cardiac imaging by echocardiography and fetal echocardiography. She utilizes her experience in these areas to study how we can use non-invasive imaging modalities for investigating normal and abnormal cardiac function in patients with congenital heart disease and in fetuses with cardiac compromise. Her primary research interests focus on fetal cardiovascular assessment and cardiac dysfunction in patients with congenital heart disease, in fetuses with congenital abnormalities, and in multiple gestation pregnancies complicated by twin-twin transfusion syndrome. Matthew Zdilla, DC, is a new Editorial Board Member for the Eur J Ther. Dr Zdilla was educated at the University of Pittsburgh and Northeast College of Health Sciences. He serves as an Associate Professor at the West Virginia University School of Medicine in the United States of America. He is an award-winning, internationally recognized clinical anatomist who has published scores of high-impact research papers regarding human diversity and the impact of anatomical variation on clinical procedures. In addition to his experience as an accomplished researcher, Zdilla brings his experience as an ad hoc reviewer for nearly 40 journals to the European Journal of Therapeutics. Joseph Schmidt, MFA has taught academic writing for the University of Louisville and various campuses of The City University of New York (CUNY). An accomplished poet, he has contributed content to, and edited a number of small literary journals. At Gaziantep University, he has lent his editorial and native English language talents to some of his Turkish colleagues in the sciences. He teaches in the university’s School of Foreign Languages (YDO).

Photo by Chris Carzoli on Unsplash INTRODUCTION l. The Need for a Children’s Hospital El Paso, Texas did not receive a children’s hospital until 2012, much later than would be expected given its demographics and geographic isolation. By that time, there were already nearly 250 children’s hospitals spread across the United States, some in areas far smaller, far older, and in far closer proximity to other urban centers.[1] Without accounting for its substantial population of undocumented immigrants,[2] El Paso is the country’s 22nd largest city (and situated in its 70th most populous county).[3] The nearest American city of comparable size is Phoenix, AZ, located about 350 miles away. Moreover, El Paso has a decidedly young demographic skew: more than 28 percent of the population is under the age of 18, compared to 26.5 percent of the population in Texas and 23.1 percent of the population nationally.[4] This gap is expected to widen in the coming years.[5] El Paso children also have less access to care than children in cities with comparable populations and population structures. Though the situation has improved in the last decade, El Paso contains several Health Professional Shortage Areas (HPSAs) for primary care, dental health, and mental health. This is in addition to many Medically Underserved Areas (MUAs) for primary care, specialty care, dental health, and mental health.[6] This means that El Paso children wait longer for their appointments and are often seen by tired and overworked providers. Before the El Paso Children’s Hospital (EPCH) opened its doors if these children needed advanced care, they had to leave the city, and many simply did not have the resources to do so. It is more difficult to assess the quality of the care that they were able to receive locally, as few systematic reviews of pediatric outcomes in the region were conducted during that period. Nevertheless, several El Paso physicians look back and describe an “unacceptably low” standard of care.[7] Regardless, access and quality are interrelated, and children’s hospitals tend to promote both.[8] ll. Why Did It Take So Long? There are several reasons why El Paso did not receive a children’s hospital until years after the need for it became apparent to forward-thinking physicians and other interested parties, including select parent groups. a. There were no wealthy benefactors willing to establish a children’s hospital endowment, forcing the hospital’s proponents to ask the taxpayers to issue $120 million in bonds for the project.[9] However, El Paso is fairly poor. The median annual household income is approximately $42,000, more than $17,000 below the state average and $25,000 below the national average.[10] Property values are low, and Texas does not do much to redistribute funds from wealthier to poorer parts of the state, so resources for community development are limited and spending priorities must be chosen carefully. b. The wealthier, less-Hispanic parts of El Paso were reluctant to fund a project that was billed primarily as a means of assisting poor, Hispanic children. c. Two previous children’s hospital projects had fallen through after their for-profit sponsors pulled out, and some El Pasoans were hesitant to try again. d. Tenet Healthcare, the owners of El Paso’s largest for-profit hospital network, opposed the project. They feared competition for the basic services they provided in their “children’s wing,” and perhaps knew that they might no longer get away with providing substandard pediatric care. When, over their objections, the project appeared on the ballot they launched a vigorous advertisement campaign against it. Some physicians joined them. e. Low levels of education and civic engagement in El Paso, coupled with an underdeveloped sense of entitlement, led to complacency. There was a lack of political will for a big project like the children’s hospital because many El Pasoans did not think that they deserved better than what they were getting. They were accustomed to a certain quality of care and a certain level of access to care. If they were not content with the status quo, they were at least tolerant of it. This last point is worth elaborating upon. Fewer than 24 percent of El Pasoans complete a bachelor’s degree, compared to nearly 32 percent of Texans and nearly 35 percent of Americans.[11] The city’s high school graduation rate is just above 75 percent, nearly 10 percent below the corresponding national and state rates.[12] Additionally, the majority of available jobs are low-paying and physically demanding, so many well-educated El Pasoans choose to make their lives elsewhere (“brain drain”).[13] Poverty and limited English proficiency compound upon low levels of education to lower access to the instruments of democracy and erode democratic culture, and they make the population more susceptible to manipulation by powerful interests – on any side. Tenet Healthcare’s advertising campaign was better funded than the campaign for the children’s hospital, and physicians and experts lined up on both sides which created confusion. In addition, and perhaps counterintuitively, given El Paso’s poor and largely Hispanic population (>80 percent),[14], [15] trust in the healthcare system is high.[16] One possible explanation is exceptional quality of care, though all the facts suggest this is not the case. Other explanations include a high degree of physician-patient ethnic concordance, a cultural deference to authority, and underentitelment, that is, the belief that one deserves less than what dispassionate others conclude s/he deserves. Any population can grow accustomed to the status quo and poverty, lack of education, and membership in an otherwise vulnerable group can prevent information filtering in from outside the city – nationwide trends – from really “taking hold.” However, in El Paso, the situation is still more complicated. Many El Pasoans have family in Mexico and cross the border regularly for shopping or recreation. In many ways, El Paso and Ciudad Juárez form a single community, and even El Pasoans who have been in the country their entire lives tend to maintain a strong connection to Mexico. This is relevant because the quality of medical care in Mexico (though improving) is low,[17] and expectations for what the government (or any large entity) will do for the common man lower still.[18] El Paso voters ultimately made the decision to fund the construction of a children’s hospital, though by a margin of less than 2 percent and with fewer than 12 percent of eligible voters weighing in.[19] The El Paso Children’s Hospital has more than delivered on its community health improvement promises. It has reduced pediatric outmigration for subspecialty and surgical care by more than 80 percent, substantially increased the county’s physician workforce, and launched several successful preventive health and health education programs. In addition, it has promoted cutting-edge research on a slew of pediatric conditions and helped to increase the city’s physician retention rate.[20] But there have been some serious hiccoughs along the way, including a bankruptcy crisis in 2015 that caused almost half of the hospital’s board to resign,[21] and there is still a lot of work to be done.[22] lll. A Better Approach to Building Children’s Hospitals The difficulty in opening a children’s hospital in El Paso serves as an important starting point for a discussion on the principles of ethical governance. Most agree that when the private sector fails to address an important community need, it is the responsibility of the government to intervene. However, people differ on what they consider an “important community need” and the precise role of government in filling needs. They may also prefer that government intervention occur at the local, state or federal level, or some combination of the three, depending on the issue before them. Five separate feasibility studies were conducted in the lead-up to the 2007 vote. All agreed that El Paso needed a children’s hospital.[23] ,But none discussed how much it needed a children’s hospital, i.e., what trade-offs would be appropriate for the community to make in order to build one. Nor could they. People will always prioritize differently. Perhaps a delay in funding a children’s hospital would allow for a restructuring of the school system. Americans usually prefer to decide such issues at the ballot box, either directly or through their representatives. However, for projects like a children’s hospital, where not all community members are informed enough on the pertinent issues to perform a cost/benefit analysis, and the risks of not acting can be severe, some other mechanism, or some supplementary mechanism, of deciding on the issue is more appropriate. In determining whether and what types of state intervention are justified, ethicists weigh several competing concerns: beneficence (the good that is likely to come to the community, folding in the harm to certain stakeholders), justice (in this case, for children, in terms of access to and quality of care) and autonomy (of the voters). However, in many communities across the country, after the need for a children’s hospital is demonstrated[24] if local voters and their representatives weigh in at all, it need only be to decide on zoning and other logistical issues because wealthy benefactors are willing to foot the bill.