Journal articles: 'QuickBooks pro phone number' – Grafiati (2024)

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There are two types of switching costs when users change their mobile operator. The first stems from price discrimination when the network charges a lower price for on-net than for off-net calls. If the majority of the switching user?s contacts are in their current network, this imposes an obstacle to changing the network, since in the new network they would have to pay a higher price for off-net calls. The other switching cost results from the switching user having to inform all their contacts about their new number in the other network. Mobile phone number portability (NP) reduces this switching cost. This paper?s aim is to determine pro-competitive regulatory policies for the post-paid and pre-paid market segments. This distinction is important since the post-paid market dominates in developed countries, while in less developed countries the prepaid market dominates. There are two operators in our model, the incumbent and a new entrant. In the postpaid market, NP reduces the level of market concentration. In the pre-paid market, NP has no impact on the convergence of market shares, and the reduction of access charges (the fee for terminating calls in the rival network) turns out to be a pro-competitive regulatory policy. There is no need for asymmetric access regulation where the incumbent pays higher access charges than the new entrant.

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“Necessity is the Mother of Invention”-one of the most Important and Interesting Man Made Inventions is Mobile Phone. there is a Rapid Increase in the Number of Users of Mobile Phone in the Last Decade. Today, it's Hard to Find a Cell Phone that Doesn't Offer some Sort of "smart" Technology because it's in such a High Demand. the Use of Mobile Phone has Become an Integral Part of Human Lives. in this Paper, an Attempt is Made to Study the Optimization of 3-Dimensional Heat Transfer Phenomena in Mobile Phone Using ANSYS for Three Different Models and Different Companies such as HTC Desire C, Nokia Lumia 900 and Sony Xperia Tipo. the Actual Dimensions and Materials are Chosen for above Models. the Three Models are Modelled in Pro/E, then Meshed by 3D-10 Nodded Tetrahedral Thermal Solid Elements (SOLID87) and Analysed in ANSYS Software, by Applying Boundary Conditions. the Analysis is Carried-out to Find the Nodal Temperatures, Directional Thermal Fluxes. it is Found that the Optimum Heat Transfer Occurs at HTC Desire C and Validated with the References.

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e14103 Background: The rapid development of digital technology holds enormous potential to transform the delivery of cancer care. Despite these digital innovations, we still face significant challenges in healthcare in using these emerging digital technologies in the clinical setting. Clinicians generally underestimate the severity and extent of chemotherapy toxicity of patients. This project seeks to conduct an exploratory field study to collect patient feedback on their experiences, and the design/functionality of the prototype of the digital health service platform designed to monitor their symptoms. Methods: Using the National Cancer Institute item library addressing the most common symptoms for chemotherapy toxicity, a digital health platform was designed by Samsung Research America (SRA) and University Hospitals. Patients age ≥ 18 years old, willingness to agree to the consent document, ability to understand use of wearable device and willingness to answer patient reported outcomes questions were included in this study. Patients who are not undergoing oral chemotherapy treatment for their cancer were excluded. Patients were given a phone that had our designed platform along with a watch. The watch had the capability of tracking blood pressure, heart rate, and pulse oximetry. Patients were set up with an electronic account that queried them on patient Reported Outcomes (PRO) regarding potential toxicity they may be experiencing. They were also able to track medication consumption and input their weight. Subjects were be asked to use the wearable device and phone for at least 28 days and no more than 90 days. At the end of the study, a phone survey was attempted. Results: Total patients enrolled: 21. 18/21 (85.7%) patients completed the 90 days of the study. Only 9 patients provided PRO with total number of side effects reported 28 times. Watch device was only utilized by 15/21 (71.4%) patients. On an average across 90 days, these patients wore the watch 430 minutes per day. At the end of the treatment, 5 patients agreed to participate in the phone survey. Three patients stated that they would do similar study in the future noting that the digital platform helped them stay on track and monitor symptoms accurately. Every patient questioned had a complaint regarding the watch functionality. Patients also found it difficult to carry a second phone in addition to their personal phone. Conclusions: Improving our digital health service platform will get us closer to achieving effective bi-lateral patient communication and ultimately improving patient care.

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The provision of pro bono activities for law students has become an established feature of the undergraduate legal education landscape in Law Schools in the United Kingdom (“UK”) and beyond, providing the experiential elements of clinical legal education programmes. Pro bono activities conducted online, or utilising and enhanced by technologies in other ways (for example, through the development of a mobile phone application providing legal guidance), are increasingly becoming a part of this offering, reflecting wider shifts within legal practice and society and an increasing recognition of the importance of digital literacy skills. This paper will situate these forms of online and technologically-enhanced pro bono activities both within the wider context of contemporary clinical legal education and also as a part of broader professional and societal shifts. It will explore a variety of innovative approaches being taken internationally, including work done by The Open University’s Open Justice Centre in the UK, before moving on to focus on a number of key challenges and opportunities which may arise through the increasing provision of these new forms of pro bono activities by Law Schools. These include the potential and pitfalls of the technology involved, issues with confidentiality (particularly in the context of online legal advice) and the issue of how to foster trust in the online environment. The paper will conclude with a number of suggestions for areas requiring further research and discussion to enable contemporary clinicians to fully utilise the potential of online and technologically-enhanced pro bono activities.

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In preparation for the PRO B study which aims to examine the effects of an app-based intensified patient-reported outcome (PRO) monitoring for metastatic breast cancer patients, prior assessment of its feasibility was carried out. Sixteen breast cancer patients visiting the breast cancer unit at Charité were recruited and downloaded an app connected to an ePRO system. They received electronic questionnaires on two occasions (baseline and the following week) and were subsequently contacted for a semi-structured phone interview for evaluation. Eleven participants answered at least one questionnaire. Some participants did not receive any or only a part of the questionnaires due to technical problems with the app. Participants who completed the evaluation questionnaire (n = 6) were overall satisfied with the weekly PRO questionnaire. All interviewed (n = 11) participants thought it was feasible to answer the PRO questionnaires on a weekly basis for one year, as planned in the PRO B study. The pretest revealed a need for major technical adjustments to the app because push notifications about the receipt of new questionnaires were not displayed on some smartphone models. Due to the low number of participants, generalization of the findings is limited to our specific context and study. Nevertheless, we could conclude that if technical aspects of the app were improved, the PRO B study could be implemented as planned. The ePRO questionnaire was considered feasible and adequate from the patients’ perspectives.

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Introduction: In order to review the requirement for all patients to return for HIV test results, we sought to describe the number of cases of HIV infection detected at Sydney Sexual Health Centre among people who did not disclose known risk factors before testing. Method: The clinic database identified all HIV testing episodes between January 2004 and January 2007, along with gender, gender of sexual partners and test result. Pro-forma medical records were reviewed for each person who tested positive for gender of sexual partners, condom use, and sexual contact with a person from a country known to have a high HIV prevalence and injecting drug use. Results: During the 3-year period, a total of 13 290 HIV tests were performed. In men who have sex with men, 6194 tests were performed and 55 (0.88%) tested positive. In women and heterosexual men 7096 tests were performed, and only four (0.06%) tested positive. All four reported known risks for HIV before testing. Conclusion: Clients with no recognised risk factors for HIV are unlikely to test positive at our Australian sexual health clinic. Providing the option for low risk people to obtain their results other than face to face has advantages for both the clinic in terms of service provision and the clients in terms of time and the proportion who receive their result.

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This study examined the relationship between the adoption of bio-fortified provitamin- A cassava varieties and farming households’ health outcomes using cross sectional data obtained from 318 cassava farmers in southeast Nigeria. The data was analysed using binary logistic regression, propensity score matching of treatment effects and percentages. The study found that number of children under five, household size, education of head of household, extension service, ownership of television, radio, mobile phone and tricycle, membership of cooperative societies, and access to credit were the significant predictors of adoption of pro-vitamin-A bio-fortified cassava varieties in the States. The study also found that the main constraints militating against adoption of pro-vitamin-A bio-fortified cassava include decaying of roots immediately after maturation,high cost of cassava stem, and high moisture content. The estimate of the effect of the adoption of bio-fortified pro-vitamin-A cassava varieties onincidence of vitamin-A deficiency related diseases was significant with an average treatment effect on the adopters of -0.463. The adoption of bio- fortified pro-vitamin-A cassava varieties has substantial effect on the reduction of vitamin-A deficiency related health outcomes. There is need for wider awareness and dissemination of the varieties among cassava farmers, while interventions should target the promotion of both production and consumption of such cassava varieties. Key words: adoption of bio-fortified cassava varieties; vitamin A deficiency related diseases

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12118 Background: The safety profile of Targeted therapies (TT) and immunotherapy (IT) may be underestimated and negatively affect the clinical outcome. Methods: A nationwide, randomized, open-label trial (NCT04726020) conducted among 29 Italian centers involved two cohorts of 223 adult patients (pts) with a solid tumor, receiving TT (group B, 119 pts) or IT (group C, 104 pts). Pts were randomized to receive a weekly nurse monitoring phone call, together with an educational leaflet with some practical advice about toxicities (experimental arm), or only the educational leaflet (control arm). In the experimental arm, pts received their monitoring phone call before their treatment began, then every week for up to 16 weeks of treatment were completed. The primary objective was the evaluation of the difference in toxicities according to patient-reported outcome (PRO)-CTCAE. Results: Both arms were comparable in terms of pts’ characteristics (e.g. site of primary tumor, line of treatment). The adherence to the project (that is the completion of every expected call) was 62.1% in group B and 66.9% in group C. In group B, in the experimental arm, we found a higher number of pts without pain (53.7 vs 39.9%, p = 0.047); a trend of lower fatigue (29.2 vs 18%, p = 0.067) was also observed. In group C, a higher number of pts did not report fatigue (29.1 vs 17.5%, p = 0.043), shortness of breath (61.4 vs 38.5%, p = 0.002) or dry skin (72 vs 52.3%, p = 0.004). More pts also referred to be without pain (51.6 vs 38.8%, p = 0.065) and pruritus (75.9 vs 64.5%, p = 0.088), even if these difference were not statistically significant. Conclusions: The use of PRO assessment through active nurse monitoring might lead to a better tolerance of TT and IT with possible implications on pts’ quality of life and ultimately on treatment outcome. In particular, in the IT group, several symptoms were prevented from occurring, thus encouraging a major effort to implement such active monitoring in this population. Clinical trial information: NCT04726020.

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126 Background: Since the 1996 formation of Project Access, a nationwide program linking uninsured, low-income, or underserved patients to specialty care, the US has experienced a growth of third-party, safety net care coordination programs that provide sub-specialty care at no or reduced cost. These programs pre-negotiate with local physicians and hospitals to offer pro bono services to patients. Little is known about the provision of oncologic services within these programs. This study evaluated the current landscape of oncologic services within US safety net care coordination programs. Methods: This study reviewed websites via an online search from 04/22/19 - 04/28/19 using keywords “Project Access”, “healthcare”, and individual state names. The websites were reviewed for information on location, services offered, and patient eligibility criteria. Where online data on oncologic services was unavailable, individual programs were called on 05/08/19 for additional information. Five programs were unreachable by phone or e-mail. Results: Websites of 29 safety net care coordination programs in 22 states were identified, serving only approximately 40 counties. Online, one program highlighted "limited" access to oncologic care, while another offered chemotherapy at a reduced cost ($5000/round). When contacted by phone, 55% offered access to oncologic services and 48% assisted with chemotherapy costs. One program provided chemotherapy only if the cancer diagnosis was made after the patient was enrolled in their system. Virtually all programs who offered chemotherapy did so through affiliated large hospital systems. A commonly reported reason for lack of oncology care was a reluctance of oncologists to commit to potential long-term agreements of free care. Online, one program offered PET scans. By phone, 89% offered some imaging. Two programs (7%) explicitly required US citizenship for care. Conclusions: Third-party care coordination centers are increasing in number and provide a novel, and potentially unrecognized, approach to increasing oncology service access. Further research should identify barriers contributing to the relative lack of oncologic services in these programs compared to other specialties.

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Background Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain. Objective This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries. Methods Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups. Results A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04). Conclusions In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference. Trial Registration ClinicalTrials.gov NCT03991546; https://clinicaltrials.gov/ct2/show/NCT03991546

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Objectives: Patient-reported outcomes (PROs) are an important clinical tool to effectively collect, compile, and assess patient data and clinical progress. Beyond just tracking patient progress, PROs facilitate patient-provider communication and can be used to inform care practices. Though recent studies have focused on the merits of PRO collection in orthopaedics, few have sought to understand the impact of the coronavirus pandemic on PRO collection. Our objective is to review the initialization of an electronic PRO collection platform at our Orthopaedic Sports Medicine clinics and surgery center before and during the coronavirus pandemic. We focus specifically on our first 7,557 patients in a retrospective study and the interplay between our collection tactics and the patients’ responses to PROs from November 2019 to July 2020. Methods: Starting in the fall of 2019, we implemented a new clinic-wide data capturing system to collect PROs and maintain our outcomes database. We began with a small group of providers and their patients before expanding to include most providers and staff in three clinics. Patients received the following forms prior to their first visit: Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference, PROMIS Physical Function, and subsequent corresponding anatomic-specific scales. The Brief Resilience Scale (BRS) was later added in the spring of 2020. A secure link to the surveys was sent to the patient’s email or phone prior to their appointment or accessed via an iPad at the clinic’s kiosk during their appointment. However, due to coronavirus cleaning protocols, forms were only sent to the patient’s email or phone beginning in March. Upon completion of July 2020 collection, we utilized STATA statistical software to analyze the data and identify trends in patient responses. For statistical analysis, we used chi-squared tests. Results: For the purpose of this study, we collected PROs from 7,557 patients between November 2019 and July 2020. After analyzing all data points in STATA, we determined differences in several collection categories, including the extent of completion and time of completion. Out of all patients prompted to complete one or more PROs, 37.20% of patients (n = 2811) did not complete any PROs, 11.86% of patients (n = 896) completed some but not all assigned PROs, and 50.95% of patients (n = 3850) completed all assigned PROs. Patients who completed all or some of their PROs completed them before their appointment 56.02% of the time (n = 2773), within an hour of their appointment 35.49% of the time (n = 1757), and after their appointment 8.48% of the time (n = 420) (see Figure 1). After separating PRO completion rates by month, we noticed a shift in compliance and patient response patterns before and during the coronavirus pandemic. From November to February, the average number of patients who completed one or more PROs was 80.20% (n = 1797) before dropping to an average of 57.74% (n = 5760; p <0.001) between March and July. The overall PRO compliance rate similarly dropped at our first PRO collection site, Clinic A, from an average of 86.75% to 76.81%, respectively (see Figure 2). Clinic operations were significantly reduced in late March due to the coronavirus pandemic, leading to majority telehealth visits and restrictions on clinic-wide shared iPad use. Though more than half of patients on average completed their PROs prior to their appointment throughout the year, this trend was especially prevalent during the coronavirus pandemic. For all or some PROs completed prior to appointment time, 42.34% were completed on average between November and February compared to 62.42% between March and July (see Figure 3). Beyond completion metrics, we observed a difference in appointment cancellations before and during the coronavirus pandemic. From November to February, 21.28% of patient appointments were canceled on average compared to 35.74% of appointments canceled on average from March to July. The number of cancelations during the coronavirus pandemic was significantly different than before the pandemic (p <0.001). Conclusions: In a short period of time (9 months) after initial implementation of a PRO platform, our practice has amassed significant data and reported outcomes for over 7,000 patients. Prior to the coronavirus pandemic, patients were relatively receptive to the new PRO collection platform with over 80% of patients completing some or all assigned PROs. However, following our clinic-wide cessation of shared iPads due to coronavirus concerns, we noted a significant decrease in our patient compliance (80.20% down to 57.74%; p <0.001). Though discontinuation of iPad and kiosk use likely only contributed in part to this significant decrease, this observation still suggests that shared devices may play an important role in promoting PRO compliance within the clinic. It’s also important to note the limitations in this study, including the staggered integration of each provider’s patients. This likely impacted the increased compliance rates in November with 282 patients versus 1677 patients in July. In addition, compliance may have been affected by the transition from two research staff members helping collect PROs to one research staff member. Methods of promoting compliance also changed as we shifted to telehealth visits. In March and April, members of our research team called patients about their incomplete PROs, likely prompting increased responses prior to patient appointments. We are utilizing these observations to improve our workflow for collecting patient PROs and increase compliance within the clinic. After reflecting on our initial findings, we feel the use of devices in clinic and full staff involvement can bolster completion of PROs and are important tools in order to best maintain a data collection platform with high patient compliance.

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Background. Female adolescents are considered a risk group for cardiometabolic disease due to their lifestyle (LS). Objective. To evaluate the association between LS classes and body composition groups with cardiometabolic disease risk factors and pro- and anti-inflammatory biomarkers in female adolescents. Methods. This cross-sectional study was carried out with female adolescents aged 14 to 19 years, from Viçosa-MG, Brazil. Latent class analysis assessed LS classes. Kinanthropometric measurements were taken together with the body fat percentage (BF%), being analyzed by the Dual Energy X-ray Absorptiometry (DEXA) equipment. Blood pressure and biochemical parameters were analyzed in the Health Division of the Federal University of Viçosa. The pro- and anti-inflammatory biomarkers were analyzed using Luminex technology. Associations with biomarkers were estimated by multiple linear regression. Results. 405 female adolescents were evaluated. The majority, 82.57%, 72.90%, and 65.31%, were classified as inactive by the number of steps, with high screen and cell phone time, respectively. Furthermore, 41.55% did meet the minimum of 60 minutes of moderate-to-vigorous physical activity (MVPA) and 54.69% had high values of BF% (DEXA). The “Sedentary & Inactive LS” class together with the high levels of weight and BF% were associated with increased levels of blood pressure, lipid profile, and uric acid. It was also found that “Inactive & Sedentary LS”, high BF%, insulin resistance, and ultra-sensitive C-reactive protein were associated with the concentrations of proinflammatory biomarkers of tumor necrosis factor-α, interleukin-6, and leptin. Conclusion. We concluded that female adolescents with overweight/obese and high BF% presented higher values of anthropometric indicators, levels of blood pressure, concentration of uric acid and hs-CRP, and lower concentration of HDL. Inactive and Sedentary lifestyle of these girls, along with excess body fat, insulin resistance, and higher concentrations of hs-CRP were associated with the higher concentration proinflammatory markers.

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Background The COVID-19 epidemic in Italy has severely affected people aged more than 80, especially socially isolated. Aim of this paper is to assess whether a social and health program reduced mortality associated to the epidemic. Methods An observational retrospective cohort analysis of deaths recorded among >80 years in three Italian cities has been carried out to compare death rate of the general population and “Long Live the Elderly!” (LLE) program. Parametric and non-parametric tests have been performed to assess differences of means between the two populations. A multivariable analysis to assess the impact of covariates on weekly mortality has been carried out by setting up a linear mixed model. Results The total number of services delivered to the LLE population (including phone calls and home visits) was 34,528, 1 every 20 day per person on average, one every 15 days during March and April. From January to April 2019, the same population received one service every 41 days on average, without differences between January-February and March-April. The January-April 2020 cumulative crude death rate was 34.8‰ (9,718 deaths out of 279,249 individuals; CI95%: 34.1–35.5) and 28.9‰ (166 deaths out of 5,727 individuals; CI95%:24.7–33.7) for the general population and the LLE sample respectively. The general population weekly death rate increased after the 11th calendar week that was not the case among the LLE program participants (p<0.001). The Standardized Mortality Ratio was 0.83; (CI95%: 0.71–0.97). Mortality adjusted for age, gender, COVID-19 weekly incidence and prevalence of people living in nursing homes was lower in the LLE program than in the general population (p<0.001). Conclusions LLE program is likely to limit mortality associated with COVID-19. Further studies are needed to establish whether it is due to the impact of social care that allows a better clients’ adherence to the recommendations of physical distancing or to an improved surveillance of older adults that prevents negative outcomes associated with COVID-19.

