Статті в журналах з теми "Scholia vetera"

Abstract Proclus’ Commentary on Plato’s Timaeus has been preserved in several manuscripts from the IX to the XVI centuries and in a paper scroll of the XI century, Patmos Eileton 897, containing two large parts of Book III (on the world’s body, on the recto, and on the world’s soul, on the verso of the scroll) and a large corpus of scholia vetera to it. This paper aims to examine the two main branches of the tradition of the Commentary and to give some observations on the exegetical apparatus to Proclus in the different forms of scholia figurata (and/or schemata), exegetical scholia, scholia to Proclus.

Beweise aus den scholia vetera und scholia recentiora bezeugen, daß rhetorische Ausbildung in den Händen der Grammatiker in Byzanz schon früh begann. Sie explizierten die klassischen Texte anhand von Begriffen aus den Progymnasmata und führten rhetorischen Analysen der Texte durch. Die Terminologie in den scholia ist nicht ganz in Einklang mit der die man in ‘mainstream’, auf Hermogenes gegründete Rhetoriklehrbücher findet, und kann aus älteren, vielleicht peripatetischen, Quellen entlehnt sein. Doch der Konflikt der Begriffe war nicht eine Quelle des Unbehagens für den byzantinischen Lehrer, sondern ein Instrument zum flexiblen Denken.

Academics have a professional need to be published; publishers have a commercial incentive to create demand. In recent years these convergent interests have released a flood of edited volumes, not all of which can demonstrate a compelling claim to intrinsic or lasting scholarly importance. So it is reassuring to be reminded that a publishing house that contributes liberally, if not recklessly, to the flood continues to produce heavyweight volumes of unquestionable scholarly importance. Consider, for example, the new edition of the Thucydides scholia, on which Alexander Kleinlogel worked from 1960 until a few months before his death on 1 January 2007. The complex task of bringing his material to publishable form was undertaken by Klaus Alpers; illness prevented Alpers from steering the volume through its final stages, which were overseen by Stefano Valente. The introduction comprises 202 pages (the chapter on transmission is incomplete, breaking off after four pages); the lavish edition of the scholia vetera occupies 705 pages. The material for a projected second volume containing the scholia recentiora was not left in a publishable state, except for the Lexicon Patmense, which is included as a forty-eight-page appendix to the present volume's introduction. Reviewing Karl Hude's Teubner edition of the scholia, published in 1927, H. T. Deas concluded: ‘obviously this is work which will not require to be done again. Indeed, were it not a praiseworthy task for the sake of completeness, one might be permitted to doubt whether it was worth doing at all’ (CR 42 [1928], 145–6). That reminder of the extremes of fallibility should strike terror into every reviewer's soul.

Abstract Introduction We examine the current status of the military relevance of opioids, their use and misuse in military and veteran populations, the national security consequences of opioid use in our military age population, public health implications, and military, veteran, and government solutions for opioid addiction. Materials and Methods A literature search of recent published research, federal government, and related open source materials was conducted using PubMed, Google, and Google Scholar, and all materials retrieved were manually identified, screened, and evaluated for inclusion. A modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was used for the selection of relevant articles. Heath policy literature and relevant demographic information published within the last 5 years was also included to provide current information and search for solutions to address the escalating national opioid crisis. Results Synthetic opioids are used for pain and trauma management, not readily substituted, and have exceptionally high addiction potential. Combat wounded veterans have greater potential for opioid misuse than civilian populations. Assessment, management, and treatment of opioid use in this population are essential. Veterans receiving synthetic opioids have been noted to have multiple overdose risk factors. Opioids are readily available nationally as “street drugs” and also in the form of fentanyl-contaminated heroin. The opioid crisis affects the military age population and the top states for military enlistments. Younger age males with lower education and income are at significant risk for opioid use disorder. Recently increased drug overdose deaths contribute to an increased U.S. mortality rate with a commensurate decline in life expectancy at birth. Opioid abuse contributes to increased incidence of infectious disease. Behavioral health programs directed at military and veterans to identify risk factors for opioid misuse have been introduced. Prescription drug monitoring initiatives continue for these populations with increased information exchanged between military and civilian healthcare. Lifesaving interventions for opioid addiction include methadone maintenance and fentanyl test strip accessibility. Newly implemented federal funding healthcare initiatives to the states are now directed at opioid use prevention and enhanced surveillance. Conclusions Given increasing rates of opioid addiction and death, viable solutions are universally needed. Successful intervention measures should be widely shared between military, veteran, and civilian healthcare and public health communities. Increased collaboration between these groups could inculcate successful programs to prevent and decrease opioid use. Results received from recent military and veterans’ programs for prescription and electronic medical record (EMR) monitoring and data sharing may also prove useful for civilian healthcare providers and hospital systems. Future evaluations from ongoing federally funded programs to the states for addiction surveillance and intervention may help create measures to address the proliferation of opioid addiction with increased death rates. Anticipated results from these federal efforts should help inform opioid programs in military and veterans’ health systems.

Abstract Introduction: The incidence of posttraumatic stress disorder (PTSD) is common within the population and even more so among veterans. Current medication treatment is limited primarily to antidepressants. Such medicines have shown to produce low remission rates and may require 9 patients to be treated for 1 to have a response. Aside from the Veterans Affairs/Department of Defense guidelines, other guidelines do not recommend pharmacotherapy as a first-line option, particularly in the veteran population. Marijuana has been evaluated as an alternative and novel treatment option with 16 states legalizing its use for PTSD. Methods: A systematic search was conducted to evaluate the evidence for the use of marijuana for PTSD. Studies for the review were included based on a literature search from Ovid MEDLINE and Google Scholar. Results: Five studies were identified that evaluated the use of marijuana for PTSD. One trial was conducted in Israel and actively used marijuana. Three studies did not use marijuana in the treatment arm but instead evaluated the effects postuse. A retrospective chart review from New Mexico relied on patients to recall their change in PTSD symptoms when using marijuana. Three studies concluded there might be a benefit, but two discouraged its use. Although the two negative studies show a statistical difference in worse PTSD outcomes, clinical significance is unclear. Discussion: Conflicting data exist for the use of marijuana for PTSD; however, current evidence is limited to anecdotal experiences, case reports, and observational studies, making it difficult to make clinical recommendations.

Some time in 1608, there arrived at Corpus Christi College, Cambridge a distinguished foreign visitor who, through the good offices of the Chancellor of the University, Robert Cecil, earl of Salisbury, and of Merlin Higden, a Fellow of Corpus, had been given permission to examine a manuscript in the college library. The visiting scholar had secured access to the library through a network of contacts that included his friend, a naturalized Frenchman and diplomat working for Cecil, Sir Stephen Lesieur, and a Chiswick clergyman, William Walter. What makes this apparently unremarkable (and hitherto unremarked) incident of more than trivial interest is that the industrious researcher was Jacques Bongars, veteran roving French ambassador in Germany and staunch Calvinist, and that his text was William of Tyre’s Historia Ierosolymitana.