[25] In communities like El Paso, where no such benefactors make themselves known, voters or their representatives are asked to make a much more difficult decision: whether to fund a children’s hospital by raising taxes on themselves. That may not be fair to them, especially if their community is already poor, and it is certainly not fair to the children whose health and quality of life are at stake. Though El Paso did eventually vote to fund a children’s hospital, similarly situated communities may vote differently, and their children could suffer as a result, just as El Paso children suffered during the delay. Communities like El Paso may also be in a poor position to make truly autonomous decisions on this issue. Poverty and lack of education can lead to confusion or ambivalence owing to lack of information or access to the tools necessary to become informed. For-profit hospital chains unwilling to establish their own children’s hospitals, and others who stand to lose out, can use their considerable power to unduly influence the debate, which can also be inaccurately cast as one about redistributing resources from wealthy white households to poor, “undeserving” ethnic minorities. But one need not accept an argument about diminished community autonomy to conclude that some form of state or federal intervention to tip the scales on specific children’s hospital projects is ethically permissible. This is partially because the autonomy concern, with respect to the children’s hospital issue, is a red herring. As noted above, voters and local officials in most communities barely weigh in on children’s hospital projects at all. Projects which, it is important to stress, concern the welfare of a non-voting vulnerable group and so maybe should not be subject to majoritarianism to begin with! Moreover, if a state or the federal government were to establish a uniform process for determining whether a community needs a children’s hospital, e.g. delegating authority to a health planning agency that performs regular and transparent health infrastructure assessments and proactively issues “certificates of need” (as opposed to issuing them only after an application by interested parties), the democratic process is respected more than if a children’s hospital were simply foisted upon a community by wealthy benefactors. If the state or federal government were also to help qualifying local communities obtain their children’s hospitals, much local hesitancy about the hospital would shrink. One may wonder whether this is just “kicking the problem up to another level of government.” There is, after all, no assurance that political will for building children’s hospitals in needy communities will be higher at the state or federal level than at the local level. It may even be lower, as state and federal officials are more emotionally removed from the conditions on the ground. However, a key difference is that the reliance on a single governmental agency – one that has the resources to perform thorough, less biased assessments – removes a lot of the extraneous variables with bearing on the success of a children’s hospital project. Such an agency focuses only on the first part of the project, establishing that the hospital is necessary. This is a lower hurdle to clear, and it provides momentum for the next parts of the process, which may include varying degrees of state or federal government intervention, all of which could also be managed by a different agency. This system also makes capture by powerful interests difficult. Not only do these interests often appear less powerful at the state or federal level than locally, but a health planning agency applies objective criteria in making its determinations, and the next steps occur “in a different house.” Finally, state or federal involvement leads to parity across communities and sounder resource management because children’s hospitals generally serve areas outside the communities in which they are situated. Once a certificate of need has been issued to a community indicating that it needs a children’s hospital, the state[26] may (1) build the hospital using its own funds or funds appropriated to it for that purpose by the federal government or (2) let the local community take the lead, providing subsidies on a sliding scale to ensure that the communities which struggle to afford a children’s hospital still get one. For a variety of political and budgetary reasons, this latter route is more realistic, and it has the advantage of building local community buy-in, which could be important if the children’s hospital is to successfully recruit personnel, receive referrals from local physicians and actively participate in the local medical education/research enterprises. A certificate of need issued by an impartial government agency as part of its mandate might itself be enough to persuade a local community to take action. It could spur proponents to organize, if they had not done so earlier, and could be used as ammunition in their advertisement campaigns. But if the community is still apathetic or hesitant, the state can launch educational initiatives, including those aimed at changing underentitlement, and help it negotiate with for-profit hospital chains to see if they can be incentivized to take a children’s hospital project on. The state may also consider issuing different types of certificates of need and, for the highest level, require that the community build a children’s hospital, in the same way, that it (often) requires it to have police or fire protection. Subsidies would almost certainly have to be offered for this to be politically viable (and ethically acceptable). CONCLUSION There are several issues with this framework, including precisely how a financially infeasible but necessary children’s hospital can be made feasible. Details will have to be filled in. Nevertheless, it is something worth investigating. It could significantly improve the current situation, in which communities like El Paso are essentially left to fend for themselves. Disclaimer: The author has family associated with the El Paso Children’s Hospital. Chetan Moorthy and Sadhana Chheda are his parents. Chheda served as Board Secretary and works at Children’s as a neonatologist. Moorthy contracts with Children’s to provide radiology services. Both have practiced in El Paso for decades, and their experience is drawn upon to support some of the article’s claims, particularly those for which no hard data has been collected. [1] Casimir, Georges. 2019. “Why Children’s Hospitals Are Unique and So Essential.” Frontiers in Pediatrics 7 (July). https://doi.org/10.3389/fped.2019.00305. [2] Pew Research Center’s Hispanic Trends Project. 2019. “Metro Area U.S. Unauthorized Immigrant Population Estimates, 2016 and 2007.” Pew Research. March 11, 2019. https://www.pewresearch.org/hispanic/interactives/unauthorized-immigrants-by-metro-area-table/. [3] “City and Town Population Totals: 2010-2019.” 2020. United States Census Bureau. https://www.census.gov/data/tables/time-series/demo/popest/2010s-total-cities-and-towns.html. [4] “El Paso, Texas: Demographic Profile.” 2017. EPTX. 2017. https://www.elpasotexas.gov/economic-development/business-services/data-and-statistics/population. [5] “Community Health Needs Assessment 2014.” 2014. El Paso Children’s Hospital. https://elpasochildrens.org/wp-content/uploads/2019/08/epch-chna-report-final-9-29-14-v3.pdf. [6] Ibid. [7] Moorthy, Chetan, and Sadhana Chheda. 2020. Conditions in El Paso, Texas: Physician Services and Patient Perceptions. Interview by Gyan Moorthy. In-Person. [8] “All Children Need Children’s Hospitals.” n.d. National Association of Children’s Hospitals and Related Institutions. Accessed November 29, 2020. https://www.upstate.edu/gch/pdf/academics/allchildren.pdf. [9] Schalden, Mary. 2015. “Children’s Hospital Timeline.” El Paso Times, October 5, 2015. https://www.elpasotimes.com/story/news/2015/10/05/childrens-hospital-timeline/73394588/. [10] “El Paso, Texas: Demographic Profile.” 2017. [11] Ibid. [12] “High School Graduation Rate Data for El Paso, TX.” 2018. Open Data Network. 2018. https://www.opendatanetwork.com/entity/1600000US4824000/El_Paso_TX/education.graduation_rates.percent_high_school_graduate_or_higher?year=2018. [13] Anderson, Lindsey. 2015. “More People Leave El Paso for Elsewhere than Other Major Cities.” El Paso Times, July 22, 2015. https://www.elpasotimes.com/story/news/local/2015/07/22/more-people-leave-el-paso-elsewhere-than-other/71987220/. [14] “El Paso, Texas: Demographic Profile.” 2017. [15] Armstrong, Katrina, Karima L. Ravenell, Suzanne McMurphy, and Mary Putt. 2007. “Racial/Ethnic Differences in Physician Distrust in the United States.” American Journal of Public Health 97 (7): 1283–89. https://doi.org/10.2105/AJPH.2005.080762. [16] Moorthy, Chetan, and Sadhana Chheda. 2020. [17] Barber, Ryan M., Nancy Fullman, Reed J. D. Sorensen, Thomas Bollyky, Martin McKee, Ellen Nolte, Amanuel Alemu Abajobir, et al. 2017. “Healthcare Access and Quality Index Based on Mortality from Causes Amenable to Personal Health Care in 195 Countries and Territories, 1990–2015: A Novel Analysis from the Global Burden of Disease Study 2015.” The Lancet 390 (10091): 231–66. https://doi.org/10.1016/S0140-6736(17)30818-8. [18] Lagos, Lorenzo Felipe. 2012. “Institutional Trust: The Case Study of Mexican State Institutions.” Student Perspectives on Institutions, Choices, and Ethics 7 (4): 39. [19] “Final Election Results (2007).” 2007. El Paso County Elections Department. https://el-paso-county-elections.s3.amazonaws.com/documents/files/000/000/300/original/ELECTION_RESULTS_FINAL.pdf?1450312070. [20] “2018 Annual Community Benefit Report.” 2018. El Paso Children’s Hospital. https://elpasochildrens.org/wp-content/uploads/2018/11/epch_communityreport_2018_small.pdf. [21] Flores, Aileen B. 2015. “Taxpayers Still Owe $116M for Construction of El Paso Children’s Hospital.” El Paso Times, May 27, 2015. https://www.elpasotimes.com/story/news/local/2015/05/27/taxpayers-still-owe-116m-construction-childrens-hospital/31261601/. [22] Moorthy, Chetan, and Sadhana Chheda. 2020. [23] “History of El Paso Children’s Hospital.” 2020. El Paso Children’s Hospital. 2020. https://elpasochildrens.org/about-us/. [24] In many states, a “certificate of need” must be obtained before new healthcare facilities can be created. See Mercatus Center. 2015. “How State Certificate-of-Need (CON) Laws Affect Access to Health Care.” Medium. December 23, 2015. https://medium.com/concentrated-benefits/how-state-certificate-of-need-con-laws-impact-access-to-health-care-b8d3ec84242f for more. Certificates of need may slow the founding of hospitals in some areas, but they could also spur it when political will is low or absent. [25] Moorthy, Chetan, and Sadhana Chheda. 2020. [26] Given federal/state separation of powers, it is very unlikely that the federal government would be directly involved at this step.

