Journal articles: 'Blue Shield of California Foundation' – Grafiati (2024)

Abstract:

Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p<.001), 2) reduction of subject reported medical utilization from baseline (p<.05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.

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Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

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Background: Nearly half of hospitalized patients with bacteriuria or treated for pneumonia receive unnecessary antibiotics (noninfectious or nonbacterial syndrome such as asymptomatic bacteriuria), excess duration (antibiotics prescribed for longer than necessary), or avoidable fluoroquinolones (safer alternative available) at hospital discharge.1–3 However, whether antibiotic overuse at discharge varies between hospitals or is associated with patient outcomes remains unknown. Methods: From July 2017 to December 2018, trained abstractors at 46 Michigan hospitals collected detailed data on a sample of adult, non–intensive care, hospitalized patients with bacteriuria (positive urine culture with or without symptoms) or treated for community-acquired pneumonia (CAP; includes those with the disease formerly known as healthcare-associated pneumonia [HCAP]). Antibiotic prescriptions at discharge were assessed for antibiotic overuse using a previously described, guideline-based hierarchical algorithm.3 Here, we report the proportion of patients discharged with antibiotic overuse by the hospital. We also assessed hospital-level correlation (using Pearson’s correlation coefficient) between antibiotic overuse at discharge for patients with bacteriuria and patients treated for CAP. Finally, we assessed the association of antibiotic overuse at discharge with patient outcomes (mortality, readmission, emergency department visit, and antibiotic-associated adverse events) at 30 days using logit generalized estimating equations adjusted for patient characteristics and probability of treatment. Results: Of 17,081 patients (7,207 with bacteriuria; 9,874 treated for pneumonia), nearly half (42.2%) had antibiotic overuse at discharge (36.3% bacteriuria and 51.1% pneumonia). The percentage of patients discharged with antibiotic overuse varied 5-fold among hospitals from 14.7% (95% CI, 8.0%–25.3%) to 74.3% (95% CI, 64.2%–83.8%). Hospital rates of antibiotic overuse at discharge were strongly correlated between bacteriuria and CAP (Pearson’s correlation coefficient, 0.76; P ≤ .001) (Fig. 1). In adjusted analyses, antibiotic overuse at discharge was not associated with death, readmission, emergency department visit, or Clostridioides difficile infection. However, each day of overuse was associated with a 5% increase in the odds of patient-reported antibiotic-associated adverse events after discharge (Fig. 2). Conclusions: Antibiotic overuse at discharge was common, varied widely between hospitals, and was associated with patient harm. Furthermore, antibiotic overuse at discharge was strongly correlated between 2 disparate diseases, suggesting that prescribing culture or discharge processes—rather than disease-specific factors—contribute to overprescribing at discharge. Thus, discharge stewardship may be needed to target multiple diseases.Funding: This study was supported by the Society for Healthcare Epidemiology of America and by Blue Cross Blue Shield of Michigan and Blue Care Network.Disclosures: Valerie M. Vaughn reports contracted research for Blue Cross and Blue Shield of Michigan, the Department of VA, the NIH, the SHEA, and the APIC. She also reports receipt of funds from the Gordon and Betty Moore Foundation Speaker’s Bureau, the CDC, the Pew Research Trust, Sepsis Alliance, and the Hospital and Health System Association of Pennsylvania.

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Background: Clinicians often diagnose bacterial infections such as urinary tract infection (UTI) and pneumonia in patients who are asymptomatic or have nonbacterial causes of their symptoms. Misdiagnosis of infection leads to unnecessary antibiotic use and potentially delays correct diagnoses. Interventions to improve diagnosis often focus on infections separately. However, if misdiagnosis is linked, broader interventions to improve diagnosis may be more effective. Thus, we assessed whether misdiagnosis of UTI and community-acquired pneumonia (CAP) was correlated. Methods: From July 2017 to July 2019, abstractors at 46 Michigan hospitals collected data on a sample of adult, non–intensive care, hospitalized patients with bacteriuria (positive urine culture) or who were treated for presumed CAP (discharge diagnosis plus antibiotics). Patients with concomitant bacterial infections were excluded. Using a previously described method,1,2 patients were assessed for UTI or CAP based on symptoms, signs, and laboratory or radiology findings. Misdiagnosis of UTI was defined as patients with asymptomatic bacteriuria (ASB) treated with antibiotics number of patients with bacteriuria Misdiagnosis of CAP was defined as patients treated for presumed CAP who did not have CAP number of patients treated for presumed CAP. Hospital-level correlation was assessed using Pearson’s correlation coefficient between misdiagnosis of UTI and CAP. For patients with prescriber data (N = 3,293), we also assessed emergency department (ED)-level correlation. Results: Of 11,914 patients with bacteriuria, 31.9% (N = 3,796) had ASB. Of those, 2,973 of 3,796 (78.3%) received antibiotics. Of 14,085 patients treated for CAP, 1,602 (11.4%) did not have CAP. Incidence of misdiagnosis varied by hospital: those with high rates of misdiagnosis of UTI were more likely to have high rates of misdiagnosis of CAP (Pearson’s correlation coefficient, 0.58; P ≤ .001) (Fig. 1). Of 2,137 patients misdiagnosed with UTI, 1,159 (54.2%) had antibiotic treatment started in the ED; of those, 942 (81.3%) remained on antibiotics on day 3 of hospitalization. Of 1,156 patients misdiagnosed with CAP, 871 (75.3%) had antibiotic therapy started in the ED, and 789 of these 871 patients (90.6%) were still on antibiotics on day 3 of hospitalization. Hospitals with high rates of UTI misdiagnosis in the ED were more likely to have high rates of CAP misdiagnosis in the ED (Pearson’s correlation coefficient, 0.33; P ≤ .001). Conclusions: Misdiagnosis of 2 unrelated infections was moderately correlated by hospital and weakly correlated by hospital ED. Potential causes include differences in organizational culture (eg, low tolerance for diagnostic uncertainty, emergency department culture), organizational initiatives (eg, sepsis, stewardship), or coordination between emergency and hospital medicine. Additionally, antibiotics initiated in the ED were typically continued following admission, potentially reflecting diagnosis momentum.Funding: This work was supported by Blue Cross Blue Shield of Michigan and Blue Care Network.Disclosures: Valerie M. Vaughn reports contract research for Blue Cross and Blue Shield of Michigan, the Department of Veterans’ Affairs, the NIH, the SHEA, and the APIC. She also reports fees from the Gordon and Betty Moore Foundation Speaker’s Bureau, the CDC, the Pew Research Trust, Sepsis Alliance, and The Hospital and Health System Association of Pennsylvania.

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The Biodiversity Literacy in Undergraduate Education - Data Initiative (BLUE Data) is a US National Science Foundation-funded Research Coordination Network in Undergraduate Biology (RCN-UBE) working to generate community consensus around biodiversity data literacy skills. This diverse network brings together biodiversity, data, and education specialists to identify core biodiversity data competencies for undergraduate students, develop strategies for integrating these competencies into the introductory biology curriculum, and build capacity for sustained development and implementation of biodiversity and data literacy education. Since the start of funding one year ago, BLUE Data has been working to review the current landscape of data literacy competencies from primary to graduate education in biodiversity data science, identify gaps in student learning related to data and biodiversity science core skills, and generate community consensus on defined biodiversity data literacy standards. At a recent BLUE Data workshop associated with the Emerging Innovations for Biodiversity Data conference in Berkeley, California, participants worked together to define competencies and identify strategies to facilitate broad-scale integration of transferrable data literacy skills and knowledge to improve undergraduate biology training and meet increasing workforce demands in both data and biodiversity sciences. This discussion also identified current efforts and explored existing resources in order to identify gaps that should be targeted in our efforts moving forward. In this presentation, we will introduce the SPNHC and TDWG communities to BLUE Data, and describe our vision and goals, partners, and educational modules. We will share results from our recent activities, including the outcomes of the Emerging Innovations for Biodiversity Data workshop. BLUE Data welcomes new partnerships with those also interested in defining the undergraduate biodiversity data literacy landscape and charting future efforts of this network.

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Regional surgical quality Collaboratives are improving surgical quality and cutting costs by building regional relationships that leverage information sharing to improve outcomes. The South Carolina Surgical Quality Collaborative (SCSQC) is a new regional surgical quality Collaborative focused on improving general surgery outcomes in South Carolina. It is a joint effort which brings together the skills and resources of Health Sciences South Carolina, the South Carolina Hospital Association, and the Blue Cross Blue Shield of SC Foundation to create a web-based data collection system to provide real-time outcomes data to participating surgeons, and establishing a supportive network for sharing best practices and promoting data driven quality improvement. Members of the SCSQC abstracted more than 8000 general surgery cases from eight participating hospitals in its first year. These facilities are spread across the state of South Carolina and range from large academic referral centers to small community hospitals. The resulting data should be representative of much of the surgical care provided in South Carolina. Monthly conference calls and quarterly face-to-face meetings occur with site Surgeon Leads, site Surgical Clinical Quality Reviewer, and Collaborative leaders. Each site is pursuing a quality improvement project addressing issues identified from analysis of their initial data. Early results on these efforts are encouraging. The SCSQC is a new regional surgical quality Collaborative, which leverages multiple state resources, builds on the successes of similar Collaboratives in Michigan and Tennessee, with the goal to improve the quality and value of general surgical care for South Carolinians.

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Abstract Objectives To compare effects of diets varying in carbohydrate (carb) and fat on plasma lipids and lipoprotein subfractions. Methods Participants (N = 164, 70% female, 18–65 y, BMI ≥ 25 kg/m2) achieved 10–14% weight loss on a run-in diet and then were randomized to 3 test diets for 20 weeks of weight-loss maintenance. Percentages of total energy from carb-fat-protein for high-, moderate-, and low-carb diets were 60-20-20 (HI), 40-40-20 (MOD), and 20–60-20 (LO). Relative amounts of added sugar (15% total carb) and saturated fat (35% total fat) were fixed across diets. Plasma was collected at START (post-weight loss) and END of trial. The primary outcome for this ancillary study was lipoprotein insulin resistance (LPIR) – a 6-component weighted score of triglyceride-rich, high-density, and low-density lipoprotein particle (TRL-P, HDL-P, LDL-P) sizes and subfraction concentrations (large/very large TRL-P, large HDL-P, small LDL-P) (NMR spectroscopy, LabCorp). Other outcomes included large LDL-P concentration, triglycerides (TG), and cholesterol (HDL-C, LDL-C). Means (±SE) and END–START changes (mean [95% CI]) were constructed and compared from repeated measures ANOVA. Results Retention was 90% and 147 participants provided evaluable data, with no difference in body weight by diet after randomization. LPIR was 32.6 ± 1.5 at START. Change in LPIR differed by diet (P = 0.009): LO (−5.3 [−9.2, −1.5]), MOD (−0.02 [−4.1, 4.1]), HI (3.6 [−0.6, 7.7]). Diet effects favoring LO compared to HI were observed for large/very large TRL-P (P = 0.005), large HDL-P (P = 0.045), TG (P = 0.006), and HDL-C (P = 0.04). There were no mean differences between diets for particle sizes, LDL-P subfraction concentrations, and LDL-C (START: 79.3 ± 1.8 mg/dL; END–START: HI, 8.2 [4.2, 12.2]; MOD, 11.7 [7.8, 15.7]; LO, 10.0 [6.3, 13.7]). Conclusions With 3-fold higher saturated fat content (21% vs 7% total energy), a low- vs high-carb diet improved LPIR, a biomarker of diabetes risk, and several other components of the metabolic syndrome, with no adverse effects on LDL-P or LDL-C. These results from a large feeding study suggest that carb restriction may help prevent cardiometabolic disease independent of body weight. Funding Sources Nutrition Science Initiative (gifts from Arnold Ventures and Robert Lloyd Corkin Charitable Foundation), New Balance Foundation, Many Voices Foundation, Blue Cross Blue Shield.

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Background: Almost three-quarters of American adults use the Internet. Eighty percent of these adults use online health information resources. Ask-the-Pharmacist (ATP) services provide individualized clinical information to online consumers. Objective: To characterize the content of online queries submitted by or on behalf of women to an ATP service. Methods: A retrospective review was conducted of online queries submitted to the Blue Shield of California ATP service between 2003 and 2004. Questions were characterized and analyzed using Analysis ToolPak package and SPSS software (version 12). Results: A total of 1,056 submitted queries were analyzed. The mean age of female consumers was 45.6 years (range 18–88). Thirty-three percent inquired about drug adverse effects; of these, 19% reported experiencing acute adverse reactions. Drug efficacy or indications were the subject of 26% of queries. The most common drug-related queries were about antidepressants (8.6%) and contraceptives (8.2%), with a majority interested in the adverse effects of these drug classes. Over-the-counter products accounted for 4.9% of the queries. Contraception and dermatology were the most frequent indications listed for women aged 18–35 years; for women over the age of 50 years, menopause was the most frequent indication. Conclusions: The questions asked regarding the health of female consumers reflect the fact that consumers need more information to make treatment decisions. Women want to know the differences in drug efficacy and adverse effects among different medications. Healthcare providers should be aware of these issues to better anticipate women's healthcare needs. In addition, this information may help health plans to develop specific materials targeted toward these issues.

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Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in US Veterans’ Affairs (VA) hospitals. Whether fluoroquinolone use at discharge has also declined, in particular since antibiotic stewardship programs became mandated at VA hospitals in 2014, is unknown. Methods: In this retrospective cohort study of hospitalizations with infection between January 1, 2014, and December 31, 2017, at 125 VA hospitals, we assessed inpatient and discharge fluoroquinolone (ciprofloxacin, levofloxacin, and moxifloxacin) use as (1) proportion of hospitalizations with a fluoroquinolone prescribed and (2) fluoroquinolone days per 1,000 hospitalizations. After adjusting for illness severity, comorbidities, and age, we used multilevel logit and negative binomial models to assess for hospital-level variation and longitudinal prescribing trends. Results: Of 560,219 hospitalizations meeting inclusion criteria as hospitalizations with infection (Fig. 1), 209,602 of 560,219 (37.4%) had a fluoroquinolone prescribed either during hospitalization (182,337 of 560,219, 32.5%) or at discharge (110,003 of 560,219, 19.6%) (Fig. 1). Hospitals varied appreciably in inpatient, discharge, and total fluoroquinolone use, with 71% of hospitals in the highest prescribing quartile located in the southern United States. Nearly all measures of fluoroquinolone use decreased between 2014 and 2017, with the largest decreases found in inpatient fluoroquinolone and ciprofloxacin use (Fig. 2). In contrast, there was minimal decline in fluoroquinolone use at discharge (Fig. 2), which accounted for 1,433 of 2,339 (61.3%) of hospitalization-related fluoroquinolone days by 2017. Between 2014 and 2017, fluoroquinolone use decreased in VA hospitals, largely driven by a decrease in inpatient fluoroquinolone (especially ciprofloxacin) use. Fluoroquinolone prescribing at discharge, and levofloxacin prescribing overall, remain prime targets for stewardship.Funding: This work was funded by a locally initiated project grant from the Center for Clinical Management Research at the VA Ann Arbor Healthcare System.Disclosures:Valerie M. Vaughn reports contract research for Blue Cross and Blue Shield of Michigan, the Department of Veterans’ Affairs, the NIH, the SHEA, and the APIC. She also reports fees from the Gordon and Betty Moore Foundation Speaker’s Bureau, the CDC, the Pew Research Trust, Sepsis Alliance, and The Hospital and Health System Association of Pennsylvania.Disclaimer The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