Veterum Patrum et scriptorum ecclesiasticorum doctrina in Instituto Philologiae Classicae Universitatis Studiorum Varsaviensis tum demum reapse tractari est coepta, cum mutato rei publicae statu et ipsis viris doctis et iuvenibus studiosis nova educandi via aperiebatur dabaturąue facultas. Itaque iam nunc duo seminaria legendis istorum auctorum operibus instituta sunt et scholae habentur, quibus de eorum textu, lingua et stilo disseritur quibusque praecipuae illorum auctorum doctrinae theses disputantur. Hoc etiam tempore nonnulla meletemata, articuli et libri divulgati sunt, quae ad varias quaestiones solvendas aspectabant. Plures sunt quoque auditores, qui ad haec studia fovenda vel proprio ingenio vel curiositate incitantur.

Abstract Andrew Schelling recalls and discusses a college course, “World Poetry,” which Norman O. Brown taught at University of California, Santa Cruz, in 1974. The turbulent politics and weird, harrowing culture changes of North America set a context. Brown's class met weekly in a remote meadow ringed by second-growth redwoods. Brown developed his interest in the “law of metamorphosis,” which he thought poetry captures, and put his attention on how the human body changes, producing text as sound or performance. Using two anthologies compiled by Jerome Rothenberg, Brown drew students into a poetry that was physical, raw, multilingual, and perhaps a scriptural base for the era's counterculture. Schelling portrays Brown as a quixotic figure, Sir John Falstaff among scholars. A quick sketch of the “Santa Cruz ecosystem” brings into the mix Gregory Bateson, whose thoughts on evolution paralleled Brown's on poetry, and Jan Willis, veteran civil rights activist and scholar of Sanskrit.

Summary The sixteenth-century Hellenist Adolf van Meetkercke (1528-1591) was a talented humanist and diplomat, who divided his time between philology and politics, excelling in both professions. Meetkercke’s first scholarly work was his Commentary on the ancient and correct pronunciation of the Greek language (De veteri et recta pronuntiatione linguæ Græcæ commentarius), published in 1565 by Goltzius in Bruges and reedited in 1576 by Plantin in Antwerp. In this work, the scholar from Bruges defended the reconstructed pronunciation today closely associated with Erasmus. After offering a biographical sketch of Meetkercke and briefly recapitulating the pronunciation debate, I discuss his innovative treatise, which was the first freestanding systematic outline of the reconstructed pronunciation. I argue that the Commentary was tremendously influential and had an impact beyond the subject of pronunciation. In particular, I intend to illustrate that Meetkercke elaborated a linguistic ideology which advocated the active usage of the Ancient Greek language as a learned lingua franca next to Latin, and which involved appropriating this classical language from the Byzantine teachers who had brought it to western Europe in a ‘corrupt’ state. In the conclusion, I dwell on Meetkercke’s importance for language studies and briefly relate his rather aggressive domestication of Ancient Greek to the position of this language in the present-day Low Countries.

Parents with a sick child in a neonatal intensive care unit (NICU) usually experience stress, anxiety, and vulnerability. These precarious feelings can affect early parent–child interactions and have consequences for the child’s neurodevelopment. Parents who have had a sick child in an NICU (veteran parents) can offer helpful interventions for these vulnerable families. This article is a scoping review of parental interventions used with the families of NICU infants, and an overview of French perspectives. Two independent reviewers studied the scientific literature published in English between 2001 to 2021 using Covidence software. The databases used were MEDLINE, ISI Web of Science, the Cochrane Database, and Google Scholar. Themes were identified from the articles’ results using an open coding approach. The data are presented in a narrative format. Ten articles were included, and four major themes addressed: (1) description of activities, (2) recommendations, (3) impact, and (4) barriers (resulting from recruitment, training, remuneration, and organization). Activities were very diverse, and a step-by-step implementation was recommended by all authors. Peer-support interventions might be a potential resource for those anxious parents and improve their NICU experiences. These challenges are described by SOS Préma in France. This article brings together recent studies on partnership in the NICU. It is an innovative topic in neonatology with vast issues to explore.

Nightmares are highly prevalent and distressing for the sufferer, which underlines the need for well-documented treatments. A comprehensive literature review and meta-analysis of the effects of different pharmacological placebo-controlled randomized clinical trials, covering the period up to 1 December 2022, was performed. Searches were conducted in PubMed, Embase, Web of Science, PsychInfo, Cinahl, and Google Scholar, resulting in the identification of 1762 articles, of which 14 met the inclusion criteria: pharmacological intervention of nightmares, based on a placebo-controlled randomized trial published in a European language, reporting outcomes either/or in terms of nightmare frequency, nightmare distress, or nightmare intensity, and reporting sufficient information enabling calculation of effect sizes. Most studies involved the effect of the α1-adrenergic antagonist prazosin in samples of veterans or soldiers suffering from posttraumatic stress disorder. Other medications used were hydroxyzine, clonazepam, cyproheptadine, nabilone, and doxazosin. The vast majority of studies were conducted in the USA. The studies comprised a total of 830 participants. The Clinician-Administered PTSD Scale was the most frequently used outcome measure. The results showed an overall effect size of Hedges’ g = 0.50 (0.42 after adjustment for publication bias). The synthetic cannabinoid nabilone (one study) showed the highest effect size (g = 1.86), followed by the histamine H1-antagonist hydroxyzine (one study), and prazosin (10 studies), with effect sizes of g = 1.17 and g = 0.54, respectively. Findings and limitations are discussed, and recommendations for future studies are provided.

Introduction Cannabis was used as a medicinal plant in Asia before the Christian era. Nowadays, after 40years of a “war on drugs” with an illegal status, there is a big interest on the use of cannabis in some medical conditions. With more and more users revealing having used this substance to cope with certain psychiatric manifestations, researchers have tried to explore this substance in the psychiatric field where the actual pharmacological treatments and psychotherapy remain ineffective in some cases. Objectives To Explore the medical use of cannabis in psychiatric disorders. Methods A literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar over the last 10 years. Results Giving the interactions between cannabinoids and specific neurotransmitters, it has been suggested that cannabis may have medical effect on some psychiatric illnesses. In this direction, a significant overlap has been demonstrated between PTSD and cannabis use. CBD a non-psychotomimetic cannabinoid, seemed to show promising results as an enhancer of fear extinction and therapeutic consolidation of emotional memories. Military veterans are increasingly using it for reducing induced nightmares although this residual symptom remains difficult to treat. No benefit for improving depression was proved. One isolated study indicated a potential efficacy for cannabinoid combined with terpene in ADHD. Conclusions Studies exploring the possibility of using cannabis in the treatment of psychiatric illnesses are promising but it is premature to recommend this drug for the moment especially since it requires gradual titration, regular assessment and precaution in certain diseases. Disclosure No significant relationships.