Every crisis at the same time reveals, forewarns and implies changes with cyclical trends that can be analyzed from different disciplinary perspectives, building scenarios to anticipate the future, despite uncertainties and risks. And the current crisis certainly appears as one of the most problematic of the modern era: recently, Luigi Ferrara, Director of the School of Design at the George Brown College in Toronto and of the connected Institute without Boundaries, highlighted how the pandemic has simply accelerated undergoing dynamics, exacerbating other crises – climatic, environmental, social, economic – which had already been going on for a long time both locally and globally. In the most economically developed contexts, from North America to Europe, the Covid emergency has led, for example, to the closure of almost 30% of the retail trade, as well as to the disposal and sale of many churches. Places of care and assistance, such as hospitals and elderly houses, have become places of death and isolation for over a year, or have been closed. At the same time, the pandemic has imposed the revolution of the remote working and education, which was heralded – without much success – more than twenty years ago. In these even contradictory dynamics, Ferrara sees many possibilities: new roles for stronger and more capable public institutions as well as the opportunity to rethink and redesign the built environment and the landscape. Last but not least, against a future that could be configured as dystopian, a unique chance to enable forms of citizenship and communities capable of inhabiting more sustainable, intelligent and ethical cities and territories; and architects capable of designing them. This multifactorial and pervasive crisis seems therefore to impose a deep review of the current unequal development models, in the perspective of that “creative destruction” that Schumpeter placed at the basis of the dynamic entrepreneurial push: «To produce means to combine materials and forces within our reach. To produce other things, or the same things by a different method, means to combine these materials and forces differently» (Schumpeter, 1912). A concept well suiting to the design practice as a response to social needs and improving the living conditions. This is the perspective of Architectural Technology, in its various forms, which has always placed the experimental method at the center of its action. As Eduardo Vittoria already pointed out: «The specific contribution of the technological project to the development of an industrial culture is aimed at balancing the emotional-aesthetic data of the design with the technical-productive data of the industry. Design becomes a place of convergence of ideas and skills related to factuality, based on a multidisciplinary intelligence» (Vittoria, 1999). A lucid and appropriate critique of the many formalistic emphases that have invested contemporary architecture. In the most acute phases of the pandemic, the radical nature of this polycrisis has been repeatedly invoked as a lever for an equally radical modification of the development models, for the definitive defeat of conjunctural and emergency modes of action. With particular reference to the Italian context, however, it seems improper to talk about a “change of models” – whether economic, social, productive or programming, rather than technological innovation – since in the national reality the models and reference systems prove to not to be actually structured. The current socio-economic and productive framework, and the political and planning actions themselves, are rather a variegated and disordered set of consolidated practices, habits often distorted when not deleterious, that correspond to stratified regulatory apparatuses, which are inconsistent and often ineffective. It is even more difficult to talk about programmatic rationality models in the specific sector of construction and built environment transformation, where the enunciation of objectives and the prospection of planning actions rarely achieve adequate projects and certain implementation processes, verified for the consistency of the results obtained and monitored for the ability in maintaining the required performance over time. Rather than “changing the model”, in the Italian case, we should therefore talk about giving shape and implementation to an organic and rational system of multilevel and inter-sectorial governance models, which assumes the principles of subsidiarity, administrative decentralization, inter-institutional and public-private cooperation. But, even in the current situation, with the pandemic not yet over, we are already experiencing a sort of “return to order”: after having envisaged radical changes – new urban models environmentally and climatically more sustainable, residential systems and public spaces more responsive to the pressing needs of social demand, priority actions to redevelop the suburbs and to strength infrastructures and ecosystem services, new advanced forms of decision-making decentralization for the co-planning of urban and territorial transformations, and so on – everything seems to has been reset to zero. This is evident from the list of actions and projects proposed by the National Recovery and Resilience Plan (NRRP), where no clear national strategy for green transition emerges, even though it is repeatedly mentioned. As highlighted by the Coordination of Technical-Scientific Associations for the Environment and Landscape1, and as required by EU guidelines2, this transition requires a paradigm shift that assumes eco-sustainability as a transversal guideline for all actions. With the primary objective of protecting ecosystem balances, improving and enhancing the natural and landscape capital, as well as protecting citizen health and well-being from environmental risks and from those generated by improper anthropization phenomena. The contents of the Plan explicitly emphases the need to «repair the economic and social damage of the pandemic crisis» and to «contribute to addressing the structural weaknesses of the Italian economy», two certainly relevant objectives, the pursuit of which, however, could paradoxically contrast precisely with the transition to a more sustainable development. In the Plan, the green revolution and the ecological transition are resolved in a dedicated axis (waste management, hydrogen, energy efficiency of buildings, without however specific reform guidelines of the broader “energy” sector), while «only one of the projects of the Plan regards directly the theme Biodiversity / Ecosystem / Landscape, and in a completely marginal way» (CATAP, 2021). Actions are also limited for assessing the environmental sustainability of the interventions, except the provision of an ad hoc Commission for the streamlining of some procedural steps and a generic indication of compliance with the DNSH-Do not significant Harm criterion (do not cause any significant damage), without specific guidelines on the evaluation methods. Moreover, little or nothing in the Plan refers on actions and investments in urban renewal, abandoned heritage recovery3, of in protecting and enhancing areas characterized by environmental sensitivity/fragility; situations widely present on the national territory, which are instead the first resource for a structural environmental transition. Finally yet importantly, the well-known inability to manage expenditure and the public administration inefficiencies must be considered: a limit not only to the effective implementation of projects, but also to the control of the relationship between time, costs and quality (also environmental) of the interventions. In many places, the Plan has been talked about as an opportunity for a real “reconstruction”, similar to that of post-war Italy; forgetting that the socio-economic renaissance was driven by the INA-Casa Plan4, but also by a considerable robustness of the cultural approach in the research and experimentation of new housing models (Schiaffonati, 2014)5. A possible “model”, which – appropriately updated in socio-technical and environmental terms – could be a reference for an incisive governmental action aiming at answering to a question – the one of the housing – far from being resolved and still a priority, if not an emergency. The crisis also implies the deployment of new skills, with a review of outdated disciplinary approaches, abandoning all corporate resistances and subcultures that have long prevented the change. A particularly deep fracture in our country, which has implications in research, education and professions, dramatically evident in the disciplines of architectural and urban design. Coherently with the EU Strategic Agenda 2019-2024 and the European Pillar of Social Rights, the action plan presented by the Commission in March 2021, with the commitment of the Declaration of Porto on May 7, sets three main objectives for 2030: an employment rate higher than 78%, the participation of more than 60% of adults in training courses every year and at least 15 million fewer people at risk of social exclusion or poverty6. Education, training and retraining, lifelong learning and employment-oriented skills, placed at the center of EU policy action, now require large investments, to