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We are witnessing a lot of unimaginable achievements in information and nanotechnology, and their application in modern medicine which can be considered a revolution in medicine. "Is it radical transformation through innovation?", as asked Jozef Schumpeter, and how does conventional medicine respond to these challenges? How did it begin, and how long did information technology arrive? With this paper we tried to give at least a partial answer. So far a doctor, we can conditionally say, was the only bearer of medical knowledge - medical information, in his hands was a "general database" (professional literature), as well as a database of personal, medical data (medical card of the patient). However, now the situation is completely different. Digitization of medicine and networking, and absolute availability of knowledge, as well as electronic records, represent the systematic storage of a large number of medical findings, quick and targeted search and usability of information about a particular person, and immense help to the doctor. The introduction of algorithms enables the lightning processing of incoming information. However, "knowledge from a computer" can be a danger to the availability of information to lay people, which makes it necessary to verify the validity of the information source. The new concept of "transferring and disseminating knowledge from a computer" aims to transfer responsibility for personal health. In the development of nano technology, two critical moments are: decryption of DNA (genome analysis, to details reveals the "biology" of a person) and micro-sensors and wireless transmission technologies that are integrated into an innovative mobile phone (smartphone) that allows monitoring of a number of vital parameters. Miniature ultrasound devices and powerful micro-analyzers, in smartphones and virtual browsing are a reality. Does the doctor lose the ground under his feet? What is the general attitude of patients towards innovation? The answers to these questions are very different, and we tried to present them with the track of the facts pro et contra. With the conclusion about the undeniable contribution and benefits of innovative technologies in medicine, there are many open questions. We wanted to mention and discuss some of the dilemmas related to information technology and nano technology.

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Background and Objectives: Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values. Method: One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN). Results: Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTeSD (p < 0.01), QTpSD (p < 0.05), mean Te (p < 0.05), TeSD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only TeSD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTeSD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for TeSD (AUC: 0.736, p < 0.001) and QTeSD (AUC: 0.696, p < 0.01). Conclusion: Both mean Te and TeSD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162).

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Background:Registry studies and clinical trials are increasingly incorporating patient reported outcomes (PROs) to measure the full burden of disease and better measure the efficacy and value of medicines; however, the burden of paper-based surveys, time constraints, and privacy concerns impede the widespread use of PROs in routine clinical care.Objectives:To develop a simple and secure technological solution to incorporate validated PROs into routine clinical care for patients with rheumatic diseases, and to assess the patient response to functional assessment of chronic illness therapy fatigue (FACIT-F), patient health questionnaire-2 (PHQ-2), and healthcare resource utilization (HCRU) questionnaires delivered using this ePRO method.Methods:A novel ePRO questionnaire delivery system was developed by Software4Specialists in partnership with OPAL Rheumatology. Validated PRO questionnaires were sent from the patient’s electronic medical record (Audit4, Software4Specialists) and delivered to the patient’s email address at time intervals specified by the rheumatologist (defaults to quarterly) or completed in the clinic waiting room prior to the consultation using a tablet or the patient’s smart phone (in-practice). Completed questionnaires were encrypted and returned directly to the patient’s Audit4 electronic medical record held on the clinician’s server for review at the next clinical consultation. The link to the PRO questionnaire expired within 28 days if the questionnaire was not completed, and the questionnaires were automatically cancelled if 2 consecutive links expired. This technology was made available to up to 111 rheumatologists located in 42 clinics in 6 states/territories in Australia, and the use of this technology to furnish the clinical consultation was voluntary for clinicians and patients. Deidentified clinical data was extracted from the servers of participating rheumatologists and aggregated across all sites.1 Data collected between April 2016-Dec 2020 was analysed descriptively.Results:Between April 2016-Dec 2020, 99,505 FACIT-F, PHQ-2 and HCRU questionnaires have been delivered to 5,784 patients from 39 of 42 contributing clinics (93%). 85% of questionnaires were delivered via email and 15% in-practice. Overall, 85% of patients completed at least one questionnaire, and of all questionnaires sent, 73% were completed. These rates have remained consistent over time. The completion rates were higher when questionnaires were delivered to patients in-practice compared to email (96% vs 69%). Females were more likely to engage with the questionnaires than males (87% vs 81%), and older patients were slightly more likely to complete all questionnaires delivered. 69% of questionnaires sent via email were completed on the day they were delivered and 94% were completed within 7 days. The median (IQR) number of questionnaires completed per patient was 3 (1,7) and the median (IQR) time since the first questionnaire was completed was 13 months (5,26).Conclusion:The novel Audit4 ePRO delivery system is an effective tool for incorporating PROs into routine clinical care to capture data directly from the patient on the impact of their condition on their quality of life. The data generated provides a unique opportunity to understand the full burden of disease for patients in the real-world setting and the impact of interventions.References:[1]Littlejohn GO, Tymms KE, Smith T, Griffiths HT. Using big data from real-world Australian rheumatology encounters to enhance clinical care and research. Clin Exp Rheum 2020:38(5): 874 -880.Acknowledgements:The authors acknowledge the members of OPAL Rheumatology Ltd and their patients for providing clinical data for this study, and Software4Specialists Pty Ltd for providing the Audit4 platform.Disclosure of Interests:Kathleen Tymms: None declared, Tegan Smith: None declared, Claire Deakin: None declared, Tim Freeman: None declared, David Hoffman: None declared, Dana Segelov: None declared, Hedley Griffiths Consultant of: AbbVie, Gilead, Novartis and Lilly., Sabina Ciciriello: None declared, Peter Youssef: None declared, David Mathers: None declared, Catherine OSullivan: None declared, Geoff Littlejohn Consultant of: Over the last 5 years Geoffrey Littlejohn has received educational grants and consulting fees from AbbVie, Bristol Myers Squibb, Eli Lilly, Gilead, Novartis, Pfizer, Janssen, Sandoz, Sanofi and Seqirus

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Background:Gout flares are considered a key clinical and research outcome in gout. Early treatment of gout flares increases patient well-being and warrants timely notification of the treating clinician.Objectives:To test the feasibility of a smartphone app to home-monitor gout flares real-time for both patients with a suspicion of and established gout.Methods:Thirty patients were recruited during their visit at the outpatient rheumatology clinic. Inclusion criteria were age ≥ 18 years, smartphone possession, established gout (crystal proven) or a clinical suspicion of gout and at least one flare reported in the last three months.A straight-forward query app was used to incorporate an adapted version of the 2017 four-criteria gout flare definition.[1] For 90 consecutive days the app asked patients to report their current pain score on an 11-points scale as screening question. Scoring pain below 4 terminated the query, otherwise the app posed the remaining criteria: does the patient experience warm and/or swollen joints and are symptoms regarded as a gout flare. Responses were transmitted in real-time to the dashboard and the clinician was alerted via email if predefined conditions were met. End of study evaluation consisted of the number of generated alerts, duration of (possible) flares and actions taken. Patient feasibility was assessed by measuring app attrition and using a questionnaire based on the Technology Acceptance Model. [2] All constructs were analysed using descriptive statistics.Results:All 30 recruited patients finished the trial. Three minor, resolvable technical issues were reported. Seventeen participants never missed a question. In total 110 responses (4.1%) were missed with three participants responsible for 66 missings. 90% of the participants rated app usability good to excellent and 70% would recommend the app to other patients.Twelve out of thirty patients generated a total amount of 174 alerts where four patients with a suspicion of gout were responsible for 148 alerts (85%). These patients scored three out of four criteria as they had warm, swollen and painful joints but, after consultation with the clinician, their symptoms were not regarded as a gout flare.The 174 alerts belonged to 23 (possible) flares with a median duration of 5 days [IQR 3,5 – 7,5]. Twenty-one pro-active telephone calls were made which resulted in four visits to the clinic within 48 hours. Clinical guidance over the phone consisted of checking in on patient’s symptoms, giving advice and ten medication adjustments.Conclusion:This prospective study shows feasibility of a smartphone app for home-monitoring gout flares for patients because of high usability scores and low attrition rates. The app has added value for gout care because it enables clinicians to act on flares as they occur. The next step is to further implement the app whilst perpetuating investigation into the added value for patients and clinical practice alike.References:[1]Gaffo AL, Dalbeth N, Saag KG, et al. Brief Report: Validation of a Definition of Flare in Patients With Established Gout. Arthritis Rheumatol. 2018;70(3):462-467.[2]Davis Jr. FD. A Technology Acceptance Model for empirically testing new end-user information systems: theory and results. MIT PhD thesis. 1985[3]Stoyanov SR, Hides L, Kavanagh DJ, Wilson H. Development and Validation of the User Version of the Mobile Application Rating Scale (uMARS). JMIR Mhealth Uhealth. 2016;4(2):e72.Acknowledgements:This study was funded by AbbVie and Menarini.Disclosure of Interests: :Bart Pouls: None declared, Charlotte Bekker: None declared, Bart van den Bemt Grant/research support from: UCB, Pfizer and Abbvie, Consultant of: Delivered consultancy work for UCB, Novartis and Pfizer, Speakers bureau: Pfizer, AbbVie, UCB, Biogen and Sandoz., Angelo Gaffo Grant/research support from: Received a research grant from AMGEN, Marcel Flendrie Grant/research support from: M. Flendrie has received grants from Menarini and Grunenthal., Consultant of: M. Flendrie has received consultancy fees from Menarini and Grunenthal.

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Eighteen years ago, I started my out-patients’ experience as specialist dermatologist. I worked from the very first day with National Health Insurance System. It was a chance to build a huge experience (more than 120,000 visits since then). Over time, relationships with patients have changed, influenced by many factors. To preserve good relationships we have to reflect and to use different approaches. In 2001, my stamp and my signature were enough for a consultation. The cell phone era was at the beginning. Over the years, the process has become more and more complicated. Today, if the computer, internet, different types of applications, software, other devices (printer, card reader, etc.) are not working, my knowledge becomes absolutely necessary, but not sufficient for a consultation. So, the doctor is now, totally dependent on IT issues. Besides instant information, cell phones induce a lack of intimacy. Everyone could reach you everywhere, every moment. You are almost “forced” to give advice on whatsapp, e-mail, messenger and people expect you to answer on-site, otherwise you are not “reachable”. Time is the first pressure that we are feeling. Patients want and expect a consultation as soon as possible even you have appointments for the next few weeks. I try my best not to push later than 10 days, if it is a new ordinary consultation. Sometimes, it is possible for me to see the patient on-site (a child, an emergency, pregnant women, etc.). In the literature, time for appointment could vary from 7 working days in Brazil [1], to median 41 days in Canada (Ontario) [2] or median 45 days in US (Pennsylvania) [3] to a certain dramatic situation waiting list of 57 weeks in a unit in UK [4]. The number of consultations tends to increase. It is not only a perception, but a reality, revealed also by a French study (21% increase from 2000 to 2010) [5]. Time is also a burden for the doctor, because the real time for consultation has dramatically reduced in favor of bureaucratic issues. Official papers seem to be more important than people. It is a constant effort to remain emphatic and to really listen to patient’s history. The stories that we are ignoring for lacking time could give us important clues for diagnosis, approach, could enforce the relationship and give trust, could relief the worries. “You are the 5th dermatologist I am seeing”- a young woman told me the other day. I looked at her: she was around 20, some pimples on her jaw (not too many) and some tiny scars on her forehead covered by a lot of makeup. Not quite a good start for a relationship. Her expectations were not fulfilled by visiting the other doctors. Maybe the expectations were not realistic, maybe she was fed up trying different things. “How can I propose something new or miraculous when she tried probably “everything”? - I asked myself. I spent at least half an hour discussing about acne, therapeutic options and adjusting the expectations to our limits. It was more a counseling session than a dermatologic consultation. Today, patients are coming in our office very informed. They “know” the diagnosis and sometimes even the treatment they want or need. After “Dr. Google” you can be a second opinion. Dermatology is underestimated even by other physicians that feel competent enough to prescribe medication inducing iatrogenesis [6]. So, what to expect from patients? It is a good thing to have an informed patient. It will save you a lot of time and energy in expanded explanations. But, there is also a lot of incorrect or 1 Dali Medical, Bucharest, Romania 118 misunderstood information, prejudices from other’s experience shared on forums, incorrect auto-diagnosis or even incorrect auto-medication. It is our duty to listen and to correct, as much as we can. Patients have to be taught how to choose important information from the constant “soup of news feed”. The flux of information is huge, also for doctors as for patients. Thousands of opinions, articles, and new approaches invade our space daily. A good selection criteria for useful, relevant data is absolutely necessary. A “happy” patient seems to be the one with a certain diagnosis, with clear treatment plan, including explaining side effects and with a contact number in case of recurrence [7]. The access of any information being so instant, patients expect a rapid response of the treatment. The result has to be now and definitive. The pressure of quick response is not very subtle, the doctor feeling it as a burden. It takes time to explain and to understand the progression of chronic illnesses. Sometimes, the expectations are to get well with any treatment, eventually without any changes of their life style, even when doctor explains that some habits could aggravate or maintain the lesions. Taking responsibility for some adjustments is an important part to discuss with patient, as part of therapeutic approach. Paternal, omniscient doctor’s image is no longer in actuality and patient is an important part of the relationship. Instead of an “infantile” patient, coming for any transitory rash or any mosquito bite, it is better to “grow” him/her as a self-confident “partner”. The new and healthy bond has to transform patient from the passive, sometimes passive-aggressive role, into an assumed, informed, pro-active one. Cooperation is the key of healthy relation. Patient has the right to ask for explanations, to discuss therapeutic options, to refuse treatments. Patients have opinions that have to be respected and sometimes corrected if they are distorted. On the way to get therapeutic alliance and long-term cooperation, the doctor-patient relationship has to be personalized, giving value to it. This kind of relationship will make the difference in the end and even the direction is to involve more high tech and robots. Face-to-face relationship will not be replaced by anything and it will be highly appreciated after the “speed” condition passes. More social skills are often required, doctors not being known as the best communicators. Sometimes, doctors are not aware of patients’ perception regarding communication [8]. I have got my social skills working day by day, no special courses were made during faculty, unfortunately. “We need fewer memorizers and more thinkers and communicators in modern medicine” is the most recent conclusion of Canadian Debate Series regarding medical students’ selection [9]. Another pressure point is the constant fear of errors. With all the efforts of protocols for reducing the risk of mistakes or misconducts, unfortunately there are lots of gaps and debates. The fear of error and malpraxis leads to excess of medication and investigations, sometimes too expensive and useless. Doctors should not be scared by the abundance of products, instruments, techniques, aggressively promoted. They have to be more flexible, more intuitive and more eager to try, making personal experience and not taking results for granted. Many of these products will not pass the test of time, even they are presented as “miraculous”. Sometimes, patients’ needs are the trigger for experimenting new methods and push us to progress faster. Not only patients are in a rush, doctors too. The race for EMC points is making the doctor more informed, but we have to be careful not to become too superficial. Even a doctor is getting a diploma after a “3 days course”, it doesn’t mean that he/she will be an expert in that field, not even competent. It will take a lot of time and energy to really get the expertise, that course being only the very first step on the road. The “diplomas wall”, real or virtual is a false goal. In the end, the real skills are more important than a sublime image and it will take time to get them. Sometimes, vanity makes the teamwork harder. This will be unproductive for both doctors and patients. It is not a shame to refer the patient to an expert on a field when you feel that you have reached a limit. People are hardly trying to change our state from patient to client, that new status being debatable. Being a client means to take some responsibilities as in a contract. That is the good part. But, fortunately, remaining a doctor means more than providing services. Practicing medicine is a state of knowledge, art, experience, intuition, with magic touches sometimes. Fortunately, with all the changes during the last years, dermatologists seem to remain satisfied with their specialty. A recent Mexican study shows that 93% of dermatologists (with an average of 16 years of practice) were happy with their professional life, more than 98% choosing it once again [10]. Maintaining certain levels of professional and personal happiness, keeping informed and open-minded, avoiding burn-out, trying to fulfill patients’ expectations, doctors are not in a battle, but in strong alliance with patients.

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CREATING CONSPIRACY BELIEFS: How Our Thoughts Are Shaped by Dolores Albarracín et al. New York: Cambridge University Press, 2022. 308 pages. Paperback; $39.99. ISBN: 9781108965026. *Conspiracy thinking is a prominent topic of discussion in American life today--and Christians, with their concern for truth, should not only be informed about, but contributing to, this discussion. This includes awareness of how scholars in the neuro-psychological and social sciences are contributing to our understanding of the nature of conspiracy thinking. *This book investigates the causes of conspiracy thinking in the United States. Its authors draw their findings from existing social scientific literature on conspiracism, general social psychology research, and six empirical statistical studies conducted during the last two years of the Trump presidency (2019-2021): three cross-sectional online surveys, a longitudinal phone panel survey on "deep state" conspiracy claims, a "manipulation" of fear experiment on the alleged relationship between the COVID-19 virus and 5G technology, and a social media study of Twitter hashtags and "fear words." *This book shares many similarities with previous academic works on conspiracy thinking--for example, Hofstadter (1965), Pipes (1997), Robins and Post (1997), Sunstein and Vermeule (2008), Barkun (2013), and Uscinski and Parent (2014)--but distinguishes itself by relying extensively on recent polling data and statistics instead of interviews, case studies, newspaper op-eds, or conspiracist media. Indeed, the authors consciously dispute psychological works that scrutinize the personality traits and life experiences of conspiracy believers, and political science works that link conspiracy fears to power asymmetries. Such approaches, they contend, insufficiently explain the process through which conspiracy beliefs are spread. They argue, instead, that psychological and political factors are themselves shaped by a mixture of personal, media, and social media contacts. *Their central aim is thus to examine how patterns of media consumption shape conspiracy beliefs, habits that are themselves affected by one's pre-existing feelings of anxiety, which is herein defined as a nonspecific "perception of threat [that] depends on relatively stable psychological motivations of belief defense [the desire to maintain a coherent set of beliefs], belief accuracy [the desire to maintain a realistic view of the world], and social integration [the desire for trust, status, and acceptance within a group], as well as sociopolitical factors and situational factors like communications and media exposure" (p. 163). *When these needs are not met, anxiety rises. But whereas desire for belief accuracy produces, on its own, an increase in critical discernment--and hence a decrease in false conspiracy beliefs--the combination of pre-existing anxiety (e.g., feelings of ostracism) with shared conspiracy narratives increases one's predisposition to believe conspiracy claims. When one's need for closure and community trumps their need for belief accuracy, new information will be interpreted in ways that justify their emotional state and existing beliefs. The emotional turmoil and social discomfort of anxious individuals make them more prone to accept conspiracist interpretations for troubling situations, drawing them into an alternative "media ecosystem." *Assent to conspiracy claims occurs when anxiety is assuaged by theories that offer plausible and unfalsifiable "proofs" of "hidden hand" driving events. Plausibility is achieved when a theory offers the believer historic similarity (similar plots occurred in the past), psychological similarity (the enemy's alleged motive is conceivable), and normative plausibility (other members of one's community share the same belief). The unfalsifiable nature of conspiracy claims lies in their assertion that proofs of a nefarious plot have been hidden or destroyed by the conspirators; such claims dovetail with the believer's existing distrust of authoritative sources of information. The repetition of conspiracist messages by like-minded others (friends, social networks, etc.), and by popular media (e.g., Fox News) reinforces these beliefs. The believer's wounded ego can further elicit schizotypy, paranoia, and narcissism, which serve as means of self-defence against debunkers and skeptics. *The influence of various media is proportional to time spent with, and trust placed in, these sources of information, along with the consumer's prior levels of neuroticism, suspiciousness, and impulsivity. Online media have an additional influence via their use of bots, individually tailored algorithms, and various forms of "information laundering" in reply threads and chatrooms. Heavy media consumption aligns the consumer's view of the world with the one shown in their preferred media. *The prime contribution of this book is its postulation that anxiety precedes conspiracy thinking (rather than the inverse), a psychological explanation for conspiracy belief that does not lead its authors to conclude, as others have, that conspiracism is inherently a form of neurosis. However, its heavy use of statistics, jargon, and unduly complicated flowcharts renders the text onerous, especially for those without statistical training. Given that this is meant to be the book's most 'important new input into the literature, it is also its greatest weakness. *Despite the great efforts made by its authors to produce a detailed empirical study of the effects of media on conspiracy beliefs, the book's conclusions are somewhat underwhelming as they echo the findings of many previous studies and offer few new insights into the topic. For instance, their claim that social interaction is the "proverbial elephant in the room" (pp. xiii, 205) is hardly convincing. The media consumption habits of conspiracy believers are a recurring theme throughout the literature, and none make the claim that conspiracy beliefs develop in an information vacuum. The book's conclusion that anxiety serves as an "intervening mechanism" (p. 87) between conspiracy claims and a person's needs for closure and social integration in not particularly revelatory either. That humans are social animals is an argument as old as Aristotle, and that conspiracy myths help insecure individuals improve their sense of social cohesion is at least as old as Karl Popper's "conspiracy theory of society."1 *The book's statistical data also exhibits several flaws, leading its authors to wrongly conclude, as Hofstadter did in 1965, that the phenomenon of conspiracy thinking is essentially a product of conservative angst2--a claim that has been powerfully disproven by many of Hofstadter's critics. This may be due to the timeframe of the authors' research studies, which were conducted mostly during and after President Trump's first impeachment trial (in 2019-2020), which elicited a massive conservative media backlash. It could also be due to their failure to examine long-term patterns of conspiracy chatter, which would have shown (see Uscinski and Parent, 2014) that conspiracy ideation ebbs and flows along political lines over longer periods of time. Their data also contains some unrepresentative samples, namely, the overrepresentation of low-wage earners, the unemployed, and the highly educated, and the underrepresentation of working-class high school graduates and Hispanics (pp. 243-44). *One could surmise that such flaws are due to an extraordinary historical context (the Trump presidency and COVID-19 restrictions), but they are also likely attributable to the implicit political biases of current social psychological research, which, as Duarte et al. demonstrated,3 is strongly skewed to the political left. This is made evident in the authors' clearly stated opinion that conservative media is the primary cause of conspiracy beliefs and related violence (pp. 224, 169-70) from which its audience--akin to cultists and terrorists--should be deprogrammed with "corrective alternatives" and ridicule (p. 215). This seems to contradict their 'primary claim that anxiety is the underlying cause (and not the product) of conspiracy beliefs, which should presumably be allayed with kinder methods than these. By identifying conspiracy theories as both a product of right-wing media and, simultaneously, as a "type of misinformation" (p. 11), the authors leave themselves open to the charge of circular reasoning. Indeed, their political bias is shown in their frequent use of contested progressive concepts and phrases such as "racialized," "Latinx," "pro-social behavior to reduce [one's] carbon footprint," and by 'connecting peaceable conservative media such as Focus on the Family to the use of gun violence by Edgar Maddison Welch in a Washington pizzeria (p. 219). *The small number of conspiracy theories on which the authors based their surveys is another example of skewed sampling. Most of these represent themes that cause far more anxiety to conservatives than liberals (for example, the "deep state," COVID-19 restrictions, illegal immigration, President Obama's birth certificate), while little attention is given to conspiracy theories that traditionally appeal to the political left (for 'example, JFK, 9/11, GMOs, "BigPharma," CIA malfeasance, Hurricane Katrina) or to progressives' fears about policing, systemic racism, abortion rights, or gender identity, making it all the more likely that their research subjects who displayed conspiracist thinking stood on the right side of the political fence. *Finally, the book spends too much time discussing tangentially pertinent psychological research (for example, the influence of music on pain and imitative suicide) and too little detailing the content and origins of the few conspiracy theories their research is based on (with the exception of the 2016 "Pizzagate" panic). This makes the book difficult for the layperson to follow, when it is compared to academic works such as those of Barkun4 or Uscinski and Parent,5 which are accessible to a nonspecialized audience. Few details are given, for instance, of the Tuskegee syphilis experiments, which are mentioned frequently but never in detail as an example of a genuine government conspiracy (rather than a significant but nonsinister breach of medical ethics). In the end, the book complements the rest of the literature but falls short of providing significant new insights, and is unlikely to elicit interest among laypersons, especially those who hold conspiracy beliefs. * Notes *1Karl R. Popper, Conjectures and Refutations: The Growth of Scientific Knowledge (New York: Routledge & Kegan Paul, 1963). *2Richard Hofstadter, The Paranoid Style in American Politics, And Other Essays (New York: Knopf, 1965). *3José L. Duarte et al., "Political Diversity Will Improve Social Psychological Science," Behavioral and Brain Sciences 38 (2015): e130, https://doi.org/10.1017/S0140525X14000430. *4Michael Barkun, A Culture of Conspiracy: Apocalyptic Visions in Contemporary America (Berkeley, CA: University of California Press, 2013). *5Joseph E. Uscinski and Joseph M. Parent, American Conspiracy Theories (Oxford, UK: Oxford University Press, 2014). *Reviewed by Michel Jacques Gagné, Champlain College, St. Lambert, QC J4P 3P2. Michel is a historian and author of Thinking Critically about the Kennedy Assassination: Debunking the Myths and Conspiracy Theories (Routledge, 2022).