Studium hoc proemio, parte principali et conclusione constat. In proemio dicitur hac in dissertatiuncula de canonibus 1024 - 1025 tractari. Pars principalis in tria particula subdividitur, nempe: 1. De ordinando in iure vetere, seu a Christo Domino usque ad Codicem Iuris Canonici Pio-Benedictinum de 1917 anno. In primis Ecclesiae saeculis quidam haeretici seu papuzani seu quintilliani docebant feminas sacerdotio idoneas esse. Eorum opiniones Ireneus, Epiphanius, et Augustinus inter haereses computant. Can. 19 Concilii Nicaeni, can. 11 Concilii Laodicensis dicunt feminas sacrae odrinationis incapaces esse. Secundum can. 2 Concilii Nemausensis (394 anni): Illud etiam a quibusdam suggestum est, ut, contra apostolicam disciplinam, incognito usque in hoc tempus, in ministerium feminae nescio quo loco leviticum videantur assumptae: quod quidem, quia indecens est, non admittit ecclesiastica disciplina: et contra rationem facta talis ordinatio destruatur: providendum ne quis sibi hoc ultra praesumat. Similitter statutum est in Conciliis: Arausicano I, Epaonensi, Aurelianensi II, Turonico II et Parisiensi (anno 829). Quae capita conciliorum in Decretum Magistri Gratiani assumpta sunt. Quod Decretum in scholis usitatum est usque ad Codicem luris Canonici Pio-Benedictinum. 2. Can 968 Codicis luris Canonici dicit: sacram ordinationem valide recipit solus vir baptizatus: licite autem, qui ad normam sacrorum canonum debitis qualitatibus, iudicio ordinarii, praeditus sit, neque ulla detineatur irregularitate aliove impedimento. Sacra Congregatio pro Doctrina Fidei in declaratione Inter insigniores, diei 15 octobris 1976 anni mandatum exequens a Beatissimo Patre acceptum, explicavit sibi non agnoscere adimittendi mulieres ad sacerdotalem ordinationem; atque aestimat oportere, pro praesentibus adiunctis, ut in luce clariore ponat hanc doctrinam, quae dolenter forsitan a quibusdam percipiatur, unde tam en oriens bonum paulatim discernetur, quippe quae conferre possit ad respectiva viri ac mulieris munera altius investiganda [ AAS 69 (1977) 100]. 3. Can. 1024 Codicis luris Canonici Papae Ioannis Pauli II sonat: sacram ordinationem valide recipit solus vir baptisatus. Iuxta can. 1025 §1 ad licite ordines presbyteratus vel diaconatus conferendos requiritur, ut candidatus, probatione ad normam iuris peracta, debitis qualitatibus iudicio proprii episcopi aut superioris maioris competentis praeditus sit, nulla detineatur irregularitate nulloque impedimento. Papa Joannes Paulus II in epistola apostolica Ordinatio sacerdotalis diei 22 maii 1994 anni confirmavit doctrinam Ecclesiae de mulieribus non ordinandis. Congregatio pro Doctrina Fidei publicavit responsum ad dubium circa doctrinam epistolae apostolicae Ordinatio sacerdotalis die 25 octobris 1995 anni. Sub fine articuli can. 754 Codicis Canonum Ecclesiarum Orientalium exponitur.

This article presents some of the personal observations of a veteran Israeli scholar whose long-years' encounters with the 'real' as well as the 'imagined' eastern Europe have shaped his historical research. As an Israeli-born historian of Polish-Ukrainian origin, (the so-called 'second generation') he claims to share an ambivalent attitude towards his countries of origin with other fellow- historians. Jewish emigrants from eastern Europe have been until very late in the modern era members of an old ethno-religious group. One ethnos out of many in a diverse multi-ethnic environment, whose demographic core survived and flourished for centuries in the old places. Several decades of social, economic, and political upheavals exposed the Jewish population to drastic changes. These changes lead several intellectuals who left their home countries to look back at what have happened as both involved actors, and distant observers. Israeli historians of east European origin found themselves confronted with a crucial question: in what way the past in the Old Country connected (if at all) to the history of Israel. Following some 40 years of academic career in the field of eastern European Jewish history, it is claimed that until the collapse of the Soviet Union, the image of eastern Europe that runs through the Israeli historical research has been shaped in large part by members of the different generations of emigrants, outside of eastern Europe. The renewed direct contact after 1989 caused a dramatic change: within a few years, Israeli historians were examining archives and libraries throughout eastern Europe. After seven decades of isolation between the Israeli historian and the primary sources necessary to his/her research in the archives, the new wave of documents was celebrated in Israeli Universities. Yet far more influential was the revolution prompted in 1989 on the historical perspective from which Israeli historians could now examine the Jewish past. What happened in 1989 has seemed, to some Israeli historians, a breaking point marking the end of the eastern European period in the course of Jewish history. The article concludes with some thoughts on a new historical (Israeli) perspective. A one that fits a time when hundreds of thousands of immigrants from what was the largest eastern-European Jewish collective in the world inhabit a remote Middle Eastern nation-state.

The starting point for the prevention of human disease is the study of the vital functions of a healthy organism, taking into account complex effects of external and internal factors. More often in clinical practice, doctors observe patients with advanced pathology, when the body has undergone significant changes, including at the level of systemic regulation (CNS, hypothalamus) and at the level of intercellular signaling and neuro-immune-endocrine interactions. Therefore, the basis of these changes, more often, are insignificant but permanent factors of the external or internal environment, which gradually accumulate and disrupt the functioning of central regulatory systems. The aim of our study was to analyze modern sources of information that highlight current issues of the role of the hypothalamus in the development of adaptation programs during the formation of stressors. Materials and methods: analysis of scientific publications taken from Google Scholar databases, Web of Science, Pub Med by keywords: rats, stress reactions, adaptation, neuroendocrine regulation, neurotransmitters, hypothalamus, supraoptic nucleus, paraventricular nucleus. Conclusions: Thus, the analysis of scientific sources demonstrated that the main stress studies were devoted to determining the state and role of dominant systems, but there were few facts that had explained the long-term changes of the hypothalamus in regulatory systems. These issues remain unresolved and need to be studied. Introduction. Today, many facts and clinical observations about the complex effects of chronic stress of human body. The National Institutes of Health and the U.S. Veterans Health Administration conducted a large-scale cohort study that had provided evidence of an association between post-traumatic stress disorder and cardiovascular risk, had identified mechanisms that could cause this association, and had assessed prognostic risk, cardiovascular diseases [1]. Moreover, they form a post-stress syndrome, which by itself becomes a pathogenetic mechanism of disease formation. Rebeca Robles-García together with other researchers in 2020 demonstrated that high urbanization could increase the risk of post-traumatic stress disorder due to the concentration of poverty, limited living space, substance use and crime. Women tend to be more disadvantaged socially and economically and are more likely to be victims of collective and domestic violence than men. Accordingly, urban women are more prone to traumatic events that increase the prevalence of post-traumatic stress disorder than rural women and men in both rural and urban areas, especially those without social and family protection and support [2]. That is, even minor and indistinct stressors that act constantly and can not be overcome by man become an important etiological factor in the formation of a number of diseases.