stimulate employment transitions towards the emerging sectors of green, circular and digital economies (environmental design and assessment, risk assessment & management, safety, durability and maintainability, design and management of the life cycle of plans, projects, building systems and components: contents that are completely marginal or absent in the current training offer of Architecture). Departments and PhDs in the Technological Area have actively worked with considerable effectiveness in this field. In these regards, we have to recall the role played by Romano Del Nord «protagonist for commitment and clarity in identifying fundamental strategic lines for the cultural and professional training of architects, in the face of unprecedented changes of the environmental and production context» (Schiaffonati, 2021). Today, on the other hand, the axis of permanent and technical training is almost forgotten by ministerial and university policies for the reorganization of teaching systems, with a lack of strategic visions for bridging the deficit of skills that characterizes the area of architecture on the facing environmental and socio-economic challenges. Also and precisely in the dual perspective of greater interaction with the research systems and with the world of companies and institutions, and of that trans- and multi-disciplinary dimension of knowledge, methods and techniques necessary for the ecological transition of settlement systems and construction sector. Due to the high awareness of the Technological Area about the multifactorial and multi-scale dimension of the crises that recurrently affect our territories, SITdA has been configured since its foundation as a place for scientific and cultural debate on the research and training themes. With a critical approach to the consoling academic attitude looking for a “specific disciplinary” external and extraneous to the social production of goods and services. Finalizing the action of our community to «activate relationships between universities, professions, institutions through the promotion of the technological culture of architecture [...], to offer scientific-cultural resources for the training and qualification of young researchers [...], in collaboration with the national education system in order to advance training in the areas of technology and innovation in architecture» (SITdA Statute, 2007). Goals and topics which seem to be current, which Techne intends to resume and develop in the next issues, and already widely present in this n. 22 dedicated to the Circular Economy. A theme that, as emerges from the contributions, permeates the entire field of action of the project: housing, services, public space, suburbs, infrastructures, production, buildings. All contexts in which technological innovation invests both processes and products: artificial intelligence, robotics and automation, internet of things, 3D printing, sensors, nano and biotechnology, biomaterials, biogenetics and neuroscience feed advanced experiments that cross-fertilize different contributions towards common objectives of circularity and sustainability. In this context, the issue of waste, the superfluous, abandonment and waste, emerge, raising the question of re-purpose: an action that crosses a large panel of cases, due to the presence of a vast heritage of resources – materials, artefacts, spaces and entire territories – to be recovered and re-functionalized, transforming, adapting, reusing, reconverting, reactivating the existing for new purposes and uses, or adapting it to new and changing needs. Therefore, by adopting strategies and techniques of reconversion and reuse, of re-manufacturing and recycling of construction and demolition waste, of design for disassembly that operate along even unprecedented supply chains and which are accompanied by actions to extend the useful life cycle of materials , components and building systems, as well as product service logic also extended to durable goods such as the housing. These are complex perspectives but considerably interesting, feasible through the activation of adequate and updated skills systems, for a necessary and possible future, precisely starting from the ability – as designers, researchers and teachers in the area of Architectural Technology – to read the space and conceive a project within a system of rationalities, albeit limited, but substantially founded, which qualify the interventions through approaches validated in research and experimental verification. Contrarily to any ineffective academicism, which corresponds in fact to a condition of subordination caused by the hegemonic dynamics at the base of the crisis itself, but also by a loss of authority that derives from the inadequate preparation of the architects. An expropriation that legitimizes the worst ignorance in the government of the territories, cities and artifacts. Education in Architecture, strictly connected to the research from which contents and methods derive, has its central pivot in the project didactic: activity by its nature of a practical and experimental type, applied to specific places and contexts, concrete and material, and characterized by considerable complexity, due to the multiplicity of factors involved. This is what differentiates the construction sector, delegated to territorial and urban transformations, from any other sector. A sector that borrows its knowledge from other production processes, importing technologies and materials. With a complex integration of which the project is charged, for the realization of the buildings, along a succession of phases for corresponding to multiple regulatory and procedural constraints. The knowledge and rationalization of these processes are the basis of the evolution of the design and construction production approaches, as well as merely intuitive logics. These aspects were the subject of in-depth study at the SITdA National Conference on “Producing Project” (Reggio Calabria, 2018), and relaunched in a new perspective by the International Conference “The project in the digital age. Technology, Nature, Culture” scheduled in Naples on the 1st-2nd of July 2021. A reflection that Techne intends to further develop through the sharing of knowledge and scientific debate, selecting topics of great importance, to give voice to a new phase and recalling the practice of design research, in connection with the production context, institutions and social demand. “Inside the Polycrisis. The possible necessary” is the theme of the call we launched for n. 23, to plan the future despite the uncertainties and risks, foreshadowing strategies that support a unavoidable change, also by operating within the dynamics that, for better or for worse, will be triggered by the significant resources committed to the implementation of the Recovery Plan. To envisage systematic actions based on the centrality of a rational programming, of environmentally appropriate design at the architectural, urban and territorial scales, and of a continuous monitoring of the implementation processes. With the commitment also to promote, after each release, a public moment of reflection and critical assessment on the research progresses. NOTES 1 “Osservazioni del Coordinamento delle Associazioni Tecnico-scientifiche per l’Ambiente e il Paesaggio al PNRR”, 2021. 2 EU Guidelines, SWD-2021-12 final, 21.1.2021. 3 For instance, we can consider the 7,000 km of dismissed railways, with related buildings and areas. 4 The two seven-year activities of the Plan (1949-1963) promoted by Amintore Fanfani, Minister of Labor and Social Security at the time, represented both an employment and a social maneuver, which left us the important legacy of neighborhoods that still today they have their own precise identity, testimony of the architectural culture of the Italian twentieth century. But also a «grandiose machine for the housing» (Samonà, 1949), based on a clear institutional and organizational reorganization, with the establishment of a single body (articulated in the plan implementation committee, led by Filiberto Guala, with regulatory functions of disbursement of funds, assignment of tasks and supervision, and in the INA-Casa Management directed by the architect Arnaldo Foschini, then dean of the Faculty of Architecture), which led to the construction of two million rooms for over 350,000 families. See Di Biagi F. (2013), Il Contributo italiano alla storia del Pensiero – Tecnica, Enciclopedia Treccani. 5 From Quaderni of the Centro Studi INA-Casa, to Gescal and in the Eighties to the activity of CER. Complex theme investigated by Fabrizio Schiaffonati in Il progetto della residenza sociale, edited by Raffaella Riva. 6 Ferruccio De Bortoli underlines in Corriere della Sera of 15 May 2021: «The revolution of lifelong learning (which) is no less important for Brussels than the digital or green one. By 2030, at least 60 per cent of the active population will have to participate in training courses every year. It will be said: but 2030 is far away. There’s time. No, because most people have escaped that to achieve this goal, by 2025 – that is, in less than four years – 120 million Europeans will ideally return to school. A kind of great educational vaccination campaign. Day after tomorrow».