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Abstract Background A randomized controlled pilot trial was conducted to assess if melanoma patients treated with immunotherapy had the number of grade 3 or 4 adverse events during treatment reduced by 50% using a tailored electronic patient-reported outcomes tool in addition to standard toxicity monitoring compared to standard monitoring alone. Secondary endpoints were: if more AEs were reported in the intervention group, if there was a difference between the two groups in the number of telephone consultations, extra out-patient visits, number of days in the hospital, days in steroid treatment and the time patients experienced grade 2 or higher toxicity. Patients and methods Melanoma patients receiving immunotherapy at the Department of Oncology, Odense University Hospital, Denmark participated. Standard care included assessment of AEs by a clinician before each treatment cycle using the Common Terminology Criteria for Adverse Events. In addition, patients randomized to the intervention reported their AEs weekly by an electronic PRO-tool based on the PRO-CTCAE platform. Results One hundred forty-six melanoma patients were randomized. In this study, we did not detect a difference between the two groups in the number of grade 3 or 4 AEs (P = 0.983), in the overall number of AEs (P = 0.560) or in the time the patients in the two groups experienced grade 2 or higher toxicity (0.516). The number of phone contacts was significantly higher in the intervention group (P = 0.009) and there was a tendency towards patients in the intervention group having more extra visits (P = 0.156). Conclusion It has been examined if the number of severe AEs for melanoma patients receiving immunotherapy could be reduced by involving the patients in the reporting of symptoms. The results do not justify the expansion of the pilot study into a regular phase III study with this particular set-up. However, a significant difference in the number of phone contacts was found as patients in the intervention group called more frequently, indicating that their attention to AEs was increased. Even though the use of an electronic PRO tool could not reduce the number of severe AEs in this melanoma population, a positive impact on other endpoints such as QoL, communication, or treatment-planning, cannot be excluded. Trial registration Clinicaltrials.gov NCT03073031 Registered 8 March 2017, Retrospectively registered.

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Abstract In response to the rapidly rising number of asylum applications, student-run asylum clinics (SRACs) designed to provide pro bono forensic medical evaluations have emerged at medical schools across the United States. Distinct from traditional student-run clinics in the services they provide and in their operational models, SRACs face a unique set of challenges. This study aims to identify the common challenges in building SRACs and to collect insights to inform a structured approach to collaborative problem-solving. This study gathered data from online surveys and semi-structured phone interviews with representative medical student SRAC leaders. 14 clinics participated in the 2017 online survey, 15 clinics in the 2018 online survey, and eight clinics in the 2018–2019 phone interviews. We identified common challenges in five areas: volunteer recruitment, clinic operations, case demand, institutional support, and leadership. SRACs stand to benefit from ongoing extramural collaborations to overcome shared challenges.

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Abstract All papers published in this volume of IOP Conference Series: Materials Science and Engineering have been peer reviewed through processes administered by the Editors. Reviews were conducted by expert referees to the professional and scientific standards expected of a proceedings journal published by IOP Publishing. • Type of peer review: Single-blind • Describe criteria used by Reviewers when accepting/declining papers. Was there the opportunity to resubmit articles after revisions? The criteria used by the reviewers were as follows (with Excellent, Good, Fair, Poor and Very Poor highlight for each criteria): –Significance of actual state of the problem; –Originality of the work; –Quality of research methodology; –Validity of the results and interpretation; –Clarity of the conclusions; –Validity of the future results; –Adequacy of recognition of the quotations of previous work; –Quality of the language. The reviewer’s recommendations were: –Accepted as it is; –Accepted with minor revisions; –Resubmitted with major revisions; –Rejected. Yes, of course was the possibility for all authors to resubmit articles after reviewer’s comments. • Conference submission management system: The Conference management system consist in our platform www.modtech.ro with the database included such as: REGISTER, LOGIN, USERS INFORMATION (email, city/country, uploading paper time, options (automatically email to the each author, view & edit details about the participant), delete the user account), NEWSLETTER (inform in a same time all the participants), FILES (uploading abstracts and full papers, message for accepted/denied). Also, the modtech.ro website has the information about ORGANIZERS, TOPICS, CONFERENCE COMMITIES, PUBLICATION ETHICS AND MALPRACTICE STATEMENT, ModTech ATTENDANCE POLICY, CALL FOR PAPERS (Abstract template, Paper template, Poster template, Copyright, Attendance Application Form), REGISTRATION, IMPORTANT DATES, PUBLICATIONS, BOOK OF ABSTRACTS, PLENARY/KEYNOTE/INVITED SPEAKERS, VENUE, NEWS, CONTACT. • Number of submissions received: 131 • Number of submissions sent for review: 128 (3 paper rejected after the plagiarism report) • Number of submissions accepted: 125 (IOP-91; IJMMT-20; 14-withdrawn due to the loss of SCOPUS indexation by the IOP) • Acceptance Rate (Number of Submissions Accepted / Number of Submissions Received X 100): 95.4% • Average number of reviews per paper: 2 • Total number of reviewers involved: 39 • Any additional info on review process (ie plagiarism check system): Was used the PLAGIARISM DETECTOR PRO v. 1861 • Contact person for queries: Dumitru Nedelcu, Phone: +40771346968, Email: office.modtech@gmail.com

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Objectives This study aimed to (1) estimate the total pool of neonatal therapists (occupational therapists, physical therapists, and speech-language pathologists who work in the neonatal intensive care unit [NICU]) and the average number represented in each U.S. based NICU, and (2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors. Study Design This study used several methods of data collection (surveys, phone calls, and web site searches) that were combined to establish a comprehensive list of factors across each NICU in the United States. Results We estimate that there are 2,333 full-time equivalent (FTE) positions designated to neonatal therapy coverage, with 4,232 neonatal therapists covering those FTEs. Among 564 NICUs with available neonatal therapy staffing data, 432 (76%) had a dedicated therapy team, 103 (18%) had pro re nata (as the circ*mstances arise; PRN) therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level-IV (n = 112; 97%) and -III (n = 269; 83%) NICUs compared with level-II NICUs (n = 51; 42%; p < 0.001). Having a dedicated therapy team was related to having more NICU beds (p < 0.001), being part of a free-standing children's hospital or children's hospital within a hospital (p < 0.001), and being part of an academic medical center or community hospital (p < 0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p = 0.001) but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p > 0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred U.S. based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of level-IV NICUs had at least one CNT). Conclusion Understanding the composition of neonatal therapy teams at different hospitals across the U.S. can drive change to expand neonatal therapy services aimed at optimizing outcomes of high-risk infants and families. Key Points

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We need a clear, unified, and consistent voice to effect the complete dismantling, the abolition, of the mechanisms of animal exploitation.And that will only come from what we say and do, no matter who we are.— Gary L. Francione, animal rights theoristThe history of hashtags is relatively short but littered with the remnants of corporate hashtags which may have seemed a good idea at the time within the confines of the boardroom. It is difficult to understand the rationale behind the use of hashtags as an effective communications tactic in 2019 by corporations when a quick stroll through their recent past leaves behind the much-derided #qantasluxury (Glance), #McDstories (Hill), and #myNYPD (Tran).While hashtags have an obvious purpose in bringing together like-minded publics and facilitating conversation (Kwye et al. 1), they have also regularly been the subject of “hashtag takeovers” by activists and other interested parties, and even by trolls, as the Ecological Society of Australia found in 2015 when their seemingly innocuous #ESA15 hashtag was taken over with p*rnographic images (news.com.au). Hashtag takeovers have also been used as a dubious marketing tactic, where smaller and less well-known brands tag their products with trending hashtags such as #iphone in order to boost their audience (Social Garden). Hashtags are increasingly used as a way for activists or other interested parties to disrupt a message. It is, I argue, predictable that any hashtag related to an even slightly controversial topic will be subject to some form of activist hashtag takeover, with varying degrees of success.That veganism and the dairy industry should attract such conflict is unsurprising given that the two are natural enemies, with vegans in particular seeming to anticipate and actively engage in the battle for the opposing hashtag.Using a comparative analysis of the #Veganuary and #Februdairy hashtags and how they have been used by both pro-vegan and pro-dairy social media users, this article illustrates that the enthusiastic and well-meaning social media efforts of farmers and dairy supporters have so far been unable to counteract those of well-organised and equally passionate vegan activists. This analysis compares tweets in the first week of the respective campaigns, concluding that organisations, industries and their representatives should be extremely wary of engaging said activists who are not only highly-skilled but are also highly-motivated. Grassroots, ideology-driven activism is a formidable opponent in any public space, let alone when it takes place on the outspoken and unstructured landscape of social media which is sometimes described as the “wild West” (Fitch 5) where anything goes and authenticity and plain-speaking is key (Macnamara 12).I Say Hashtag, You Say Bashtag#Februdairy was launched in 2018 to promote the benefits of dairy. The idea was first mooted on Twitter in 2018 by academic Dr Jude Capper, a livestock sustainability consultant, who called for “28 days, 28 positive dairy posts” (@Bovidiva; Howell). It was a response to the popular Veganuary campaign which aimed to “inspire people to try vegan for January and throughout the rest of the year”, a campaign which had gained significant traction both online and in the traditional media since its inception in 2014 (Veganuary). Hopes were high: “#Februdairy will be one month of dairy people posting, liking and retweeting examples of what we do and why we do it” (Yates). However, the #Februdairy hashtag has been effectively disrupted and has now entered the realm of a bashtag, a hashtag appropriated by activists for their own purpose (Austin and Jin 341).The Dairy Industry (Look Out the Vegans Are Coming)It would appear that the dairy industry is experiencing difficulties in public perception. While milk consumption is declining, sales of plant-based milks are increasing (Kaiserman) and a growing body of health research has questioned whether dairy products and milk in particular do in fact “do a body good” (Saccaro; Harvard Milk Study). In the 2019 review of Canada’s food guide, its first revision since 2007, for instance, the focus is now on eating plant-based foods with dairy’s former place significantly downgraded. Dairy products no longer have their own distinct section and are instead placed alongside other proteins including lentils (Pippus).Nevertheless, the industry has persevered with its traditional marketing and public relations activities, choosing to largely avoid addressing animal welfare concerns brought to light by activists. They have instead focused their message towards countering concerns about the health benefits of milk. In the US, the Milk Processing Education Program’s long-running celebrity-driven Got Milk campaign has been updated with Milk Life, a health focused campaign, featuring images of children and young people living an active lifestyle and taking part in activities such as skateboarding, running, and playing basketball (Milk Life). Interestingly, and somewhat inexplicably, Milk Life’s home page features the prominent headline, “How Milk Can Bring You Closer to Your Loved Ones”.It is somewhat reflective of the current trend towards veganism that tennis aces Serena and Venus Williams, both former Got Milk ambassadors, are now proponents for the plant-based lifestyle, with Venus crediting her newly-adopted vegan diet as instrumental in her recovery from an auto-immune disease (Mango).The dairy industry’s health focus continues in Australia, as well as the use of the word love, with former AFL footballer Shane Crawford—the face of the 2017 campaign Milk Loves You Back, from Lion Dairy and Drinks—focusing on reminding Australians of the reputed nutritional benefits of milk (Dawson).Dairy Australia meanwhile launched their Legendairy campaign with a somewhat different focus, promoting and lauding Australia’s dairy families, and with a message that stated, in a nod to the current issues, that “Australia’s dairy farmers and farming communities are proud, resilient and innovative” (Dairy Australia). This campaign could be perceived as a morale-boosting exercise, featuring a nation-wide search to find Australia’s most legendairy farming community (Dairy Australia). That this was also an attempt to humanise the industry seems obvious, drawing on established goodwill felt towards farmers (University of Cambridge). Again, however, this strategy did not address activists’ messages of suffering animals, factory farms, and newborn calves being isolated from their grieving mothers, and it can be argued that consumers are being forced to make the choice between who (or what) they care about more: animals or the people making their livelihoods from them.Large-scale campaigns like Legendairy which use traditional channels are of course still vitally important in shaping public opinion, with statistics from 2016 showing 85.1% of Australians continue to watch free-to-air television (Roy Morgan, “1 in 7”). However, a focus and, arguably, an over-reliance on traditional platforms means vegans and animal activists are often unchallenged when spreading their message via social media. Indeed, when we consider the breakdown in age groups inherent in these statistics, with 18.8% of 14-24 year-olds not watching any commercial television at all, an increase from 7% in 2008 (Roy Morgan, “1 in 7”), it is a brave and arguably short-sighted organisation or industry that relies primarily on traditional channels to spread their message in 2019. That these large-scale campaigns do little to address the issues raised by vegans concerning animal welfare leaves these claims largely unanswered and momentum to grow.This growth in momentum is fuelled by activist groups such as the People for the Ethical Treatment of Animals (PETA) who are well-known in this space, with 5,494,545 Facebook followers, 1.06 million Twitter followers, 973,000 Instagram followers, and 453,729 You Tube subscribers (People for the Ethical Treatment of Animals). They are also active on Pinterest, a visual-based platform suited to the kinds of images and memes particularly detrimental to the dairy industry. Although widely derided, PETA’s reach is large. A graphic video posted to Facebook on February 13 2019 and showing a suffering cow, captioned “your cheese is not worth this” was shared 1,244 times, and had 4.6 million views in just over 24 hours (People for the Ethical Treatment of Animals). With 95% of 12-24 year olds in Australia now using social networking sites (Statista), it is little wonder veganism is rapidly growing within this demographic (Bradbury), with The Guardian labelling the rise of veganism unstoppable (Hancox).Activist organisations are joined by prominent and charismatic vegan activists such as James Aspey (182,000 Facebook followers) and Earthling Ed (205,000 Facebook followers) in distributing information and images that are influential and often highly graphic or disturbing. Meanwhile Instagram influencers and You Tube lifestyle vloggers such as Ellen Fisher and FreeLee share information promoting vegan food and the vegan lifestyle (with 650,320 and 785,903 subscribers respectively). YouTube video Dairy Is Scary has over 5 million views (Janus) and What the Health, a follow-up documentary to Cowspiracy: The Sustainability Secret, promoting veganism, is now available on Netflix, which itself has 9.8 million Australian subscribers (Roy Morgan, “Netflix”). BOSH’s plant-based vegan cookbook was the fastest selling cookbook of 2018 (Chiorando).Additionally, the considerable influence of celebrities such as Miley Cyrus, Beyonce, Alicia Silverstone, Zac Efron, and Jessica Chastain, to name just a few, speaking publicly about their vegan lifestyle, encourages veganism to become mainstream and increases its widespread acceptance.However not all the dairy industry’s ills can be blamed on vegans. Rising costs, cheap imports, and other pressures (Lockhart, Donaghy and Gow) have all placed pressure on the industry. Nonetheless, in the battle for hearts and minds on social media, the vegans are leading the way.Qualitative research interviewing new vegans found converting to veganism was relatively easy, yet some respondents reported having to consult multiple resources and required additional support and education on how to be vegan (McDonald 17).Enter VeganuaryUsing a month, week or day to promote an idea or campaign, is a common public relations and marketing strategy, particularly in health communications. Dry July and Ocsober both promote alcohol abstinence, Frocktober raises funds for ovarian cancer, and Movember is an annual campaign raising awareness and funds for men’s health (Parnell). Vegans Matthew Glover and Jane Land were discussing the success of Movember when they raised the idea of creating a vegan version. Their initiative, Veganuary, urging people to try vegan for the month of January, launched in 2014 and since then 500,000 people have taken the Veganuary pledge (Veganuary).The Veganuary website is the largest of its kind on the internet. With vegan recipes, expert advice and information, it provides all the answers to Why go vegan, but it is the support offered to answer How to go vegan that truly sets Veganuary apart. (Veganuary)That Veganuary participants would use social media to discuss and share their experiences was a foregone conclusion. Twitter, Facebook, and Instagram are all utilised by participants, with the official Veganuary pages currently followed/liked by 159,000 Instagram followers, receiving 242,038 Facebook likes, and 45,600 Twitter followers (Veganuary). Both the Twitter and Instagram sites make effective use of hashtags to spread their reach, not only using #Veganuary but also other relevant hashtags such as #TryVegan, #VeganRecipes, and the more common #Vegan, #Farm, and #SaveAnimals.Februdairy Follows Veganuary, But Only on the CalendarCalling on farmers and dairy producers to create counter content and their own hashtag may have seemed like an idea that would achieve an overall positive response.Agricultural news sites and bloggers spread the word and even the BBC reported on the industry’s “fight back” against Veganuary (BBC). However the hashtag was quickly overwhelmed with anti-dairy activists mobilising online. Vegans issued a call to arms across social media. The Vegans in Australia Facebook group featured a number of posts urging its 58,949 members to “thunderclap” the Februdairy hashtag while the Project Calf anti-dairy campaign declared that Februdairy offered an “easy” way to spread their information (Sandhu).Februdairy farmers and dairy supporters were encouraged to tell their stories, sharing positive photographs and videos, and they did. However this content was limited. In this tweet (fig. 1) the issue of a lack of diverse content was succinctly addressed by an anti-Februdairy activist.Fig. 1: Content challenges. (#Februdairy, 2 Feb. 2019)MethodUtilising Twitter’s advanced search capability, I was able to search for #Veganuary tweets from 1 to 7 January 2019 and #Februdairy tweets from 1 to 7 February 2019. I analysed the top tweets provided by Twitter in terms of content, assessed whether the tweet was pro or anti Veganuary and Februdairy, and also categorised its content in terms of subject matter.Tweets were analysed to assess whether they were on message and aligned with the values of their associated hashtag. Veganuary tweets were considered to be on message if they promoted veganism or possessed an anti-dairy, anti-meat, or pro-animal sentiment. Februdairy tweets were assessed as on message if they promoted the consumption of dairy products, expressed sympathy or empathy towards the dairy industry, or possessed an anti-vegan sentiment. Tweets were also evaluated according to their clarity, emotional impact and coherence. The overall effectiveness of the hashtag was then evaluated based on the above criteria as well as whether they had been hijacked.Results and FindingsOverwhelmingly, the 213 #Veganuary tweets were on message. That is they were pro-Veganuary, supportive of veganism, and positive. The topics were varied and included humorous memes, environmental facts, information about the health benefits of veganism, as well as a strong focus on animals. The number of non-graphic tweets (12) concerning animals was double that of tweets featuring graphic or shocking imagery (6). Predominantly the tweets were focused on food and the sharing of recipes, with 44% of all pro #Veganuary tweets featuring recipes or images of food. Interestingly, a number of well-known corporations tweeted to promote their vegan food products, including Tesco, Aldi, Iceland, and M&S. The diversity of veganism is reflected in the tweets. Organisations used the hashtag to promote their products, including beauty and shoe products, social media influencers promoted their vegan podcasts and blogs, and, interestingly, the Ethiopian Embassy of the United Kingdom tweeted their support.There were 23 (11%) anti-Veganuary tweets. Of these, one was from Dr. Jude Capper, the founder of Februdairy. The others expressed support for farming and farmers, and a number were photographs of meat products, including sausages and fry-ups. One Australian journalist tweeted in favour of meat, stating it was yummy murder. These tweets could be described as entertaining and may perhaps serve as a means of preaching to the converted, but their ability to influence and persuade is negligible.Twitter’s search tool provided access to 141 top #Februdairy tweets. Of these 82 (52%) were a hijack of the hashtag and overtly anti-Februdairy. Vegan activists used the #Februdairy hashtag to their advantage with most of their tweets (33%) featuring non-graphic images of animals. They also tweeted about other subject matters, including environmental concerns, vegan food and products, and health issues related to dairy consumption.As noted by the activists (see fig. 1 above), most of the pro-Februdairy tweets were images of milk or dairy products (41%). Images of farms and farmers were the next most used (26%), followed by images of cows (17%) (see fig. 2). Fig. 2: An activist makes their anti-Februdairy point with a clear, engaging image and effective use of hashtags. (#Februdairy, 6 Feb. 2019)The juxtaposition between many of the tweets was also often glaring, with one contrasting message following another (see fig. 3). Fig. 3: An example of contrasting #Februdairy tweets with an image used by the activists to good effect, making their point known. (#Februdairy, 2 Feb. 2019)Storytelling is a powerful tool in public relations and marketing efforts. Yet, to be effective, high-quality content is required. That many of the Februdairy proponents had limited social media training was evident; images were blurred, film quality was poor, or they failed to make their meaning clear (see fig. 4). Fig. 4: A blurred photograph, reflective of some of the low-quality content provided by Februdairy supporters. (#Februdairy, 3 Feb. 2019)This image was tweeted in support of Februdairy. However the image and phrasing could also be used to argue against Februdairy. We can surmise that the tweeter was suggesting the cow was well looked after and seemingly content, but overall the message is as unclear as the image.While some pro-Februdairy supporters recognised the need for relevant hashtags, often their images were of a low-quality and not particularly engaging, a requirement for social media success. This requirement seems to be better understood by anti-Februdairy activists who used high-quality images and memes to create interest and gain the audience’s attention (see figs. 5 and 6). Fig. 5: An uninspiring image used to promote Februdairy. (#Februdairy, 6 Feb. 2019) Fig. 6: Anti-Februdairy activists made good use of memes, recognising the need for diverse content. (#Februdairy, 3 Feb. 2019)DiscussionWhat the #Februdairy case makes clear, then, is that in continuing its focus on traditional media, the dairy industry has left the battle online to largely untrained, non-social media savvy supporters.From a purely public relations perspective, one of the first things we ask our students to do in issues and crisis communication is to assess the risk. “What can hurt your organisation?” we ask. “What potential issues are on the horizon and what can you do to prevent them?” This is PR101 and it is difficult to understand why environmental scanning and resulting action has not been on the radar of the dairy industry long before now. It seems they have not fully anticipated or have significantly underestimated the emerging issue that public perception, animal cruelty, health concerns, and, ultimately, veganism has had on their industry and this is to their detriment. In Australia in 2015–16 the dairy industry was responsible for 8 per cent (A$4.3 billion) of the gross value of agricultural production and 7 per cent (A$3 billion) of agricultural export income (Department of Agriculture and Water Resources). When such large figures are involved and with so much at stake, it is hard to rationalise the decision not to engage in a more proactive online strategy, seeking to engage their publics, including, whether they like it or not, activists.Instead there are current attempts to address these issues with a legislative approach, lobbying for the introduction of ag-gag laws (Potter), and the limitation of terms such as milk and cheese (Worthington). However, these measures are undertaken while there is little attempt to engage with activists or to effectively counter their claims with a widespread authentic public relations campaign, and reflects a failure to understand the nature of the current online environment, momentum, and mood.That is not to say that the dairy industry is not operating in the online environment, but it does not appear to be a priority, and this is reflected in their low engagement and numbers of followers. For instance, Dairy Australia, the industry’s national service body, has a following of only 8,281 on Facebook, 6,981 on Twitter, and, crucially, they are not on Instagram. Their Twitter posts do not include hashtags and unsurprisingly they have little engagement on this platform with most tweets attracting no more than two likes. Surprisingly they have 21,013 subscribers on YouTube which featured professional and well-presented videos. This demonstrates some understanding of the importance of effective storytelling but not, as yet, trans-media storytelling.ConclusionSocial media activism is becoming more important and recognised as a legitimate voice in the public sphere. Many organisations, perhaps in recognition of this as well as a growing focus on responsible corporate behaviour, particularly in the treatment of animals, have adjusted their behaviour. From Unilever abandoning animal testing practices to ensure Dove products are certified cruelty free (Nussbaum), to Domino’s introducing vegan options, companies who are aware of emerging trends and values are changing the way they do business and are reaping the benefits of engaging with, and catering to, vegans. Domino’s sold out of vegan cheese within the first week and vegans were asked to phone ahead to their local store, so great was the demand. From their website:We knew the response was going to be big after the demand we saw for the product on social media but we had no idea it was going to be this big. (Domino’s Newsroom)As a public relations professional, I am baffled by the dairy industry’s failure to adopt a crisis-based strategy rather than largely rely on the traditional one-way communication that has served them well in the previous (golden?) pre-social media age. However, as a vegan, persuaded by the unravelling of the happy cow argument, I cannot help but hope this realisation continues to elude them.References@bovidiva. “Let’s Make #Februdairy Happen This Year. 28 Days, 28 Positive #dairy Posts. From Cute Calves and #cheese on Crumpets, to Belligerent Bulls and Juicy #beef #burgers – Who’s In?” Twitter post. 15 Jan. 2018. 1 Feb. 2019 <https://twitter.com/bovidiva/status/952910641840447488?lang=en>.Austin, Lucinda L., and Yan Jin. Social Media and Crisis Communication. 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Abstract:

The Arab world witnessed an influx of satellite channels during the 1990s and in the early years of the first decade of the new century. Many analysts in the Arab world applauded this influx as a potential tool for political change in the Arab countries. Two stations were at the heart of the new optimism: Al-Jazeera and Al Arabiya, the two most prominent 24-hour news channels in the region. Al-Jazeera proved to be more controversial because in its early years of broadcasting it managed to break taboos in the Arab media by tackling issues of human rights and hosting Arab dissidents. Also, its coverage of international conflicts (primarily Afghanistan and Iraq) has marked it as a counter-hegemonic news outlet. For the first time, the flow of news went from South to North. Some scholars who study Arab satellite media, and Al-Jazeera specifically, have gone so far as to suggest that it has created a new Arab public sphere (Lynch, Miladi). However, the political developments in the Arab world, mainly the recent revolutions in Tunisia and Egypt and what is now happening in Bahrain, Libya, and Yemen, have raised questions as to how credible these suggestions are. And are we going to claim the same powers for social media in the Arab world? This article takes the form of a personal reflection on how successful (or not) Arab satellite channels are proving to be as a tool for political change and reform in the Arab world. Are these channels editorially free from Arab governments’ political and economic interests? And could new media (notably social networking sites) achieve what satellite channels have been unable to over the last two decades? 1996 saw the launch of Al-Jazeera, the first 24-hour news channel in the Arab world. However, it didn’t have much of an impact on the media scene in the region until 1998 and gained its controversial reputation through its coverage of the Afghanistan and Iraq wars (see Zayani; Miles; Allan and Zelizer; El-Nawawy and Iskandar). In the Arab world, it gained popularity with its compelling talk shows and open discussions of human rights and democracy (Alterman). But its dominance didn’t last long. In 2003, Al Walid Al Ibrahim, son-in-law of the late King Fahd of Saudi Arabia (1921-2005) established Al Arabiya, the second 24-hour news channel in the Arab world, just before the start of the Iraq war. Many scholars and analysts saw in this a direct response to the popularity that Al-Jazeera was achieving with the Arab audiences. Al Arabiya, however, didn’t achieve the level of popularity that Al-Jazeera enjoyed throughout its years of broadcasting (Shapiro). Al Arabiya and Al-Jazeera Arabic subsequently became rivals representing political and national interests and not just news competitors. Indeed, one of Wikileaks’ latest revelations states that Al-Jazeera changed its coverage to suit Qatari foreign policy. The US ambassador to Qatar, Joseph LeBaron, was reported as saying: The Qatari prime minister, Hamad bin Jassim al-Thani, had joked in an interview that Al-Jazeera had caused the Gulf State such headaches that it might be better to sell it. But the ambassador remarked: “Such statements must not be taken at face value.” He went on: “Al-Jazeera’s ability to influence public opinion throughout the region is a substantial source of leverage for Qatar, one which it is unlikely to relinquish. Moreover, the network can also be used as a chip to improve relations. For example, Al-Jazeera’s more favourable coverage of Saudi Arabia's royal family has facilitated Qatari–Saudi reconciliation over the past year.” (Booth). The unspoken political rivalry between Saudi Arabia and Qatar on Lebanese domestic disputes, over Iran, and over the Palestinian internal conflict was played out in the two channels. This brings us to my central question: can Arab satellite channels, and specifically Al-Jazeera Arabic and Al Arabiya, be regarded as tools for democratic political change? In the recent revolution in Tunisia (spring 2011), satellite channels had to catch up with what social media were reporting: and Al-Jazeera more so than Al Arabiya because of previous encounters between Al-Jazeera and Zein Al Abidine bin Ali’s regime (Greenslade, The Guardian). Bin Ali controlled the country’s media and access to satellite media to suit his interests. Al-Jazeera was banned from Tunisia on several occasions and had their offices closed down. Bin Ali allowed private TV stations to operate but under indirect state control when it came to politics and what Ben Ali’s regime viewed as national and security interests. Should we therefore give social networking credit for facilitating the revolution in Tunisia? Yes, we should. We should give it credit for operating as a mobilising tool. The people were ready, the political moment came, and the people used it. Four out of ten Tunisians are connected to the Internet; almost 20 per cent of the Tunisian population are on Facebook (Mourtada and Salem). We are talking about a newly media-literate population who have access to the new technology and know how to use it. On this point, it is important to note that eight out of ten Facebook users in Tunisia are under the age of 30 (Mourtada and Salem). Public defiance and displays of popular anger were sustained by new media outlets (Miladi). Facebook pages have become sites of networking and spaces for exchanging and disseminating news about the protests (Miladi). Pages such as “The people of Tunisia are burning themselves, Mr President” had around 15,000 members. “Wall-posts” specifying the date and place of upcoming protest became very familiar on social media websites. They even managed to survive government attempts to disable and block these sites. Tunisian and non-Tunisians alike became involved in spreading the message through these sites and Arab transnationalism and support for the revolution came to a head. Many adjacent countries had Facebook pages showing support for the Tunisian revolution. And one of the most prominent of these pages was “Egyptians supporting the Tunisian revolution.” There can be little doubt, therefore, that the success of the Tunisian revolution encouraged the youth of Egypt (estimated at 80 per cent of its Facebook users) to rise up and persist in their call for change and political reform. Little did Wael Ghonim and his friends on the “Kolinah Khaled Said” (“We are all Khaled Said”) Facebook page know where their call for demonstrations on the 25 January 2011 would lead. In the wake of the Tunisian victory, the “We are all Khaled Said” page (Said was a young man who died under torture by Egyptian police) garnered 100,000 hits and most of these virtual supporters then took to the streets on 25 January which was where the Egyptian revolution started. Egyptians were the first Arab youth to have used the Internet as a political platform and tool to mobilise people for change. Egypt has the largest and most active blogosphere in the Arab world. The Egyptian bloggers were the first to reveal corruption and initiated calls for change as early as 2007 (Saleh). A few victories were achieved, such as the firing and sentencing of two police officers condemned for torturing Imad Al Kabeer in 2007 (BBC Arabic). However, these early Egyptian bloggers faced significant jail sentences and prosecution (BBC News). Several movements were orchestrated via Facebook, including the 6 April uprising of 2007, but at this time such resistance invariably ended in persecution and even more oppression. The 25 January revolution therefore took the regime by surprise. In response, former Egyptian president Hosni Mubarak and his entourage (who controlled the state media and privately owned TV stations such as Dream TV) started making declarations that “Egypt is not Tunisia,” but the youth of Egypt were determined to prove them wrong. Significantly, Mubarak’s first reaction was to block Twitter, then Facebook, as well as disrupting mobile phone text-messaging and Blackberry-messaging services. Then, on Thursday 27 January, the regime attempted to shut down the Internet as a whole. Al-Jazeera Arabic quickly picked up on the events in Egypt and began live coverage from Cairo’s Tahrir Square, which resulted in Mubarak’s block of Al-Jazeera’s transmission in Egypt and the withdrawal of its operational licences. One joke exchanged with Tunisian activists on Facebook was that Egyptians, too, had “Ammar 404” (the nickname of the government censor in Tunisia). It was not long, however, before Arab activists from across the regions started exchanging codes and software that allowed Egyptians to access the Internet, despite the government blockades. Egyptian computer science students also worked on ways to access the Worldwide Web and overcome the government’s blockade (Shouier) and Google launched a special service to allow people in Egypt to send Twitter messages by dialling a phone number and leaving a voice message (Oreskovic, Reuters). Facebook group pages like Akher Khabar’s “Latest News” and Rased’s “RNN” were then used by the Egyptian diaspora to share all the information they could get from friends and family back home, bypassing more traditional modes of communication. This transnational support group was crucial in communicating their fellow citizens’ messages to the rest of the world; through them, news made its way onto Facebook and then through to the other Arab nations and beyond. My own personal observation of these pages during the period 25 January to 12 February revealed that the usage of social media platforms such as Facebook and Twitter changed markedly, shifting from being merely social in nature to becoming rapidly and primarily political, not only among Arab users in the Arab world, as Mourtada and Salem argue, but also throughout the Arabian diaspora. In the case of Libya’s revolution, also, social media may be seen to be a mobilising tool in the hands of both Libyans at home and across the Libyan diaspora. Libya has around 4 per cent of its population on Facebook (Mourtada and Salem), and with Gaddafi’s regime cracking down on the Internet, the Libyan diaspora has often been the source of information for what is happening inside the country. Factual information, images, and videos were circulated via the February 17th website (in Arabic and in English) to appeal to Arab and international audiences for help. Facebook and Twitter were where the hash tag “#Feb17th” was created. Omar Amer, head of the UK’s Libyan youth movement based in Manchester, told Channel 4: “I can call Benghazi or Tripoli and obtain accurate information from the people on the ground, then report it straight onto Twitter” (Channel 4 News). Websites inspired by #Feb17th were spread online and Facebook pages dedicated to news about the Libyan uprisings quickly had thousands of supporters (Channel 4 News). Social media networks have thus created an international show of solidarity for the pro-democracy protestors in Libya, and Amer was able to report that they have received overwhelming support from all around the globe. I think that it must therefore be concluded that the role Arab satellite channels were playing a few years ago has now been transferred to social media websites which, in turn, have changed from being merely social/cultural to political platforms. Moreover, the nature of the medium has meant that the diasporas of the nations concerned have been instrumental to the success of the uprisings back home. However, it would be wrong to suggest that broadcast media have been totally redundant in the revolutionary process. Throughout the Tunisian and Egyptian revolutions, Al-Jazeera became a disseminating tool for user-generated content. A call for Arab citizens to send their footage of unfolding events to the Al-Jazeera website for it to re-broadcast on its TV screens was a key factor in the dissemination of what was happening. The role Al-Jazeera played in supporting the Egyptian revolution especially (which caused some Arab analysts to give it the name “channel of revolutions”), was quickly followed by criticism for their lack of coverage of the pro-democracy protests in Bahrain. The killing of peaceful protestors in Bahrain did not get airtime the way that the killing of Egyptian pro-democracy protestors had. Tweets, Facebook posts and comments came pouring in, questioning the lack of coverage from Bahrain. Al Arabiya followed Al-Jazeera’s lead. Bahrain was put last on the running order of the coverage of the “Arab revolutions.” Newspaper articles across the Arab world were questioning the absence of “the opinion and other opinion” (Al-Jazeera’s Arabic motto) when it came to Bahrain (see Al Akhbar). Al Jazeera’s editor-in-chief, Hassan El Shoubaki, told Lebanese newspaper Al Akhbar that they were not deliberately absent but had logistical problems with the coverage since Al-Jazeera is banned in Bahrain (Hadad). However, it can be argued that Al-Jazeera was also banned in Egypt and Tunisia and that didn’t stop the channel from reporting or remodelling its screen to host and “rebroadcast” an activist-generated content. This brings us back to the Wikileaks’ revelation mentioned earlier. Al-Jazeera’s coverage of the Bahraini protests is influenced by Qatari foreign policy and, in the case of Bahrain, is arguably abiding by Qatar’s commitment to Gulf Cooperation Council security treaties. (This is one of the occasions where Al Arabiya and Al-Jazeera appear to have shared the same editorial guidelines, influenced by Qatari and Saudi Arabian shared policy.) Nevertheless, the Bahraini protests continue to dominate the social networks sites and information has kept flowing from Bahrain and it will continue to do so because of these platforms. The same scenario is also unfolding in Syria, but this time Al-Jazeera Arabic is taking a cautious stance while Al Arabiya has given the protests full coverage. Once again, the politics are obvious: Qatar is a supporter of the Syrian regime, while Saudi Arabia has long been battling politically with Syria on issues related to Lebanon, Palestine, and Iran (this position might change with Syria seeking support on tackling its own domestic unrest from the Saudi regime). All this confirms that there are limits to what satellite channels in the Arab world can do to be part of a process for democratic political reform. The Arab media world is not free of the political and economic influence of its governments, its owners or the various political parties struggling for control. However, this is clearly not a phenomenon unique to the Arab world. Where, or when, has media reporting ever been totally “free”? So is this, then, the age of new media? Could the Internet be a free space for Arab citizens to express their opinion and fulfil their democratic aspirations in bringing about freedom of speech and political freedom generally? Is it able to form the new Arab public sphere? Recent events show that the potential is there. What happened in Tunisia and Egypt was effectively the seizure of power by the people as part of a collective will to overthrow dictators and autocratic regimes and to effect democratic change from within (i.e. not having it imposed by foreign powers). The political moment in Tunisia was right and the people receptive; the army refused to respond violently to the protests and members of bin Ali’s government rose up against him. The political and social scene in Egypt became receptive after the people felt empowered by events in Tunis. Will this transnational empowerment now spread to other Arab countries open to change notwithstanding the tribal and sectarian alliances that characterise their populations? Further, since new media have proven to be “dangerous tools” in the hands of the citizens of Tunisia and Egypt, will other Arab regimes clamp down on them or hijack them for their own interests as they did the satellite channels previously? Maybe, but new media technology is arguably ahead of the game and I am sure that those regimes stand to be taken by surprise by another wave of revolutions facilitated by a new online tool. So far, Arab leaders have been of one voice in blaming the media for the protests (uprisings) their countries are witnessing—from Tunisia to Syria via Egypt, Yemen, Bahrain and Libya. As Khatib puts it: “It is as if the social, economic, and political problems the people are protesting against would disappear if only the media would stop talking about them.” Yet what is evident so far is that they won’t. The media, and social networks in particular, do not of themselves generate revolutions but they can facilitate them in ways that we are only just beginning to understand. References Allan, Stuart, and Barbie Zelizer. Reporting War: Journalism in War Time. London: Routledge, 2004. Alterman, John. New Media New Politics? From Satellite Television to the Internet in the Arab World. Washington: Washington Institute for Near East Policy, 1998. BBC News. “Egypt Blogger Jailed for ‘Insult,’” 22 Feb. 2007. 1 Mar. 2011 ‹http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/middle_east/6385849.stm›. BBC Arabic. “Three Years Jail Sentence for Two Police Officers in Egypt in a Torture Case.” 5 Nov. 2007. 26 Mar. 2011 ‹http://news.bbc.co.uk/hi/arabic/middle_east_news/newsid_7079000/7079123.stm›. Booth, Robert. “WikiLeaks Cables Claim Al-Jazeera Changed Coverage to Suit Qatari Foreign Policy.” The Guardian 6 Dec. 2010. 22 Feb. 2011 ‹http://www.guardian.co.uk/world/2010/dec/05/wikileaks-cables-al-jazeera-qatari-foreign-policy›. Channel 4 News. “Arab Revolt: Social Media and People’s Revolution.” 25 Feb. 2011. 3 Mar. 2011 ‹http://www.channel4.com/news/arab-revolt-social-media-and-the-peoples-revolution›. El-Nawawy, Mohammed, and Adel Iskandar. Al Jazeera. USA: Westview, 2002. Greenslade, Roy. “Tunisia Breaks Ties with Qatar over Al-Jazeera.” The Guardian 26 Oct. 2006. 23 Mar. 2011 ‹http://www.guardian.co.uk/media/greenslade/2006/oct/26/tunisiabreakstieswithqatar›. Hadad, Layal. “Al thowra al Arabiya tawqafet Eindah masharef al khaleegj” (The Arab Revolution Stopped at the Doorsteps of the Gulf). Al Akhbar 19 Feb. 2011. 20 Feb. 2011 ‹http://www.al-akhbar.com/node/4614›. Khatib, Lina. “How to Lose Friends and Alienate Your People.” Jadaliyya 26 Mar. 2011. 27 Mar. 2011 ‹http://www.jadaliyya.com/pages/index/1014/how-to-lose-friends-and-alienate-your-people›. Lynch, Marc. Voices of the New Arab Public: Iraq, Al-Jazeera, and Middle East Politics Today. New York: Columbia UP, 2006. Miladi, Noureddine. “Tunisia A Media Led Revolution?” Al Jazeera 17 Jan. 2011. 2 Mar. 2011 ‹http://english.aljazeera.net/indepth/opinion/2011/01/2011116142317498666.html#›. Miles, Hugh. Al Jazeera: How Arab TV News Challenged the World. London: Abacus, 2005. Mourtada, Rasha, and Fadi Salem. “Arab Social Media Report, Facebook Usage: Factors and Analysis.” Dubai School of Government 1.1 (Jan. 2011). Oreskovic, Alexei. “Google Inc Launched a Special Service...” Reuters 1 Feb. 2011. 28 Jan. 2011 ‹http://www.reuters.com/article/2011/02/01/us-egypt-protest-google-idUSTRE71005F20110201›. Saleh, Heba. “Egypt Bloggers Fear State Curbs.” BBC News 22 Feb. 2007. 28 Jan. 2011 ‹http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/middle_east/6386613.stm›. Shapiro, Samantha. “The War inside the Arab Newsroom.” The New York Times 2 Jan. 2005. Shouier, Mohammed. “Al Tahrir Qanat al Naser … Nawara Najemm” (Liberation, Victory Channel… and Nawara Najem). Al Akhbar 17 Feb. 2011. Zayani, Mohammed. The Al-Jazeera Phenomenon: Critical Perspectives on Arab Media. London: Pluto, 2005.