De geschiedschrijving die de ‘Vlaamse Frontbeweging’ tot onderwerp nam, heeft tot dusver te weinig het oog gericht naar de voorgeschiedenis die in nauw verband staat met de afschaffing van de loting en de veralgemening en uitbreiding van de dienstplicht vanaf 1909. Daarbij kwam ook nog eens de eerste taalwet van 1913 die door de strijdkrachten zou moeten toegepast worden. Dit leidde tot een veel sterkere betrokkenheid binnen de Vlaamse beweging. Daarbij werd uit de aard der zaak vooral gerekend op de jonge mannen die nog naar het leger zouden moeten. Zij zouden in staat moeten zijn om de volksjongens zonder veel scholing mee in het ‘Vlaamse’ bad te trekken en zo stapsgewijs het Nederlands een plaats te geven in de strijdkrachten.Al even belangrijk voor een goed begrip is het feit dat de vooroorlogse elite er bijzonder goed in was geslaagd om het leger dienstbaar te maken bij de start van de carrière van wie hoger onderwijs kon volgen via de ‘compagnies universitaires’. In 1909 werd bovendien de categorie van de brancardiers gecreëerd die bestond uit seminaristen, novicen en student-onderwijzers. Zij moesten enkel een cursus volgen in hun vrije tijd.Er werd dus een elite geschapen die amper in contact kwam met de werkelijkheid in het leger en die mijlenver afstond van het beroepskader. Dat leverde de nodige springstof waarop de Frontbeweging kon groeien als een voortzetting van de vooroorlogse katholieke studentenbeweging. Deze jongemannen vonden dat zij hun vooroorlogse agitatie op taalvlak moesten verder zetten in oorlogstijd. Omdat de Duitse Flamenpolitik en de toenemende uitzichtloosheid leidde tot verbittering betekende dit een bedreiging voor de machtspositie van het militaire kaderpersoneel en de koning-opperbevelhebber.De hoop en de verwachting dat de Vlaamse oud-strijders zich na afloop van de oorlog en masse achter de Frontbeweging haar eisenprogramma zou scharen, bleek echter ijdel.__________ “A Wide Field for the Student Movement Lies Open.” On the Origin and Character of the Flemish Front Movement The historiography which takes the ‘Flemish Front Movement’ as its subject has so far paid too little attention to the historical background which is closely tied to the abolition of the conscription lottery and the generalization of the service requirement from 1909. In addition to this was the first language law of 1913 that the armed forces were supposed to follow. This led to a greater participation in the Flemish Movement. This obviously included in large part the young men who still had to go into the army. They had to be up to the task of bringing boys from the common folk who did not have much schooling into the ‘Flemish’ sphere and thus work step-by-step to give Dutch a place among the armed forces.Just as important for a good understanding is the fact that the prewar elite was unusually successful in making the army a stepping stone in the career of those who could follow higher education, through the “compagnies universitaires” (university companies). Most importantly in this regard, in 1909 the category of stretcher-bearer was created, which was made up of seminary students, novice priests and student teachers. They only had to take a course in their free time.Thus, an elite was formed that was nearly never in contact with the day-to-day life of the army and which was miles away from the traditional professional circles. This provided the necessary spark from which the Front Movement could grow as an extension of the prewar Catholic student movement. These young men found that they had to continue their prewar agitation regarding language matters in wartime. Because the German Flamenpolitik (policy of coopting the Flemish Movement) and growing hopelessness led to embitterment, this constituted a threat to their position of power of the military senior staff and the king as commander-in-chief.The hope and the expectation that Flemish veterans would range themselves en masse behind the Front Movement’s list of demands after the end of the war turned out to be in vain.

The Acquired Wisdom series provides veteran academics, like myself, a soapbox from which to brandish their accomplishments, failures, and lessons they presumably learned. It can be foolish and maybe a tad dangerous to offer an old dog a platform from which to bark. But here we are. I will try my best not to be dangerous. I make no promises about folly and banality.Start at the BeginningIn the 1951 movie, Alice in Wonderland, the March Hare and the Mad Hatter give advice about how to tell a story – simply put: “Start at the beginning.” So here we go. (Hopefully the folly meter is not ticking upward yet.)

ABSTRACT Introduction: Carbon monoxide (CO) is produced from incomplete combustion of hydrocarbons and is a by-product of tobacco smoking. Chronic cigarette smokers often have carboxyhemoglobin (COHb) concentrations as high as 10%. We report a case of severely elevated COHb and polycythemia because of tobacco smoking and provide a review of the literature regarding elevated COHb in smokers. Materials and Methods: A comprehensive search of PubMed and Google Scholar was performed looking for articles on tobacco smoking and CO, COHb, CO poisoning, cigarettes, pipes, cigars and water pipes/hookah smokers. Result: COHb levels in frequent cigarette smokers generally range from 4.2% presmoking to 8.6% postsmoking. A heavy cigarette smoker presented twice with symptoms of CO toxicity and was found to have levels 21.8 to 24.2%. Cigar smokers have been found to have COHb ranging as high as 13.0 to 38.6% in case reports. Waterpipe or “hookah” smokers generally have COHb levels 10.1% +/−2.5% and case reports, and series of even higher levels associated with CO toxicity symptoms are common. Waterpipe smokers have been found to have COHb levels as high as 39.2% after smoking. Conclusions: Many active duty military and military veterans are tobacco smokers and these patients and their health care providers should be aware of the adverse effects of CO toxicity from tobacco smoking. Patients may have symptoms such as headaches, syncope, and ataxia in the setting of acute CO toxicity; however, the chronic effects of CO may not be completely understood. Future work could explore chronic CO toxicity and its effects on strength and exercise tolerance in military personnel and provide education to service members, veterans, and health care providers.