Introduction The exhibition of an artist’s work is traditionally accepted as representing the final stage of the creative process (Staniszewski). This article asks, however, whether this traditional view can be reassessed so that the curatorial practice of mounting an exhibition becomes, itself, a creative outcome feeding into work that may still be in progress, and that simultaneously operates as a learning and teaching tool. To provide a preliminary examination of the issue, we use a single case study approach, taking an example of practice currently used at an Australian university. In this program, internal and external students work together to develop and deliver an exhibition of their own work in progress. The exhibition space has a professional website (‘CQUniversity Noosa Exhibition Space’), many community members and the local media attend exhibition openings, and the exhibition (which runs for three to four weeks) becomes an outcome students can include in their curriculum vitae. This article reflects on the experiences, challenges, and outcomes that have been gained through this process over the past twelve months. Due to this time frame, the case study is exploratory and its findings are provisional. The case study is an appropriate method to explore a small sample of events (in this case exhibitions) as, following Merriam, it allows the construction of a richer picture of an under-examined phenomenon to be constructed. Although it is clear that this approach will not offer results which can be generalised, it can, nevertheless, assist in opening up a field for investigation and constructing a holistic account of a phenomenon (in this case, the exhibition space as authentic learning experience and productive teaching tool), for, as Merriam states, “much can be learned from a particular case” (51). Jennings adds that even the smallest case study is useful as it includes an “in-depth examination of the subject with which to confirm or contest received generalizations” (14). Donmoyer extends thoughts on this, suggesting that the single case study is extremely useful as the “restricted conception of generalizability … solely in terms of sampling and statistical significance is no longer defensible or functional” (45). Using the available student course feedback, anonymous end-of-term course evaluations, and other available information, this case study account offers an example of what Merriam terms a “narrative description” (51), which seeks to offer readers the opportunity to engage and “learn vicariously from an encounter with the case” (Merriam 51) in question. This may, we propose, be particularly productive for other educators since what is “learn[ed] in a particular case can be transferred to similar situations” (Merriam 51). Breaking Ground exhibition, CQUniversity Noosa Exhibition Space, 2014. Photo by Ulrike Sturm. Background The Graduate Certificate of Creative Industries (Creative Practice) (CQU ‘CB82’) was developed in 2011 to meet the national Australian Quality Framework agency’s Level 8 (Graduate Certificate) standards in terms of what is called in their policies, the “level” of learning. This states that, following the program, graduates from this level of program “will have advanced knowledge and skills for professional or highly skilled work and/or further learning … [and] will apply knowledge and skills to demonstrate autonomy, well-developed judgment, adaptability and responsibility as a practitioner or learner” (AQF). The program was first delivered in 2012 and, since then, has been offered both two and three terms a year, attracting small numbers of students each term, with an average of 8 to 12 students a term. To meet these requirements, such programs are sometimes developed to provide professional and work-integrated learning tasks and learning outcomes for students (Patrick et al., Smith et al.). In this case, professionally relevant and related tasks and outcomes formed the basis for the program, its learning tasks, and its assessment regime. To this end, each student enrolled in this program works on an individual, self-determined (but developed in association with the teaching team and with feedback from peers) creative/professional project that is planned, developed, and delivered across one term of study for full- time students and two terms for part- timers. In order to ensure the AQF-required professional-level outcomes, many projects are designed and/or developed in partnership with professional arts institutions and community bodies. Partnerships mobilised utilised in this way have included those with local, state, and national bodies, including the local arts community, festivals, and educational support programs, as well as private business and community organisations. Student interaction with curation occurs regularly at art schools, where graduate and other student shows are scheduled as a regular events on the calendar of most tertiary art schools (Al-Amri), and the curated exhibition as an outcome has a longstanding tradition in tertiary fine arts education (Webb, Brien, and Burr). Yet in these cases, it is ultimately the creative work on show that is the focus of the learning experience and assessment process, rather than any focus on engagement with the curatorial process itself (Dally et al.). When art schools do involve students in the curatorial process, the focus usually still remains on the students' creative work (Sullivan). Another interaction with curation is when students undertaking a tertiary-level course or program in museum, and/or curatorial practice are engaged in the process of developing, mounting, and/or critiquing curated activities. These programs are, however, very small in number in Australia, where they are only offered at postgraduate level, with the exception of an undergraduate program at the University of Canberra (‘215JA.2’). By adopting “the exhibition” as a component of the learning process rather than its end product, including documentation of students’ work in progress as exhibition pieces, and incorporating it into a more general creative industries focused program, we argue that the curatorial experience can become an interactive learning platform for students ranging from diverse creative disciplines. The Student Experience Students in the program under consideration in this case study come from a wide spectrum of the creative industries, including creative writing, film, multimedia, music, and visual arts. Each term, at least half of the enrolments are distance students. The decision to establish an on-campus exhibition space was an experimental strategy that sought to bring together students from different creative disciplines and diverse locations, and actively involve them in the exhibition development and curatorial process. As well as their individual project work, the students also bring differing levels of prior professional experience to the program, and exhibit a wide range of learning styles and approaches when developing and completing their creative works and exegetical reflections. To cater for the variations listed above, but still meet the program milestones and learning outcomes that must (under the program rules) remain consistent for each student, we employed a multi-disciplinary approach to teaching that included strategies informed by Gardner’s theory of multiple intelligences (Gardner, Frames of Mind), which proposed and defined seven intelligences, and repeatedly criticised what he identified as an over-reliance on linguistic and logical indices as identifiers of intelligence. He asserted that these were traditional indicators of high scores on most IQ measures or tests of achievement but were not representative of overall levels of intelligence. Gardner later reinforced that, “unless individuals take a very active role in what it is that they’re studying, unless they learn to ask questions, to do things hands on, to essentially re-create things in their own mind and transform them as is needed, the ideas just disappear” (Edutopia). In alignment with Gardner’s views, we have noted that students enrolled in the program demonstrate strengths in several key intelligence areas, particularly interpersonal, musical, body-kinaesthetic, and spacial/visual intelligences (see Gardner, ‘Multiple Intelligences’, 8–18). To cater for, and further develop, these strengths, and also for the external students who were unable to attend university-based workshop sessions, we developed a range of resources with various approaches to hands-on creative tasks that related to the projects students were completing that term. These resources included the usual scholarly articles, books, and textbooks but were also sourced from the print and online media, guest speaker presentations, and digital sites such as You Tube and TED Talks, and through student input into group discussions. The positive reception of these individual project-relevant resources is evidenced in the class online discussion forums, where consecutive groups of students have consistently reflected on the positive impact these resources have had on their individual creative projects: This has been a difficult week with many issues presenting. As part of our Free Writing exercise in class, we explored ‘brain dumping’ and wrote anything (no matter how ridiculous) down. The great thing I discovered after completing this task was that by allowing myself to not censor my thoughts by compiling a writing masterpiece, I was indeed “free” to express everything. …. … I understand that this may not have been the original intended goal of Free Writing – but it is something I would highly recommend external students to try and see if it works for you (Student 'A', week 5, term 1 2015, Moodle reflection point). I found our discussion about crowdfunding particularly interesting. ... I intend to look at this model for future exhibitions. I think it could be a great way for me to look into developing an exhibition of paintings alongside some more commercial collateral such as prints and cards (Student 'B', week 6, term 1 2015, Moodle reflection point). In class I specifically enjoyed the black out activity and found the online videos exceptional, inspiring and innovating. I really enjoyed this activity and it was something that I can take away and use within the classroom when educating (Student 'C', week 8, term 1 2015, Moodle reflection point). The application of Gardner’s principles and strategies dovetailed with our framework for assessing learning outcomes, where we were guided by Boud’s seven propositions for