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Abstract Background: The National Comprehensive Cancer Network guideline on Genetic/Familial High Risk: Breast, Ovarian and Pancreatic Cancer (NCCN) recommends offering increased screening and risk-reduction options to women with a pathogenic/likely pathogenic variant (PV/LPV) in 8 clinically-actionable hereditary breast and ovarian cancer (HBOC) genes: ATM, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, and TP53. These options range from biannual clinical breast exams and annual breast MRI screening to risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO). Yet health insurance company policies addressing the medical necessity of genetic testing for these genes vary widely. While some payers have adopted the NCCN testing criteria verbatim, others have made specific changes or have developed their own criteria. We sought to quantify the potential impact of this variability on access to enhanced medical management for carriers of PV/LPV in these 8 HBOC genes in a large cohort of patients undergoing genetic testing at a single commercial laboratory. Methods: We reviewed clinical and family histories for patients undergoing multigene panel testing that included testing for the 8 genes of interest and identified 107,344 patients who met NCCN testing criteria (excluding prostate cancer criteria, which were not assessed in this study) for HBOC (v.2.2021). We then compared the histories of these patients to testing criteria for 3 different payer groups: Aetna, Blue Shield of California/Federal Blue Cross-Blue Shield, and eviCore (used by over 30 payers including AmeriHealth, Highmark and Horizon). These are the largest payer groups in our cohort and together represent 19% of patients tested. For each patient we determined whether they met testing criteria for the 3 payer groups. For individuals found to have a PV/LPV we determined the potential missed management opportunities for those who would not have been tested under each payer’s criteria. In addition, we sought to estimate the maximal impact of this missed management for patients with BRCA PV/LPV (not accounting for patient age or medical history). Results: Among patients meeting NCCN testing criteria for HBOC, 10,10,477 (9.8%) were found to have PVs/LPVs in one of the 8 genes. Under the three payer policies 2% to 10.3% of all patients, and up to 4.0% (n=423) of PV/LPV carriers, would not have been eligible for genetic testing. Based on NCCN management guidelines, up to 423 eligible patients would not have been offered annual breast MRI, 208 patients would not have been offered RRM, and 163 eligible patients would not have been offered RRSO. This lack of testing access due to misaligned medical policies also represents missed opportunities for offering potentially life-saving screening and risk reduction measures to these patients as well. Assuming lifetime cancer risks of 85% for breast cancer and 40% for ovarian cancer, and risk-reduction of 95% with RRM and 80% with RRSO. Had all policies matched NCCN testing criteria, up to 132 breast cancers could have potentially been detected earlier or prevented and 52 ovarian cancers could potentially have been prevented in our cohort. Conclusions: In addition to complicating clinical practice, varying testing guidelines have broader implications. Our data show that a significant number of mutation carriers are being missed by payer policies that deviate from NCCN testing criteria. In turn, this represents missed opportunities to offer proactive screening and risk-reduction options that could potentially save lives for those at risk for hereditary cancer. Based on findings from other studies, these actions would likely reduce health insurer costs as well. Citation Format: Robert T Pilarski, Stephanie Noble, Lily Hoang, Randy Hew, Stephanie Gandomi, Holly LaDuca, Jill Dolinsky. Inequitable access to genetic testing leads to missed screening and prevention opportunities for individuals at risk for hereditary breast and ovarian cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-09-19.

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Over the past decade, fixed recorders have come into increasing use for long-term sampling of whale calls in remote ocean regions. Concurrently, the development of several types of autonomous underwater vehicles has demonstrated measurement capabilities that promise to revolutionize ocean science. These two lines of technical development were merged with the addition of broadband (5 Hz to 30 kHz) omni-directional hydrophones to seagliders. In August 2006, the capability of three Acoustic Seagliders (ASGs) to detect whale calls was tested in an experiment offshore Monterey, California. In total, 401 dives were completed and over 107 hours of acoustic data recorded. Blue whale calls were detected on all but two of the 76 dives where acoustic data were analyzed in detail, while humpback and sperm whale calls were detected on roughly 20% of those dives. Various whistles, clicks and burst calls, similar to those produced by dolphins and small whales, were also detected, suggesting that the capability of ASGs can be expanded to sample a broad range of marine mammal species. The potential to include whale call detection in the suite of standard oceanographic measures is unprecedented and provides a foundation for mobile sampling strategies at scales that better match the vertical and horizontal movements of the whales themselves. This capability opens new doors for investigation of cetacean habitats and their role in marine ecosystems, as envisioned in future ocean observing systems.

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Background:Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous (IV) antibiotic therapy after discharge from the hospital. Infectious disease (ID) physicians are often consulted prior to PICC placement, but whether their approval influences PICC appropriateness and complications is not known. Methods: Using data from the Michigan Hospital Medicine Safety Consortium (HMS) on PICCs placed in critically ill and hospitalized medical patients between January 1, 2015, and July 26, 2019, we examined the association between ID physician approval of PICC insertion for IV antibiotics and device appropriateness and outcomes. Appropriateness was defined according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) as a composite measure of (1) avoiding PICC use for durations ≤5 days; (2) using single-lumen instead of multilumen catheters; and (3) avoiding PICC use in patients with chronic kidney disease (eGFR>45 mL/min). The associations between ID approval of PICC use and odds of PICC-related complications (eg, deep vein thrombosis, central-line–associated bloodstream infection, and catheter occlusion) were also assessed. Multivariable models adjusting for patient severity of illness and hospital-level clustering were fit to both outcomes. Results were expressed as odds ratios (ORs) with corresponding 95% CIs. Results: Data from 36,594 patients who underwent PICC placement across 42 Michigan hospitals were included in the analysis. In total, 21,653 (55%) PICCs were placed for the indication of IV antibiotics; 14,935 (69%) of these had a documented ID consultation prior to placement, whereas 6,718 (31%) did not. Of the 14,935 PICCs with an ID consultation, 10,238 (69%) had ID approval documented prior to device placement (Fig. 1). Compared to no approval, PICCs approved by ID prior to insertion were more likely to be appropriate (OR, 3.51; 95% CI, 3.28–3.77; P < .001). Specifically, approval was associated with higher single-lumen use (OR, 5.13; 95% CI, 4.72–5.58; P < .001), less placement of PICCs with dwell times ≤ 5 days (OR, 0.29; 95% CI, 0.25–0.32; P < .001), and less frequent use in patients with chronic kidney disease (OR, 0.80; 95% CI, 0.73–0.87; P < .001). ID approval of PICCs prior to insertion was associated with a significantly lower odds of PICC-related complications (OR, 0.57; 95% CI, 0.51–0.64) (Table 1). Conclusions: ID approval of PICC use for IV antibiotic therapy in hospitalized patients was associated with greater appropriateness and fewer complications. Policies aimed at ensuring ID review prior to PICC use may help improve patient and device safety.Funding: NoneDisclosures:Valerie M. Vaughn reports contract research for Blue Cross and Blue Shield of Michigan, the Department of Veterans’ Affairs, the NIH, the SHEA, and the APIC. She also reports fees from the Gordon and Betty Moore Foundation Speaker’s Bureau, the CDC, the Pew Research Trust, Sepsis Alliance, and The Hospital and Health System Association of Pennsylvania.

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Category: Foot & Ankle Introduction/Purpose: Medical coverage gap in United States refers to people who are uninsured because the state they are living has still opted-out of Medicaid expansion under Patient Protection and Affordable Care Act (PPACA) and they are too poor to be benefited from subsidies designed for middle-class Americans. A large percentage of this population lives in south. Despite increasing participation of the states in expanded Medicaid, it is still unclear that if such an expansion has led to improve the access to care. However, approximately one in three American is covered under Blue Cross Blue Shield (BCBS) private insurance. The purpose of this study is to determine the access to foot and ankle care based on medical insurance, nature of illness and Medicaid expansion of the state. Methods: Five pairs of Medicaid expended (California, New York, Ohio, Minnesota and Washington) and non-expanded (Utah, Texas, Alabama, Missouri, and North Carolina) states with different geographic location were selected for the study. Twenty providers from each state were randomly selected via American Orthopedic Foot & Ankle Society (AOFAS) directory with private or academic affiliations. Each provider’s office was contacted by fictitious call for the earliest available appointment in foot and ankle clinic. A standardized script was used by the same researcher every time for a 30 year old male patient with acute Achilles tendon rupture or chronic bunion with either Medicaid or BCBS insurances. Available appointment for physician was considered as an access to foot and ankle care. We registered time until appointment (if given) and reason for denial (if denied) on phone. We also recorded requirements for insurance details, PCP (Primary Care Physician) referral or imaging records. Results: 200 providers’ offices were contacted on phone for foot and ankle clinic appointment. Successful appointment was given by 36%(72/200) offices irrespective of condition and insurance. 29% of calls with Medicaid could successfully schedule an appointment compared to 43% when calling with BCBS(P=0.03). Success rate for appointment was same for Achilles rupture and Bunion (36% each). The mean time until earliest appointment was 10.7(range 1-37) days with Medicaid and 10.5 (range 1-45) days with BCBS. For Medicaid patients, no significant difference was found in appointment rates between expanded states (30%) and non-expanded (28%) states (P=0.82). Overall appointment success rate was highest in Utah (65%) and lowest in New York (10%). Differences were observed across geographical locations, as well as between academic and private institutes. Conclusion: In our study, access to foot and ankle care clinic seems to be significantly better with BCBS private insurance compared to Medicaid. Sample size is surely a limitation, but we have included more states than similarly-designed studies for better geographic variability. There was no significant difference for appointment wait-time between Achilles tendon rupture and Bunion as well as Medicaid and BCBS insurance. Medicaid expansion facility in the state has not been associated with higher success rate but associated with lengthening of wait-time. Inability to provide insurance details or PCP-referral is definitely an important barrier for the access to podiatric care.

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Abstract Background: The Memphis Statistical Area, which covers counties in Arkansas, Mississippi, and Tennessee, leads in disparities in mortality rates between Black breast cancer patients compared to White counterparts1. Urban Health Education & Support Services (UHESS), in partnership with RabbleHealth, and West Cancer Center & Research Institute (WCCRI), initiated a solutions-oriented, community-based scalable initiative in January 2023 to measurably address social determinants of health (SDOH), which often drive cancer inequities that disproportionately impact individuals of marginalized communities. By leveraging a community-driven, co-creation sustainable approach, the team sought to measurably improve breast cancer equality utilizing digital enablement and the knowledge of local breast cancer survivors and leading healthcare professionals, including navigators. Methods: A four-phase approach was leveraged to 1. improve access to locally available breast cancer services in communities that are traditionally underserved and 2. measure the public health impact against root causes of breast inequities (i.e., care pathway metrics), and 3. create a repeatable, scalable model to expand to other underserved communities. In Phase 1, UHESS leveraged the Mid-South Regional Breast Cancer Coalition, which convenes ten local breast cancer patient advocacy organizations, to recruit focus groups for co-creation throughout all phases of the initiative. The working group consisted of eight representatives from a variety of Memphis-based cancer organizations, faith-based organizations, navigator programs, and WCCRI. This phase centered around establishing trust with the local patient advocacy community. In Phase 2, an initial patient survey was circulated to identify key resources that reduce health inequities and barriers to access. Human-centered design facilitators supported a series of Listen & Learn workshops with patients to convey root causes of gaps in access to relevant services and with navigators to understand professional needs of navigators and scale the ability improve patient access to resources. To co-create a solution, facilitated patient and navigator workshops were held in Phase 3 to gather patient-centric user experience and design enhancements for a digital patient engagement app. These requirements as well as navigator-defined metrics needs were digitized and organized by SDoH. Phase 4, the Deploy & Measure phase, will begin in September of 2023 and the community-based deployment model focuses on three drivers including: (a) embedding within navigator workflow, (b) activating faith-based organizations, and (c) leveraging societies. Health equity performance data will be analyzed weekly to rapidly target those ZIP codes with the greatest need. Results: Co-design efforts included over 50 members of the Greater Memphis community and final initiative results will be presented at the meeting. Planning for further research regarding community impact and model scalability is already underway. Conclusion: By leveraging a community-driven, co-creation sustainable approach, this model enables a better way to measurably improve breast cancer equality utilizing digital enablement and the knowledge of local breast cancer survivors and leading healthcare professionals, including navigators. Initiative Funding Acknowledgements: Gilead Life Sciences & Blue Cross Blue Shield of Tennessee Foundation 1. Vidal G, Bursac Z, Miranda-Carboni G, White-Means S, Starlard-Davenport A. Racial disparities in survival outcomes by breast tumor subtype among African American women in Memphis, Tennessee. Cancer Med. 2017 Jul;6(7):1776-1786. doi: 10.1002/cam4.1117. Epub 2017 Jun 14. PMID: 28612435; PMCID: PMC5504313. Citation Format: Gregory Vidal, Stacey Tinianov, Aubrey Kelly, Andrea Curry, Carla Baker. Addressing Breast Cancer Disparities: Co-Creating Digital Interventions with Patients, Navigators & the Community to Address Social Determinants of Health in the Memphis Statistical Area [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-10.

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BackgroundMost people with bipolar disorder spend a significant percentage of their lifetime experiencing either subsyndromal depressive symptoms or major depressive episodes, which contribute greatly to the high levels of disability and mortality associated with the disorder. Despite the importance of bipolar depression, there are only a small number of recognised treatment options available. Consecutive treatment failures can quickly exhaust these options leading to treatment-resistant bipolar depression (TRBD). Remarkably few studies have evaluated TRBD and those available lack a comprehensive definition of multi-therapy-resistant bipolar depression (MTRBD).AimsTo reach consensus regarding threshold definitions criteria for TRBD and MTRBD.MethodBased on the evidence of standard treatments available in the latest bipolar disorder treatment guidelines, TRBD and MTRBD criteria were agreed by a representative panel of bipolar disorder experts using a modified Delphi method.ResultsTRBD criteria in bipolar depression was defined as failure to reach sustained symptomatic remission for 8 consecutive weeks after two different treatment trials, at adequate therapeutic doses, with at least two recommended monotherapy treatments or at least one monotherapy treatment and another combination treatment. MTRBD included the same initial definition as TRBD, with the addition of failure of at least one trial with an antidepressant, a psychological treatment and a course of electroconvulsive therapy.ConclusionsThe proposed TRBD and MTRBD criteria may provide an important signpost to help clinicians, researchers and stakeholders in judging how and when to consider new non-standard treatments. However, some challenging diagnostic and therapeutic issues were identified in the consensus process that need further evaluation and research.Declaration of interestIn the past 3 years, M.B. has received grant/research support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, MBF, NHMRC, Beyond Blue, Rotary Health, Geelong Medical Research Foundation, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Meat and Livestock Board, Organon, Novartis, Mayne Pharma, Servier, Woolworths, Avant and the Harry Windsor Foundation, has been a speaker for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck, Merck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Eli Lilly, Grunbiotics, Glaxo SmithKline, Janssen Cilag, LivaNova, Lundbeck, Merck, Mylan, Otsuka, Pfizer and Servier. A.J.C. has in the past 3 years received honoraria for speaking from Astra Zeneca and Lundbeck, honoraria for consulting from Allergan, Janssen, Lundbeck and LivaNova and research grant support from Lundbeck. G.M.G. holds shares in P1Vital and has served as consultant, advisor or CME speaker for Allergan, Angelini, Compass pathways, MSD, Lundbeck, Otsuka, Takeda, Medscape, Minervra, P1Vital, Pfizer, Servier, Shire and Sun Pharma. J.G. has received research funding from National Institute for Health Research, Medical Research Council, Stanley Medical Research Institute and Wellcome. H.G. received grants/research support, consulting fees or honoraria from Gedeon Richter, Genericon, Janssen Cilag, Lundbeck, Otsuka, Pfizer and Servier. R.H.M.-W. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending advisory boards) from various pharmaceutical companies including Astra Zeneca, Cyberonics, Eli Lilly, Janssen, Liva Nova, Lundbeck, MyTomorrows, Otsuka, Pfizer, Roche, Servier, SPIMACO and Sunovion. R.M. has received research support from Big White Wall, Electromedical Products, Johnson and Johnson, Magstim and P1Vital. S.N. received honoraria from Lundbeck, Jensen and Otsuka. J.C.S. has received funds for research from Alkermes, Pfizer, Allergan, J&J, BMS and been a speaker or consultant for Astellas, Abbott, Sunovion, Sanofi. S.W has, within the past 3 years, attended advisory boards for Sunovion and LivaNova and has undertaken paid lectures for Lundbeck. D.J.S. has received honoraria from Lundbeck. T.S. has reported grants from Pathway Genomics, Stanley Medical Research Institute and Palo Alto Health Sciences; consulting fees from Sunovion Pharamaceuticals Inc.; honoraria from Medscape Education, Global Medical Education and CMEology; and royalties from Jones and Bartlett, UpToDate and Hogrefe Publishing. S.P. has served as a consultant or speaker for Janssen, and Sunovion. P.T. has received consultancy fees as an advisory board member from the following companies: Galen Limited, Sunovion Pharmaceuticals Europe Ltd, myTomorrows and LivaNova. E.V. received grants/ research support, consulting fees or honoraria from Abbott, AB-Biotics, Allergan, Angelini, Dainippon Sumitomo, Ferrer, Gedeon Richter, Janssen, Lundbeck, Otsuka and Sunovion. L.N.Y. has received grants/research support, consulting fees or honoraria from Allergan, Alkermes, Dainippon Sumitomo, Janssen, Lundbeck, Otsuka, Sanofi, Servier, Sunovion, Teva and Valeant. A.H.Y. has undertaken paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders and LivaNova. He has also previously received funding for investigator-initiated studies from AstraZeneca, Eli Lilly, Lundbeck and Wyeth. P.R.A.S. has received research funding support from Corcept Therapeutics Inc. Corcept Therapeutics Inc fully funded attendance at their internal conference in California USA and all related expenses. He has received grant funding from the Medical Research Council UK for a collaborative study with Janssen Research and Development LLC. Janssen Research and Development LLC are providing non-financial contributions to support this study. P.R.A.S. has received a presentation fee from Indivior and an advisory board fee from LivaNova.