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Abstract:

Connecting I’ve moved house on the weekend, closer to the centre of an Australian capital city. I had recently signed up for broadband, with a major Australian Internet company (my first contact, cf. Turner). Now I am the proud owner of a larger modem than I have ever owned: a white cable modem. I gaze out into our new street: two thick black cables cosseted in silver wire. I am relieved. My new home is located in one of those streets, double-cabled by Telstra and Optus in the data-rush of the mid-1990s. Otherwise, I’d be moth-balling the cable modem, and the thrill of my data percolating down coaxial cable. And it would be off to the computer supermarket to buy an ASDL modem, then to pick a provider, to squeeze some twenty-first century connectivity out of old copper (the phone network our grandparents and great-grandparents built). If I still lived in the country, or the outskirts of the city, or anywhere else more than four kilometres from the phone exchange, and somewhere that cable pay TV will never reach, it would be a dish for me — satellite. Our digital lives are premised upon infrastructure, the networks through which we shape what we do, fashion the meanings of our customs and practices, and exchange signs with others. Infrastructure is not simply the material or the technical (Lamberton), but it is the dense, fibrous knotting together of social visions, cultural resources, individual desires, and connections. No more can one easily discern between ‘society’ and ‘technology’, ‘carriage’ and ‘content’, ‘base’ and ‘superstructure’, or ‘infrastructure’ and ‘applications’ (or ‘services’ or ‘content’). To understand telecommunications in action, or the vectors of fibre, we need to consider the long and heterogeneous list of links among different human and non-human actors — the long networks, to take Bruno Latour’s evocative concept, that confect our broadband networks (Latour). The co-ordinates of our infrastructure still build on a century-long history of telecommunications networks, on the nineteenth-century centrality of telegraphy preceding this, and on the histories of the public and private so inscribed. Yet we are in the midst of a long, slow dismantling of the posts-telegraph-telephone (PTT) model of the monopoly carrier for each nation that dominated the twentieth century, with its deep colonial foundations. Instead our New World Information and Communication Order is not the decolonising UNESCO vision of the late 1970s and early 1980s (MacBride, Maitland). Rather it is the neoliberal, free trade, market access model, its symbol the 1984 US judicial decision to require the break-up of AT&T and the UK legislation in the same year that underpinned the Thatcherite twin move to privatize British Telecom and introduce telecommunications competition. Between 1984 and 1999, 110 telecommunications companies were privatized, and the ‘acquisition of privatized PTOs [public telecommunications operators] by European and American operators does follow colonial lines’ (Winseck 396; see also Mody, Bauer & Straubhaar). The competitive market has now been uneasily installed as the paradigm for convergent communications networks, not least with the World Trade Organisation’s 1994 General Agreement on Trade in Services and Annex on Telecommunications. As the citizen is recast as consumer and customer (Goggin, ‘Citizens and Beyond’), we rethink our cultural and political axioms as well as the axes that orient our understandings in this area. Information might travel close to the speed of light, and we might fantasise about optical fibre to the home (or pillow), but our terrain, our band where the struggle lies today, is narrower than we wish. Begging for broadband, it seems, is a long way from warchalking for WiFi. Policy Circuits The dreary everyday business of getting connected plugs the individual netizen into a tangled mess of policy circuits, as much as tricky network negotiations. Broadband in mid-2003 in Australia is a curious chimera, welded together from a patchwork of technologies, old and newer communications industries, emerging economies and patterns of use. Broadband conjures up grander visions, however, of communication and cultural cornucopia. Broadband is high-speed, high-bandwidth, ‘always-on’, networked communications. People can send and receive video, engage in multimedia exchanges of all sorts, make the most of online education, realise the vision of home-based work and trading, have access to telemedicine, and entertainment. Broadband really entered the lexicon with the mass takeup of the Internet in the early to mid-1990s, and with the debates about something called the ‘information superhighway’. The rise of the Internet, the deregulation of telecommunications, and the involuted convergence of communications and media technologies saw broadband positioned at the centre of policy debates nearly a decade ago. In 1993-1994, Australia had its Broadband Services Expert Group (BSEG), established by the then Labor government. The BSEG was charged with inquiring into ‘issues relating to the delivery of broadband services to homes, schools and businesses’. Stung by criticisms of elite composition (a narrow membership, with only one woman among its twelve members, and no consumer or citizen group representation), the BSEG was prompted into wider public discussion and consultation (Goggin & Newell). The then Bureau of Transport and Communications Economics (BTCE), since transmogrified into the Communications Research Unit of the Department of Communications, Information Technology and the Arts (DCITA), conducted its large-scale Communications Futures Project (BTCE and Luck). The BSEG Final report posed the question starkly: As a society we have choices to make. If we ignore the opportunities we run the risk of being left behind as other countries introduce new services and make themselves more competitive: we will become consumers of other countries’ content, culture and technologies rather than our own. Or we could adopt new technologies at any cost…This report puts forward a different approach, one based on developing a new, user-oriented strategy for communications. The emphasis will be on communication among people... (BSEG v) The BSEG proposed a ‘National Strategy for New Communications Networks’ based on three aspects: education and community access, industry development, and the role of government (BSEG x). Ironically, while the nation, or at least its policy elites, pondered the weighty question of broadband, Australia’s two largest telcos were doing it. The commercial decision of Telstra/Foxtel and Optus Vision, and their various television partners, was to nail their colours (black) to the mast, or rather telegraph pole, and to lay cable in the major capital cities. In fact, they duplicated the infrastructure in cities such as Sydney and Melbourne, then deciding it would not be profitable to cable up even regional centres, let alone small country towns or settlements. As Terry Flew and Christina Spurgeon observe: This wasteful duplication contrasted with many other parts of the country that would never have access to this infrastructure, or to the social and economic benefits that it was perceived to deliver. (Flew & Spurgeon 72) The implications of this decision for Australia’s telecommunications and television were profound, but there was little, if any, public input into this. Then Minister Michael Lee was very proud of his anti-siphoning list of programs, such as national sporting events, that would remain on free-to-air television rather than screen on pay, but was unwilling, or unable, to develop policy on broadband and pay TV cable infrastructure (on the ironies of Australia’s television history, see Given’s masterly account). During this period also, it may be remembered, Australia’s Internet was being passed into private hands, with the tendering out of AARNET (see Spurgeon for discussion). No such national strategy on broadband really emerged in the intervening years, nor has the market provided integrated, accessible broadband services. In 1997, landmark telecommunications legislation was enacted that provided a comprehensive framework for competition in telecommunications, as well as consolidating and extending consumer protection, universal service, customer service standards, and other reforms (CLC). Carrier and reseller competition had commenced in 1991, and the 1997 legislation gave it further impetus. Effective competition is now well established in long distance telephone markets, and in mobiles. Rivalrous competition exists in the market for local-call services, though viable alternatives to Telstra’s dominance are still few (Fels). Broadband too is an area where there is symbolic rivalry rather than effective competition. This is most visible in advertised ADSL offerings in large cities, yet most of the infrastructure for these services is comprised by Telstra’s copper, fixed-line network. Facilities-based duopoly competition exists principally where Telstra/Foxtel and Optus cable networks have been laid, though there are quite a number of ventures underway by regional telcos, power companies, and, most substantial perhaps, the ACT government’s TransACT broadband network. Policymakers and industry have been greatly concerned about what they see as slow takeup of broadband, compared to other countries, and by barriers to broadband competition and access to ‘bottleneck’ facilities (such as Telstra or Optus’s networks) by potential competitors. The government has alternated between trying to talk up broadband benefits and rates of take up and recognising the real difficulties Australia faces as a large country with a relative small and dispersed population. In March 2003, Minister Alston directed the ACCC to implement new monitoring and reporting arrangements on competition in the broadband industry. A key site for discussion of these matters has been the competition policy institution, the Australian Competition and Consumer Commission, and its various inquiries, reports, and considerations (consult ACCC’s telecommunications homepage at http://www.accc.gov.au/telco/fs-telecom.htm). Another key site has been the Productivity Commission (http://www.pc.gov.au), while a third is the National Office on the Information Economy (NOIE - http://www.noie.gov.au/projects/access/access/broadband1.htm). Others have questioned whether even the most perfectly competitive market in broadband will actually provide access to citizens and consumers. A great deal of work on this issue has been undertaken by DCITA, NOIE, the regulators, and industry bodies, not to mention consumer and public interest groups. Since 1997, there have been a number of governmental inquiries undertaken or in progress concerning the takeup of broadband and networked new media (for example, a House of Representatives Wireless Broadband Inquiry), as well as important inquiries into the still most strategically important of Australia’s companies in this area, Telstra. Much of this effort on an ersatz broadband policy has been piecemeal and fragmented. There are fundamental difficulties with the large size of the Australian continent and its harsh terrain, the small size of the Australian market, the number of providers, and the dominant position effectively still held by Telstra, as well as Singtel Optus (Optus’s previous overseas investors included Cable & Wireless and Bell South), and the larger telecommunications and Internet companies (such as Ozemail). Many consumers living in metropolitan Australia still face real difficulties in realising the slogan ‘bandwidth for all’, but the situation in parts of rural Australia is far worse. Satellite ‘broadband’ solutions are available, through Telstra Countrywide or other providers, but these offer limited two-way interactivity. Data can be received at reasonable speeds (though at far lower data rates than how ‘broadband’ used to be defined), but can only be sent at far slower rates (Goggin, Rural Communities Online). The cultural implications of these digital constraints may well be considerable. Computer gamers, for instance, are frustrated by slow return paths. In this light, the final report of the January 2003 Broadband Advisory Group (BAG) is very timely. The BAG report opens with a broadband rhapsody: Broadband communications technologies can deliver substantial economic and social benefits to Australia…As well as producing productivity gains in traditional and new industries, advanced connectivity can enrich community life, particularly in rural and regional areas. It provides the basis for integration of remote communities into national economic, cultural and social life. (BAG 1, 7) Its prescriptions include: Australia will be a world leader in the availability and effective use of broadband...and to capture the economic and social benefits of broadband connectivity...Broadband should be available to all Australians at fair and reasonable prices…Market arrangements should be pro-competitive and encourage investment...The Government should adopt a National Broadband Strategy (BAG 1) And, like its predecessor nine years earlier, the BAG report does make reference to a national broadband strategy aiming to maximise “choice in work and recreation activities available to all Australians independent of location, background, age or interests” (17). However, the idea of a national broadband strategy is not something the BAG really comes to grips with. The final report is keen on encouraging broadband adoption, but not explicit on how barriers to broadband can be addressed. Perhaps this is not surprising given that the membership of the BAG, dominated by representatives of large corporations and senior bureaucrats was even less representative than its BSEG predecessor. Some months after the BAG report, the Federal government did declare a broadband strategy. It did so, intriguingly enough, under the rubric of its response to the Regional Telecommunications Inquiry report (Estens), the second inquiry responsible for reassuring citizens nervous about the full-privatisation of Telstra (the first inquiry being Besley). The government’s grand $142.8 million National Broadband Strategy focusses on the ‘broadband needs of regional Australians, in partnership with all levels of government’ (Alston, ‘National Broadband Strategy’). Among other things, the government claims that the Strategy will result in “improved outcomes in terms of services and prices for regional broadband access; [and] the development of national broadband infrastructure assets.” (Alston, ‘National Broadband Strategy’) At the same time, the government announced an overall response to the Estens Inquiry, with specific safeguards for Telstra’s role in regional communications — a preliminary to the full Telstra sale (Alston, ‘Future Proofing’). Less publicised was the government’s further initiative in indigenous telecommunications, complementing its Telecommunications Action Plan for Remote Indigenous Communities (DCITA). Indigenous people, it can be argued, were never really contemplated as citizens with the ken of the universal service policy taken to underpin the twentieth-century government monopoly PTT project. In Australia during the deregulatory and re-regulatory 1990s, there was a great reluctance on the part of Labor and Coalition Federal governments, Telstra and other industry participants, even to research issues of access to and use of telecommunications by indigenous communicators. Telstra, and to a lesser extent Optus (who had purchased AUSSAT as part of their licence arrangements), shrouded the issue of indigenous communications in mystery that policymakers were very reluctant to uncover, let alone systematically address. Then regulator, the Australian Telecommunications Authority (AUSTEL), had raised grave concerns about indigenous telecommunications access in its 1991 Rural Communications inquiry. However, there was no government consideration of, nor research upon, these issues until Alston commissioned a study in 2001 — the basis for the TAPRIC strategy (DCITA). The elision of indigenous telecommunications from mainstream industry and government policy is all the more puzzling, if one considers the extraordinarily varied and significant experiments by indigenous Australians in telecommunications and Internet (not least in the early work of the Tanami community, made famous in media and cultural studies by the writings of anthropologist Eric Michaels). While the government’s mid-2003 moves on a ‘National Broadband Strategy’ attend to some details of the broadband predicament, they fall well short of an integrated framework that grasps the shortcomings of the neoliberal communications model. The funding offered is a token amount. The view from the seat of government is a glance from the rear-view mirror: taking a snapshot of rural communications in the years 2000-2002 and projecting this tableau into a safety-net ‘future proofing’ for the inevitable turning away of a fully-privately-owned Telstra from its previously universal, ‘carrier of last resort’ responsibilities. In this aetiolated, residualist policy gaze, citizens remain constructed as consumers in a very narrow sense in this incremental, quietist version of state securing of market arrangements. What is missing is any more expansive notion of citizens, their varied needs, expectations, uses, and cultural imaginings of ‘always on’ broadband networks. Hybrid Networks “Most people on earth will eventually have access to networks that are all switched, interactive, and broadband”, wrote Frances Cairncross in 1998. ‘Eventually’ is a very appropriate word to describe the parlous state of broadband technology implementation. Broadband is in a slow state of evolution and invention. The story of broadband so far underscores the predicament for Australian access to bandwidth, when we lack any comprehensive, integrated, effective, and fair policy in communications and information technology. We have only begun to experiment with broadband technologies and understand their evolving uses, cultural forms, and the sense in which they rework us as subjects. Our communications networks are not superhighways, to invoke an enduring artefact from an older technology. Nor any longer are they a single ‘public’ switched telecommunications network, like those presided over by the post-telegraph-telephone monopolies of old. Like roads themselves, or the nascent postal system of the sixteenth century, broadband is a patchwork quilt. The ‘fibre’ of our communications networks is hybrid. To be sure, powerful corporations dominate, like the Tassis or Taxis who served as postmasters to the Habsburg emperors (Briggs & Burke 25). Activating broadband today provides a perspective on the path dependency of technology history, and how we can open up new threads of a communications fabric. Our options for transforming our multitudinous networked lives emerge as much from everyday tactics and strategies as they do from grander schemes and unifying policies. We may care to reflect on the waning potential for nation-building technology, in the wake of globalisation. We no longer gather our imagined community around a Community Telephone Plan as it was called in 1960 (Barr, Moyal, and PMG). Yet we do require national and international strategies to get and stay connected (Barr), ideas and funding that concretely address the wider dimensions of access and use. We do need to debate the respective roles of Telstra, the state, community initiatives, and industry competition in fair telecommunications futures. Networks have global reach and require global and national integration. Here vision, co-ordination, and resources are urgently required for our commonweal and moral fibre. To feel the width of the band we desire, we need to plug into and activate the policy circuits. Thanks to Grayson Cooke, Patrick Lichty, Ned Rossiter, John Pace, and an anonymous reviewer for helpful comments. Works Cited Alston, Richard. ‘ “Future Proofing” Regional Communications.’ Department of Communications, Information Technology and the Arts, Canberra, 2003. 17 July 2003 <http://www.dcita.gov.au/Article/0,,0_1-2_3-4_115485,00.php> —. ‘A National Broadband Strategy.’ Department of Communications, Information Technology and the Arts, Canberra, 2003. 17 July 2003 <http://www.dcita.gov.au/Article/0,,0_1-2_3-4_115486,00.php>. Australian Competition and Consumer Commission (ACCC). Broadband Services Report March 2003. Canberra: ACCC, 2003. 17 July 2003 <http://www.accc.gov.au/telco/fs-telecom.htm>. —. Emerging Market Structures in the Communications Sector. 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Canberra: Australian Government Publishing Service (AGPS), 1994. Bureau of Transport and Communications Economics (BTCE). Communications Futures Final Project. Canberra: AGPS, 1994. Cairncross, Frances. The Death of Distance: How the Communications Revolution Will Change Our Lives. London: Orion Business Books, 1997. Communications Law Centre (CLC). Australian Telecommunications Regulation: The Communications Law Centre Guide. 2nd edition. Sydney: Communications Law Centre, University of NSW, 2001. Department of Communications, Information Technology and the Arts (DCITA). Telecommunications Action Plan for Remote Indigenous Communities: Report on the Strategic Study for Improving Telecommunications in Remote Indigenous Communities. Canberra: DCITA, 2002. Estens, D. Connecting Regional Australia: The Report of the Regional Telecommunications Inquiry. Canberra: DCITA, 2002. <http://www.telinquiry.gov.au/rti-report.php>, accessed 17 July 2003. Fels, Alan. ‘Competition in Telecommunications’, speech to Australian Telecommunications Users Group 19th Annual Conference. 6 March, 2003, Sydney. <http://www.accc.gov.au/speeches/2003/Fels_ATUG_6March03.doc>, accessed 15 July 2003. Flew, Terry, and Spurgeon, Christina. ‘Television After Broadcasting’. In The Australian TV Book. Ed. Graeme Turner and Stuart Cunningham. Allen & Unwin, Sydney. 69-85. 2000. Given, Jock. Turning Off the Television. Sydney: UNSW Press, 2003. Goggin, Gerard. ‘Citizens and Beyond: Universal service in the Twilight of the Nation-State.’ In All Connected?: Universal Service in Telecommunications, ed. Bruce Langtry. Melbourne: University of Melbourne Press, 1998. 49-77 —. Rural Communities Online: Networking to link Consumers to Providers. Melbourne: Telstra Consumer Consultative Council, 2003. Goggin, Gerard, and Newell, Christopher. Digital Disability: The Social Construction of Disability in New Media. Lanham, MD: Rowman & Littlefield, 2003. House of Representatives Standing Committee on Communications, Information Technology and the Arts (HoR). Connecting Australia!: Wireless Broadband. Report of Inquiry into Wireless Broadband Technologies. Canberra: Parliament House, 2002. <http://www.aph.gov.au/house/committee/cita/Wbt/report.htm>, accessed 17 July 2003. Lamberton, Don. ‘A Telecommunications Infrastructure is Not an Information Infrastructure’. Prometheus: Journal of Issues in Technological Change, Innovation, Information Economics, Communication and Science Policy 14 (1996): 31-38. Latour, Bruno. Science in Action: How to Follow Scientists and Engineers Through Society. Cambridge, MA: Harvard University Press, 1987. Luck, David. ‘Revisiting the Future: Assessing the 1994 BTCE communications futures project.’ Media International Australia 96 (2000): 109-119. MacBride, Sean (Chair of International Commission for the Study of Communication Problems). Many Voices, One World: Towards a New More Just and More Efficient World Information and Communication Order. Paris: Kegan Page, London. UNESCO, 1980. Maitland Commission (Independent Commission on Worldwide Telecommunications Development). The Missing Link. Geneva: International Telecommunications Union, 1985. Michaels, Eric. Bad Aboriginal Art: Tradition, Media, and Technological Horizons. Sydney: Allen & Unwin, 1994. Mody, Bella, Bauer, Johannes M., and Straubhaar, Joseph D., eds. Telecommunications Politics: Ownership and Control of the Information Highway in Developing Countries. Mahwah, NJ: Erlbaum, 1995. Moyal, Ann. Clear Across Australia: A History of Telecommunications. Melbourne: Thomas Nelson, 1984. Post-Master General’s Department (PMG). Community Telephone Plan for Australia. Melbourne: PMG, 1960. Productivity Commission (PC). Telecommunications Competition Regulation: Inquiry Report. Report No. 16. Melbourne: Productivity Commission, 2001. <http://www.pc.gov.au/inquiry/telecommunications/finalreport/>, accessed 17 July 2003. Spurgeon, Christina. ‘National Culture, Communications and the Information Economy.’ Media International Australia 87 (1998): 23-34. Turner, Graeme. ‘First Contact: coming to terms with the cable guy.’ UTS Review 3 (1997): 109-21. Winseck, Dwayne. ‘Wired Cities and Transnational Communications: New Forms of Governance for Telecommunications and the New Media’. In The Handbook of New Media: Social Shaping and Consequences of ICTs, ed. Leah A. Lievrouw and Sonia Livingstone. London: Sage, 2002. 393-409. World Trade Organisation. General Agreement on Trade in Services: Annex on Telecommunications. Geneva: World Trade Organisation, 1994. 17 July 2003 <http://www.wto.org/english/tratop_e/serv_e/12-tel_e.htm>. —. Fourth protocol to the General Agreement on Trade in Services. Geneva: World Trade Organisation. 17 July 2003 <http://www.wto.org/english/tratop_e/serv_e/4prote_e.htm>. Links http://www.accc.gov.au/pubs/publications/utilities/telecommunications/Emerg_mar_struc.doc http://www.accc.gov.au/speeches/2003/Fels_ATUG_6March03.doc http://www.accc.gov.au/telco/fs-telecom.htm http://www.aph.gov.au/house/committee/cita/Wbt/report.htm http://www.dcita.gov.au/Article/0,,0_1-2_3-4_115485,00.html http://www.dcita.gov.au/Article/0,,0_1-2_3-4_115486,00.html http://www.noie.gov.au/projects/access/access/broadband1.htm http://www.noie.gov.au/publications/NOIE/BAG/report/index.htm http://www.pc.gov.au http://www.pc.gov.au/inquiry/telecommunications/finalreport/ http://www.telinquiry.gov.au/final_report.html http://www.telinquiry.gov.au/rti-report.html http://www.wto.org/english/tratop_e/serv_e/12-tel_e.htm http://www.wto.org/english/tratop_e/serv_e/4prote_e.htm Citation reference for this article Substitute your date of access for Dn Month Year etc... MLA Style Goggin, Gerard. "Broadband" M/C: A Journal of Media and Culture< http://www.media-culture.org.au/0308/02-featurebroadband.php>. APA Style Goggin, G. (2003, Aug 26). Broadband. M/C: A Journal of Media and Culture, 6,< http://www.media-culture.org.au/0308/02-featurebroadband.php>