assessment reform in higher education, which aim to “set directions for change, designed to enhance learning achievements for all students and improve the quality of their experience” (26). Boud asserts that assessment has most effect when: it is used to engage students in productive learning; feedback is used to improve student learning; students and teachers become partners in learning and assessment; students are inducted into the assessment practices of higher education; assessment and learning are placed at the centre of subject and program design; assessment and learning is a focus for staff and institutional development; and, assessment provides inclusive and trustworthy representation of student achievement. These propositions were integral to the design of learning outcomes for the exhibition. Teachers worked with students, individually and as a group, to build their capacity to curate the exhibition, and this included such things as the design and administration of invitations, and also the physical placement of works within the exhibition space. In this way, teachers and students became partners in the process of assessment. The final exhibition, as a learning outcome, meant that students were engaged in productive learning that placed both assessment and knowledge at the centre of subject and project design. It is a collation of creative pieces that embodies the class, as a whole; however, each piece also represents the skills and creativity of individual students and, in this way, are is a trustworthy representations of student achievement. While we aimed to employ all seven recommendations, our main focus was on ensuring that the exhibition, as an authentic learning experience, was productive and that the students were engaged as responsible and accountable co-facilitators of it. These factors are particularly relevant as almost all the students were either currently working, or planning to work, in their chosen creative field, where the work would necessarily involve both publication, performance, and/or exhibition of their artwork plus collaborative practice across disciplinary boundaries to make this happen (Brien). For this reason, we provided exhibition-related coursework tasks that we hoped were engaging and that also represented an authentic learning outcome for the students. Student Curatorship In this context, the opportunity to exhibit their own works-in-progress provided an authentic reason, with a deadline, for students to both work, and reflect, on their creative projects. The documentation of each student’s creative process was showcased as a stand-alone exhibition piece within the display. These exhibits not only served not only to highlight the different learning styles of each student, but also proved to inspire creativity and skill development. They also provided a working model whereby students (and potential enrollees) could view other students’ work and creative processes from inception to fully-realised project outcomes. The sample online reflections quoted above not only highlight the effectiveness of the online content delivery, but this engagement with the online forum also allowed remote students to comment on each other’s projects as well as to and respond to issues they were encountering in their project planning and development and creative practice. It was essential that this level of peer engagement was fostered for the curatorial project to be viable, as both internal and external students are involved in designing the invitation, catalogue, labels, and design of the space, while on-campus students hang and label work according to the group’s directions. Distance students send in items. This is a key point of this experiment: the process of curating an exhibition of work from diverse creative fields, and from students located thousands of kilometres apart, as a way of bringing cohesion to a diverse cohort of students. That cohesiveness provided an opportunity for authentic learning to occur because it was in relation to a task that each student apparently understood as personally, academically, and professionally relevant. This was supported by the anonymous course evaluation comments, which were overwhelmingly positive about the exhibition process – there were no negative comments regarding this aspect of the program, and over 60 per cent of the class supplied these evaluations. This also met a considerable point of anxiety in the current university environment whereby actively engaging students in online learning interactions is a continuing issue (Dixon, Dixon, and Axmann). A key question is: what relevance does this curatorial process have for a student whose field is not visual art, but, for instance, music, film, or writing? By displaying documentation of work in progress, this process connects students of all disciplines with an audience. For example, one student in 2014 who was a singer/songwriter, had her song available to be played on a laptop, alongside photographs of the studio when she was recording her song with her band. In conjunction with this, the cover artwork for her CD, together with the actual CD and CD cover, were framed and exhibited. Another student, who was also a musician but who was completing a music history project, sent in pages of the music transcriptions he had been working on during the course. This manuscript was bound and exhibited in a way that prompted some audience members to commented that it was like an artist’s book as well as a collection of data. Both of these students lived over 1,000 kilometres from the campus where the exhibition was held, but they were able to share with us as teaching staff, as well as with other students who were involved in the physical setting up of the exhibition, exactly how they envisaged their work being displayed. The feedback from both of these students was that this experience gave them a strong connection to the program. They described how, despite the issue of distance, they had had the opportunity to participate in a professional event that they were very keen to include on their curricula vitae. Another aspect of students actively participating in the curation of an exhibition which features work from diverse disciplines is that these students get a true sense of the collaborative interconnectedness of the disciplines of the creative industries (Brien). By way of example, the exhibit of the singer/songwriter referred to above involved not only the student and her band, but also the photographer who took the photographs, and the artist who designed the CD cover. Students collaboratively decided how this material was handled in the exhibition catalogue – all these names were included and their roles described. Breaking Ground exhibition, CQUniversity Noosa Exhibition Space, 2014. Photo by Ulrike Sturm. Outcomes and Conclusion We believe that the curation of an exhibition and the delivery of its constituent components raises student awareness that they are, as creatives, part of a network of industries, developing in them a genuine understanding of the way the creating industries works as a profession outside the academic setting. It is in this sense that this curatorial task is an authentic learning experience. In fact, what was initially perceived as a significant challenge—, that is, exhibiting work in progress from diverse creative fields—, has become a strength of the curatorial project. In reflecting on the experiences and outcomes that have occurred through the implementation of this example of curatorial practice, both as a learning tool and as a creative outcome in its own right, a key positive indicator for this approach is the high level of student satisfaction with the course, as recorded in the formal, anonymous university student evaluations (with 60–100 per cent of these completed for each term, when the university benchmark is 50 per cent completion), and the high level of professional outcomes achieved post-completion. The university evaluation scores have been in the top (4.5–5/.5) range for satisfaction over the program’s eight terms of delivery since 2012. Particularly in relation to subsequent professional outcomes, anecdotal feedback has been that the curatorial process served as an authentic and engaged learning experience because it equipped the students, now graduates, of the program with not only knowledge about how exhibitions work, but also a genuine understanding of the web of connections between the diverse creative arts and industries. Indeed, a number of students have submitted proposals to exhibit professionally in the space after graduation, again providing anecdotal feedback that the experience they gained through our model has had a sustaining impact on their creative practice. While the focus of this activity has been on creative learning for the students, it has also provided an interesting and engaging teaching experience for us as the program’s staff. We will continue to gather evidence relating to our model, and, with the next iteration of the exhibition project, a more detailed comparative analysis will be attempted. At this stage, with ethics approval, we plan to run an anonymous survey with all students involved in this activity, to develop questions for a focus group discussion with graduates. We are also in the process of contacting alumni of the program regarding professional outcomes to map these one, two, and five years after graduation. We will also keep a record of what percentage of students apply to exhibit in the space after graduation, as this will also be an additional marker of how professional and useful they perceive the experience to be. In conclusion, it can be stated that the 100 per cent pass rate and 0 per cent attrition rate from the program since its inception, coupled with a high level (over 60 per cent) of student progression to further post-graduate study in the creative industries, has not been detrimentally affected by this curatorial experiment, and has encouraged staff to continue with this approach. References Al-Amri, Mohammed. “Assessment Techniques Practiced in Teaching Art at Sultan Qaboos University in Oman.” International Journal of Education through Art 7.3 (2011): 267–282. AQF Levels. Australian Qualifications Framework website. 18 June 2015 ‹http://www.aqf.edu.au/aqf/in-detail/aqf-levels/›. Boud, D. Student Assessment for Learning in and after Courses: Final Report for Senior Fellowship. Sydney: Australian Learning and Teaching Council, 2010. 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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/›.