During the War on Terror, the United States military has been conducting an increasing number of foreign campaigns by remote control using drones—also called unmanned aerial vehicles (UAVs) or remotely piloted vehicles (RPVs)—to extend the reach of military power and augment the technical precision of targeted strikes while minimizing bodily risk to American combatants. Stationed on bases throughout the southwest, operators fly weaponized drones over the Middle East. Viewing the battle zone through a computer screen that presents them with imagery captured from a drone-mounted camera, these combatants participate in war from a safe distance via an interface that resembles a video game. Increasingly, this participation takes the form of targeted killing. Despite their relative physical safety, in 2008 reports began mounting that like boots-on-the-ground combatants, many drone operators seek the services of chaplains or other mental health professionals to deal with the emotional toll of their work (Associated Press; Schachtman). Questions about the nature of the stress or trauma that drone operators experience have become a trope in news coverage of drone warfare (see Bumiller; Bowden; Saleton; Axe). This was exemplified in May 2013, when former Air Force drone pilot Brandon Bryant became a public figure after speaking to National Public Radio about his remorse for participating in targeted killing strikes and his subsequent struggle with post-traumatic stress (PTS) (Greene and McEvers). Stories like Bryant’s express American culture’s struggle to understand the role screen-mediated, remotely controlled killing plays in shifting the location of combatants’s sense of moral agency. That is, their sense of their ability to act based on their own understanding of right and wrong. Historically, one of the primary ways that psychiatry has conceptualized combat trauma has been as combatants’s psychological response losing their sense of moral agency on the battlefield (Lifton).This articleuses the popular science fiction novel Ender's Game as an analytic lens through which to examine the ways that screen-mediated warfare may result in combat trauma by investigating the ways in which it may compromise moral agency. The goal of this analysis is not to describe the present state of drone operators’s experience (see Asaro), but rather to compare and contrast contemporary public discourses on the psychological impact of screen-mediated war with the way it is represented in one of the most influential science fiction novels of all times (The book won the Nebula Award in 1985, the Hugo Award in 1986, and appears on both the Modern Library 100 Best Novels and American Library Association’s “100 Best Books for Teens” lists). In so doing, the paper aims to counter prevalent modes of critical analysis of screen-mediated war that cannot account for drone operators’s trauma. For decades, critics of postmodern warfare have denounced how fighting from inside tanks, the cockpits of planes, or at office desks has removed combatants from the experiences of risk and endangerment that historically characterized war (see Gray; Levidow & Robins). They suggest that screen-mediation enables not only physical but also cognitive and emotional distance from the violence of war-fighting by circumscribing it in a “magic circle.” Virtual worlds scholars adopted the term “magic circle” from cultural historian Johan Huizinga, who described it as the membrane that separates the time and space of game-play from those of real life (Salen and Zimmerman). While military scholars have long recognized that only 2% of soldiers can kill without hesitation (Grossman), critics of “video game wars” suggest that screen-mediation puts war in a magic circle, thereby creating cyborg human-machine assemblages capable of killing in cold blood. In other words, these critics argue that screen-mediated war distributes agency between humans and machines in such a way that human combatants do not feel morally responsible for killing. In contrast, Ender’s Game suggests that even when militaries utilize video game aesthetics to create weapons control interfaces, screen-mediation alone ultimately cannot blur the line between war and play and thereby psychically shield cyborg soldiers from combat trauma.Orson Scott Card’s 1985 novel Ender’s Game—and the 2013 film adaptation—tells the story of a young boy at an elite military academy. Set several decades after a terrible war between humans and an alien race called the buggers, the novel follows the life of a boy named Ender. At age 6, recruiters take Andrew “Ender” Wiggin from his family to begin military training. He excels in all areas and eventually enters officer training. There he encounters a new video game-like simulator in which he commands space ship battalions against increasingly complex configurations of bugger ships. At the novel’s climax, Ender's mentor, war hero Mazer Rackham, brings him to a room crowded with high-ranking military personnel in order to take his final test on the simulator. In order to win Ender opts to launch a massive bomb, nicknamed “Little Doctor”, at the bugger home world. The image on his screen of a ball of space dust where once sat the enemy planet is met by victory cheers. Mazer then informs Ender that since he began officer training, he has been remotely controlling real ships. The video game war was, "Real. Not a game" (Card 297); Ender has exterminated the bugger species. But rather than join the celebration, Ender is devastated to learn he has committed "xenocide." Screen-mediation, the novel shows, can enable people to commit acts that they would otherwise find heinous.US military advisors have used the story to set an agenda for research and development in augmented media. For example, Dr. Michael Macedonia, Chief Technology Officer of the Army Office for Simulation, Training, and Instrumentation told a reporter for the New York Times that Ender's Game "has had a lot of influence on our thinking" about how to use video game-like technologies in military operations (Harmon; Silberman; Mead). Many recent programs to develop and study video game-like military training simulators have been directly inspired by the book and its promise of being able to turn even a six-year-old into a competent combatant through well-structured human-computer interaction (Mead). However, it would appear that the novel’s moral regarding the psychological impact of actual screen-mediated combat did not dissuade military investment in drone warfare. The Air Force began using drones for surveillance during the Gulf War, but during the Global War on Terror they began to be equipped with weapons. By 2010, the US military operated over 7,000 drones, including over 200 weapons-ready Predator and Reaper drones. It now invests upwards of three-billion dollars a year into the drone program (Zucchino). While there are significant differences between contemporary drone warfare and the plot of Ender's Game—including the fact that Ender is a child, that he alone commands a fleet, that he thinks he is playing a game, and that, except for a single weapon of mass destruction, he and his enemies are equally well equipped—for this analysis, I will focus on their most important similarities: both Ender and actual drone operators work on teams for long shifts using video game-like technology to remotely control vehicles in aerial combat against an enemy. After he uses the Little Doctor, Mazer and Graff, Ender's long-time training supervisors, first work to circumvent his guilt by reframing his actions as heroic. “You're a hero, Ender. They've seen what you did, you and the others. I don't think there's a government on Earth that hasn't voted you their highest metal.” “I killed them all, didn't I?” Ender asked. “All who?” asked Graff. “The buggers? That was the idea.” Mazer leaned in close. “That's what the war was for.” “All their queens. So I killed all their children, all of everything.” “They decided that when they attacked us. It wasn't your fault. It's what had to happen.” Ender grabbed Mazer's uniform and hung onto it, pulling him down so they were face to face. “I didn't want to kill them all. I didn't want to kill anybody! I'm not a killer! […] but you made me do it, you tricked me into it!” He was crying. He was out of control. (Card 297–8)The novel up to this point has led us to believe that Ender at the very least understands that what he does in the game will be asked of him in real life. But his traumatic response to learning the truth reveals that he was in the magic circle. When he thinks he is playing a game, succeeding is a matter of ego: he wants to be the best, to live up to the expectations of his trainers that he is humanity’s last hope. When the magic circle is broken, Ender reconsiders his decision to use the Little Doctor. Tactics he could justify to win the game, reframed as real military tactics, threaten his sense of himself as a moral agent. Being told he is a hero provides no solace.Card wrote the novel during the Cold War, when computers were coming to play an increasingly large role in military operations. Historians of military technology have shown that during this time human behavior began to be defined in machine-like, functionalist terms by scientists working on cybernetic systems (see Edwards; Galison; Orr). Human skills were defined as components of large technological systems, such as tanks and anti-aircraft weaponry: a human skill was treated as functionally the same as a machine one. The only issue of importance was how all the components could work together in order to meet strategic goals—a cybernetic problem. The reasons that Mazer and Graff have for lying to Ender suggest that the author believed that as a form of technical augmentation, screen-mediation can be used to evacuate individual moral agency and submit human will to the command of the larger cybernetic system. Issues of displaced agency in the military cyborg assemblage are apparent in the following quote, in which Mazer compares Ender himself to the bomb he used to destroy the bugger home world: “You had to be a weapon, Ender. Like a gun, like the Little Doctor, functioning perfectly but not knowing what you were aimed at. We aimed you. We're responsible. If there was something wrong, we did it” (298). Questions of distributed agency have also surfaced in the drone debates. Government and military leaders have attempted to depersonalize drone warfare by assuring the American public that the list of targets is meticulously researched: drones kill those who we need