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Introduction Since December 2010 the dramatic spectacle of the spread of mass uprisings, civil unrest, and protest across North Africa and the Middle East have been chronicled daily on mainstream media and new media. Broadly speaking, the Arab Spring—as it came to be known—is challenging repressive, corrupt governments and calling for democracy and human rights. The convulsive events linked with these debates have been striking not only because of the rapid spread of historically momentous mass protests but also because of the ways in which the media “have become inextricably infused inside them” enabling the global media ecology to perform “an integral part in building and mobilizing support, co-ordinating and defining the protests within different Arab societies as well as trans-nationalizing them” (Cottle 295). Images of mass protests have been juxtaposed against those of individuals prepared to self-destruct for political ends. Video clips and photographs of the individual suffering of Tunisian Mohamed Bouazizi’s self-immolation and the Bahraini Abdulhad al-Khawaja’s emaciated body foreground, in very graphic ways, political struggles that larger events would mask or render invisible. Highlighting broad commonalties does not assume uniformity in patterns of protest and media coverage across the region. There has been considerable variation in the global media coverage and nature of the protests in North Africa and the Middle East (Cottle). In Tunisia, Egypt, Libya, and Yemen uprisings overthrew regimes and leaders. In Syria it has led the country to the brink of civil war. In Bahrain, the regime and its militia violently suppressed peaceful protests. As a wave of protests spread across the Middle East and one government after another toppled in front of 24/7 global media coverage, Bahrain became the “Arab revolution that was abandoned by the Arabs, forsaken by the West … forgotten by the world,” and largely ignored by the global media (Al-Jazeera English). Per capita the protests have been among the largest of the Arab Spring (Human Rights First) and the crackdown as brutal as elsewhere. International organizations have condemned the use of military courts to trial protestors, the detaining of medical staff who had treated the injured, and the use of torture, including the torture of children (Fisher). Bahraini and international human rights organizations have been systematically chronicling these violations of human rights, and posting on Websites distressing images of tortured bodies often with warnings about the graphic depictions viewers are about to see. It was in this context of brutal suppression, global media silence, and the reluctance of the international community to intervene, that the Bahraini-Danish human rights activist Abdulhad al-Khawaja launched his “death or freedom” hunger strike. Even this radical action initially failed to interest international editors who were more focused on Egypt, Libya, and Syria, but media attention rose in response to the Bahrain Formula 1 race in April 2012. Pro-democracy activists pledged “days of rage” to coincide with the race in order to highlight continuing human rights abuses in the kingdom (Turner). As Al Khawaja’s health deteriorated the Bahraini government resisted calls for his release (Article 19) from the Danish government who requested that Al Khawaja be extradited there on “humanitarian grounds” for hospital treatment (Fisk). This article does not explore the geo-politics of the Bahraini struggle or the possible reasons why the international community—in contrast to Syria and Egypt—has been largely silent and reluctant to debate the issues. Important as they are, those remain questions for Middle Eastern specialists to address. In this article I am concerned with the overlapping and interpenetration of two ecologies. The first ecology is the ethical framing of a prison hunger strike as a corporeal-environmental act of (self) destruction intended to achieve political ends. The second ecology is the operation of global media where international inaction inadvertently foregrounds the political struggles that larger events and discourses surrounding Egypt, Libya, and Syria overshadow. What connects these two ecologies is the body of the hunger striker, turned into a spectacle and mediated via a politics of affect that invites a global public to empathise and so enter into his suffering. The connection between the two lies in the emaciated body of the hunger striker. An Ecological Humanities Approach This exploration of two ecologies draws on the ecological humanities and its central premise of connectivity. The ecological humanities critique the traditional binaries in Western thinking between nature and culture; the political and social; them and us; the collective and the individual; mind, body and emotion (Rose & Robin, Rieber). Such binaries create artificial hierarchies, divisions, and conflicts that ultimately impede the ability to respond to crises. Crises are major changes that are “out of control” driven—primarily but not exclusively—by social, political, and cultural forces that unleash “runaway systems with their own dynamics” (Rose & Robin 1). The ecological humanities response to crises is premised on the recognition of the all-inclusive connectivity of organisms, systems, and environments and an ethical commitment to action from within this entanglement. A founding premise of connectivity, first articulated by anthropologist and philosopher Gregory Bateson, is that the “unit of survival is not the individual or the species, but the organism-and-its-environment” (Rose & Robin 2). This highlights a dialectic in which an organism is shaped by and shapes the context in which it finds itself. Or, as Harries-Jones puts it, relations are recursive as “events continually enter into, become entangled with, and then re-enter the universe they describe” (3). This ensures constantly evolving ecosystems but it also means any organism that “deteriorates its environment commits suicide” (Rose & Robin 2) with implications for the others in the eco-system. Bateson’s central premise is that organisms are simultaneously independent, as separate beings, but also interdependent. Interactions are not seen purely as exchanges but as dynamic, dialectical, dialogical, and mutually constitutive. Thus, it is presumed that the destruction or protection of others has consequences for oneself. Another dimension of interactions is multi-modality, which implies that human communication cannot be reduced to a single mode such as words, actions, or images but needs to be understood in the complexity of inter-relations between these (see Rieber 16). Nor can dissemination be reduced to a single technological platform whether this is print, television, Internet, or other media (see Cottle). The final point is that interactions are “biologically grounded but not determined” in that the “cognitive, emotional and volitional processes” underpinning face-to-face or mediated communication are “essentially indivisible” and any attempt to separate them by privileging emotion at the expense of thought, or vice versa, is likely to be unhealthy (Rieber 17). This is most graphically demonstrated in a politically-motivated hunger strike where emotion and volition over-rides the survivalist instinct. The Ecology of a Prison Hunger Strike The radical nature of a hunger strike inevitably gives rise to medico-ethical debates. Hunger strikes entail the voluntary refusal of sustenance by an individual and, when prolonged, such deprivation sets off a chain reaction as the less important components in the internal body systems shut down to protect the brain until even that can no longer be protected (see Basoglu et al). This extreme form of protest—essentially an act of self-destruction—raises ethical issues over whether or not doctors or the state should intervene to save a life for humanitarian or political reasons. In 1975 and 1991, the World Medical Association (WMA) sought to negotiate this by distinguishing between, on the one hand, the mentally/psychological impaired individual who chooses a “voluntary fast” and, on the other hand, the hunger striker who chooses a form of protest action to secure an explicit political goal fully aware of fatal consequences of prolonged action (see Annas, Reyes). This binary enables the WMA to label the action of the mentally impaired suicide while claiming that to do so for political protesters would be a “misconception” because the “striker … does not want to die” but to “live better” by obtaining certain political goals for himself, his group or his country. “If necessary he is willing to sacrifice his life for his case, but the aim is certainly not suicide” (Reyes 11). In practice, the boundaries between suicide and political protest are likely to be much more blurred than this but the medico-ethical binary is important because it informs discourses about what form of intervention is ethically appropriate. In the case of the “suicidal” the WMA legitimises force-feeding by a doctor as a life-saving act. In the case of the political protestor, it is de-legitimised in discourses of an infringement of freedom of expression and an act of torture because of the pain involved (see Annas, Reyes). Philosopher Michel Foucault argued that prison is a key site where the embodied subject is explicitly governed and where the exercising of state power in the act of incarceration means the body of the imprisoned no longer solely belongs to the individual. It is also where the “body’s range of significations” is curtailed, “shaped and invested by the very forces that detain and imprison it” (Pugliese 2). Thus, prison creates the circ*mstances in which the incarcerated is denied the “usual forms of protest and judicial safeguards” available outside its confines. The consequence is that when presented with conditions that violate core beliefs he/she may view acts of self-destruction—such as hunger strikes or lip sewing—as one of the few “means of protesting against, or demanding attention” or achieving political ends still available to them (Reyes 11; Pugliese). The hunger strike implicates the state, which, in the act of imprisoning, has assumed a measure of power and responsibility for the body of the individual. If a protest action is labelled suicidal by medical professionals—for instance at Guantanamo—then the force-feeding of prisoners can be legitimised within the WMA guidelines (Annas). There is considerable political temptation to do so particularly when the hunger striker has become an icon of resistance to the state, the knowledge of his/her action has transcended prison confines, and the alienating conditions that prompted the action are being widely debated in the media. This poses a two-fold danger for the state. On the one hand, there is the possibility that the slow emaciation and death while imprisoned, if covered by the media, may become a spectacle able to mobilise further resistance that can destabilise the polity. On the other hand, there is the fear that in the act of dying, and the spectacle surrounding death, the hunger striker would have secured the public attention to the very cause they are championing. Central to this is whether or not the act of self-destruction is mediated. It is far from inevitable that the media will cover a hunger strike or do so in ways that enable the hunger striker’s appeal to the emotions of others. However, when it does, the international scrutiny and condemnation that follows may undermine the credibility of the state—as happened with the death of the IRA member Bobby Sands in Northern Ireland (Russell). The Media Ecology and the Bahrain Arab Spring The IRA’s use of an “ancient tactic ... to make a blunt appeal to sympathy and emotion” in the form of the Sands hunger strike was seen as “spectacularly successful in gaining worldwide publicity” (Willis 1). Media ecology has evolved dramatically since then. Over the past 20 years communication flows between the local and the global, traditional media formations (broadcast and print), and new communication media (Internet and mobile phones) have escalated. The interactions of the traditional media have historically shaped and been shaped by more “top-down” “politics of representation” in which the primary relationship is between journalists and competing public relations professionals servicing rival politicians, business or NGOs desire for media attention and framing issues in a way that is favourable or sympathetic to their cause. However, rapidly evolving new media platforms offer bottom up, user-generated content, a politics of connectivity, and mobilization of ordinary people (Cottle 31). However, this distinction has increasingly been seen as offering too rigid a binary to capture the complexity of the interactions between traditional and new media as well as the events they capture. The evolution of both meant their content increasingly overlaps and interpenetrates (see Bennett). New media technologies “add new communicative ingredients into the media ecology mix” (Cottle 31) as well as new forms of political protests and new ways of mobilizing dispersed networks of activists (Juris). Despite their pervasiveness, new media technologies are “unlikely to displace the necessity for coverage in mainstream media”; a feature noted by activist groups who have evolved their own “carnivalesque” tactics (Cottle 32) capable of creating the spectacle that meets television demands for action-driven visuals (Juris). New media provide these groups with the tools to publicise their actions pre- and post-event thereby increasing the possibility that mainstream media might cover their protests. However there is no guarantee that traditional and new media content will overlap and interpenetrate as initial coverage of the Bahrain Arab Spring highlights. Peaceful protests began in February 2011 but were violently quelled often by Saudi, Qatari and UAE militia on behalf of the Bahraini government. Mass arrests were made including that of children and medical personnel who had treated those wounded during the suppression of the protests. What followed were a long series of detentions without trial, military court rulings on civilians, and frequent use of torture in prisons (Human Rights Watch 2012). By the end of 2011, the country had the highest number of political prisoners per capita of any country in the world (Amiri) but received little coverage in the US. The Libyan uprising was afforded the most broadcast time (700 minutes) followed by Egypt (500 minutes), Syria (143), and Bahrain (34) (Lobe). Year-end round-ups of the Arab Spring on the American Broadcasting Corporation ignored Bahrain altogether or mentioned it once in a 21-page feature (Cavell). This was not due to a lack of information because a steady stream has flowed from mobile phones, Internet sites and Twitter as NGOs—Bahraini and international—chronicled in images and first-hand accounts the abuses. However, little of this coverage was picked up by the US-dominated global media. It was in this context that the Bahraini-Danish human rights activist Abdulhad Al Khawaja launched his “freedom or death” hunger strike in protest against the violent suppression of peaceful demonstrations, the treatment of prisoners, and the conduct of the trials. Even this radical action failed to persuade international editors to cover the Bahrain Arab Spring or Al Khawaja’s deteriorating health despite being “one of the most important stories to emerge over the Arab Spring” (Nallu). This began to change in April 2012 as a number of things converged. Formula 1 pressed ahead with the Bahrain Grand Prix, and pro-democracy activists pledged “days of rage” over human rights abuses. As these were violently suppressed, editors on global news desks increasingly questioned the government and Formula 1 “spin” that all was well in the kingdom (see BBC; Turner). Claims by the drivers—many of who were sponsored by the Bahraini government—that this was a sports event, not a political one, were met with derision and journalists more familiar with interviewing superstars were diverted into covering protests because their political counterparts had been denied entry to the country (Fisk). This combination of media events and responses created the attention, interest, and space in which Al Khawaja’s deteriorating condition could become a media spectacle. The Mediated Spectacle of Al Khawaja’s Hunger Strike Journalists who had previously struggled to interest editors in Bahrain and Al Khawaja’s plight found that in the weeks leading up to the Grand Prix and since “his condition rapidly deteriorated”’ and there were “daily updates with stories from CNN to the Hindustan Times” (Nulla). Much of this mainstream news was derived from interviews and tweets from Al Khawaja’s family after each visit or phone call. What emerged was an unprecedented composite—a diary of witnesses to a hunger strike interspersed with the family’s struggles with the authorities to get access to him and their almost tangible fear that the Bahraini government would not relent and he would die. As these fears intensified 48 human rights NGOs called for his release from prison (Article 19) and the Danish government formally requested his extradition for hospital treatment on “humanitarian grounds”. Both were rejected. As if to provide evidence of Al Khawaja’s tenuous hold on life, his family released an image of his emaciated body onto Twitter. This graphic depiction of the corporeal-environmental act of (self) destruction was re-tweeted and posted on countless NGO and news Websites (see Al-Jazeera). It was also juxtaposed against images of multi-million dollar cars circling a race-track, funded by similarly large advertising deals and watched by millions of people around the world on satellite channels. Spectator sport had become a grotesque parody of one man’s struggle to speak of what was going on in Bahrain. In an attempt to silence the criticism the Bahraini government imposed a de facto news blackout denying all access to Al Khawaja in hospital where he had been sent after collapsing. The family’s tweets while he was held incommunicado speak of their raw pain, their desperation to find out if he was still alive, and their grief. They also provided a new source of information, and the refrain “where is alkhawaja,” reverberated on Twitter and in global news outlets (see for instance Der Spiegel, Al-Jazeera). In the days immediately after the race the Danish prime minister called for the release of Al Khawaja, saying he is in a “very critical condition” (Guardian), as did the UN’s Ban-Ki Moon (UN News and Media). The silencing of Al Khawaja had become a discourse of callousness and as global media pressure built Bahraini ministers felt compelled to challenge this on non-Arabic media, claiming Al Khawaja was “eating” and “well”. The Bahraini Prime Minister gave one of his first interviews to the Western media in years in which he denied “AlKhawaja’s health is ‘as bad’ as you say. According to the doctors attending to him on a daily basis, he takes liquids” (Der Spiegel Online). Then, after six days of silence, the family was allowed to visit. They tweeted that while incommunicado he had been restrained and force-fed against his will (Almousawi), a statement almost immediately denied by the military hospital (Lebanon Now). The discourses of silence and callousness were replaced with discourses of “torture” through force-feeding. A month later Al Khawaja’s wife announced he was ending his hunger strike because he was being force-fed by two doctors at the prison, family and friends had urged him to eat again, and he felt the strike had achieved its goal of drawing the world’s attention to Bahrain government’s response to pro-democracy protests (Ahlul Bayt News Agency). Conclusion This article has sought to explore two ecologies. The first is of medico-ethical discourses which construct a prison hunger strike as a corporeal-environmental act of (self) destruction to achieve particular political ends. The second is of shifting engagement within media ecology and the struggle to facilitate interpenetration of content and discourses between mainstream news formations and new media flows of information. I have argued that what connects the two is the body of the hunger striker turned into a spectacle, mediated via a politics of affect which invites empathy and anger to mobilise behind the cause of the hunger striker. The body of the hunger striker is thereby (re)produced as a feature of the twin ecologies of the media environment and the self-environment relationship. References Ahlul Bayt News Agency. “Bahrain: Abdulhadi Alkhawaja’s Statement about Ending his Hunger Strike.” (29 May 2012). 1 June 2012 ‹http://abna.ir/data.asp?lang=3&id=318439›. Al-Akhbar. “Family Concerned Al-Khawaja May Be Being Force Fed.” Al-Akhbar English. (27 April 2012). 1 June 2012 ‹http://english.al-akhbar.com/content/family-concerned-al-khawaja-may-be-being-force-fed›. 