Tiffany is running down a suburban street with headphones and a hoodie on. Her breath is clearly audible, rhythmic, steady, and in pace with her footsteps. The Tiffany’s Story video testimonial on the Be Smart. Be Well. website then cuts to Tiffany sitting at home describing her earlier experiences with asthma: “The hospital became like my second home... I couldn’t breathe on my own.” Dr. Wolf, who has been treating Tiffany since she was diagnosed with asthma at age 8, joins in, “At that time she had really severe asthma. It was very difficult to manage and remained very difficult to manage for many years” (Be Smart. Be Well). As a child, Tiffany could never run, with steady breath, as she did at the beginning of the video, titled The Right Meds Keep Her in the Ring (Be Smart. Be Well). But after figuring out a treatment regime that worked, Tiffany became a healthy teenager; the video features her in contexts where she is jogging, smiling radiantly with her mother, and holding up victory belts from her boxing matches. From a child unable to breathe on her own, to a teenager with dreams of going to the Olympics, Tiffany’s asthma story underscores some of the defining narratives of contemporary asthma care. Her experience moves from uncontrolled asthma that limited her activities to a well-managed condition where she is able to pursue her aspirations without interference. Her Olympic dreams fit perfectly, reproduce even, the iconic image of the asthmatic athlete. It’s an image that has been in circulation since the early years of the contemporary asthma epidemic, a moment in the 1990s when federal health agencies and advocacy organizations worked to give the growing population of child asthmatics hope and encouragement to overcome their asthma. Yet the figure of the athletic asthmatic, and other accomplished icons with well-controlled asthma, also promotes an idealized image of health: “you can be greater than you are,” when you take your medication. The messages, of course, are well intentioned, designed to educate and show kids that asthma does not equate with disability. Yet these messages frequently work on logic where drugs control symptoms to enable you to do better in life. In some corners of asthma care, concern with symptoms is subsumed by narratives of activity and accomplishment. This article sketches shifts in the meaning of health and disease in the context of asthma treatment, moving from a time when treatments were not disease-specific and illness was seen as debilitating, to the contemporary moment where pharmaceutical companies market disease and promote health through direct-to-consumer advertising (DTCA). It’s a move situated within a broader, biomedicalized context where health isn’t just achieved, it’s augmented. Tiffany’s story is typical of someone with severe or even moderate asthma: uncontrolled symptoms, use of emergency care, unresponsive to medications, and an inability to live life as fully as desired. Symptoms and the threat of symptoms prevent people from undertaking routine activities (such as exercise, visiting friends, or attending work or school) and going into spaces that might trigger an attack. Asthma, in other words, can prevent people from living a “normal” life. But it can also be more than a chronic inconvenience that shapes behaviors; in the U.S., asthma still kills more than 3,000 people each year (Moorman et al. 20). Medical practitioners, researchers, and patients persistently search for insight into asthma’s causes and possible cures (Whitmarsh). Both cause and cure still allude, but preventative measures have improved dramatically in the last thirty years, through both pharmaceutical advancements and better public health approaches. Whereas a century ago, or even 30 years ago, severe asthmatics would have lead quite restricted lives—confined to their homes and unable to be active—today’s asthmatics are not limited by their condition to the degree they were decades before. We see this in asthma research that shows improved morbidity, decreased hospitalizations, and better quality of life (Moorman et al. 1-67). We also see this in DTCA, asthma advocacy campaigns, and even public health messages that actively combat the historic image of the weak, invalid asthmatic with stories of famous athletes, entertainers, or politicians who overcame asthma to achieve great things. It moves the discourse from an overly negative image—as one asthmatic interlocutor conveyed, “there was a stereotype in the 80s, in the movies, where the nerdy wimpy kid always had asthma, and the inhaler was associated with that”—to an extraordinarily positive image of high achieving asthmatics. Inhalers, formerly a sign of weakness, are now common in competitive sport contexts (Arie 344). The contrast between these representations—the 1980s nerdy wimp and the 21st century athlete—is stark. The latter image participates in the shift towards augmented health, where active bodies have become the new idealized norm. The shifting representations of asthmatics, even over the last twenty years, makes sense in the context of biomedicalization (Clarke et al. 172), where treatment regimes moved from a focus on “attaining control over the body” under medicalization, to “enabling the transformation of bodies to include desired new properties and identities” (Clarke et al. 183). The right treatment will allow you to do things that your body wouldn’t let you do otherwise. The question is: should treatment be sold on this premise? What would have been considered a return to health a hundred years ago wouldn’t be considered doing enough to manage your asthma today. A hundred years ago, the absence of symptoms would have been a success; today, the focus is on the degree to which one feels limited and how much you can accomplish in the span of 24-hours. Missed school and work days are a key measure in asthma epidemiology and care; these public health measures not only signal uncontrolled asthma, but do so by counting absence in the context of labor. The discursive shift can also be seen in the change from the urge to “breathe easy” (language from the Centers for Disease Control) to suggestions in pharmaceutical ads that you can “breathe better.” What new selves are being created by emergent health rhetorics, as Metzel asks (6), rhetorics which seem to be consumerist and neoliberal as much as they are biomedical? Role Reversal Historically, those with severe asthma led their lives carefully, or in reclusion. French novelist Marcel Proust, in addition to his literary accomplishments, spent much of his life confined to his home. Despite searching through medical texts and experimenting with various treatments, Proust’s asthma “dominated” his daily life, in the words of Mark Jackson (6). Writing of asthma’s history, Jackson continues, Proust constitutes the archetypal asthmatic, whose breathlessness and discomfort echo across space and time. Proust’s intimate descriptions of his symptoms—‘an asthmatic never knows if he will be able to breathe’ he wrote to the novelist Andre Gide in 1919—bear striking similarities both to Greek and medieval accounts of asthma many centuries earlier and to recent surveys suggesting that, at the turn of the millennium, many asthmatics continue to suffer from severe attacks that prevent them from speaking or make them fear for their lives. (8) In Proust’s time, advertisements for asthma and other respiratory treatments focused on providing symptom relief; some even purported to cure respiratory woes. These advertisements were rarely asthma specific, in part, because manufacturers sought the widest possible customer base, but also because it was difficult to distinguish one respiratory illness from another (Jackson 201). Asthmatics like Proust tried a range of remedies, including asthma cigarettes, the Carbolic Smoke Ball, and various forms of early inhalers. Most of these early asthma remedies instructed customers to use their product when in need of relief. Some ads stated that more regular use could stave off symptoms as well remedy them in the moment, but prevention wasn’t the primary message. The principle focus was addressing symptoms at hand. Just about a hundred years later, at the beginning of the U.S. asthma epidemic, symptoms were still center stage. National attention turned towards the asthmatic condition as the public health effects of severe asthma became visible—asthma-related deaths and hospitalizations had increased, along with rising prevalence rates. Asthma—formerly kept hidden in homes and in low-income communities—emerged as a major public health issue (Mitman 245). Advocacy campaigns were created on the heels of the epidemic’s emergence; they aimed to make asthma visible and show kids that their condition didn’t have to get in the way of life. Elite athletes became central figures in these campaigns. The Asthma All-Stars program, which featured Olympic medalists Jackie Joyner-Kersee and Amy Van Dyken, as well as Pittsburgh Steeler Jerome Bettis, worked to educate the public through acknowledgement of the condition as well as treatment advocacy. The National Library of Medicine’s exhibit on asthma, “Breath of Life” (1999), exemplifies this period with a showcase of famous asthmatics. In the exhibit, more than half the profiles of contemporary asthmatics feature Olympic or all-star athletes; entertainers, politicians, and scientists round out the exhibit. The legacy of the asthmatic athlete persists today; it’s still common to see sports figures speaking at fundraisers or spearheading events. These images are important, particularly for patient populations who truly feel limited and unable to do things because of their asthma. Athletes who speak about their condition are always clear: well-controlled asthma comes from adherence to treatment. The importance of these images also stems from the use of the image of the All-Star asthmatic to counter the historical stereotype of the weak, invalid asthmatic, who, like Proust, could not even leave the house. The man who recalled the stereotyped asthmatic from the 1980s, stated “I think I mapped myself onto that [stereotype], like, this is a disability, right, the media tells me this is a disability cause it’s always the kids who can’t do anything who are puffing their puffers.” In step with emergent 21st century health rhetoric, and increasing asthma prevalence, the image of the asthmatic was revised, falling in line with newly normalized