Abstract:

Abstract Introduction: VTE affects 1.6-1.8/1000 hospitalized patients per year; active cancer increases the rate of VTE 6-fold. Despite the high risk of VTE, studies show cancer patients receive inpatient VTE prophylaxis at a lower rate than general medical patients. In addition, VTE prophylaxis is often held for a platelet value of <50x109/L, despite a lack of evidence. Current recommendations for all inpatients with cancer (and no contraindication to blood thinners) are to receive prophylactic anticoagulation, regardless of an increased bleeding tendency in this population. A formal risk:benefit ratio of inpatient VTE prophylaxis for cancer patients has not been evaluated to date. Methods: The Michigan Hospital Medicine Safety Consortium, a 49 hospital quality collaborative, has prospectively collected data on VTE risk factors and outcomes in medical patients > 18 years of age. Exclusion criteria include surgical patients, pregnancy, admission to the ICU or for palliative care, therapeutic anticoagulation, diagnosis of acute thrombus, history of VTE within 6 months, and length of stay < 2 days. We compared rates of VTE prophylaxis, bleeding and new VTE between cancer and general medicine patients who were eligible for prophylaxis (i.e. no contraindications including active bleed within 3 months, coagulopathy, or high risk brain metastasis). Student's t-test was used for continuous variables and chi-square for categorical data. Logistic regression was used to calculate odds ratio (OR). The number needed to treat and number needed to harm were used to derive a risk:benefit ratio. Results: Between 7/2012-7/2015, 86,634 admissions were captured in the cohort; 70,086 were eligible for VTE prophylaxis and included in this analysis. 22% of cases had a diagnosis of cancer. Table 1. Demographics on Admission Cancer (n= 15,166), % General Medicine (n=54,920), % p Race (Caucasian) 82.3 74.3 <0.001 Age mean yrs (SD) 72.5 (14.4) 63.7 (18.8) <0.001 Gender (female) 53.6 56.5 <0.001 Central Line 17.8 4.1 <0.001 History of VTE 7.6 5.3 <0.001 Caprini risk score ≥ 5 88.1 35.8 <0.001 Charleston Index mean (SD) 5.1 (2.5) 2.1 (2.0) <0.001 Ever Smoked 59.6 56.3 <0.001 Obese 29.3 37.1 <0.001 Surgery w/in 30 days 3.6 2.1 <0.001 Trauma w/in 30 days 0.3 0.4 0.01 Of cancer admissions, 89.5% had solid tumors, 13.5% hematologic malignancies, 3.4% both and 20% metastatic disease. Active treatment for cancer was delivered <6 months from index admission in 32.1%, within 6-12 mo in 3.2%, >12 mo in 44.4% and no treatment or unknown in 20.3%. When compared to general medical admissions, cancer admissions were more likely to receive VTE prophylaxis (72.16% vs 69.21%, p<0.001), and have a new VTE out to 90 days post discharge despite prophylaxis (0.91% vs 0.45%, p<0.001, unadjusted OR 2.07 (95% CI 1.6-2.7)). There was no difference in VTE rate with regard to platelet count in cancer cases (0.43% for plt < 50 vs 1.08% for plt ≥ 50, p=0.10). Among all patients receiving VTE prophylaxis, bleeding was more common in cancer cases (major bleeding 0.84% vs 0.58%, p=0.005; minor bleeding 1.80% vs 1.36%, p=0.002). Among cancer cases, bleeding rates were higher in patients with platelet <50 vs ≥ 50 (major bleed 4.86% vs 1.88%, p<0.001; minor bleed 2.88% vs 1.7%, p=0.04). Table 2. The Number Needed to Treat (NNT) to Prevent One VTE During Admission or 90 Days Post Discharge and Number Needed to Harm (NNH) to Cause One Major Bleed During Admission with Risk:Benefit Ratio (NNH:NNT) General Medicine Cancer NNT 1428 NNT 1000 NNH 2500 NNH 277.9 NNH:NNT 1.75 NNH:NNT 0.28 Conclusions: In this prospective inpatient cohort, we compared general medicine to cancer cases and found cancer admissions received VTE prophylaxis at a higher rate. This is different than previously reported data, likely due to the exclusion of patients with contraindications to prophylaxis. However, despite prophylaxis, cancer patients had a higher rate of VTE during admission and 90 days post discharge as well as more bleeding complications. The risk:benefit ratio of VTE prophylaxis is 6 times worse in cancer patients due to bleeding. While bleeding occurs more frequently in cancer patients with platelet count <50x109/L, VTE occurs at a similar rate regardless of platelet count, meaning that cancer patients are at high risk of both clotting and bleeding. Recommendations for inpatient VTE prophylaxis for cancer patients require a targeted approach to identify a subset who would most benefit from VTE prophylaxis. Disclosures Flanders: Institute for Healthcare Improvement and the Society of Hospital Medicine: Consultancy; Wiley Publishing: Patents & Royalties; CDC Foundation: Research Funding; Blue Cross Blue Shield of Michigan: Research Funding; Michigan Hospital Association: Research Funding. Sood:Bayer: Research Funding.

Abstract:

My father was a true blue “promdi” from Angeles City, Pampanga. A son of a humble businessman who grew up with 3 siblings. A happy-go-lucky teenager who sometimes got into trouble with the usual traps of growing up and never really cared about his future. With the carefree attitude growing up, he was given an ultimatum by my grandfather. “Son, if you won’t study and don’t get serious with your life, you will be a bum or a beggar on the street.” Having an epiphany, he started getting inspiration from an uncle who was an EENT doctor -- observing in his clinic during summer and that started the fire that built his career of becoming a doctor. He graduated from the University of Santo Tomas Faculty of Medicine in Manila in 1959 then flew to the United States and had seven years of specialization -- first at the Elmhurst Hospital, New York City where he became Chief Resident in Otolaryngology. Not content with his training in ENT he decided to take a second specialty in Ophthalmology, with a three-year residency in Toronto East General Hospital in Canada. He could have stayed in North America to practice but opted to return to his hometown and serve his fellow Kapampangans, establishing Clinica Henson Eye, Ear, Nose and Throat Center in Angeles City. He always liked to tell stories about his residency training days in the US. They did a lot of stapedectomy cases during those times and after every procedure the surgeon whispered in the ear of the patient and asked, “Who is the president of the United States” and the patient should answer “John F. Kennedy.” A memorable situation was while he was doing a tonsillectomy, the nurse said out loud that JFK had been just been assassinated. The most memorable memento he brought home after his training was a Zeiss operating microscope. His mentors told him he should buy one and bring it home to better diagnose and manage ENT cases especially otologic procedures. They said it was a good investment since his children could also use it in their future practice. I’m happy and proud to say that we still use this microscope in our clinic OPD in Angeles City. His thirst for learning and improving his craft continued as he grew his practice. He did further training in Facial Plastic and Cosmetic Surgery in the 70’s at the University of California at Davies Sacramento USA and Shirakabe Clinic Osaka, Japan with the guidance of his mentor Dr. Jose Mathay. He eventually set up a cosmetic surgery clinic along Roxas Blvd in the 80’s and was one of the founding members of the Philippine Society for Cosmetic Surgery. His core competence was Rhinoplasty using silicone implant during those days. My mom, a fine arts graduate and portrait artist, helped in carving and designing the silicone implants. I must say that they were a perfect combination. Most of his patients were the wives of military officers and personnel from Clark Air Force base during the 70’s and 80’s. He also practiced in St. Luke’s Medical Center, Quezon City. Passion for teaching also led him to be a Professor of Otolaryngology at the University of the East Ramon Magsaysay Memorial Medical Hospital and Angeles University Foundation. I remember one of his students in UERM told me that his lectures also included life lessons, how to enjoy your practice and how to be a well-rounded doctor. He inspired a lot of students and residents who trained under him. Growing up as the child of a doctor, my siblings and I were enthralled by his life as a medical man. He was well-respected in the community not just in medicine but also in government service. His passion to serve brought him into politics and he once served as a provincial Board Member of the province of Pampanga during the Cory Aquino administration. He was also very active in the Rotary Club both locally and internationally. He was a people person and everyone knew him. He had that certain charisma that lights up the room. As a family, we were known to be a tennis team. Everybody played including my mom and my brothers. He also enjoyed playing golf with my mom-- and don’t even ask who was the better player! Family dinner was usually spent in debates about medical and surgical cases with my mother as the referee. He really took care of his patients. He always reminded us to give the best service to our patients because they travelled from faraway places just to see you. He never gave up even on challenging cases. I was always in awe when I saw him do local anesthesia on patients undergoing tonsillectomy and Caldwell Luc procedures after my residency. He always advocated using local anesthesia on almost all his surgical procedures. Seeing patients with him in the clinic has taught me a lot but it was also interesting and challenging because we sometimes debated on treatments in front of a patient. I enjoyed travelling with him during conferences and courses abroad. He liked to update himself by observing in FESS, temporal bone and oculoplasty courses. These were our bonding moments as father and son and also with my brother Raoul who is an ophthalmologist[1]oculoplastic surgeon. One thing I miss most about him is when we used to do surgery together. When my brother and I encounter difficult or challenging cases he was always there to provide advice on how to go about it. I am indeed lucky to have a father with the same passion and vocation. I hope I can continue the legacy with my children. I hope my father remains to be an inspiration to his former students and residents. A true gentleman to his family, profession and the community he served.

Abstract:

Abstract Advances in novel agents and treatment combinations have improved prognosis and increased disease-free and overall survival for patients (pts) with multiple myeloma (MM). However, currently available data on disease presentation, treatment patterns, and outcomes for real-world MM pts at the global level are limited. This is due to several factors, including the overrepresentation of medically fit pts in clinical trials making generalization of outcomes challenging, the large number of treatment combinations, and varying global access/practice patterns. INSIGHT-MM (NCT02761187) is a global, prospective, non-interventional, observational study which aims to further understand disease and pt characteristics at presentation, treatment and clinical outcomes of real-world MM pts, as well as the association of treatment with tolerability, effectiveness, health-related quality of life (HRQoL), and healthcare resource utilization (HRU), on both a country-specific and global basis. As this is an observational study, no formal hypothesis will be tested. The INSIGHT-MM objectives are summarized in the Table. At least 5000 pts aged ≥18 yrs with newly diagnosed or relapsed/refractory MM will be enrolled over a 3-yr period and followed prospectively for ≥5 yrs, until death or end of study, whichever comes first. Pts not available for data collection for >9 mos will have follow-up for survival. No study drug or medications will be provided; no modification of standard of care pt management will be assigned per protocol. Choice of therapy for all pts will be decided by the treating healthcare provider independent of study participation. Baseline pt and MM-specific characteristics, diagnosis, comorbidities, and prior therapies will be recorded based on review of hospital/clinic records. MM management, disease status and safety data will be obtained as part of routine office visits and recorded quarterly by each site in electronic case report forms. Quarterly assessment of MM management will be done based on prior and current treatment and recorded reason for treatment changes. Effectiveness of therapy will be assessed based on response, progression status, time to next therapy, vital status, and date and cause of death. Treatment tolerability will be assessed based on serious and non-serious adverse events leading to treatment discontinuation or dose modification. Incidence of second primary malignancies will be recorded. HRQoL, a specific type of patient reported outcome (PRO), will be collected at study entry and at predefined intervals following initiation of therapy using a secure electronic data collection system. HRQoL will be collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the MM module (EORTC QLQ-MY20). To capture pt satisfaction with MM-directed therapy, including the dimension of convenience, the 9-item Treatment Satisfaction Questionnaire for Medication will be used. The 5-dimension, 5-level EuroQol (EQ-5D-5L) PRO instrument will capture self-reported preference-based measures of health status suitable for calculating quality-adjusted life year (QALY) data to inform health economic evaluations. Frailty will be assessed using the Charlson Comorbidity Index, the Katz Index of Independence in Activities of Daily Living, and the Lawton Instrumental Activities of Daily Living. HRU will be evaluated using inpatient and intensive care unit admissions, length of stay, outpatient clinic visits, and emergency room visits. Data for all participating pts will be extracted by healthcare professionals at the site level and entered into a central database; descriptive statistical analyses will be done to address the study objectives. Interim analyses are planned after 1000 and 5000 pts have been enrolled and a final analysis will be conducted within 1 year after the last pt entered has completed ≥5 yrs follow-up. Data will be analyzed biannually to address emerging clinical questions identified by investigators to increase understanding of real-world treatment patterns. INSIGHT-MM aims to promote better understanding of contemporary demographics, patterns of care, and outcomes for real-world MM pts to inform treatment practice, supportive care, and pt outcomes. The study is currently ongoing and recruiting pts; further details regarding study rationale and protocol will be provided. Table 1 Table 1. Disclosures Davies: Takeda: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria. Palumbo:Janssen Cilag: Honoraria; Takeda: Employment, Honoraria. Zonder:Bristol Myers Squibb: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Prothena: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Pharmacyclics: Other: DSMC membership. Girnius:Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Speakers Bureau. Costello:Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Usmani:Array: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amgen: Consultancy, Research Funding, Speakers Bureau; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Millenium: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Onyx: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; BioPharma: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Pharmacyclics: Research Funding; Britsol-Myers Squibb: Consultancy, Research Funding; Skyline: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Speakers Bureau. Berdeja:Abbvie, Acetylon, Amgen, Bluebird, BMS, Calithera, Celgene, Constellation, Curis, Epizyme, Janssen, Karyopharm, Kesios, Novartis, Onyx, Takeda, Tragara: Research Funding. Omel:Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Member of Takeda's "Patient Leadership Council". Token payment. Thompson:Celgene: Membership on an entity's Board of Directors or advisory committees, Other: MDS/AML Registry; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; AIM Specialty Health: Membership on an entity's Board of Directors or advisory committees; VIA Oncology: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees, Other: Multiple Myeloma International Registry; Doximity: Equity Ownership, Membership on an entity's Board of Directors or advisory committees. Shah:Array: Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria, Research Funding; Bristol-Myers Squibb: Research Funding; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Schwartz:Bayer: Consultancy; Blue Cross and Blue Shield Associations: Consultancy; Pfizer: Consultancy; Takeda: Consultancy. Hajek:Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees. Terpos:Amgen: Consultancy, Honoraria, Research Funding; Celgene: Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Genesis: Consultancy, Honoraria, Research Funding; Novartis: Honoraria. Hungria:Takeda: Consultancy; Roche: Consultancy; International Myeloma Foundation Latin America: Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Speakers Bureau; Bristol: Consultancy; Amgen: Consultancy. Mateos:Takeda: Honoraria; Amgen: Honoraria; Janssen: Honoraria; Celgene: Honoraria. Cook:Bristol-Myers Squibb: Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Research Funding, Speakers Bureau; Glycomimetics: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau; Sanofi: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau. Leleu:Novartis: Honoraria; LeoPharma: Honoraria; Pierre Fabre: Honoraria; Amgen: Honoraria; Bristol-Myers Squibb: Honoraria; Takeda: Honoraria; Celgene: Honoraria; Janssen: Honoraria; TEVA: Membership on an entity's Board of Directors or advisory committees. Goldschmidt:Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; Chugai: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium: Membership on an entity's Board of Directors or advisory committees, Research Funding; Onyx: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees. Seal:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment, Equity Ownership. Pashos:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Stull:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Romanus:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Cacioppo:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Bell:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment, Equity Ownership. Yu:Takeda Restricted Stock Unit (RSU), a publicly traded company: Equity Ownership; Takeda Development Center Americas, Inc., Deerfield, IL, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Luptakova:Takeda Oncology: Employment. Niculescu:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Noga:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment, Equity Ownership. Skacel:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Chari:Array Biopharma: Consultancy, Research Funding; Amgen Inc.: Honoraria, Research Funding; Celgene: Consultancy, Research Funding; Takeda: Consultancy, Research Funding; Pharmacyclics: Research Funding; Novartis: Consultancy, Research Funding; Janssen: Consultancy, Research Funding.