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Al Gore brought climate change into … our living rooms. … The 2008 oil price hikes [and the global financial crisis] awakened the world to potential economic hardship in a rapidly urbanising world where the petrol-driven automobile is still king. (Mouritz 47) Six hundred million cars (Urry, “Climate Change” 265) traverse the world’s roads, or sit idly in garages and clogging city streets. The West’s economic progress has been built in part around the success of the automotive industry, where the private car rules the spaces and rhythms of daily life. The problem of “automobile dependence” (Newman and Kenworthy) is often cited as one of the biggest challenges facing countries attempting to combat anthropogenic climate change. Sociologist John Urry has claimed that automobility is an “entire culture” that has re-defined movement in the contemporary world (Urry Mobilities 133). As such, it is the single most significant environmental challenge “because of the intensity of resource use, the production of pollutants and the dominant culture which sustains the major discourses of what constitutes the good life” (Urry Sociology 57-8). Climate change has forced a re-thinking of not only how we produce and dispose of cars, but also how we use them. What might a society not dominated by the private, petrol-driven car look like? Some of the pre-eminent writers on climate change futures, such as Gwynne Dyer, James Lovelock and John Urry, discuss one possibility that might emerge when oil becomes scarce: societies will descend into civil chaos, “a Hobbesian war of all against all” where “regional warlordism” and the most brutish, barbaric aspects of human nature come to the fore (Urry, “Climate Change” 261). Discussing a post-car society, John Urry also proffers another scenario in his “sociologies of the future:” an Orwellian “digital panopticon” in which other modes of transport, far more suited to a networked society, might emerge on a large scale and, in the long run, “might tip the system” into post-car one before it is too late (Urry, “Climate Change” 261). Amongst the many options he discusses is car sharing. Since its introduction in Germany more than 30 years ago, most of the critical literature has been devoted to the planning, environmental and business innovation aspects of car sharing; however very little has been written on its cultural dimensions. This paper analyses this small but developing trend in many Western countries, but more specifically its emergence in Sydney. The convergence of climate change discourse with that of the global financial crisis has resulted in a focus in the mainstream media, over the last few months, on technologies and practices that might save us money and also help the environment. For instance, a Channel 10 News story in May 2009 focused on the boom in car sharing in Sydney (see: http://www.youtube.com/watch? v=EPTT8vYVXro). Car sharing is an adaptive technology that doesn’t do away with the car altogether, but rather transforms the ways in which cars are used, thought about and promoted. I argue that car sharing provides a challenge to the dominant consumerist model of the privately owned car that has sustained capitalist structures for at least the last 50 years. In addition, through looking at some marketing and promotion tactics of car sharing in Australia, I examine some emerging car sharing subjectivities that both extend and subvert the long-established discourses of the automobile’s flexibility and autonomy to tempt monogamous car buyers into becoming philandering car sharers. Much literature has emerged over the last decade devoted to the ubiquitous phenomenon of automobility. “The car is the literal ‘iron cage’ of modernity, motorised, moving and domestic,” claims Urry (“Connections” 28). Over the course of twentieth century, automobility became “the dominant form of daily movement over much of the planet (dominating even those who do not move by cars)” (Paterson 132). Underpinning Urry’s prolific production of literature is his concept of automobility. This he defines as a complex system of “intersecting assemblages” that is not only about driving cars but the nexus between “production, consumption, machinic complexes, mobility, culture and environmental resource use” (Urry, “Connections” 28). In addition, Matthew Paterson, in his Automobile Politics, asserts that “automobility” should be viewed as everything that makes driving around in a car possible: highways, parking structures and traffic rules (87). While the private car seems an inevitable outcome of a capitalistic, individualistic modern society, much work has gone into the process of naturalising a dominant notion of automobility on drivers’ horizons. Through art, literature, popular music and brand advertising, the car has long been associated with seductive forms of identity, and societies have been built around a hegemonic culture of car ownership and driving as the pre-eminent, modern mode of self-expression. And more than 50 years of a popular Hollywood film genre—road movies—has been devoted to glorifying the car as total freedom, or in its more nihilistic version, “freedom on the road to nowhere” (Corrigan). As Paterson claims, “autonomous mobility of car driving is socially produced … by a range of interventions that have made it possible” (18). One of the main reasons automobility has been so successful, he claims, is through its ability to reproduce capitalist society. It provided a commodity around which a whole set of symbols, images and discourses could be constructed which served to effectively legitimise capitalist society. (30) Once the process is locked-in, it then becomes difficult to reverse as billions of agents have adapted to it and built their lives around “automobility’s strange mixture of co-ercion and flexibility” (Urry, “Climate Change” 266). The Decline of the Car Globally, the greatest recent rupture in the automobile’s meta-narrative of success came about in October 2008 when three CEOs from the major US car firms (General Motors, Ford and Chrysler) begged the United States Senate for emergency loan funds to avoid going bankrupt. To put the economic significance of this into context, Emma Rothschild notes “when the listing of the ‘Fortune 500’ began in 1955, General Motors was the largest American corporation, and it was one of the three largest, measured in revenues, every year until 2007” (Rothschilds, “Can we transform”). Curiously, instead of focusing on the death of the car (industry), as we know it, that this scenario might inevitably herald, much of the media attention focused on the hypocrisy and environmental hubris of the fact that all the CEOs had flown in private luxury jets to Washington. “Couldn’t they have at least jet-pooled?” complained one Democrat Senator (Wutkowski). In their next visit to Washington, most of them drove up in experimental vehicles still in pre-production, including plug-in hybrids. Up until that point no other manufacturing industry had been bailed out in the current financial crisis. Of course it’s not the first time the automobile industries have been given government assistance. The Australian automotive industry has received on-going government subsidies since the 1980s. Most recently, PM Kevin Rudd granted a 6.2 billion dollar ‘green car’ package to Australian automotive manufacturers. His justification to the growing chorus of doubts about the economic legitimacy of such a move was: “Some might say it's not worth trying to have a car industry, that is not my view, it is not the view of the Australian government and it never will be the view of any government which I lead” (The Australian). Amongst the many reasons for the government support of these industries must include the extraordinary interweaving of discourses of nationhood and progress with the success of the car industry. As the last few months reveal, evidently the mantra still prevails of “what’s good for the country is good for GM and vice versa”, as the former CEO of General Motors, Charles “Engine” Wilson, argued back in 1952 (Hirsch). In post-industrial societies like Australia it’s not only the economic aspects of the automotive industries that are criticised. Cars seem to be slowly losing their grip on identity-formation that they managed to maintain throughout “the century of the car” (Gilroy). They are no longer unproblematically associated with progress, freedom, youthfulness and absolute autonomy. The decline and eventual death of the automobile as we know it will be long, arduous and drawn-out. But there are some signs of a post-automobile society emerging, perhaps where cars will still be used but they will not dominate our society, urban space and culture in quite the same way that they have over the last 50 years. Urry discusses six transformations that might ‘tip’ the hegemonic system of automobility into a post-car one. He mentions new fuel systems, new materials for car construction, the de-privatisation of cars, development of communications technologies and integration of networked public transport through smart card technology and systems (Urry, Mobilities 281-284). As Paterson and others have argued, computers and mobile phones have somehow become “more genuine symbols of mobility and in turn progress” than the car (157). As a result, much automobile advertising now intertwines communications technologies with brand to valorise mobility. Car sharing goes some way in not only de-privatising cars but also using smart card technology and networked systems enabling an association with mobility futures. In Automobile Politics Paterson asks, “Is the car fundamentally unsustainable? Can it be greened? Has the car been so naturalised on our mobile horizons that we can’t imagine a society without it?” (27). From a sustainability perspective, one of the biggest problems with cars is still the amount of space devoted to them; highways, garages, car parks. About one-quarter of the land in London and nearly one-half of that in Los Angeles is devoted to car-only environments (Urry, “Connections” 29). In Sydney, it is more like a quarter. We have to reduce the numbers of cars on our roads to make our societies livable (Newman and Kenworthy). Car sharing provokes a re-thinking of urban space. If one quarter of Sydney’s population car shared and we converted this space into green use or local market gardens, then we’d have a radically transformed city. Car sharing, not to be confused with ‘ride sharing’ or ‘car pooling,’ involves a number of people using cars that are parked centrally in dedicated car bays around the inner city. After becoming a member (much like a 6 or 12 monthly gym membership), the cars can be booked (and extended) by the hour via the web or phone. They can then be accessed via a smart card. In Sydney there are 3 car sharing organisations operating: Flexicar (http://www.flexicar.com.au/), CharterDrive (http://www.charterdrive.com.au/) and GoGet (http://www.goget.com.au/).[1] The largest of these, GoGet, has been operating for 6 years and has over 5000 members and 200 cars located predominantly in the inner city suburbs. Anecdotally, GoGet claims its membership is primarily drawn from professionals living in the inner-urban ring. Their motivation for joining is, firstly, the convenience that car sharing provides in a congested, public transport-challenged city like Sydney; secondly, the financial savings derived; and thirdly, members consider the environmental and social benefits axiomatic. [2] The promotion tactics of car sharing seems to reflect this by barely mentioning the environment but focusing on those aspects which link car sharing to futuristic and flexible subjectivities which I outline in the next section. Unlike traditional car rental, the vehicles in car sharing are scattered through local streets in a network allowing local residents and businesses access to the vehicles mostly on foot. One car share vehicle is used by 22-24 members and gets about seven cars off the street (Mehlman 22). With lots of different makes and models of vehicles in each of their fleets, Flexicar’s website claims, “around the corner, around the clock” “Flexicar offers you the freedom of driving your own car without the costs and hassles of owning one,” while GoGet asserts, “like owning a car only better.” Due to the initial lack of interest from government, all the car sharing organisations in Australia are privately owned. This is very different to the situation in Europe where governments grant considerable financial assistance and have often integrated car sharing into pre-existing public transport networks. Urry discusses the spread of car sharing across the Western world: Six hundred plus cities across Europe have developed car-sharing schemes involving 50,000 people (Cervero, 2001). Prototype examples are found such as Liselec in La Rochelle, and in northern California, Berlin and Japan (Motavalli, 2000: 233). In Deptford there is an on-site car pooling service organized by Avis attached to a new housing development, while in Jersey electric hire cars have been introduced by Toyota. (Urry, “Connections” 34) ‘Collaborative Consumption’ and Flexible, Philandering Subjectivities Car sharing shifts the dominant conception of a car from being a ‘commodity’, which people purchase and subsequently identify with, to a ‘service’ or network of vehicles that are collectively used. It does this through breaking down the one car = one person (or one family) ratio with one car instead servicing 20 or more people. One of Paterson’s biggest criticisms concerns car driving as “a form of social exclusion” (44). Car sharing goes some way in subverting the model of hyper-individualism that supports both hegemonic automobility and capitalist structures, whereby the private motorcar produces a “separation of individuals from one another driving in their own private universes with no account for anyone else” (Paterson 90). As a car sharer, the driver has to acknowledge that this is not their private domain, and the car no longer becomes an extension of their living room or bedroom, as is noted in much literature around car cultures (Morris, Sheller, Simpson). There are a community of people using the car, so the driver needs to be attentive to things like keeping the car clean and bringing it back on time so another person can use it. So while car sharing may change the affective relationship and self-identification with the vehicle itself, it doesn’t necessarily change the phenomenological dimensions of car driving, such as the nostalgic pleasure of driving on the open road, or perhaps more realistically in Sydney, the frustration of being caught in a traffic jam. However, the fact the driver doesn’t own the vehicle does alter their relationship to the space and the commodity in a literal as well as a figurative way. Like car ownership, evidently car sharing also produces its own set of limitations on freedom and convenience. That mobility and car ownership equals freedom—the ‘freedom to drive’—is one imaginary which car firms were able to successfully manipulate and perpetuate throughout the twentieth century. However, car sharing also attaches itself to the same discourses of freedom and pervasive individualism and then thwarts them. For instance, GoGet in Sydney have run numerous marketing campaigns that attempt to contest several ‘self-evident truths’ about automobility. One is flexibility. Flexibility (and associated convenience) was one thing that ownership of a car in the late twentieth century was firmly able to affiliate itself with. However, car ownership is now more often associated with being expensive, a hassle and a long-term commitment, through things like buying, licensing, service and maintenance, cleaning, fuelling, parking permits, etc. Cars have also long been linked with sexuality. When in the 1970s financial challenges to the car were coming as a result of the oil shocks, Chair of General Motors, James Roche stated that, “America’s romance with the car is not over. Instead it has blossomed into a marriage” (Rothschilds, Paradise Lost). In one marketing campaign GoGet asked, ‘Why buy a car when all you need is a one night stand?’, implying that owning a car is much like a monogamous relationship that engenders particular commitments and responsibilities, whereas car sharing can just be a ‘flirtation’ or a ‘one night stand’ and you don’t have to come back if you find it a hassle. Car sharing produces a philandering subjectivity that gives individuals the freedom to have lots of different types of cars, and therefore relationships with each of them: I can be a Mini Cooper driver one day and a Falcon driver the next. This disrupts the whole kind of identification with one type of car that ownership encourages. It also breaks down a stalwart of capitalism—brand loyalty to a particular make of car with models changing throughout a person’s lifetime. Car sharing engenders far more fluid types of subjectivities as opposed to those rigid identities associated with ownership of one car. Car sharing can also be regarded as part of an emerging phenomenon of what Rachel Botsman and Roo Rogers have called “collaborative consumption”—when a community gets together “through organized sharing, swapping, bartering, trading, gifting and renting to get the same pleasures of ownership with reduced personal cost and burden, and lower environmental impact” (www.collaborativeconsumption.com). As Urry has stated, these developments indicate a gradual transformation in current economic structures from ownership to access, as shown more generally by many services offered and accessed via the web (Urry Mobilities 283). Rogers and Botsman maintain that this has come about through the “convergence of online social networks increasing cost consciousness and environmental necessity." In the future we could predict an increasing shift to payment to ‘access’ for mobility services, rather than the outright private ownerships of vehicles (Urry, “Connections”). Networked-Subjectivities or a ‘Digital Panopticon’? Cars, no longer able on their own to signify progress in either technical or social terms, attain their symbolic value through their connection to other, now more prevalently ‘progressive’ technologies. (Paterson 155) The term ‘digital panopticon’ has often been used to describe a dystopian world of virtual surveillance through such things as web-enabled social networking sites where much information is public, or alternatively, for example, the traffic surveillance system in London whereby the public can be constantly scrutinised through the centrally monitored cameras that track people’s/vehicle’s movements on city streets. In his “sociologies of the future,” Urry maintains that one thing which might save us from descending into post-car civil chaos is a system governed by a “digital panopticon” mobility system. This would be governed by a nexus system “that orders, regulates, tracks and relatively soon would ‘drive’ each vehicle and monitor each driver/passenger” (Urry, “Connections” 33). The transformation of mobile technologies over the last decade has made car sharing, as a viable business model, possible. Through car sharing’s exploitation of an online booking system, and cars that can be tracked, monitored and traced, the seeds of a mobile “networked-subjectivity” are emerging. But it’s not just the technology people are embracing; a cultural shift is occurring in the way that people understand mobility, their own subjectivity, and more importantly, the role of cars. NETT Magazine did a feature on car sharing, and advertised it on their front cover as “GoGet’s web and mobile challenge to car owners” (May 2009). Car sharing seems to be able to tap into more contemporary understandings of what mobility and flexibility might mean in the twenty-first century. In their marketing and promotion tactics, car sharing organisations often discursively exploit science fiction terminology and generate a subjectivity much more dependent on networks and accessibility (158). In the suburbs people park their cars in garages. In car sharing, the vehicles are parked not in car bays or car parks, but in publically accessible ‘pods’, which promotes a futuristic, sci-fi experience. Even the phenomenological dimensions of swiping a smart card over the front of the windscreen to open the car engender a transformation in access to the car, instead of through a key. This is service-technology of the future while those stuck in car ownership are from the old economy and the “century of the car” (Gilroy). The connections between car sharing and the mobile phone and other communications technologies are part of the notion of a networked, accessible vehicle. However, the more problematic side to this is the car under surveillance. Nic Lowe, of his car sharing organisation GoGet says, “Because you’re tagged on and we know it’s you, you are able to drive the car… every event you do is logged, so we know what time you turned the key, what time you turned it off and we know how far you drove … if a car is lost we can sound the horn to disable it remotely to prevent theft. We can track how fast you were going and even how fast you accelerated … track the kilometres for billing purposes and even find out when people are using the car when they shouldn’t be” (Mehlman 27). The possibility with the GPS technology installed in the car is being able to monitor speeds at which people drive, thereby fining then every minute spent going over the speed limit. While this conjures up the notion of the car under surveillance, it is also a much less bleaker scenario than “a Hobbesian war of all against all”. Conclusion: “Hundreds of Cars, No Garage” The prospect of climate change is provoking innovation at a whole range of levels, as well as providing a re-thinking of how we use taken-for-granted technologies. Sometime this century the one tonne, privately owned, petrol-driven car will become an artefact, much like Sydney trams did last century. At this point in time, car sharing can be regarded as an emerging transitional technology to a post-car society that provides a challenge to hegemonic automobile culture. It is evidently not a radical departure from the car’s vast machinic complex and still remains a part of what Urry calls the “system of automobility”. From a pro-car perspective, its networked surveillance places constraints on the free agency of the car, while for those of the deep green variety it is, no doubt, a compromise. Nevertheless, it provides a starting point for re-thinking the foundations of the privately-owned car. While Urry makes an important point in relation to a society moving from ownership to access, he doesn’t take into account the cultural shifts occurring that are enabling car sharing to be attractive to prospective members: the notion of networked subjectivities, the discursive constructs used to establish car sharing as a thing of the future with pods and smart cards instead of garages and keys. If car sharing became mainstream it could have radical environmental impacts on things like urban space and pollution, as well as the dominant culture of “automobile dependence” (Newman and Kenworthy), as Australia attempts to move to a low carbon economy. Notes [1] My partner Bruce Jeffreys, together with Nic Lowe, founded Newtown Car Share in 2002, which is now called GoGet. [2] Several layers down in the ‘About Us’ link on GoGet’s website is the following information about the environmental benefits of car sharing: “GoGet's aim is to provide a reliable, convenient and affordable transport service that: allows people to live car-free, decreases car usage, improves local air quality, removes private cars from local streets, increases patronage for public transport, allows people to lead more active lives” (http://www.goget.com.au/about-us.html). References The Australian. “Kevin Rudd Throws $6.2bn Lifeline to Car Industry.” 10 Nov. 2008. < http://www.theaustralian.news.com.au/business/story/ 0,28124,24628026-5018011,00.html >.Corrigan, Tim. “Genre, Gender, and Hysteria: The Road Movie in Outer Space.” A Cinema Without Walls: Movies, Culture after Vietnam. New Jersey: Rutgers University Press, 1991. Dwyer, Gwynne. Climate Wars. North Carlton: Scribe, 2008. 