killed. Drone warfare, media theorist Peter Asaro argues, has “created new and complex forms of human-machine subjectivity” that cannot be understood by considering the agency of the technology alone because it is distributed between humans and machines (25). While our leaders’s decisions about who to kill are central to this new cyborg subjectivity, the operators who fire the weapons nevertheless experience at least a retrospective sense of agency. As phenomenologist John Protevi notes, in the wake of wars fought by modern military networks, many veterans diagnosed with PTS still express guilt and personal responsibility for the outcomes of their participation in killing (Protevi). Mazer and Graff explain that the two qualities that make Ender such a good weapon also create an imperative to lie to him: his compassion and his innocence. For his trainers, compassion means a capacity to truly think like others, friend or foe, and understand their motivations. Graff explains that while his trainers recognized Ender's compassion as an invaluable tool, they also recognized that it would preclude his willingness to kill.It had to be a trick or you couldn't have done it. It's the bind we were in. We had to have a commander with so much empathy that he would think like the buggers, understand them and anticipate them. So much compassion that he could win the love of his underlings and work with them like a perfect machine, as perfect as the buggers. But somebody with that much compassion could never be the killer we needed. Could never go into battle willing to win at all costs. If you knew, you couldn't do it. If you were the kind of person who would do it even if you knew, you could never have understood the buggers well enough. (298)In learning that the game was real, Ender learns that he was not merely coming to understand a programmed simulation of bugger behavior, but their actual psychology. Therefore, his compassion has not only helped him understand the buggers’ military strategy, but also to identify with them.Like Ender, drone operators spend weeks or months following their targets, getting to know them and their routines from a God’s eye perspective. They both also watch the repercussions of their missions on screen. Unlike fighter pilots who drop bombs and fly away, drone operators use high-resolution cameras and fly much closer to the ground both when flying and assessing the results of their strikes. As one drone operator interviewed by the Los Angeles Times explained, "When I flew the B-52, it was at 30,000 to 40,000 feet, and you don't even see the bombs falling … Here, you're a lot closer to the actual fight, or that's the way it seems" (Zucchino). Brookings Institute scholar Peter Singer has argued that in this way screen mediation actually enables a more intimate experience of violence for drone operators than airplane pilots (Singer).The second reason Ender’s trainers give for lying is that they need someone not only compassionate, but also innocent of the horrors of war. The war veteran Mazer explains: “And it had to be a child, Ender,” said Mazer. “You were faster than me. Better than me. I was too old and cautious. Any decent person who knows what warfare is can never go into battle with a whole heart. But you didn't know. We made sure you didn't know" (298). When Ender discovers what he has done, he loses not only his innocence but his sense of himself as a moral agent. After such a trauma, his heart is no longer whole.Actual drone operators are, of course, not kept in a magic circle, innocent of the repercussions of their actions. Nor do they otherwise feel as though they are playing, as several have publicly stated. Instead, they report finding drone work tedious, and some even play video games for fun (Asaro). However, Air Force recruitment advertising makes clear analogies between the skills they desire and those of video game play (Brown). Though the first generations of drone operators were pulled from the ranks of flight pilots, in 2009 the Air Force began training them from the ground. Many drone operators, then, enter the role having no other military service and may come into it believing, on some level, that their work will be play.Recent military studies of drone operators have raised doubts about whether drone operators really experience high rates of trauma, suggesting that the stresses they experience are seated instead in occupational issues like long shifts (Ouma, Chappelle, and Salinas; Chappelle, Psy, and Salinas). But several critics of these studies have pointed out that there is a taboo against speaking about feelings of regret and trauma in the military in general and among drone operators in particular. A PTS diagnosis can end a military career; given the Air Force’s career-focused recruiting emphasis, it makes sense that few would come forward (Dao). Therefore, it is still important to take drone operator PTS seriously and try to understand how screen-mediation augments their experience of killing.While critics worry that warfare mediated by a screen and joystick leads to a “‘Playstation’ mentality towards killing” (Alston 25), Ender's Game presents a theory of remote-control war wherein this technological redistribution of the act of killing does not, in itself, create emotional distance or evacuate the killer’s sense of moral agency. In order to kill, Ender must be distanced from reality as well. While drone operators do not work shielded by the magic circle—and therefore do not experience the trauma of its dissolution—every day when they leave the cyborg assemblage of their work stations and rejoin their families they still have to confront themselves as individual moral agents and bear their responsibility for ending lives. In both these scenarios, a human agent’s combat trauma serves to remind us that even when their bodies are physically safe, war is hell for those who fight. This paper has illustrated how a science fiction story can be used as an analytic lens for thinking through contemporary discourses about human-technology relationships. However, the US military is currently investing in drones that are increasingly autonomous from human operators. This redistribution of agency may reduce incidence of PTS among operators by decreasing their role in, and therefore sense of moral responsibility for, killing (Axe). Reducing mental illness may seem to be a worthwhile goal, but in a world wherein militaries distribute the agency for killing to machines in order to reduce the burden on humans, societies will have to confront the fact that combatants’s trauma cannot be a compass by which to measure the morality of wars. Too often in the US media, the primary stories that Americans are told about the violence of their country’s wars are those of their own combatants—not only about their deaths and physical injuries, but their suicide and PTS. To understand war in such a world, we will need new, post-humanist stories where the cyborg assemblage and not the individual is held accountable for killing and morality is measured in lives taken, not rates of mental illness. ReferencesAlston, Phillip. “Report of the Special Rapporteur on Extrajudicial, Summary, or Arbitrary Executions, Addendum: Study on Targeted Killings.” United Nations Human Rights Council (2010). Asaro, Peter M. “The Labor of Surveillance and Bureaucratized Killing: New Subjectivities of Military Drone Operators”. Social Semiotics 23.2 (2013): 196-22. Associated Press. “Predator Pilots Suffering War Stress.” Military.com 2008. Axe, David. “How to Prevent Drone Pilot PTSD: Blame the ’Bot.” Wired June 2012.Bowden, Mark. “The Killing Machines: How to Think about Drones.” The Atlantic Sep. 2013.Brown, Melissa T. Enlisting Masculinity: The Construction of Gender in US Military Recruiting Advertising during the All-Volunteer Force. London: Oxford University Press, 2012. Bumiller, Elisabeth. “Air Force Drone Operators Report High Levels of Stress.” New York Times 18 Dec. 2011: n. pag. Card, Orson Scott. Ender’s Game. Tom Doherty Associates, Inc., 1985. Chappelle, Wayne, D. Psy, and Amber Salinas. “Psychological Health Screening of Remotely Piloted Aircraft (RPA) Operators and Supporting Units.” Paper presented at the Symposium on Mental Health and Well-Being across the Military Spectrum, Bergen, Norway, 12 April 2011: 1–12. Dao, James. “Drone Pilots Are Found to Get Stress Disorders Much as Those in Combat Do.” New York Times 22 Feb. 2013: n. pag. Edwards, Paul N. The Closed World: Computers and the Politics of Discourse in Cold War America. Cambridge: MIT Press, 1997.Galison, Peter. “The Ontology of the Enemy: Norbert Wiener and the Cybernetic Vision.” Critical Inquiry 21.1 (1994): 228.Gray, Chris Hables “Posthuman Soldiers in Postmodern War.” Body & Society 9.4 (2003): 215–226. 27 Nov. 2010.Greene, David, and Kelly McEvers. “Former Air Force Pilot Has Cautionary Tales about Drones.” National Public Radio 10 May 2013.Grossman, David. On Killing. Revised. Boston: Back Bay Books, 2009. Harmon, Amy. “More than Just a Game, But How Close to Reality?” New York Times 3 Apr. 2003: n. pag. Levidow, Les, and Robins. Cyborg Worlds: The Military Information Society. London: Free Association Books, 1989. Lifton, Robert Jay. Home from the War: Vietnam Veterans: Neither Victims nor Executioners. New York: Random House, 1973. Mead, Corey. War Play: Video Games and the Future of Armed Conflict. Boston: Houghton Mifflin Harcourt, 2013. Orr, Jackie. Panic Diaries: A Genealogy of Panic Disorder. Durham: Duke University Press, 2006.Ouma, J.A., W.L. Chappelle, and A. Salinas. Facets of Occupational Burnout among US Air Force Active Duty and National Guard/Reserve MQ-1 Predator and MQ-9 Reaper Operators. Air Force Research Labs Technical Report AFRL-SA-WP-TR-2011-0003. Wright-Patterson AFB, OH: Air Force Research Laboratory. 2011.Protevi, John. “Affect, Agency and Responsibility: The Act of Killing in the Age of Cyborgs.” Phenomenology and the Cognitive Sciences 7.3 (2008): 405–413. Salen, Katie, and Eric Zimmerman. Rules of Play: Game Design Fundamentals. Cambridge, MA: MIT Press, 2003. Saleton, William. “Ghosts in the Machine: Do Remote-Control War Pilots Get Combat Stress?” Slate.com Aug. 2008. Schachtman, Nathan. “Shrinks Help Drone Pilots Cope with Robo-Violence.” Wired Aug. 2008.Silberman, Steve. “The War Room.” Wired Sep. 2004: 1–5.Singer, P.W. Wired for War: The Robotics Revolution and Conflict in the Twenty-First Century. New York: Penguin Press, 2009. Zucchino, David. “Drone Pilots Have Front-Row Seat on War, from Half a World Away.” Los Angeles Times 21 Feb. 2010: n. pag.