Abstract:

Whether one is employed in a nonprofit or for-profit organisation, inspiring employees to live the brand requires an orchestrated coordination of brand values, employee engagement, organisational culture and leadership style. This paper demonstrates how a strong organisational brand highlights the role of the CEO and executive team in engaging employees. Several for-profit and nonprofit organisational examples are provided — Blue Cross Blue Shield, Disney, California Dental Association, Lululemon, Rush University Medical Center, Stamford University, Southwest, World Wildlife Fund and Zurich — and concepts are applied to the current stage of the College of American Pathologists (CAP). Specific concepts include authenticity, elevator pitch, storytelling and brand ambassadors.

Abstract:

Blue Shield of California's Community Health Advocate Program was created to support whole person-health needs by helping individuals of all socio-economic statuses navigate and access community resources, social services, and medical systems. Blue Shield's Health Reimagined team is partnering with medical providers, community resources centers, and community partners to provide intensive person-centered and technology-enabled care to patients, ensuring social needs are met while promoting health equity. A key aspect of the Health Reimagined initiative embeds Community Health Advocates (CHAs) within physician practices serving patients using a payor-agnostic approach, by which Blue Shield aims to increase access to social services and community resources, improve health outcomes, reduce medical costs, and improve overall patient experience. The purpose of this case study is to understand the provider's perspective of embedding a CHA into the care team and the resulting impact on the practice and patients. Blue Shield also sought to identify best practices and barriers of a CHA program within primary and specialty care practices. As part of an ongoing two-year mixed-methods impact evaluation (2019–2021), 10 semi-structured interviews were conducted with a total of 18 providers and office staff at five primary care and specialty practices where CHAs have been embedded. We also conducted two focus groups with the same five CHAs at different points in time. Several themes emerged from the provider, office staff, and CHA interviews. Provider practices found great value in adding a CHA to their care team as the CHA brings flexibility and continuity to patient care. They also found that having access to a CHA with shared life experiences of the communities they served is a key component to the program's success. Providers and staff reported a new understanding of the social determinants of health that impacts a patient's wellbeing with the embedding of a CHA in the care team. Overall, practitioners expressed high satisfaction with the CHA program. During the COVID-19 pandemic, CHAs have been critically important in care, as social needs have increased, and resources have shifted. The CHA program is constantly adapting to address challenges faced by all stakeholders and applying new knowledge to ensure best practices are implemented within the CHA program.

Abstract:

Introduction: The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan that aims to improve the treatment of diabetes through three initiatives-encouraging increased prescribing of continuous glucose monitoring (CGM), SGLT2i/GLP-1RA medications, and low carbohydrate diet (LCD), defined as 80-130 total grams of carbohydrates per day, with patients on an SGLT2i instructed to stay &gt;100g among 264 primary care practices. The aim of this study was to evaluate physician experience prescribing LCD through case studies. Methods: Each physician participating in MCT2D submitted a case study evaluating their experience implementing MCT2D initiatives. Close-ended questions were assessed using a 4-point scale (Yes, Somewhat, Too Early to Tell, No). Open-ended responses on intervention success were analyzed using a multi-step process of data immersion, generating initial codes, and reorganization. Results: Physicians prescribed a LCD either alone or in combination with CGM and/or SGLT2i/GLP-1RA in 375 of 970 case studies. More than half (51.5%) reported that the intervention(s) achieved the target outcome. Case studies incorporating all three interventions were associated with greater physician satisfaction with results, as compared to diet alone (p&lt;0.01). Five major themes regarding intervention effectiveness were: glycemic control, weight loss, patient motivation, simplification of medications, and combined benefit of multiple interventions. Improvement of blood glucose was reported in 45.9% of LCD alone cases and in 69.1% of cases that involved all three interventions. An increase in patient motivation to achieve improvement in health was most frequently discussed in cases where diet and CGM were combined (67.3%). Conclusion: LCD may have a synergistic effect with the use of CGM and newer medications. These exploratory findings require confirmation through future investigations. Disclosure K.L.Khosrovaneh: None. H.L.Diez: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck & Co., Inc., Procter & Gamble, Johnson & Johnson, Eli Lilly and Company. N.Kim: None. J.Rau: None. J.Reiss: None. R.Hisamatsu: None. D.H.Griauzde: None. L.A.Young: None. J.Weisensel: None. J.E.Aikens: None.

Abstract:

Objective: The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan. MCT2D aims to improve type 2 diabetes care by encouraging prescribing of continuous glucose monitoring (CGM), SGLT2i/GLP-1RA medications, and low carbohydrate diets. The study’s purpose was to describe clinic-level resources and barriers to CGM initiation in counties with high and low social vulnerabilities. Methods: We surveyed primary care practice providers about practice-level CGM patient education and barriers, and providers’ understanding of insurance coverage. 169 of 264 practices (64%) completed the survey. We classified practices as high vulnerability (HV; quartile 4), or low vulnerability (LV; quartiles 1-3) using the county-level CDC Social Vulnerability Index. Results: Among HV practices, the main CGM education was prescriber instruction (61.5%), while for LV it was printed material (69.8%). For both HV and LV practices the second most common educational resource was web links (53.9% and 51.6%, respectively). For both practice types, the most common barrier to CGM was patients’ lack of smartphone (60.5%, 62.4%, respectively), followed by patients’ lack of internet (55.3%) for HV practices and patients’ ability to use CGM (38.5%) for LV practices. Provider understanding of Michigan Medicaid CGM coverage policy was similar across practices with most reporting incorrectly that it was akin to Medicare (≥3 injections daily) (35.3% (HV) and 44.0% (LV)) or reporting lack of awareness of coverage (32.4% (HV) and 24.1% (LV)). Conclusions: There is a mismatch between practices’ educational approaches and patients’ access to technology. Improved transparency of CGM coverage criteria would enhance provider understanding and promote equitable access for patients. Limitations include that the data is county-level and further analysis evaluating other practice level social determinants of health is needed. Disclosure K.L.Khosrovaneh: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. C.D.Jamison: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. H.L.Diez: None. J.E.Aikens: None. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck & Co., Inc., Procter & Gamble, Johnson & Johnson, Eli Lilly and Company. J.Rau: None. J.Reiss: None. L.A.Young: None. J.Weisensel: None. P.Okeke: None. K.R.Mizokami-stout: None.

Abstract:

AbstractAlthough the promotion of biodiversity has been recognized as an important conservation goal, salt marsh restoration typically focuses on reestablishing dominant foundation species. Salt marsh restoration projects that add or remove sediment to optimize marsh elevation often result in a bare landscape following construction. Restoration managers must decide whether to plant and, if so, which species. This decision can be difficult because few studies have examined the ecological functions of individual species, especially those that are less abundant. Within a major salt marsh restoration project in Elkhorn Slough, California, where 17,000 plants of five high marsh species were planted, we investigated how rarer species and the naturally recruiting dominant (Salicornia pacifica) differ in ecosystem function. We evaluated 31 different metrics related to blue carbon, plant productivity, environmental effects, and community interactions. No single species had the greatest ecological function across this suite of metrics, and measured effects were mainly independent, with only 16 of 435 pairwise comparisons revealing a strong correlation. We found significant differences among species for 18 metrics, revealing key contrasts in ecosystem function, with significant effects of marsh elevation and interaction between effects of species and elevation on some of these functions. S. pacifica scored highest for metrics such as recruitment and canopy height but other species outperformed Salicornia in other metrics. Frankenia salina had the greatest ecological function in the highest number of metrics, including cover and belowground biomass carbon content, but other species had higher rates of photosynthesis and harbored fewer individuals of invasive arthropods. We recommend planting a suite of less common species at restoration sites to provide more diverse functions across the landscape. F. salina in particular is recommended for its tolerance of hypersalinity and low moisture conditions. Our demonstration of the value of complementing restoration of the dominant foundation species with restoration of less common species is applicable to restoration of other ecosystems beyond salt marshes. The approach we implemented, evaluating a large suite of functions for multiple species across a restored landscape, can serve as a model for investigations of the importance of biodiversity for enhancing multifunctionality in other restored ecosystems.

Abstract:

IntroductionPrevious research has shown that through the complex network of factors, it is necessary to identify determinants that influence healthy food consumption patterns in preschool‐aged children (3–5 years old). The family food environment, including parental consumption and availability, has been shown to be a strong indicator of child's food preference.ObjectiveThe primary objective of this study is to provide cross sectional information on specific foods in preschool participants' (3–5 years old) households using a validated home food inventory survey, and to explore if the foods in the home are representative of parental diets.MethodsChildren from 13 low‐income childcare centers in East Tennessee participated in a 12‐week physical activity and nutrition program, which included a parent education portion. Parents (n =35) submitted baseline questionnaires (demographics, socioeconomic characteristics, shopping habits, food security), food‐frequency questionnaires and 108‐item home food inventory surveys at two points of time during the program.ResultsComplete data were collected from 35 parents (32.34 ± 9.4). 41.6% received food assistance (n=10, no data for n=11) and 45.7% of parents reported household income less than $50,000 (n=16). This predefined inventory assessed a broad range of food groups to capture the variation of all items in a household. Several “healthy” and “unhealthy” products were flagged for variable availability, including low fat sour cream, 2% milk, potatoes and corn, and higher fat condiments. Preliminary data suggest that home food inventory surveys are representative of parental consumption reported on food frequency questionnaires.ConclusionThis study contributes to research on home food availability by identifying the presence of a wide range of food items in the homes of preschool children at two points in time. It also suggests that household food inventories are a practical approach to understanding foods available for consumption in the home as it relates to dietary behaviors.Support or Funding InformationBlue Cross Blue Shield Foundation and East Tennessee Children's Hospital Foundation

Abstract:

Black men are disproportionately impacted by Type 2 diabetes (T2D) and are more likely to die from diabetes complications than non-Hispanic White men. To address the unique challenges this group faces in diabetes self-management, we implemented a 3-month peer-led and empowerment-based DSME/S intervention in metro-Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were recruited and randomized to either the intervention group (n=12) − 10 hours of DSME and 9 hours of DSMS, or to an enhanced usual care (EUC) group (n=13) − 10 hours of DSME. Peer leaders (n=3), trained by certified diabetes care and education specialists (CDCES) who used training materials related to Black men with diabetes, led the sessions (mean age: 59.7 years; 100% Black, male, and with at least some college education). Changes in A1C levels, diabetes self-care activities, and diabetes distress levels were assessed at baseline and post-intervention. In the intervention group, the mean A1C at baseline was 7.73%, SD 2.16, and at follow-up, 7.06%, SD 1.39. The EUC group experienced a 0.13% decrease in A1C levels (p = 0.68). Within the intervention group, differences in average diet and blood-glucose testing scores, both measured using the Summary of Diabetes Self-Care Activities (SDSCA) measure, from baseline were statistically significant [(p = 0.03, mean change: 1.32, SD 1.71) and (p &lt; 0.05, mean change: 0.50, SD 0.74), respectively]; EUC group general diet scores were: p = 0.08, mean change: 1.77. Diabetes distress scores among those who attended 1-6 sessions, ≤ 50%, (n=4): p = 0.92, mean change: −0.75, SD 14.06. Of those who attended 7-12 sessions, &gt; 50%, (n=7), the decrease in score was statistically significant: p = 0.003, mean change: −5.71, SD 3.20. Implementing a peer-led DSMS program for Black men was feasible, adopted, and led to positive changes in outcomes. Scaling up the program is warranted to measure sustainability. Disclosure A.Ewen: None. K.A.Kloss: None. R.Nwankwo: None. M.M.Funnell: None. G.Piatt: None. J.M.Hawkins: None. Funding National Institute on Aging (2P30AG024824–16); Blue Cross Blue Shield Foundation of Michigan (003063.MG)

Abstract:

Background: Effective weight management treatments (WMTs) include nutrition counseling, very low-calorie (VLC) meal replacement, anti-obesity medications (AOMs), and bariatric surgery. Little is known about how these WMTs influence weight change among individual primary care patients and populations. Methods: This was a retrospective cohort study using medical record data from one academic health system. Participants were adults with primary care between October 2015 and March 2020. We used serial cross-sections to examine obesity prevalence and WMT use. We used a multistate model to investigate weight trajectories for patients with obesity and no WMT use prior to baseline. This is a time-to-event model with events representing transitions between 5 successive categories of weight change relative to baseline (i.e., ≥10% weight loss, 5-10% weight loss, baseline weight +/-5%, 5-10% weight gain, or ≥10% weight gain). The primary exposures were WMTs; controls were baseline age, BMI, and prior year primary care. Patients with WMT use were propensity matched 1:1 to controls. The primary outcome was the model-based probability of ≥5% weight loss at 1 year. Results: Among primary patients, the prevalence of obesity increased from 39.2% in 2017 to 40.7% in 2019 (n=138,632); WMT use increased from 2.8% to 8.9% (difference: 6.1%, 95% CI: 5.8-6.4%). In the multistate model (n=10,296), the one-year probability of ≥5% weight loss among patients without WMT exposure was 15.5% [95% CI: 14.8-16.1%]. In contrast, ≥5% weight loss was more likely for patients with year-long exposures to any WMT (nutrition counseling: 23.4%, 95% CI: 21.5-25.3%; VLC meal replacement: 56.4%, 95% CI: 48.7-62.8%; AOMs: 27.8%, 95% CI: 25.1-30.5%; bariatric surgery: 94.4%, 95% CI: 91.1-96.4%). Conclusions: Use of all WMTs increased the probability of achieving ≥5% weight loss at the individual-patient level but underutilization limits their ability to reduce weight at the population-level. Disclosure D.H.Griauzde: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. J.Henderson: None. A.P.Ehlers: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK123416)

Abstract:

Ocean-based industries like shipping, aquaculture, and wind energy are growing at an unprecedented rate resulting in challenges related to siting and environmental management. As marine aquaculture and other ocean-based industries continue to expand, robust marine spatial planning analyses that reconcile existing ocean uses and integrate pertinent environmental and planning data are critical for identifying compatible locations. In this study, a series of geospatial analyses were used for aquaculture siting within and around a heavily trafficked and highly utilized maritime port in the San Diego Bay area of California, USA. Using a centralized geodatabase representing key aquaculture planning spatial datasets, recommendations for specific areas for aquaculture were developed based on appropriate environmental conditions for candidate shellfish and algae aquaculture species culture systems. Areas that were known constraints were first identified to determine potentially usable areas for shellfish and macroalgae (i.e., seaweed) aquaculture using an exclusion analysis, a type of multi-criteria decision analysis, to eliminate all areas without compatibility. Within the remaining usable area, we further considered shellfish and macroalgae culture system-specific factors within a ‘culture systems analysis’ to determine where different culture systems have potential for success. This analysis provides a foundation of coastal intelligence for guiding the aquaculture industry and natural resource managers towards appropriate siting decisions. This study can serve as a replicable example of aquaculture spatial planning approaches for siting sustainable aquaculture and other blue economy industries.