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IntroductionThe tagline for the 2008 Game On exhibition at the Australian Centre for the Moving Image in Melbourne invites visitors to “play your way through the history of videogames.” The Melbourne hosting follows on from exhibitions that have included the Barbican (London), the Royal Museum (Edinburgh) and the Science Museum (London). The Game On exhibition presents an exemplary instance of how digital games and digital games culture are recovered, organised and presented. The Science Museum exhibition offered visitors a walkthrough from the earliest to the latest consoles and games (Pong to Wii Sports) with opportunities for game play framed by curatorial plaques. This article will explore some of the themes and narratives embodied within the exhibition that see digital games technologies enrolled within a media teleology that emphasises technological advancement and upgrade. Narratives of Technological Upgrade The Game On exhibition employed a “social contextualisation” approach, connecting digital gaming developments with historical events and phenomena such as the 1969 moon landing and the Spice Girls. Whilst including thematic strands such as games and violence and games in education, the exhibition’s chronological ordering highlighted technological advancement. In doing so, the exhibition captured a broader tension around celebrating past technological advancement in gaming, whilst at the same time emphasising the quaint shortfalls and looking to future possibilities. That technological advancements stand out, particularly as a means of organising a narrative of digital gaming, resonates with Stephen Kline, Nick Dyer-Withford and Greig de Peuter’s analysis of digital gaming as a “perpetual innovation economy.” For Kline et al., corporations “devote a growing share of their resources to the continual alteration and upgrading of their products” (66). Technological upgrade and advancement were described by the Game On curator as an engaging aspect of the exhibition: When we had a BBC news presenter come in, she was talking about ‘here we have the PDP 1 and here I have the Nintendo DS’. She was just sort of comparing and contrasting. I know certainly that journalists were very keen on: ‘yeah, but how much processing power does the PDP 1 have?’, ‘what does it compare to today?’ – and it is very hard to compare. How do you compare Space War on the PDP 1 with something that runs on your mobile phone? They are very different systems. (Lee)This account of journalistic interest in technological progression and the curator’s subsequent interpretation raise a significant tension around understanding digital gaming. The concern with situating past gaming technologies and comparing capacities and capabilities, emphasises both the fascination with advancement and technological progress in the field and how the impressiveness of this advancement depends on remembering what has come before. Questions of remembering, recovering and forgetting are clear in the histories that console manufacturers offer when they describe past innovation and pioneering developments. For example, the company history provided by Nintendo on its website is exclusively a history of games technologies with no reference to the proceeding business of playing-card games from the late nineteenth century. Its website-published history only starts with the 1985 release of the NES (Nintendo Entertainment System), “an instant hit [that] over the course of the next two years, it almost single-handedly revitalized the video game industry” (Nintendo, ‘History’), and thereby overlooks the earlier 1983 less successful Famicom system. Past technologies are selectively remembered and recovered as part of the foundations for future success. This is a tension, that can be unpacked in a number of ways, across current industry transformations and strategies that potentially erase the past whilst simultaneously seeking to recover it as part of an evidence-base for future development. The following discussion develops an analysis of how digital gaming history is recovered and constructed.Industry Wind Change and Granny on the WiiThere is “unease, almost embarrassment”, James Newman suggests, “about the videogames industry within certain quarters of the industry itself” (6). Newman goes on to suggest:Various euphemisms have passed into common parlance, all seemingly motivated by a desire to avoid the use of the word ‘game’ and perhaps even ‘computer’, thereby adding a veneer of respectability, distancing the products and experiences from the childish pursuits of game, play and toys, and downplaying the technology connection with its unwanted resonances of nerds in bedrooms hunched over ZX Spectrums and Commodore 64s and the amateurism of hobbyist production. (6-7) The attempted move away from the resonances of “nerds in bedrooms” has been a strategic decision for Nintendo especially. This is illustrated by the naming of consoles: ‘family’ in Famicom, ‘entertainment’ in NES and, more recently, the renaming of the Wii from ‘Revolution’. The seventh generation Nintendo Wii console, released in November and December 2006, may be been seen as industry leading in efforts to broaden gaming demographics. In describing the console for instance, Satoru Iwata, the President of Nintendo, stated, “we want to appeal to mothers who don't want consoles in their living rooms, and to the elderly and to young women. It’s a challenge, like trying to sell cosmetics to men” (Edge Online). This position illustrates a digital games industry strategy to expand marketing to demographic groups previously marginalised.A few examples from the marketing and advertising campaigns for the Nintendo Wii help to illustrate this strategy. The marketing associated with the Wii can be seen as part of a longer lineage of Nintendo marketing with Kline et al. suggesting, “it was under Nintendo’s hegemony that the video game industry began to see the systematic development of a high-intensity marketing apparatus, involving massive media budgets, ingenious event marketing, ground breaking advertising and spin off merchandising” (118). The “First Experiences” show on the Wii website mocks-up domestic settings as the backdrop to the Wii playing experience to present an ideal, potential Wii-play scenario. These advertisem*nts can be seen to position the player within an imagined home and game-play environment and speak for the Wii. As Keith Grint and Steve Woolgar suggest, “technology does not speak for itself but has to be spoken for” (32). As part of their concern with addressing, “the particular regime of truth which surrounds, upholds, impales and represents technology” (32), Grint and Woolgar “analyse the way certain technologies gain specific attributes” (33). Across advertisem*nts for the Wii there are a range of domestic environments and groups playing. Of these, the power to bring the family together and facilitate ease of game-play for the novice is most noticeable. David Morley’s comment that, “‘hi-tech’ discourse is often carefully framed and domesticated by a rather nostalgic vision of ‘family values’” (438) is borne out here.A television advertisem*nt aired on Nickelodeon illustrates the extent to which the Wii was at the forefront in motioning forward a strategy of industry and gaming inclusiveness around the family: “the 60-second spot shows a dad mistaking the Wii Remote for his television remote control. Dad becomes immersed in the game and soon the whole family joins in” (Nintendo World Report). From confused fathers to family bonding, the Wii is presented as the easy-to-use and accessible device that brings the family together. The father confusing the Wii remote with a television remote control is an important gesture to foreground the accessibility of the Wii remotes compared to previous “joypads”, and emphasize the Wii as an accessible device with no bedroom, technical wizardry required. Within the emerging industry inclusivity agenda, the ‘over technological’ past of digital gaming is something to move away from. The forms of ‘geek’ or ‘hardcore’ that epitomise previous dominant representations of gaming have seemingly stood in the way of the industry reaching its full market potential. This industry wind change is captured in the comments of a number of current industry professionals.For Matthew Jeffrey, head of European Recruitment for Electronic Arts (EA), speaking at the London Games Week Career Fair, the shift in the accessibility and inclusivity of digital gaming is closely bound up with Nintendo’s efforts and these have impacted upon EA’s strategy: There is going to be a huge swathe of new things and the great thing in the industry, as you are all easy to identify, is that Nindento DS and the Wii have revolutionised the way we look at the way things are going on.Jeffrey goes on to add, “hopefully some of you have seen that your eighty year old grandparent is quite happy to play a game”, pointing to the figure of the grandparent as a game-player to emphasise the inclusivity shift within gaming.Similarly, at Edinburgh Interactive Festival 2007, the CEO of Ubisoft Yves Guillemot in his “The New Generation of Gaming: Facing the Challenges of a Changing Market” speech outlined the development of a family friendly portfolio to please a new, non-gamer population that would include the recruitment of subject experts for “non-game” titles. This instance of the accessibility and inclusivity strategy being advocated is notable for it being part of a keynote speech at the Edinburgh Interactive Festival, an event associated with the Edinburgh festival that is both an important industry gathering and receives mainstream press coverage. The approaches taken by the other leading console manufacturers Sony and Microsoft, illustrate that whilst this is by no means a total shift, there is nevertheless an industry-wide engagement. The ‘World of Playstation: family and friends’ for example suggests that, “with PlayStation, games have never been more family-friendly” and that “you can even team up as a family to challenge your overseas relatives to a round of online quizzing over the PLAYSTATION Network” (Playstation).What follows from these accounts and transformations is a consideration of where the “geeky” past resides in the future of gaming as inclusive and accessible. Where do these developments leave digital gaming’s “subcultural past” (“subcultural” as it now becomes even within the games industry), as the industry forges on into mainstream culture? Past digital games technologies are clearly important in indicating technological progression and advancement, but what of the bedroom culture of gaming? How does “geek game culture” fit within a maturing future for the industry?Bedroom Programmers and Subcultural Memories There is a tension between business strategy directed towards making gaming accessible and thereby fostering new markets, and the games those in industry would design for people like themselves. This is not to deny the willingness or commitment of games developers to work on a variety of games, but instead to highlight transformation and tension. In their research into games development, Dovey and Kennedy suggest that, the “generation, now nearing middle-age and finding themselves in the driving seat of cultures of new media, have to reconcile a subcultural history and a dominant present” (145). Pierre Bourdieu’s account of symbolic capital is influential in tracing this shift, and Dovey and Kennedy note Bourdieu’s comment around, “the subjective image of the occupational project and the objective function of the occupation” (145). This shift is highly significant for ways of understanding maturation and inclusivity strategies within digital gaming.Bourdieu’s account of the “conservative functions attached” to an occupation for Dovey and Kennedy: Precisely describes the tensions between designers’ sense of themselves as ‘outsiders’ and rebels (‘the subjective image of the occupational project’) on the one hand and their position within a very tight production machine (‘the objective function of the occupation’) on the other. (145) I would suggest the “production machine”, that is to say the broader corporate management structures by which games development companies are increasingly operated, has a growing role in understandings of the industry. This approach was implicit in Iwata’s comments on selling cosmetics to men and broadening demographics, and Jeffrey’s comments pointing to how EA’s outlook would be influenced by the accessibility and inclusivity strategy championed by Nintendo. It may be suggested that as the occupational project of gaming is negotiated and shifts towards an emphasis on accessibility and inclusivity, the subjective image must be similarly reoriented. That previous industry models are being replaced, is highlighted in this excerpt from a Managing Director of a ‘leisure software’ company in the Staying ahead report on the creative industries by the Work Foundation:The first game that came from us was literally two schoolchildren making a game in their bedroom … the game hadn’t been funded, but made for fun … As those days are gone, the biggest challenges nowadays for game developers are finding funding that doesn’t impinge on creativity, and holding onto IP [intellectual property], which is so important if you want a business that is going to have any value. (27)This account suggests a hugely important transition from bedroom production, the days that ‘are gone’, towards Intellectual Property-aware production. The creative industries context for these comments should not be overlooked and is insightful for further recognising the shifts and negotiations taking place in digital gaming, notably, around the maturation of the games industry. The creative industries context is made explicit in creative industries reports such as Staying ahead and in the comments of Shaun Woodward (former Parliamentary Under-Secretary of State at the Department for Culture, Media and Sport) in a keynote speech at the 2006 British Video Games Academy Awards, in which he referred to the games industry as “one of our most important creative industries”. The forms of collaboration between, for instance, The Independent Games Developers Association (TIGA) and the Department of Culture, Media and Sport (see Gamasutra), further indicate the creative industries context to the maturation of the UK games industry.The creative industries context also presents the anchor through which tensions between a subcultural history and professional future and the complex forms of recovery can be more fully engaged with. The Game On curator’s indication that making comparisons between different games technologies systems was a delicate balance insightfully provides cautions to any attempt to mark out a strict departure from the ‘subcultural’ to the ‘professional’. Clearly put, the accessibility and inclusivity strategy that shifts away from geek culture and technical wizardry remains in conversation with geek elements as the foundation for the future. As technologies are recovered within a lineage of technological development and upgrade, the geek bedroom culture of gaming is almost mythologized to offer the industry history creative credentials and future potential. Recovering and Combining: Technologies and Memories for a Professional Future Emphasised thus far has been a shift from the days gone by of bedroom programming towards an inclusive and accessible professional and mature future. This is a teleological shift in the sense that the latest technological developments can be located within a past replete with innovation and pioneering spirit. In relation to the Wii for example, a Nintendo employee states:Nintendo is a company where you are praised for doing something different from everyone else. In this company, when an individual wants to do something different, everyone else lends their support to help them overcome any hurdles. I think this is how we made the challenge of Wii a possibility. (Nintendo)Nintendo’s history, alluded to here and implicit throughout the interviews with Nintendo staff from which this comment is taken, and previous and existing ‘culture’ of experimentation is offered here as the catalyst and enabler of the Wii. A further example may be offered in relation to Nintendo’s competitor Sony.A hugely significant transformation in digital gaming, further to the accessibility and inclusivity agenda, is the ability of players to develop their own games using games engines. For Phil Harrison (Sony), gaming technology is creating a, “‘virtual community’ of collaborative digital production, marking a return to the ‘golden age of video game development, which was at home, on your own with a couple of friends, designing a game yourself’” (Kline et al., 204). Bedroom gaming that in the earlier comments was regarded as days gone by for professionals, takes on a new significance as a form of user-engagement. The previous model of bedroom production, now outmoded compared to industry production, is relocated as available for users and recovered as the ‘golden age of gaming’. It is recovered as a model for users to aspire to. The significance of this for business strategy is made clear by Kline et al. who suggest that, “thousands of bright bulbs have essentially become Sony’s junior development community” (204). An obsolete model of past production is recovered and deployed within a future vision of the games industry that sees users participating and extending forms of games engagement and consumption. Similarly, the potential of ‘bedroom’ production and its recovery in relation to growth areas such as games for mobile phones, is carefully framed by Intellectual Property Rights (Edwards and Coulton). In this respect, forms of bedroom production are carefully situated in terms of industry strategies.The “Scarce Talent Seminars” as part of the London Games Week 2008 “Skills Week” further illustrate this continual recovery of ‘past’, or more accurately alternative, forms of production in line with narratives of professionalisation and industry innovation. The seminars were stated as offering advice on bridging the gap between the “bedroom programmer” and the “professional developer”. The discourse of ‘talent’ framed this seminar, and the bedroom programmer is held up as being (not having) raw talent with creative energies and love and commitment for gaming that can be shaped for the future of the industry. This discourse of bedroom programmers as talent emphasises the industry as an enabler of individual talent through access to professional development and technological resources. This then sits alongside the recovery of historical narratives in which bedroom gaming culture is celebrated for its pioneering spirit, but is ultimately recovered in terms of current achievements and future possibilities. “Skills Week” and guidance for those wanting to work in the industry connects with the recovery of past technologies and ways of making games visible amongst the potential industry workers of the future – students. The professional future of the industry is intertwined with graduates with professional qualifications. Those qualifications need not be, and sometimes preferably should not be, in ‘gaming’ courses. What is important is the love of games and this may be seen through the appreciation of gaming’s history. During research conducted with games design students in higher education courses in the UK, many students professed a love of games dating back to the Spectrum console in the 1980s. There was legitimacy and evidence of professing long-seated interests in consoles. At the same time as acknowledging the significant, embryonic power these consoles had in stimulating their interests, many students engaged in learning games design skills with the latest software packages. Similarly, they engaged in bedroom design activities themselves, as in the days gone by, but mainly as training and to develop skills useful to securing employment within a professional development studio. Broadly, students could be said to be recovering both technologies and ways of working that are then enrolled within their development as professional workers of the future. The professional future of the gaming industry is presented as part of a teleological trajectory that mirrors the technological progression of the industry’s upgrade culture. The days of bedroom programming are cast as periods of incubation and experimentation, and part of the journey that has brought gaming to where it is now. Bedroom programming is incorporated into the evidence-base of creative industries policy reports. Other accounts of bedroom programming, independent production and attempts to explore alternative publishing avenues do not feature as readily.In the 2000 Scratchware Manifesto for example, the authors declare, “the machinery of gaming has run amok”, and say, “Basta! Enough!” (Scratchware). The Scratchware Manifesto puts forward Scratchware as a response: “a computer game, created by a microteam, with pro-quality art, game design, programming and sound to be sold at paperback prices” (Scratchware). The manifesto goes on to say, “we need Scratchware because there is more than one way to develop good computer games” (Scratchware, 2000). Using a term readily associated with the Zapatista Army of National Liberation, the Scratchware Manifesto called for a revolution in gaming and stated, “we will strive for […] originality over the tried and tested” (Scratchware). These are the experiences and accounts of the games industry that seem to fall well outside of the technological and upgrade focused agenda of professional games development.The recovery and framing of past technologies and industry practices, in ways supportive to current models of technological upgrade and advancement, legitimises these models and marginalizes others. A eulogized and potentially mythical past is recovered to point to cultures of innovation and creative vibrancy and to emphasize current and future technological prowess. We must therefore be cautious of the instrumental dangers of recovery in which ‘bright bulbs’ are enrolled and alternative forms of production marginalised.As digital gaming establishes a secure footing with increased markets, the growing pains of the industry can be celebrated and recovered as part of the ongoing narratives of the industry. Recovery is vital to make sense of both the past and future. Within digital gaming, the PDP-1 and the bedroom geek both exist in the past, present and future as part of an industry strategy and trajectory that seeks to move away from them but also relies on them. They are the legitimacy, the evidence and the potential for affirming industry models. The extent to which other narratives can be told and technologies and memories recovered as alternative forms of evidence and potential is a question I, and hopefully others, will leave open.ReferencesDovey, John, and Helen W. Kennedy. Game Cultures. Maidenhead: Open University Press, 2006.Edge-Online. "Iwata: Wii Is 'Like Selling Make-Up to Men.'" Edge-Online 19 Sep. 2006. 29 Sep. 2006 ‹http://www.edge-online.com/news/iwata-wii-like-selling-make-up-men›.Edwards, Reuben, and Paul Coulton. "Providing the Skills Required for Innovative Mobile Game Development Using Industry/Academic Partnerships." 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