Introduction The scientific validity of climate change claims, how to intervene (if at all) in environmental, economic, political and social consequences of climate change, and the adaptation and mitigation needed with any given climate change scenario, are contested areas of public, policy and academic discourses. For marginalised populations, the climate discourses around adaptation, mitigation, vulnerability and resilience are of particular importance. This paper considers the silence around disabled people in these discourses. Marci Roth of the Spinal Cord Injury Association testified before Congress in regards to the Katrina disaster: [On August 29] Susan Daniels called me to enlist my help because her sister in-law, a quadriplegic woman in New Orleans, had been unsuccessfully trying to evacuate to the Superdome for two days. […] It was clear that this woman, Benilda Caixetta, was not being evacuated. I stayed on the phone with Benilda, for the most part of the day. […] She kept telling me she’d been calling for a ride to the Superdome since Saturday; but, despite promises, no one came. The very same paratransit system that people can’t rely on in good weather is what was being relied on in the evacuation. […] I was on the phone with Benilda when she told me, with panic in her voice “the water is rushing in.” And then her phone went dead. We learned five days later that she had been found in her apartment dead, floating next to her wheelchair. […] Benilda did not have to drown. (National Council on Disability, emphasis added) According to the Intergovernmental Panel on Climate Change (IPCC), adaptation is the “Adjustment in natural or human systems in response to actual or expected climatic stimuli or their effects, which moderates harm or exploits beneficial opportunities” (IPCC, Climate Change 2007). Adaptations can be anticipatory or reactive, and depending on their degree of spontaneity they can be autonomous or planned (IPCC, Fourth Assessment Report). Adaptations can be private or public (IPCC, Fourth Assessment Report), technological, behavioural, managerial and structural (National Research Council of Canada). Adaptation, in the context of human dimensions of global change, usually refers to a process, action or outcome in a system (household, community, group, sector, region, country) in order for that system to better cope with, manage or adjust to some changing condition, stress, hazard, risk or opportunity (Smit and Wandel). Adaptation can encompass national or regional strategies as well as practical steps taken at the community level or by individuals. According to Smit et al, a framework for systematically defining adaptations is based on three questions: (i) adaptation to what; (ii) who or what adapts; and (iii) how does adaptation occur? These are essential questions that have to be looked at from many angles including cultural and anthropological lenses as well as lenses of marginalised and highly vulnerable populations. Mitigation (to reduce or prevent changes in the climate system), vulnerability (the degree to which a system is susceptible to, and unable to cope with, the adverse effects of climate change), and resilience (the amount of change a system can undergo without changing state), are other important concepts within the climate change discourse. Non-climate stresses can increase vulnerability to climate change by reducing resilience and can also reduce adaptive capacity because of resource deployment to competing needs. Extending this to the context of disabled people, ableism (sentiment to expect certain abilities within humans) (Wolbring, “Is there an end to out-able?”) and disablism (the unwillingness to accommodate different needs) (Miller, Parker and Gillinson) are two concepts that will thus play themselves out in climate discourses. The “Summary for Policymakers” of the IPCC 2007 report, Climate Change 2007: Impacts, Adaptation and Vulnerability, states: “Poor communities can be especially vulnerable, in particular those concentrated in high-risk areas. They tend to have more limited adaptive capacities, and are more dependent on climate-sensitive resources such as local water and food supplies.” From this quote one can conclude that disabled people are particularly impacted, as the majority of disabled people live in poverty (Elwan). For instance, CARE International, a humanitarian organisation fighting global poverty, the UN Office for the Coordination of Humanitarian Affairs, and Maplecroft, a company that specialises in the calculation, analysis and visualisation of global risks, conclude: “The degree of vulnerability is determined by underlying natural, human, social, physical and financial factors and is a major reason why poor people—especially those in marginalised social groups like women, children, the elderly and people with disabilities—are most affected by disasters” (CARE International). The purpose of this paper is to expose the reader to (a) how disabled people are situated in the culture of the climate, adaptation, mitigation and resilience discourse; (b) how one would answer the three questions, (i) adaptation to what, (ii) who or what adapts, and (iii) how does adaptation occur (Smit et al), using a disabled people lens; and (c) what that reality of the involvement of disabled people within the climate change discourse might herald for other groups in the future. The paper contends that there is a pressing need for the climate discourse to be more inclusive and to develop a new social contract to modify existing dynamics of ableism and disablism so as to avoid the uneven distribution of evident burdens already linked to climate change. A Culture of Neglect: The Situation of Disabled People As climates changes, environmental events that are classified as natural disasters are expected to be more frequent. In the face of recent disaster responses, how effective have these efforts been as they relate to the needs and challenges faced by disabled people? Almost immediately after Hurricane Katrina devastated the Gulf Coast, the National Council on Disability (NCD) in the United States estimated that 155,000 people with disabilities lived in the three cities hardest hit by the hurricane (about 25 per cent of the cities’ populations). The NCD urged emergency managers and government officials to recognise that the need for basic necessities by hurricane survivors with disabilities was “compounded by chronic health conditions and functional impairments … [which include] people who are blind, people who are deaf, people who use wheelchairs, canes, walkers, crutches, people with service animals, and people with mental health needs.” The NCD estimated that a disproportionate number of fatalities were people with disabilities. They cited one statistic from the American Association of Retired Persons (AARP): “73 per cent of Hurricane Katrina-related deaths in New Orleans area were among persons age 60 and over, although they comprised only 15 per cent of the population in New Orleans.” As the NCD stated, “most of those individuals had medical conditions and functional or sensory disabilities that made them more vulnerable. Many more people with disabilities under the age of 60 died or were otherwise impacted by the hurricanes.” As these numbers are very likely linked to the impaired status of the elderly, it seems reasonable to assume similar numbers for non-elderly disabled people. Hurricane Katrina is but one example of how disabled people are neglected in a disaster (Hemingway and Priestley; Fjord and Manderson). Disabled people were also disproportionately impacted in other disasters, such as the 1995 Great Hanshin Earthquake in Japan (Nakamura) or the 2003 heatwave in France, where 63 per cent of heat-related deaths occurred in institutions, with a quarter of these in nursing homes (Holstein et al.). A review of 18 US heatwave response plans revealed that although people with mental or chronic illnesses and the homeless constitute a significant proportion of the victims in recent heatwaves, only one plan emphasised outreach to disabled persons, and only two addressed the shelter and water needs of the homeless (Ebi and Meehl; Bernhard and McGeehin). Presence of Disabled People in Climate Discourse Although climate change will disproportionately impact disabled people, despite the less than stellar record of disaster adaptation and mitigation efforts towards disabled people, and despite the fact that other social groups (such as women, children, ‘the poor’, indigenous people, farmers and displaced people) are mentioned in climate-related