health ideals (Clarke et al. 181; Metzel 2; Sinding 262). Active Asthmatics If 19th and early 20th century inhaler advertisements declared their products could relieve if not cure respiratory symptoms, at the beginning of the 21st century asthma treatment went beyond simply relieving symptoms; advertisements and medical discourse emphasized preventative symptom control, improved lung function, and better breathing. With the development of long-term controller medications, many asthmatics could reliably prevent symptoms a majority of the time. When combination inhalers hit the market in the early 2000s, the mood of advertisements could be summed up by a line from a GlaxoSmithKline commercial, “Coping is not the same as controlling” (GlaxoSmithKline). Prevention rather than symptom relief was the order of the new century. And yet just in the last ten years, pharmaceutical messages have shifted yet again, moving from an emphasis on controlling symptoms to living a better life: don’t let asthma slow you down, or stop you from living the life you want to live. It’s a message predicated on a particular view of what a normal life should look like, one characterized as augmented health. A 2012 Advair commercial reflects the tone of augmented health, “Asthma can hold you back, but it doesn’t always have to. Advair is clinically proven to significantly increase symptom free days, to help you do more of the things you like to do, more of the things you have to do, and more of what you want to do” (Advair). Strategically placed throughout the commercial, a voice chimes in “GO!” as the hero of the commercial, a middle aged asthmatic man, bikes down a wooded trail; moves through a busy hallway where he greets one person after the next, all of whom hand him file folders or blue prints; dances at a nightclub; and walks down bleachers to join a group of friends at a ballgame. The commercial ends with the man arriving home well after dark, comfortably settling into bed, and then energetically waking up to do it all over again the next day. Marked by words like increase, more, and go, the Advair commercial depicts a life full of activity. Not only that, the commercial leverages contexts that are commonly problematic for asthmatics: being outside and in foliage rich areas; biking and dancing, or other physical activities that could leave one breathless; and sleeping comfortably—nighttime attacks are common among asthmatics. The message is clear: look at all the things asthmatics can do when their condition is well controlled—with Advair, of course. It’s a message that builds on an earlier trend in asthma advocacy, during the 1990s, when well-known asthmatic athletes were used to bring visibility to asthma. If asthma control in the 1990s emphasized that asthmatics didn’t need to be held back, 21st century ads suggest that one could do more. By augmenting your health, asthma control can transform your life by allowing you to do more.Today, DTCA for asthma drugs are just as likely to emphasize improved lung function as they are symptom control, and, as advertised in the Advair commercial, improved lung function enables one to do more. A man featured in a 2012 Symbicort commercial explains, “Symbicort helps significantly improve my lung function, starting within five minutes… With Symbicort, today I’m breathing better” (Symbicort). The man’s renewed capacity to go on fishing trips with loved ones is the example in this commercial. Control, relief, and cure are nowhere to be found in these DTC advertisements; symptoms have been dropped from the frame. Rather than work off illness, or the older stereotype of the weak, homebound asthmatic, the new wave of DTCA champions augmented health: a higher quality of life, where patient-consumers can “do” whatever they like. What would have been considered a return to normal a hundred years ago, in Proust’s time, wouldn’t be considered doing enough to manage your asthma today. A hundred years ago, getting out of the house would have been enough; today, it’s a question of how much can you accomplish in the span of 24-hours. The portrayal of health in these DTCA calls to mind Lauren Berlant’s description of OTC cold medicine, which claim to make you feel better, but are really more concerned with making sure people can stay productive (28). Conclusion Had Proust lived a century later, he may have, like Tiffany, led a less restricted life. Or as Dr. Wolf put it, “A normal life. Busy and as active as she’d like to be. But she needs to take medication to do it” (Be Well. Be Smart). Symptom-free doesn’t seem to be enough anymore. Contemporary images of asthmatics—as an all-star athlete, an aspiring boxer, and a hyper-busy city dweller—are shaped by an imagined healthy norm. Advocacy campaigns originally intended to combat long-standing negative representations partake in the promotion of augmented health. Increasingly, health is no longer defined by the absence of symptoms, but by how active you are and how much you do. Busy and productive is a gold standard of the idealized norm, a norm that circulates—to a greater or lesser extent—in direct-to-consumer advertising, asthma advocacy campaigns, and public health messages (Sinding 262). Without doubt, the pharmaceutical industry plays a tremendous role in shaping contemporary health norms. Yet, as Joseph Dumit describes it, "the pharmaceutical industry is a massive elephant. Like the blind men of the famous parable, we each catch a hold of a tiny piece of it -- leg, tail, trunk -- and think we have a handle on it" (18). A powerful force with influence on many aspects of contemporary life, the pharmaceutical industry could be understood through the lens of biomedicalization: Biomedicalization imposes new mandates and performances that become incorporated into one’s sense of self. The subjectivities that arise out of these performances of what it is to be healthy (e.g., proactive, prevention-conscious, neo-rational) suggest how biomedical technoscience indicates a type of governmentality that can enact itself at the level of subjective identities and social relations. (Clarke et al. 182) Disease marketing—prevalent in the 1990s—is no longer needed or effective; health marketing has taken over and pharmaceutical companies are not at the table alone (Elliott 97). Instead of working through disease difference, health marketing attempts to level ground through images and standards that everyone can work towards, asthmatics included. Of course, pharmaceutical marketing simultaneously renders invisible socioeconomic conditions that contribute to asthma incidence, and marginalized populations that struggle to access medication and medical care in the first place. Augmented health works to flatten difference across social, economic, political, and ecological scales, as if these inequalities didn’t matter for disease management. Scholars writing about emergent modes of health—how health is imagined, constructed, studied, and sold—have documented how new health regimes work off potential risk categories, race, class, and gendered ideologies, or hoped-for modes of living. Some are literally “against health” (the title of Metzel and Kirkland’s edited volume). But to be against health, as Metzel writes is not to be against needed treatment (9). To examine the ways in which DTCA or advocacy campaigns promote specific, idealized images of health—images where people are athletic, outgoing, and busy—and question whether these drugs go above and beyond the restoration of health, should not be equated with a statement about whether medication is necessary. Epidemiological evidence and clinical studies are clear that contemporary treatments help reduce the burden of asthma in various ways: through reduced hospitalizations, lower death rates, and better-controlled asthma. Drugs keep many asthmatics relatively symptom-free. The point, rather, is that health is complex, structured by various institutions, actors, politics, and materials. One of the valences of the new health regime is augmented health, seen in the context of this paper at work in DTCA and possibly emerging in other corners of the asthma care arena as well. To date, most writing on augmentation has focused on how advancements in science and technology extend the capacity of human bodies—from prosthetics and fertility drugs, to steroids and life support (Hogle 696). Less has been written on the ways in which chronic conditions like diabetes, heart disease, and asthma—conditions where life hinges on medications, but are common enough that they are deemed unexceptional—produce a rhetoric of augmentation; where the new healthy is augmented living. It’s not the drugs for life rhetoric that works off new risk categories, as Dumit has shown (201); asthmatics are symptomatic, always at risk anyways, and often already on drugs for life. Drugs for chronic conditions like asthma may simply control symptoms, but they’re increasingly sold on the promise of enhancing life capacities as well. As Elliott has observed, it’s part of a move from disease marketing to health marketing (97). The discursive shift in asthma care, and perhaps other chronic disease contexts as well, doesn’t register as enhancement or augmentation because it mirrors the new health norm that is part of the broader context of biomedicalization. As the frame of health shifts, questions about bodies, ethics, and enhancement technologies might need to shift as well. Linda Hogle’s question is apt here: “what is necessary to sustain health? At which point does repair become something more than restorative, and for which (and whose) purposes are interventions defined as 'therapeutic'” (697). Since health norms have become augmented in the last ten years, this question becomes all the more difficult to answer. Within these new health regimes, potential has not only become open-ended, it also seems to be a therapeutic goal. References Arie, Sophie. “What Can We Learn from Asthma in Elite Athletes?” British Medical Journal 344 (2012). Be Smart. Be Well. “The Right Meds Keep Her in the Ring.” Be Smart. Be Well. 14 Aug. 2013. 1 Dec. 2013 ‹http://www.besmartbewell.com/childhood-asthma/tiffany.htm›. Clarke, Adele, Janet Shim, Laura Mamo, Jennifer Fosket, and Jennifer Fishman. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review 68 (2003): 161-194. Dumit, Joseph. Drugs for Life: How Pharmaceutical Companies Define Our Health. 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