reports such as the IPCC reports and the Human Development Report 2007/2008, the same reports do not mention disabled people. Even worse, the majority of the material generated by, and physically set up for, discourses on climate, is inaccessible for many disabled people (Australian Human Rights Commission). For instance, the IPCC report, Climate Change 2007: Impacts, Adaptation and Vulnerability, contains Box 8.2: Gender and natural disasters, makes the following points: (a) “men and women are affected differently in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction”; (b) “natural disasters have been shown to result in increased domestic violence against, and post-traumatic stress disorders in, women”; and (c) “women make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery.” The content of Box 8.2 acknowledges the existence of different perspectives and contributions to the climate discourse, and that it is beneficial to explore these differences. It seems reasonable to assume that differences in perspectives, contributions and impact may well also exist between people with and without disabilities, and that it may be likewise beneficial to explore these differences. Disabled people are differently affected in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction. Disabled people could also make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery, important as distributors of relief efforts and in reconstruction design. The Bonn Declaration from the 2007 international conference, Disasters are always Inclusive: Persons with Disabilities in Humanitarian Emergency Situations, highlighted many problems disabled people are facing and gives recommendations for inclusive disaster preparedness planning, for inclusive response in acute emergency situations and immediate rehabilitation measures, and for inclusive post-disaster reconstruction and development measures. Many workshops were initiated by disabled people groups, such as Rehabilitation International. However, the disabled people disaster adaptation and mitigation discourse is not mainstreamed. Advocacy by people with disability for accessible transport and universal or “life-cycle” housing (among other things) shows how they can contribute significantly to more effective social systems and public facilities. These benefit everyone and help to shift public expectations towards accessible and flexible amenities and services—for example, emergency response and evacuation procedures are much easier for all if such facilities are universally accessible. Most suggestions by disabled people for a more integrative, accessible physical environment and societal attitude benefit everyone, and gain special importance with the ever-increasing proportion of elderly people in society. The IPCC Fourth Assessment Report is intended to be a balanced assessment of current knowledge on climate change mitigation. However, none of the 2007 IPCC reports mention disabled people. Does that mean that disabled people are not impacted by, or impact, climate change? Does no knowledge of adaptation, mitigation and adaptation capacity from a disabled people lens exist, or does the knowledge not reach the IPCC, or does the IPCC judge this knowledge as irrelevant? This culture of neglect and unbalanced assessment of knowledge evident in the IPCC reports was recognised before for rise of a ‘global’ climate discourse. For instance, a 2001 Canadian government document asked that research agendas be developed with the involvement of, among others, disabled people (Health Canada). The 2009 Nairobi Declaration on Africa’s response to climate change (paragraph 36) also asks for the involvement of disabled people (African Ministerial Conference on the Environment). However, so far nothing has trickled up to the international bodies, like the IPCC, or leading conferences such as the United Nations Climate Change Conference Copenhagen 2009. Where Will It End? In his essay, “We do not need climate change apartheid in adaptation”, in the Human Development Report 2007/2008, Archbishop Desmond Tutu suggests that we are drifting into a situation of global adaptation apartheid—that adaptation becomes a euphemism for social injustice on a global scale (United Nations Development Programme). He uses the term “adaptation apartheid” to highlight the inequality of support for adaptation capacity between high and low income countries: “Inequality in capacity to adapt to climate change is emerging as a potential driver of wider disparities in wealth, security and opportunities for human development”. I submit that “adaptation apartheid” also exists in regard to disabled people, with the invisibility of disabled people in the climate discourse being just one facet. The unwillingness to accommodate, to help the “other,” is nothing new for disabled people. The ableism that favours species-typical bodily functioning (Wolbring, “Is there an end to out-able?”; Wolbring, “Why NBIC?”) and disablism (Miller, Parker, and Gillinson)—the lack of accommodation enthusiasm for the needs of people with ‘below’ species-typical body abilities and the unwillingness to adapt to the needs of “others”—is a form of “adaptation apartheid,” of accommodation apartheid, of adaptation disablism that has been battled by disabled people for a long time. In a 2009 online survey of 2000 British people, 38 per cent believed that most people in British society see disabled people as a “drain on resources” (Scope). A majority of human geneticist concluded in a survey in 1999 that disabled people will never be given the support they need (Nippert and Wolff). Adaptation disablism is visible in the literature and studies around other disasters. The 1988 British Medical Association discussion document, Selection of casualties for treatment after nuclear attack, stated “casualties whose injuries were likely to lead to a permanent disability would receive lower priority than those expected to fully recover” (Sunday Morning Herald). Famine is seen to lead to increased infanticide, increased competitiveness and decreased collaboration (Participants of the Nuclear Winter: The Anthropology of Human Survival Session). Ableism and disablism notions experienced by disabled people can now be extended to include those challenges expected to arise from the need to adapt to climate change. It is reasonable to expect that ableism will prevail, expecting people to cope with certain forms of climate change, and that disablism will be extended, with the ones less affected being unwilling to accommodate the ones more affected beyond a certain point. This ableism/disablism will not only play itself out between high and low income countries, as Desmond Tutu described, but also within high income countries, as not every need will be accommodated. The disaster experience of disabled people is just one example. And there might be climate change consequences that one can only mitigate through high tech bodily adaptations that will not be available to many of the ones who are so far accommodated in high income countries. Desmond Tutu submits that adaptation apartheid might work for the fortunate ones in the short term, but will be destructive for them in the long term (United Nations Development Programme). Disability studies scholar Erik Leipoldt proposed that the disability perspective of interdependence is a practical guide from the margins for making new choices that may lead to a just and sustainable world—a concept that reduces the distance between each other and our environment (Leipoldt). This perspective rejects ableism and disablism as it plays itself out today, including adaptation apartheid. Planned adaptation involves four basic steps: information development and awareness-raising; planning and design; implementation; and monitoring and evaluation (Smit et al). Disabled people have important knowledge to contribute to these four basic steps that goes far beyond their community. Their understanding and acceptance of, for example, the concept of interdependence, is just one major contribution. Including the concept of interdependence within the set of tools that inform the four basic steps of adaptation and other facets of climate discourse has the potential to lead to a decrease of adaptation apartheid, and to increase the utility of the climate discourse for the global community as a whole. References African Ministerial Conference on the Environment. 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This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. 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