Abstract:

Determining an appropriate set of indicators to show that a water supply is not impacted by wastewater is critical for watershed protection and for potable reuse projects. In 2010 the California State Water Resources Control Board (CA SWRCB) Blue Ribbon Panel issued a set of recommendations for a very short list (7) of compounds to be monitored for re-use projects. In 2009/10 the Santa Ana Watershed Project Authority (SAWPA) developed a separate list of potential wastewater indicator compounds (11) based on a consensus panel, with the intention of sampling all dischargers to the Santa Ana River to determine occurrence. In 2009, the Water Research Foundation (WaterRF) funded project 4167, which examined analytical performance for 22 potential compounds of interest for assessing drinking water. In 2010, a NWRI report suggested primidone as a tracer. In 2009 Buerge et al. demonstrated the effectiveness of artificial sweeteners as conservative wastewater tracers. There is some overlap among these lists but there are also some potential key indicators that are only on a single proposed list and the potential that some are on ‘none’ of the lists. MWH developed a direct online extraction/analysis method using LC-MS-MS for nearly 90 target analytes that covers all of the compounds listed in the projects above. This method has reporting limits for most of the analytes in the 5–10 ng/L range. In 2010 and again in 2011, this technique was used for a SAWPA effluent monitoring project to assess the relative amount of information obtained from the different lists. Samples from 17 wastewater effluents and the downstream receiving water were tested for ∼90 analytes. We compared (a) frequency of detection in the effluent samples (b) concentration range and (c) variability among dischargers. Data were compared to other locations collected across the country and to municipal drinking water sources and distribution system samples to determine the most persistent compounds (and therefore best indicators). The ideal generic tracer should be relatively abundant and show minimal concentration variation. It is apparent that none of the existing lists (SAWPA, SWRCB, WaterRF, primidone, sucralose/acesulfame-K) is a ‘perfect’ list and greater discerning power is obtained by looking at long lists. Specifically the SAWPA list suffers because only one compound, TCEP was detected in all effluent samples, and concentration varied by a factor of 10 among dischargers. The CA SWRCB list suffers because only sucralose was detected in all samples; iopromide was only detected in about 50% of the samples and gemfibrozil in an even smaller number of effluents. Primidone, while occurring in 100% of samples varies by five fold among local sources and thus may not be the ideal tracer. Many of the compounds in the WaterRF list are not even among the most commonly detected analytes in effluents. Taking advantage of the power of a long list covering various classes of compounds it becomes possible to identify both generic (sucralose, acesulfame-K, TCEP, primidone) and specific (iohexal, atenolol, butalbital, caffeine degradates such as theobromine and 1, 7-dimethylxanthine, triazine and degradates) tracers to not only determine the presence of wastewater, but also potential specific primary wastewater sources. Several of the compounds seen most frequently that also have less than ten fold variation include ones not commonly measured (Dehydronifedipine, dilantin, meprobamate). Once the appropriate target analytes are identified for a given set of dischargers, future monitoring can then use a smaller set, but a-priori determination of a short list of indicators may eliminate significant important potential tracer compounds.

Abstract:

I was born illegitimate. Born on an existential precipice. My unwed mother was 36 years old when she relinquished me. I was the fourth baby she was required to give away. After I emerged blood stained and blue tinged – abject, liminal – not only did the nurses refuse me my mother’s touch, I also lost the sound of her voice. Her smell. Her heart beat. Her taste. Her gaze. The silence was multi-sensory. When they told her I was dead, I also lost, within her memory and imagination, my life. I was adopted soon after but not told for over four decades. It was too shameful for even me to know. Imprinted at birth with a psychological ‘death’, I fell, as a Late Discovery Adoptee (LDA), into a socio-cultural and psychological abyss, frozen at birth at the bottom of a parturitive void from where, invisible within family, society, and self I was unable to form an undamaged sense of being.Throughout the 20th century (and for centuries before) this kind of ‘social abortion’ was the dominant script. An adoptee was regarded as a bastard, born of sin, the mother blamed, the father exonerated, and silence demanded (Lynch 28-74). My adoptive mother also sinned. She was infertile. But, in taking me on, she assumed the role of a womb worthy woman, good wife, and, in her case, reluctant mother (she secretly didn’t want children and was privately overwhelmed by the task). In this way, my mother, my adoptive mother, and myself are all the daughters of bereavement, all of us sacrificed on the altar of prejudice and fear that infertility, sex outside of marriage, and illegitimacy were unspeakable crimes for which a price must be paid and against which redemptive protection must be arranged. If, as Thomas Keneally (5) writes, “original sin is the mother fluid of history” then perhaps all three of us all lie in its abject waters. Grotevant, Dunbar, Kohler and Lash Esau (379) point out that adoption was used to ‘shield’ children from their illegitimacy, women from their ‘sexual indiscretions’, and adoptive parents from their infertility in the belief that “severing ties with birth family members would promote attachment between adopted children and parents”. For the adoptee in the closed record system, the socio/political/economic vortex that orchestrated their illegitimacy is born out of a deeply, self incriminating primal fear that reaches right back into the recesses of survival – the act of procreation is infested with easily transgressed life and death taboos within the ‘troop’ that require silence and the burial of many bodies (see Amanda Gardiner’s “Sex, Death and Desperation: Infanticide, Neonaticide, and Concealment of Birth in Colonial Western Australia” for a palpable, moving, and comprehensive exposition on the links between 'illegitimacy', the unmarried mother and child murder). As Nancy Verrier (24) states in Coming Home to Self, “what has to be understood is that separation trauma is an insidious experience, because, as a society, we fail to see this experience as a trauma”. Indeed, relinquishment/adoption for the baby and subsequent adult can be acutely and chronically painful. While I was never told the truth of my origins, of course, my body knew. It had been there. Sentient, aware, sane, sensually, organically articulate, it messaged me (and anyone who may have been interested) over the decades via the language of trauma, its lexicon and grammar cellular, hormonal, muscular (Howard & Crandall, 1-17; Pert, 72), the truth of my birth, of who I was an “unthought known” (Bollas 4). I have lived out my secret fatality in a miasmic nebula of what I know now to be the sequelae of adoption psychopathology: nausea, physical and psychological pain, agoraphobia, panic attacks, shame, internalised anger, depression, self-harm, genetic bewilderment, and generalised anxiety (Brodzinsky 25-47; Brodzinsky, Smith, & Brodzinsky 74; Kenny, Higgins, Soloff, & Sweid xiv; Levy-Shiff 97-98; Lifton 210-212; Verrier The Primal Wound 42-44; Wierzbicki 447-451) – including an all pervading sense of unreality experienced as dissociation (the experience of depersonalisation – where the self feels unreal – and derealisation – where the world feels unreal), disembodiment, and existential elision – all characteristics of Post Traumatic Stress Disorder (PTSD). In these ways, my body intervened, acted out, groaned in answer to the social overlay, and from beyond “the dermal veil” tried to procure access, as Vicky Kirby (77) writes, to “the body’s opaque ocean depths” through its illnesses, its eloquent, and incessantly aching and silent verbosities deepened and made impossibly fraught because I was not told. The aim of this paper is to discuss one aspect of how my body tried to channel the trauma of my secret fatality and liminality: my pre-disclosure art work (the cellular memory of my trauma also expressed itself, pre-disclosure, through my writings – poetry, journal entries – and also through post-coital glossolalia, all discussed at length in my Honours research “Womb Tongues” and my Doctoral Dissertation “The Womb Artist – A Novel: Translating Pre-verbal Late Discovery Adoption Trauma into Narrative”). From the age of thirty onwards I spent twelve years in therapy where the cause of my childhood and adult psychopathology remained a mystery. During this time, my embodied grief and memories found their way into my art work, a series of 5’ x 3’ acrylic paintings, some of which I offer now for discussion (figures 1-4). These paintings map and express what my body knew but could not verbalise (without language to express my grief, my body found other ways to vent). They are symptom and sign of my pre-verbal adoption trauma, evidence that my body ‘knew’ and laboured ceaselessly and silently to find creative ways to express the incarcerated trauma. Post disclosure, I have used my paintings as artefacts to inform, underpin, and nourish the writing of a collection of poetry “Womb Tongues” and a literary novel/memoir “The Womb Artist” (TWA) in an ongoing autoethnographical, performative, and critical inquiry. My practice-led research as a now conscious and creative witness, fashions the recontextualisation of my ‘self’ into my ‘self’ and society, this time with cognisant and reparative knowledge and facilitates the translation of my body’s psychopathology and memory (explicit and implicit) into a healing testimony that explores the traumatised body as text and politicizes the issues surrounding LDAs (Riley 205). If I use these paintings as a memoirist, I use them second hand, after the fact, after they have served their initial purpose, as the tangible art works of a baby buried beneath a culture’s prejudice, shame, and judgement and the personal cries from the illegitimate body/self. I use them now to explore and explain my subclinical and subterranean life as a LDA.My pre-disclosure paintings (Figures 1-4) – filled with vagin*l, fetal, uterine, and umbilical references – provide some kind of ‘evidence’ that my body knew what had happened to me as if, with the tenacity of a poltergeist, my ‘spectral self’ found ways to communicate. Not simply clues, but the body’s translation of the intra-psychic landscape, a pictorial and artistic séance into the world, as if my amygdala – as quasar and signal, homing device and history lesson (a measure, container, and memoir) – knew how to paint a snap shot or an x-ray of the psyche, of my cellular marrow memories (a term formulated from fellow LDA Sandy McCutcheon’s (76) memoir, The Magician’s Son when he says, “What I really wanted was the history of my marrow”). If, as Salveet Talwar suggests, “trauma is processed from the body up”, then for the LDA pre-discovery, non-verbal somatic signage is one’s ‘mother tongue’(25). Talwar writes, “non-verbal expressive therapies such as art, dance, music, poetry and drama all activate the sub-cortical regions of the brain and access pre-verbal memories” (26). In these paintings, eerily divinatory and pointed traumatic, memories are made visible and access, as Gussie Klorer (213) explains in regard to brain function and art therapy, the limbic (emotional) system and the prefrontal cortex in sensorimotor integration. In this way, as Marie Angel and Anna Gibbs (168) suggest, “the visual image may serve as a kind of transitional mode in thought”. Ruth Skilbeck in her paper First Things: Reflections on Single-lens Reflex Digital Photography with a Wide-angled Lens, also discusses (with reference to her photographic record and artistic expression of her mother’s death) what she calls the “dark matter” – what has been overlooked, “left out”, and/or is inexplicable (55) – and the idea of art work as the “transitional object” as “a means that some artists use, conceptually and yet also viscerally, in response to the extreme ‘separation anxiety’ of losing a loved one, to the void of the Unknown” (57). In my case, non-disclosure prevented my literacy and the evolution of the image into language, prevented me from fully understanding the coded messages left for me in my art work. However, each of my paintings is now, with the benefit of full disclosure, a powerful, penetrating, and comprehensible intra and extra sensory cry from the body in kinaesthetic translation (Lusebrink, 125; Klorer, 217). In Figure 1, ‘Embrace’, the reference to the umbilical is palpable, described in my novel “The Womb Artist” (184) this way; “two ropes tightly entwine as one, like a dark and dirty umbilical cord snaking its way across a nether world of smudged umbers”. There is an ‘abject’ void surrounding it. The cord sapped of its colour, its blood, nutrients – the baby starved of oxygen, breath; the LDA starved of words and conscious understanding. It has two parts entwined that may be seen in many ways (without wanting to reduce these to static binaries): mother/baby; conscious/unconscious; first person/third person; child/adult; semiotic/symbolic – numerous dualities could be spun from this embrace – but in terms of my novel and of the adoptive experience, it reeks of need, life and death, a text choking on the poetic while at the same time nourished by it; a text made ‘available’ to the reader while at the same narrowing, limiting, and obscuring the indefinable nature of pre-verbal trauma. Figure 1. Embrace. 1993. Acrylic on canvas.The painting ‘Womb Tongues’ (Figure 2) is perhaps the last (and, obviously, lasting) memory of the infinite inchoate universe within the womb, the umbilical this time wrapped around in a phallic/cl*torial embrace as the baby-self emerges into the constrictions of a Foucauldian world, where the adoptive script smothers the ‘body’ encased beneath the ‘coils’ of Judeo-Christian prejudice and centuries old taboo. In this way, the reassigned adoptee is an acute example of power (authority) controlling and defining the self and what knowledge of the self may be allowed. The baby in this painting is now a suffocated cl*tor*s, a bound subject, a phallic representation, a gagged ‘tongue’ in the shape of the personally absent (but socially imposing) omni-present and punitive patriarchy. Figure 2. Womb Tongues. 1997. Acrylic on canvas.‘Germination’ (Figure 3) depicts an umbilical again, but this time as emerging from a seething underworld and is present in TWA (174) this way, “a colony of night crawlers that writhe and slither on the canvas, moving as one, dozens of them as thin as a finger, as long as a dream”. The rhizomic nature of this painting (and Figure 4), becomes a heaving horde of psychosomatic and psychopathological influences and experiences, a multitude of closely packed, intense, and dendridic compulsions and symptoms, a mass of interconnected (and by nature of the silence and lie) subterranean knowledges that force the germination of a ‘ghost baby/child/adult’ indicated by the pale and ashen seedling that emerges above ground. The umbilical is ghosted, pale and devoid of life. It is in the air now, reaching up, as if in germination to a psychological photosynthesis. There is the knot and swarm within the unconscious; something has, in true alien fashion, been incubated and is now emerging. In some ways, these paintings are hardly cryptic.Figure 3. Germination.1993. Acrylic on canvas.In Figure 4 ‘The Birthing Tree’, the overt symbolism reaches ‘clairvoyant status’. This could be read as the family ‘tree’ with its four faces screaming out of the ‘branches’. Do these represent the four babies relinquished by our mother (the larger of these ‘beings’ as myself, giving birth to the illegitimate, silenced, and abject self)? Are we all depicted in anguish and as wraithlike, grotesquely simplified into pure affect? This illegitimate self is painted as gestating a ‘blue’ baby, near full-term in a meld of tree and ‘self’, a blue umbilical cord, again, devoid of blood, ghosted, lifeless and yet still living, once again suffocated by the representation of the umbilical in the ‘bowels’ of the self, the abject part of the body, where refuse is stored and eliminated: The duodenum of the damned. The Devil may be seen as Christopher Bollas’s “shadow of the object”, or the Jungian archetypal shadow, not simply a Judeo-Christian fear-based spectre and curmudgeon, but a site of unprocessed and, therefore, feared psychological material, material that must be brought to consciousness and integrated. Perhaps the Devil also is the antithesis to ‘God’ as mother. The hell of ‘not mother’, no mother, not the right mother, the reluctant adoptive mother – the Devil as icon for the rich underbelly of the psyche and apophatic to the adopted/artificial/socially scripted self.Figure 4. The Birthing Tree. 1995. Acrylic on canvas.These paintings ache with the trauma of my relinquishment and LDA experience. They ache with my body’s truth, where the cellular and psychological, flesh and blood and feeling, leak from my wounds in unspeakable confluence (the two genital lips as the site of relinquishment, my speaking lips that have been sealed through non-disclosure and shame, the psychological trauma as Verrier’s ‘primal wound’) just as I leaked from my mother (and society) at birth, as blood and muck, and ooze and pus and death (Grosz 195) only to be quickly and silently mopped up and cleansed through adoption and life-long secrecy. Where I, as translator, fluent in both silence and signs, disclose the baby’s trauma, asking for legitimacy. My experience as a LDA sets up an interesting experiment, one that allows an examination of the pre-verbal/pre-disclosure body as a fleshed and breathing Rosetta Stone, as an interface between the language of the body and of the verbalised, painted, and written text. As a constructed body, written upon and invented legally, socially, and psychologically, I am, in Hélène Cixous’s (“To Live the Orange” 83) words, “un-forgetting”, “un-silencing” and “unearthing” my ‘self’ – I am re-writing, re-inventing and, under public scrutiny, legitimising my ‘self’. I am a site of inquiry, discovery, extrapolation, and becoming (Metta 492; Poulus 475) and, as Grosz (vii) suggests, a body with “all the explanatory power” of the mind. I am, as I embroider myself and my LDA experience into literary and critical texts, authoring myself into existence, referencing with particular relevance Peter Carnochan’s (361) suggestion that “analysis...acts as midwife to the birth of being”. I am, as I swim forever amorphous, invisible, and unspoken in my mother’s womb, fashioning a shore, landscaping my mind against the constant wet, my chronic liminality (Rambo 629) providing social landfall for other LDAs and silenced minorities. As Catherine Lynch (3) writes regarding LDAs, “Through the creation of text and theory I can formulate an intimate space for a family of adoptive subjects I might never know via our participation in a new discourse in Australian academia.” I participate through my creative, self-reflexive, process fuelled (Durey 22), practice-led enquiry. I use the intimacy (and also universality and multiplicity) and illegitimacy of my body as an alterative text, as a site of academic and creative augmentation in the understanding of LDA issues. The relinquished and silenced baby and LDA adult needs a voice, a ‘body’, and a ‘tender’ place in the consciousness of society, as Helen Riley (“Confronting the Conspiracy of Silence” 11) suggests, “voice, validation, and vindication”. Judith Herman (3) argues that, “Survivors challenge us to reconnect fragments, to reconstruct history, to make meaning of their present symptoms in the light of past events”. I seek to use the example of my experience – as Judith Durey (31) suggests, in “support of evocative, creative modes of representation as valid forms of research in their own right” – to unfurl the whole, to give impetus and precedence for other researchers into adoption and advocate for future babies who may be bought, sold, arranged, and/or created by various means. The recent controversy over Gammy, the baby boy born with Down Syndrome in Thailand, highlights the urgent and moral need for legislation with regard to surrogacy (see Kajsa Ekis Ekman’s Being and Being Bought: Prostitution, Surrogacy and the Split Self for a comprehensive examination of surrogacy issues). Indeed, Catherine Lynch in her paper Doubting Adoption Legislation links the experiences of LDAs and the children of born of surrogacy, most effectively arguing that, “if the fate that closed record adoptees suffered was a misplaced solution to the question of what to do with children already conceived how can you justify the deliberate conception of a child with the intention even before its creation of cruelly removing that child from their mother?” (6). Cixous (xxii) confesses, “All I want is to illustrate, depict fragments, events of human life and death...each unique and yet at the same time exchangeable. Not the law, the exception”. I, too, am a fragment, an illustration (a painting), and, as every individual always is – paradoxically – a communal and, therefore, deeply recognisable and generally applicable minority and exception. In my illegitimacy, I am some kind of evidence. Evidence of cellular memory. Evidence of embodiment. Evidence that silenced illegitimacies will manifest in symptom and non-verbal narratives, that they will ooze out and await translation, verification, and witness. This paper is offered with reverence and with feminist intention, as a revenant mouthpiece for other LDAs, babies born of surrogacy, and donor assisted offspring (and, indeed, any) who are marginalised, silenced, and obscured. It is also intended to promote discussion in the psychological and psychoanalytic fields and, as Helen Riley (202-207) advocates regarding late discovery offspring, more research within the social sciences and the bio-medical field that may encourage legislators to better understand what the ‘best interests of the child’ are in terms of late discovery of origins and the complexity of adoption/conception practices available today. As I write now (and always) the umbilical from my paintings curve and writhe across my soul, twist and morph into the swollen and throbbing organ of tongues, my throat aching to utter, my hands ready to craft latent affect into language in translation of, and in obedience to, my body’s knowledges. It is the art of mute witness that reverses genesis, that keeps the umbilical fat and supple and full of blood, and allows my conscious conception and creation. Indeed, in the intersection of my theoretical, creative, psychological, and somatic praxis, the heat (read hot and messy, insightful and insistent signage) of my body’s knowledges perhaps intensifies – with a ripe bouquet – the inevitably ongoing odour/aroma of the reproductive world. ReferencesAngel, Maria, and Anna Gibbs. “On Moving and Being Moved: The Corporeality of Writing in Literary Fiction and New Media Art.” Literature and Sensation, eds. Anthony Uhlmann, Helen Groth, Paul Sheehan, and Stephan McLaren. Newcastle upon Tyne, UK: Cambridge Scholars Publishing, 2009: 162-172. Bollas, Christopher. The Shadow of the Object: Psychoanalysis of the Unthought Known. New York: Columbia UP, 1987. Brodzinsky, David. “Adjustment to Adoption: A Psychosocial Perspective.” Clinical Psychology Review 7 (1987): 25-47. doi: 10.1016/0272-7358(87)90003-1.Brodzinsky, David, Daniel Smith, and Anne Brodzinsky. Children’s Adjustment to Adoption: Developmental and Clinical Issues. California: Sage Publications, 1998.Carnochan, Peter. “Containers without Lids”. Psychoanalytic Dialogues 16.3 (2006): 341-362.Cixous, Hélène. “To Live the Orange”. The Hélène Cixous Reader: With a Preface by Hélène Cixous and Foreword by Jacques Derrida, ed. Susan Sellers. Oxford, UK: Routledge, 1979/1994. 81-92. ---. “Preface.” The Hélène Cixous Reader: With a Preface by Hélène Cixous and Foreword by Jacques Derrida, ed. Susan Sellers. Oxford, UK: Routledge, 1994. xv-xxii.Coull, Kim. “Womb Tongues: A Collection of Poetry.” Honours Thesis. Perth, WA: Edith Cowan University, 2007. ---. “The Womb Artist – A Novel: Translating Late Discovery Adoptee Pre-Verbal Trauma into Narrative”. Dissertation. Perth, WA: Edith Cowan University, 2014. Durey, Judith. Translating Hiraeth, Performing Adoption: Art as Mediation and Form of Cultural Production. Dissertation. Perth, WA: Murdoch University, 2010. 22 Sep. 2011 .Ekis Ekman, Kajsa. Being and Being Bought: Prostitution, Surrogacy and the Split Self. Trans. S. Martin Cheadle. North Melbourne: Spinifex Press, 2013. Gardiner, Amanda. “Sex, Death and Desperation: Infanticide, Neonaticide, and Concealment of Birth in Colonial Western Australia”. Dissertation. Perth, WA: Edith Cowan University, 2014. Grosz, Elizabeth. Volatile Bodies. NSW: Allen &. Unwin, 1994. Grotevant, Harold D., Nora Dunbar, Julie K. Kohler, and Amy. M. Lash Esau. “Adoptive Identity: How Contexts within and beyond the Family Shape Developmental Pathways.” Family Relations 49.3 (2000): 79-87.Herman, Judith L. Trauma and Recovery: From Domestic Abuse to Political Terror. London: Harper Collins, 1992. Howard, Sethane, and Mark W. Crandall. Post Traumatic Stress Disorder: What Happens in the Brain. Washington Academy of Sciences 93.3 (2007): 1-18.Keneally, Thomas. Schindler’s List. London: Serpentine Publishing Company, 1982. Kenny, Pauline, Daryl Higgins, Carol Soloff, and Reem Sweid. Past Adoption Experiences: National Research Study on the Service Response to Past Adoption Practices. Research Report 21. Australian Institute of Family Studies, 2012.Kirby, Vicky. Telling Flesh: The Substance of the Corporeal. New York and London: Routledge, 1997. Klorer, P. Gussie. “Expressive Therapy with Severely Maltreated Children: Neuroscience Contributions.” Journal of the American Art Therapy Association 22.4 (2005): 213-220. doi:10.1080/07421656.2005.10129523.Levy-Shiff, Rachel. “Psychological Adjustment of Adoptees in Adulthood: Family Environment and Adoption-Related Correlates. International Journal of Behavioural Development 25 (2001): 97-104. doi: 1080/01650250042000131.Lifton, Betty J. “The Adoptee’s Journey.” Journal of Social Distress and the Homeless 11.2 (2002): 207-213. doi: 10.1023/A:1014320119546.Lusebrink, Vija B. “Art Therapy and the Brain: An Attempt to Understand the Underlying Processes of Art Expression in Therapy.” Journal of the American Art Therapy Association 21.3 (2004): 125-135. doi:10.1080/07421656. 2004.10129496.Lynch, Catherine. “An Ado/aptive Reading and Writing of Australia and Its Contemporary Literature.” Australian Journal of Adoption 1.1 (2009): 1-401.---. Doubting Adoption Legislation. n.d.McCutcheon, Sandy. The Magician’s Son: A Search for Identity. Sydney, NSW: Penguin, 2006. Metta, Marilyn. “Putting the Body on the Line: Embodied Writing and Recovery through Domestic Violence.” Handbook of Autoethnography, eds. Stacy Holman Jones, Tony Adams, and Carolyn Ellis. Walnut Creek, CA: Left Coast Press, 2013: 486-509.Pert, Candace. Molecules of Emotion: The Science behind Mind-body Medicine. New York: Touchstone, 2007. Rambo, Carol. “Twitch: A Performance of Chronic Liminality.” Handbook of Autoethnography, eds. Stacy Holman Jones, Tony Adams, and Carolyn Ellis. Walnut Creek, CA: Left Coast Press, 2013: 627-638.Riley, Helen J. Identity and Genetic Origins: An Ethical Exploration of the Late Discovery of Adoptive and Donor-insemination Offspring Status. Dissertation. Brisbane: Queensland University of Technology, 2012.---. “Confronting the Conspiracy of Silence and Denial of Difference for Late Discovery Persons and Donor Conceived People.” Australian Journal of Adoption 7.2 (2013): 1-13.Skilbeck, Ruth. “First Things: Reflection on Single-Lens Reflex Digital Photography with a Wide-Angle Lens.” International Journal of the Image 3 (2013): 55-66. Talwar, Savneet. “Accessing Traumatic Memory through Art Making: An Art Therapy Trauma Protocol (ATTP)." 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Abstract:

The Black Summer of 2019/2020 saw the forests of southeast Australia go up in flames. The fire season started early, in September 2019, and by March 2020 fires had burned over 12.6 million hectares (Werner and Lyons). The scale and severity of the fires was quickly confirmed by scientists to be “unprecedented globally” (Boer et al.) and attributable to climate change (Nolan et al.).The fires were also a media spectacle, generating months of apocalyptic front-page images and harrowing broadcast footage. Media coverage was particularly preoccupied by the cause of the fires. Media framing of disasters often seeks to attribute blame (Anderson et al.; Ewart and McLean) and, over the course of the fire period, blame for the fires was attributed to climate change in much media coverage. However, as the disaster unfolded, denialist discourses in some media outlets sought to veil this revelation by providing alternative explanations for the fires. Misinformation originating from social media also contributed to this obscuration.In this article, we investigate the extent to which media coverage of the 2019/2020 bushfires functioned both to precipitate a climate change epiphany and also to support refutation of the connection between catastrophic fires and the climate crisis.Environmental Communication and RevelationIn its biblical sense, revelation is both an ending and an opening: it is the apocalyptic end-time and also the “revealing” of this time through stories and images. Environmental communication has always been revelatory, in these dual senses of the word – it is a mode of communication that is tightly bound to crisis; that has long grappled with obfuscation and misinformation; and that disrupts power structures and notions of the status quo as it seeks to reveal what is hidden. Climate change in particular is associated in the popular imagination with apocalypse, and is also a reality that is constantly being “revealed”. Indeed, the narrative of climate change has been “animated by the revelations of science” (McNeish 1045) and presented to the public through “key moments of disclosure and revelation”, or “signal moments”, such as scientist James Hansen’s 1988 US Senate testimony on global warming (Hamblyn 224).Journalism is “at the frontline of environmental communication” (Parham 96) and environmental news, too, is often revelatory in nature – it exposes the problems inherent in the human relationship with the natural world, and it reveals the scientific evidence behind contentious issues such as climate change. Like other environmental communicators, environmental journalists seek to “break through the perceptual paralysis” (Nisbet 44) surrounding climate change, with the dual aim of better informing the public and instigating policy change. Yet leading environmental commentators continually call for “better media coverage” of the planetary crisis (Suzuki), as climate change is repeatedly bumped off the news agenda by stories and events deemed more newsworthy.News coverage of climate-related disasters is often revelatory both in tone and in cultural function. The disasters themselves and the news narratives which communicate them become processes that make visible what is hidden. Because environmental news is “event driven” (Hansen 95), disasters receive far more news coverage than ongoing problems and trends such as climate change itself, or more quietly devastating issues such as species extinction or climate migration. Disasters are also highly visual in nature. Trumbo (269) describes climate change as an issue that is urgent, global in scale, and yet “practically invisible”; in this sense, climate-related disasters become a means of visualising and realising what is otherwise a complex, difficult, abstract, and un-seeable concept.Unsurprisingly, natural disasters are often presented to the public through a film of apocalyptic rhetoric and imagery. Yet natural disasters can be also “revelatory” moments: instances of awakening in which suppressed truths come spectacularly and devastatingly to the surface. Matthewman (9–10) argues that “disasters afford us insights into social reality that ordinarily pass unnoticed. As such, they can be read as modes of disclosure, forms of communication”. Disasters, he continues, can reveal both “our new normal” and “our general existential condition”, bringing “the underbelly of progress into sharp relief”. Similarly, Lukes (1) states that disasters “lift veils”, revealing “what is hidden from view in normal times”. Yet for Lukes, “the revelation tells us nothing new, nothing that we did not already know”, and is instead a forced confronting of that which is known yet difficult to engage with. Lukes’ concern is the “revealing” of poverty and inequality in New Orleans following the impact of Hurricane Katrina, yet climate-related disasters can also make visible what McNeish terms “the dark side effects of industrial civilisation” (1047). The Australian bushfires of 2019/2020 can be read in these terms, primarily because they unveiled the connection between climate change and extreme events. Scorching millions of hectares, with a devastating impact on human and non-human communities, the fires revealed climate change as a physical reality, and—for Australians—as a local issue as well as a global one. As media coverage of the fires unfolded and smoke settled on half the country, the impact of climate change on individual lives, communities, landscapes, native animal and plant species, and well-established cultural practices (such as the summer camping holiday) could be fully and dramatically realised. Even for those Australians not immediately impacted, the effects were lived and felt: in our lungs, and on our skin, a physical revelation that the impacts of climate change are not limited to geographically distant people or as-yet-unborn future generations. For many of us, the summer of fire was a realisation that climate change can no longer be held at arm’s length.“Revelation” also involves a temporal collapse whereby the future is dragged into the present. A revelatory streak of this nature has always existed at the heart of environmental communication and can be traced back at least as far as the environmentalist Rachel Carson, whose 1962 book Silent Spring revealed a bleak, apocalyptic future devoid of wildlife and birdsong. In other words, environmental communication can inspire action for change by exposing the ways in which the comforts and securities of the present are built upon a refusal to engage with the future. This temporal rupture where the future meets the present is particularly characteristic of climate change narratives. It is not surprising, then, that media coverage of the 2019/2020 bushfires addressed not just the immediate loss and devastation but also dread of the future, and the understanding that summer will increasingly hold such threats. Bushfires, Climate Change and the MediaThe link between bushfire risk and climate change generated a flurry of coverage in the Australian media well before the fires started in the spring of 2019. In April that year, a coalition of 23 former fire and emergency services leaders warned that Australia was “unprepared for an escalating climate threat” (Cox). They requested a meeting with the new government, to be elected in May, and better funding for firefighting to face the coming bushfire season. When that meeting was granted, at the end of Australia’s hottest and driest year on record (Doyle) in November 2019, bushfires had already been burning for two months. As the fires burned, the emergency leaders expressed frustration that their warnings had been ignored, claiming they had been “gagged” because “you are not allowed to talk about climate change”. They cited climate change as the key reason why the fire season was lengthening and fires were harder to fight. "If it's not time now to speak about climate and what's driving these events”, they asked, “– when?" (McCubbing).The mediatised uncovering of a bushfire/climate change connection was not strictly a revelation. Recent fires in California, Russia, the Amazon, Greece, and Sweden have all been reported in the media as having been exacerbated by climate change. Australia, however, has long regarded itself as a “fire continent”: a place adapted to fire, whose landscapes invite fire and can recover from it. Bushfires had therefore been considered part of the Australian “normal”. But in the Australian spring of 2019, with fires having started earlier than ever and charring rainforests that did not usually burn, the fire chiefs’ warning of a climate change-induced catastrophic bushfire season seemed prescient. As the fires spread and merged, taking homes, lives, landscapes, and driving people towards the water, revelatory images emerged in the media. Pictures of fire refugees fleeing under dystopian crimson skies, masked against the smoke, were accompanied by headlines like “Apocalypse Now” (Fife-Yeomans) and “Escaping Hell” (The Independent). Reports used words like “terror”, “nightmare” (Smee), “mayhem”, and “Armageddon” (Davidson).In the Australian media, the fire/climate change connection quickly became politicised. The Deputy Prime Minister Michael McCormack interviewed by the ABC, responding to a comment by Greens leader Adam Bandt, said connecting bushfire and climate while the fires raged was “disgraceful” and “disgusting”. People needed help, he said, not “the ravings of some pure enlightened and woke capital city greenies” (Goloubeva and Haydar). Gladys Berejiklian the NSW Premier also described it as “inappropriate” (Baker) and “disappointing” (Fox and Higgins) to talk about climate change at this time. However Carol Sparks, Mayor of bushfire-ravaged Glen Innes in rural NSW, contradicted this stance, telling the ABC (Australian Broadcasting Corporation) “Michael McCormack needs to read the science”. Climate change, she said, was “not a political thing” but “scientific fact” (Goloubeva and Haydar).As the fires merged and intensified, so did the media firestorm. Key Australian media became a sparring ground for issue definition, with media predictably split down ideological lines. Public broadcasters the ABC and SBS (Special Broadcasting Service), along with The Age, The Sydney Morning Herald and The Guardian Australia, predominantly framed the catastrophe as wrought by climate change. The Guardian, in an in-depth investigation of climate science and bushfire risk, stated that “despite the political smokescreen” the connection between the fires and global warming was “unequivocal” (Redfearn). The ABC characterised the fires as “a glimpse of the horrors of climate change’s crescendoing impact” (Rose). News outlets owned by Rupert Murdoch’s News Corp Australia, however, actively sought to play down the fires’ seriousness. On 2 January, as front pages of newspapers across the world revealed horrifying fiery images, Murdoch’s Australian ran an upbeat shot of New Year’s Day picnic races as its lead, relegating discussion of the fires to page 4 (Meade). More than simply obscuring the fires’ significance, News Corp media actively sought to convince readers that the fires were not out of the ordinary. For example, as the fires’ magnitude was becoming clear on the last day of 2019, The Australian ran a piece comparing the fires with previous conflagrations, claiming such conditions were “not unprecedented” and the fires were “nothing new” (Johnstone). News Corp’s Sky News also used this frame: “climate alarmists”, “catastrophise”, and “don’t want to look at history”, it stated in a segment comparing the event to past major bushfires (Kenny).As the fires continued into January and February 2020, the refutation of the climate change frame solidified around several themes. Conservative media continued to insist the fires were “normal” for Australia and attributed their severity to a lack of hazard reduction burning, which they blamed on “Greens policies” (Brown and Caisley). They also promoted the argument, espoused by Energy Minister Angus Taylor, that with only “1.3% of global emissions” Australia “could not have meaningful impact” on global warming through emissions reductions, and that top-down climate mitigation pressure from the UN was “doomed to fail” (Lloyd). Foreign media saw the fires in quite different terms. From the outside looking in, the Australian fires were clearly revealed as fuelled by global heating and exacerbated by the Australian government’s climate denialism. Australia was framed as a “notorious climate offender” (Shield) that was—as The New York Times put it—“committing climate suicide” (Flanagan) with its lack of coherent climate policy and its predilection for mining coal. Ouest-France ran a headline reading “High on carbon, rich Australia denies global warming” in which it called Scott Morrison’s position on climate change “incomprehensible” (Guibert). The LA Times called the Australian fires “a climate change warning to its leaders—and ours”, noting how “fossil fuel friendly Morrison” had “gleefully wielded a fist-sized chunk of coal on the floor of parliament in 2017” (Karlik). In the UK, the Independent online ran a front page spread of the fires’ vast smoke plume, with the headline “This is what a climate crisis looks like” (Independent Online), while Australian MP Craig Kelly was called “disgraceful” by an interviewer on Good Morning Britain for denying the fires’ link to climate change (Good Morning Britain).Both in Australia and internationally, deliberate misinformation spread by social media additionally shaped media discourse on the fires. The false revelation that the fires had predominantly been started by arson spread on Twitter under the hashtag #ArsonEmergency. While research has been quick to show that this hashtag was artificially promoted by bots (Weber et al.), this and misinformation like it was also shared and amplified by real Twitter users, and quickly spread into mainstream media in Australia—including Murdoch’s Australian (Ross and Reid)—and internationally. Such misinformation was used to shore up denialist discourses about the fires, and to obscure revelation of the fire/climate change connection. Blame Framing, Public Opinion and the Extent of the Climate Change RevelationAs studies of media coverage of environmental disasters show us, media seek to apportion blame. This blame framing is “accountability work”, undertaken to explain how and why a disaster occurred, with the aim of “scrutinizing the actions of crisis actors, and holding responsible authorities to account” (Anderson et al. 930). In moments of disaster and in their aftermath, “framing contests” (Benford and Snow) can emerge in which some actors, regarding the crisis as an opportunity for change, highlight the systemic issues that have led to the crisis. Other actors, experiencing the crisis as a threat to the status quo, try to attribute the blame to others, and deny the need for policy change. As the Black Summer unfolded, just such a contest took place in Australian media discourse. While Murdoch’s dominant News Corp media sought to protect the status quo, promote conservative politicians’ views, and divert attention from the climate crisis, other Australian and overseas media outlets revealed the fires’ link to climate change and intransigent emissions policy. However, cracks did begin to show in the News Corp stance on climate change during the fires: an internal whistleblower publicly resigned over the media company’s fires coverage, calling it a “misinformation campaign”, and James Murdoch also spoke out about being “disappointed with the ongoing denial of the role of climate change” in reporting the fires (ABC/Reuters).Although media reporting on the environment has long been at the forefront of shaping social understanding of environmental issues, and news maintains a central role in both revealing environmental threats and shaping environmental politics (Lester), during Australia’s Black Summer people were also learning about the fires from lived experience. Polls show that the fires affected 57% of Australians. Even those distant from the catastrophe were, for some time, breathing the most toxic air in the world. This personal experience of disaster revealed a bushfire season that was far outside the normal, and public opinion reflected this. A YouGov Australia Institute poll in January 2020 found that 79% of Australians were concerned about climate change—an increase of 5% from July 2019—and 67% believed climate change was making the bushfires worse (Australia Institute). However, a January 2020 Ipsos poll also found that polarisation along political lines on whether climate change was indeed occurring had increased since 2018, and was at its highest levels since 2014 (Crowe). This may reflect the kind of polarised media landscape that was evident during the fires. A thorough dissection in public discourse of Australia’s unprecedented fire season has been largely eclipsed by the vast coverage of the coronavirus pandemic that so quickly followed it. In May 2020, however, the fires were back in the media, when the Bushfires Royal Commission found that the Black Summer “played out exactly as scientists predicted it would” and that more seasons like it were now “locked in” because of carbon emissions (Hitch). It now remains to be seen whether the revelatory extent of the climate change blame frame that played out in media discourse on the fires will be sufficient to garner meaningful action and policy change—or whether denialist discourses will again obscure climate change revelation and seek to maintain the status quo. References Anderson, Deb, et al. "Fanning the Blame: Media Accountability, Climate and Crisis on the Australian ‘Fire Continent’." 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Abstract:

Introduction The sensational appearance of kawaii fashion in Tokyo’s Harajuku neighborhood—full of freedom, fun, and frills— has captivated hearts and imaginations worldwide. A key motivational concept for this group is “kawaii” which is commonly translated as “cute” and can also be used to describe things that are “beautiful”, “funny”, “pretty”, “wonderful”, “great”, “interesting”, and “kind” (Yamane 228; Yomota 73; Dale 320). Representations in media such as the styling of Harajuku street model and J-pop star Kyary Pamyu Pamyu, directed by Sebastian Masuda, have helped bring this fashion to a wider audience. Of this vibrant community, decora fashion is perhaps best known with its image well documented in in street-fashion magazines such as Shoichi Aoki’s FRUiTS (1997–2017), Websites such as Tokyo Fashion (2000–present), and in magazines like KERA (1998–2017). In particular, decora fashion captures the “do-it-yourself” approach for which Harajuku is best known for (Yagi 17). In this essay we draw on New Materialism to explore the ways in which decora fashion practitioners form kawaii affective assemblages with the objects they collect and transform into fashion items. We were motivated to pursue this research to build on other qualitative studies that aimed to include the voices of practitioners in accounts of their lifestyles (e.g. Nguyen; Monden; Younker) and respond to claims that kawaii fashion is a form of infantile regression. We—an Australian sociologist and kawaii fashion practitioner, a Japanese decora fashion practitioner and Harajuku street model, and a Japanese former owner of a tearoom in Harajuku—have used an action-led participatory research method to pool our expertise. In this essay we draw on both a New Materialist analysis of our own fashion practices, a 10-year longitudinal study of Harajuku (2012–2022), as well as interviews with twelve decora fashion practitioners in 2020. What Is Decora Fashion? Decora is an abbreviation of “decoration”, which reflects the key aesthetic commitment of the group to adorn their bodies with layers of objects, accessories, and stickers. Decora fashion uses bright clothing from thrift stores, layers of handmade and store-bought accessories, and chunky platform shoes or sneakers. Practitioners enjoy crafting accessories from old toys, kandi and perler beads, weaving, braiding, crocheting novelty yarn and ribbon, and designing and printing their own textiles. In addition to this act of making, decora practitioners also incorporate purchases from specialty brands like 6%DOKI DOKI, Nile Perch, ACDC Rag, YOSUKE USA, and minacute. According to our interviewees, whom we consulted in 2020, excess is key; as Momo told us: “if it’s too plain, it’s not decora”. Decora uses clashing, vibrant, electric colours, and a wild variety of kawaii versions of monsters, characters, and food which appear as motifs on their clothing (Groom 193; Yagi 17). Clashing textures and items—such as a sweat jackets, gauzy tutus, and plastic toy tiaras—are also a key concept (Koga 81). Colour is extended to practitioners’ hair through colourful hair dyes, and the application of stickers, bandaids, and jewels across their cheeks and nose (Rose, Kurebayashi and Saionji). These principles are illustrated in fig. 1, a street snap from 2015 of our co-author, Kurebayashi. Working with the contrasting primary colours across her hair, clothes, and accessories, she incorporates both her own handmade garments and found accessories to form a balanced outfit. Her Lisa Frank cat purse, made from a psychedelic vibrant pink faux fur, acts as a salient point to draw in our eyes to a cacophony of colour throughout her ensemble. The purse is a prized item from her own collection that was a rare find on Mercari, an online Japanese auction Website, 15 years ago. Her sweater dress is handmade, with a textile print she designed herself. The stickers on the print feature smiley faces, rainbows, ducks, and candy—all cheap and cheerful offerings from a discount store. Through intense layering and repetition, Kurebayashi has created a collage that is reminiscent of the clips and bracelets that decorate her hair and wrists. This collage also represents the colour, fun, and whimsy that she immerses herself in everyday. Her platform shoes are by Buffalo London, another rare find for her collection. Her hair braids are handmade by Midoroya, an online artist, which she incorporates to create variety in the textures in her outfit from head to toe. Peeking beneath her sweater is a short colourful tutu that floats and bounces with each step. Together the items converge and sing, visually loud and popping against the urban landscape. Fig. 1: Kurebayashi’s street snap in an decora fashion outfit of her own styling and making, 2015. Given the street-level nature of decora fashion, stories of its origins draw on oral histories of practitioners, alongside writings from designers and stores that cater to this group (Ash). Its emergence was relatively organic in the early 1990s, with groups enjoying mixing and combining found objects and mis-matching clothing items. Initially, decorative styles documented in street photography used a dark colour palette with layers of handmade accessories, clips, and decorations, and a Visual-kei influence. Designers such as Sebastian Masuda, who entered the scene in 1995, also played a key role by introducing accessories and clothes inspired by vintage American toys, Showa era (1926-1989) packaging, and American West Club dance culture (Sekikawa and Kumagi 22–23). Pop idols such as Tomoe Shinohara and Kyary Pamyu Pamyu are also key figures that have contributed to the pop aesthetic of decora. While decora was already practiced prior to the release of Shinohara’s 1995 single Chaimu, her styling resonated with practitioners and motivated them to pursue a more “pop” aesthetic with an emphasis on bright colours, round shapes, and handmade colourful accessories. Shinohara herself encouraged fans to take on a rebelliously playful outlook and presentation of self (Nakao 15–16; Kondō). This history resonates with more recent pop idol Kyary Pamyu Pamyu’s costuming and set design, which was directed by Sebastian Masuda. Kyary’s kawaii fashion preceded her career, as she regularly participated in the Harajuku scene and agreed to street snaps. While the costuming and set design for her music videos, such as Pon Pon Pon, resonate with the Harajuku aesthetic, her playful persona diverges. Her performance uses humour, absurdity, and imperfection to convey cuteness and provide entertainment (Iseri 158), but practitioners in Harajuku do not try to replicate this performance; Shinohara and Kyary’s stage persona promotes ‘immaturity’ and ‘imperfection’ as part of their youthful teenage rebellion (Iseri 159), while kawaii fashion practitioners prefer not to be seen in this light. When considering the toys, stickers, and accessories incorporated into decora fashion, and the performances of Shinohara and Kyary, it is understandable that some outsiders may interpret the fashion as a desire to return to childhood. Some studies of kawaii fashion more broadly have interpreted the wearing of clothing like this as a resistance to adulthood and infantile regression (e.g., Kinsella 221–222; Winge; Lunning). These studies suggest that practitioners desire to remain immature in order to “undermin[e] current ideologies of gender and power” (Hasegawa 140). In particular, Kinsella in her 1995 chapter “in Japan” asserts that fashion like this is an attempt to act “vulnerable in order to emphasize … immaturity and inability to carry out social responsibilities” (241), and suggests that this regression is “self-mutilation [which denies] the existence of a wealth of insights, feelings and humour that maturity brings with it” (235). This view has spread widely in writing about kawaii fashion, and Steele, Mears, Kawamura, and Narumi observe for instance that “prolonging childhood is compelling” as an attractive component of Harajuku culture (48). While we recognise that this literature uses the concept of “childishness” to acknowledge the rebellious nature of Harajuku fashion, our participants would like to discourage this interpretation of their practice. In particular, participants highlighted their commitment to studies, paying bills, caring for family members, and other markers they felt indicated maturity and responsibility. They also found this belief that they wanted to deny themselves adult “insights, feelings and humour” deeply offensive as it disregards their lived experience and practice. From a Sociological perspective, this infantilising interpretation is concerning as it reproduces Orientalist framings of Japanese women who enjoy kawaii culture as dependent and submissive, rather than savvy consumers (Bow 66–73; Kalnay 95). Furthermore, this commentary on youth cultures globally, which points to an infantilisation of adulthood (Hayward 230), has also been interrogated by scholars as an oversimplistic reading that doesn’t recognise the rich experiences of adults who engage in these spaces while meeting milestones and responsibilities (Woodman and Wyn; Hodkinson and Bennett; Bennett). Through our lived experience and work with the decora fashion community, we offer in this essay an alternative account of what kawaii means to these practitioners. We believe that agency, energy, and vibrancy is central to the practice of decora fashion. Rather than intending to be immature, practitioners are looking for vibrant ways to exist. A New Materialist lens offers a framework with which we can consider this experience. For example, our informant Momota, in rejecting the view that her fashion was about returning to childhood, explained that decora fashion was “rejuvenating” because it gave them “energy and power”. Elizabeth Groscz in her essay on freedom in New Materialism encourages us to consider new ways of living, not as an expression of “freedom from” social norms, but rather “freedom to” new ways of being, as expression of their “capacity for action” (140). In other words, rather than seeking freedom from adult responsibilities and regressing into a state where one is unable to care for oneself, decora fashion is a celebration of what practitioners are “capable of doing” (Groscz 140–141) by finding pleasure in collecting and making. Through encounters with kawaii objects, and the act of creating through these materials, decora fashion practitioners’ agential capacities are increased through experiences of elation, excitement and pleasure. Colourful Treasures, Fluttering Hearts: The Pleasures of Collecting kawaii Matter Christine Yano describes kawaii as having the potential to “transform the mundane material world into one occupied everywhere by the sensate and the sociable” (“Reach Out”, 23). We believe that this conceptualisation of kawaii has strong links to New Materialist theory. New Materialism highlights the ways in which human subjects are “are unstable and emergent knowing, sensing, embodied, affective assemblages of matter, thought, and language, part of and inseparable from more-than human worlds” (Lupton). Matter in this context is a social actor in its own right, energising and compelling practitioners to incorporate them into their everyday lives. For example, kawaii matter can move us to be more playful, creative, and caring (Aiwaza and Ohno; Nishimura; Yano, Pink Globalization), or help us relax and feel calm when experiencing high levels of stress (Stevens; Allison; Yano, “Reach Out”). Studies in the behavioral sciences have shown how kawaii objects pique our interest, make us feel happy and excited, and through sharing our excitement for kawaii things become kinder and more thoughtful towards each other (Nittono; Ihara and Nittono; Kanai and Nittono). Decora fashion practitioners are sensitive to this sensate and sociable aspect of kawaii; specific things redolent with “thing-power” (Bennett) shine and twinkle amongst the cultural landscape and compel practitioners to gather them up and create unique outfits. Decora fashion relies on an ongoing hunt for objects to upcycle into fashion accessories, thrifting second-hand goods in vintage stores, dollar stores, and craft shops such as DAISO, Omocha Spiral, and ACDC Rag. Practitioners select plastic goods with smooth forms and shapes, and soft, breathable, and light clothing, all with highly saturated colours. Balancing the contrast of colours, practitioners create a rainbow of matter from which they assemble their outfits. The concept of the rainbow is significant to practitioners as the synergy of contrasting colours expresses its own kawaii vitality. As our interviewee, Kanepi, described, “price too can be kawaii” (Yano, Pink Globalization 71); affordable products such as capsule toys and accessories allow practitioners to amass large collections of glistening and twinkling objects. Rare items are also prized, such as vintage toys and goods imported from America, resonating with their own “uniqueness”, and providing a point of difference to the Japanese kawaii cultural landscape. In addition to the key principles of colour, rarity, and affordability, there is also a personalised aspect to decora fashion. Amongst the mundane racks of clothing, toys, and stationary, specific matter twinkles at practitioners like treasures, triggering a moment of thrilling encounter. Our interviewee Pajorina described this moment as having a “fateful energy to it”. All practitioners described this experience as “tokimeki” (literally, a fluttering heart beat), which is used to refer to an experience of excitement in anticipation of something, or the elating feeling of infatuation (Occhi). Our interviewees sought to differentiate this experience of kawaii from feelings of care towards an animal or children through writing systems. While the kanji for “kawaii” was used to refer to children and small animals, the majority of participants wrote “kawaii” to express the vivid and energetic qualities of their fashion. We found each practitioner had a tokimeki response to certain items that and informed their collecting work. While some items fit a more mainstream interpretation of kawaii, such as characters like Hello Kitty, ribbons, and glitter, other practitioners were drawn to non-typical forms they believed were kawaii, such as frogs, snails, aliens, and monsters. As our interviewee Harukyu described: “I think people’s sense of kawaii comes from different sensibilities and perspectives. It’s a matter of feelings. If you think it is kawaii, then it is”. Guided by individual experiences of objects on the shop shelves, practitioners select things that resonate with their own inner beliefs, interests, and fantasies of what kawaii is. In this regard, kawaii matter is not “structured” or “fixed” but rather “emergent through relations” that unfold between the practitioner and the items that catch their eye in a given moment (Thorpe 12). This offers not only an affirming experience through the act of creating, but a playful outlet as well. By choosing unconventional kawaii motifs to include in their collection, and using more standard kawaii beads, jewels, and ribbons to enhance the objects’ cuteness, decora fashion practitioners are transforming, warping, and shifting kawaii aesthetic boundaries in new and experimental ways (Iseri 148; Miller 24–25). As such, this act of collecting is a joyous and elating experience of gathering and accumulating. Making, Meaning, and Memory: Creating kawaii Assemblages Once kawaii items are amassed through the process of collecting, their cuteness is intensified through hand-making items and assembling outfits. One of our interviewees, Momo, explained to us that this expressive act was key to the personalisation of their clothes as it allows them to “put together the things you like” and “incorporate your own feelings”. For example, the bracelets in fig. 2 are an assemblage made by our co-author Kurebayashi, using precious items she has collected for 10 years. Each charm has its own meaning in its aesthetics, memories it evokes, and the places in which it was found. Three yellow rubber duck charms bob along strands of twinkling pink and blue bubble-like beads. These ducks, found in a bead shop wholesaler while travelling in Hong Kong, evoke for Kurebayashi an experience of a bubble bath, where one can relax and luxuriate in self care. Their contrast with the pink and blue—forming the trifecta of primary colours—enhances the vibrant intensity of the bracelet. A large blue bear charm, contrasting in scale and colour, swings at her wrist, its round forms evoking Lorenz’s Kindchenschema. This bear charm is another rare find from America, a crowning jewel in Kurebayashi’s collection. It represents Kurebayashi’s interest in fun and colourful animals as characters, and as potential kawaii friends. Its translucent plastic form catches the light as it glistens. To balance the colour scheme of her creation, Kurebayashi added a large strawberry charm, found for just 50 Yen in a discount store in Japan. Together these objects resonate with key decora principles: personal significance, rarity, affordability, and bright contrasting colours. While the bear and duck reference childhood toys, they do not signify to Kurebayashi a desire to return to childhood. Rather, their rounded forms evoke a playful outlook on life informed by self care and creativity (Ngai 841; Rose). Through bringing the collection of items together in making these bracelets, the accessories form an entanglement of kawaii matter that carries both aesthetic and personal meaning, charged with memories, traces of past travels, and a shining shimmering vitality of colour and light. Fig. 2: Handmade decora fashion bracelet by Kurebayashi, 2022. The creation of decora outfits is the final act of expression and freedom. In this moment, decora fashion practitioners experience elation as they gleefully mix and match items from their collection to create their fashion style. This entanglement of practitioner and kawaii matter evokes what Gorscz would describe as “free acts … generated through the encounter of life with matter” (151). If we return to fig. 1, we can see how Kurebayashi and her fashion mutually energise each other as an expression of colourful freedom. While the objects themselves are found through encounters and given new life by Kurebayashi as fashion items, they also provide Kurebayashi with tools of expression that “expand the variety of activities” afforded to adults (Gorscz 154). She feels elated, full of feeling, insight, and humour in these clothes, celebrating all the things she loves that are bright, colourful, and fun. Conclusion In this essay, we have used New Materialist theory to illustrate some of the ways in which kawaii matter energises decora fashion practitioners, as an expression of what Gorscz would describe as “capacity for action” and a “freedom towards” new modes of expression. Practitioners are sensitive to kawaii’s affective potential, motivating them to search for and collect items that elate and excite them, triggering moments of thrilling encounters amongst the mundanity of the stores they search through. Through the act of making and assembling these items, practitioners form an entanglement of matter charged with their feelings, memories, and the vitality and vibrancy of their collections. Like shining rainbows in the streets, they shimmer and shine with kawaii life, vibrancy, and vitality. Acknowledgements This article was produced with the support of a Vitalities Lab Scholarship, UNSW Sydney, a National Library of Australia Asia Studies scholarship, as well as in-kind support from the University of Tokyo and the Japan Foundation Sydney. 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Abstract:

Introduction‘Dream’ has been researched across numerous fields in its multiplicity within both a physical and emotional capacity. For Pagel et al., there is no fixed definition of what ‘dream’ is or are. However, in an advertising context, ’dream’ is the idealised version of our desires, re-visualised in real life (Coombes and Batchelor 103). It could be said that for countless consumers, advertising imagery has elicited dreams of living the perfect life and procuring material pleasures (Manca et al.; Hood). Goodis asserts, “advertising doesn’t always mirror how people are acting but how they are dreaming, in a sense what we are doing is wrapping up your emotions and selling them back to you” (qtd. in Back and Quaade 65). One component of this notion of ‘dream’ in advertising is captured by wishful images of the face and body in their ‘perfect form’ presented in a field of other beauty ideals. For our purposes, ‘dream’ is a “philosophical concept” (Pagel et al. 14) by which dreams are a series of aspirations and desires that consumers internalise, while at the same time, find difficult to achieve. ‘Dream’, then, will be used to critically explore how the beauty and advertising industries collectively employ ethnic ambiguity in addition to other tactics and strategies to sell us dream-like visions of idealised beauty. Forever Dreaming: The Introduction of Ethnic AmbiguityWe can link dreams to beauty as both areas of analysis contain many cultural interpretations and can be deconstructed to reveal different meanings (Sontag). In many ways, beauty is another dream and Sontag notes that the concept of beauty is often linked to certain physical traits that an individual possesses. These physical traits are capitalised upon by product marketing by which Hood claims, aims to enhance one, or even more, of them. For example, lipstick is not marketed as simply as a mixture of wax and pigment but rather a way to “obtain beauty, find romance or gain confidence” (7). As a result, global beauty brands can find long term marketing success through meaningful product marketing. This long-term marketing success relies on influencing human behaviour and perceptions. As a result of meaningful marketing, consumers may find themselves driven to purchase implicit qualities in products advertised to reflect their dreams (Hood).Following the 1980s, this version of meaningful marketing has become a driving purpose for advertising agencies around the globe (Steel). Advertising agencies rely on deeper human insights, identifying latent desires to create a brief that must ultimately sell a dream (Steel). The ideal strategy needs to define something that will build brand loyalty and encourage consumers to have a symbiotic relationship connecting their dreams with the product being sold. As Hood argues, “advertising consists of selling not just things but also dreams”. While this concept is one that “some see as inherently damning”, it is also inherently necessary (7). We understand that people are emotional beings, investing in the artefacts they build, obtain or use with significance “beyond merely utilitarian” (7). For these reasons, beauty advertisers act as the purveyors of dreams in the form of physical perfection as an articulation of consumer’s own aspirations of beauty.These aspirations of dream beauty are a direct representation of our thoughts and feelings. As such, it should be noted that we as consumers are often encouraged to draw inspiration from imagery that is often times seen as ethnically ambiguous. “Ethnic ambiguity” is the absence of any one prominent ethnic or racial feature that is easily discernible to one specific group (Garcia 234; Harrison et al.). An example of this ethnic ambiguity can be seen in marketing campaigns by high end makeup artist and her eponymous range of cosmetics, Charlotte Tilbury. Most notably, in a 2015 launch for her “Makeup Wardrobe”, Tilbury’s makeup palettes boasted 10 aspirational ‘looks’ and personas that could be achieved simply through purchase. The images of women featured on a figurative ‘wheel of fortune’ digital display used to market products online. This digital ‘wheel of fortune’ comprised of ethnically ambiguous models against descriptive persona’s such as “The Dolce Vita” and “The Glamour Muse”. These kinds of digital marketing tools required consumers to make a decision based on what their dream ‘look’ is through an ethnically ambiguous lens and from here are guided to purchase their desired aesthetic. Like Charlotte Tilbury, the beauty industry has seen a growing body of cosmetic brands that employ ethnic ambiguity to sell dreams of hom*ogenised beauty. We will see the ways in which modern day beauty brands, such as Kylie Jenner Cosmetics and Fenty Beauty have come to adopt ethnic ambiguity or embrace entire ethnic and racial groups in order to expand their consumer influence.Aspirational Ambiguity: Dreams of DisempowermentSince the early 2000s, beauty advertising has seen a prominent rise in the use of ethnically ambiguous models. Some see this as an effort to answer the global desire for diversity and inclusion. However, the notion that beauty standards transcend racial boundaries and is inclusive, is simply another form of appropriating and fetishising ethnicity (R. Sengupta). In many ways, these manufactured dream-like versions of beauty have evolved to reach wider markets, in the hope that consumers will be emboldened to both embrace their racial heritage, and at the same time conform to hom*ogenised standards of beauty (Frith et al.; Harrison et al.).In this bid to diversify and extend consumer reach, there are three prominent reasons why ethnically ambiguous models are more likely to be featured over models whose African, Indigenous, and/or Asian heritage is more prominent. Firstly, ethnically ambiguous models do not seem to conform to a particular notion of what is considered beautiful. For many decades, popular culture has been saturated with images of thin, of young, of narrow noses and hips, of blonde, blue eyes, and Caucasian hair textures (Harrison et al.; Hunter; Saraswati). These Westernised beauty ideals have been historically shaped through years of colonial influence, grounded in an imbalance of power and imposed to create a culture of dominance and oppression (Saraswati). Secondly, ethnic models are featured to convey “the sense of the ‘exotic’, and their ‘otherness’ acts to normalise and entrench the dominant ideal of white beauty” (qtd. in Redmond 175). ‘Otherness’ can be defined as the opposite of the majority, in Westernised society this ‘other’ can mean “people who are other than white, male, able bodied, heterosexual” (qtd. in Graycar 74). This ‘otherness’ showcased by ethnically ambiguous models draws viewers in. Physical features that were possessed by one specific ethnic group such as African, Asian, Latinx or Indigenous peoples have now become blended and are no longer confined to one race. Additionally, ethnically ambiguous models enable white consumers to dream about an exotic local or lifestyle, while at the same time providing ethnic audiences a way to see themselves.Finally, it is undeniable that ethnically ambiguous and mixed-race models have become desirable due to a historical preference for light skin (Saraswati). The visual references of light-skinned beauty epitomise a colonial dream and this standardisation has been transferred to indigenous peoples, or ethnic minorities in Western countries. According to Harrison et al, “marketers use mixed-race representations as cultural currency by mythologising mixed-race bodies as the new beauty standard” to represent a racial bridge, “tailored to ameliorate perceived racial divides” (503). Therefore, ethnically ambiguous models have an assumed advantage over their racially dominant counterparts, because they appear to straddle various racial boundaries. They are constructed to embody whomever, from wherever and whenever, fetishising their roleplay for the industry, when it pleases. This further exoticises multi-racial beauty models and renders them a commodified fantasy for many consumers alike. The continued commodification of ethnic ambiguity is problematic as it exploits models with distinctly mixed-race heritage to continue to sell images of white-washed beauty (Solomon et al.). An argument could be made that scarcity contributes to mixed-race models’ value, and therefore the total number of advertising opportunities that are offered to mixed-race models remains limited. To date, numerous studies highlight a limited use of racially diverse models within the beauty industry and does not reflect the growing global body of diverse consumers with purchasing power (Wasylkiw et al.; Redmond; Johnson; Jung and Lee; Frith et al.). In fact, prior to globalisation, Yan and Bissell claim that “each culture had a unique standard of attractiveness, derived from traditional views about beauty as well as the physical features of the people” (197) and over time the construction of dream beauty is characterised using Western features combined with exoticised traits of indigenous ethnic groups. Akinro and Mbunyuza-Memani claim that this “trend of normalising white or 'western' feminine looks as the standard of beauty” has pervaded a number of these indigenous cultures, eventually disseminated through the media as the ultimate goal (308). It can also be argued that the “growing inclusion of mixed-race models in ads is driven less by the motivation to portray diversity and driven more by pragmatism,” and in a more practical sense has implications for the “financial future of the advertised brands and the advertising industry as a whole” (Harrison et al. 513). As a result, uses of mixed-race models “are rather understood as palatable responses within dominant white culture to racial and ethnic minority populations growing in … cultural prominence” (513) in a tokenistic bid to sell a dream of unified beauty.The Dream Girl: Normalisation of Mixed-RaceIn 2017, an article in CNN’s Style section highlighted the growing number of mixed-race models in Japan’s fashion and beauty industry as a modern-day phenomenon from Japan’s interlocking history with the United States (Chung and Ogura). These beauty and fashion influencers refer to themselves as hafu, an exclusionary term that historically represented an “othered” minority of mixed-race heritage in Japanese society signalling complex and troubled interactions with majority Japanese (Oshima). The complications once associated with the term ‘hafu’ are now being reclaimed by bi-racial beauty and fashion models and as such, these models are beginning to defy categorisation and, in some ways, national identity because of their chameleon-like qualities. However, while there is an increasing use of mixed-race Japanese models, everyday mixed-race women are regularly excluded within general society; which highlights the incongruent nature of ‘half’ identity. And yet there is an increasing preference and demand from fashion and beauty outlets to feature them in Japanese and Western popular culture (Harrison et al.; Chung and Ogura). Numéro Tokyo’s editorial director Sayumi Gunji, estimated that almost 30-40 per cent of runway models in present day Japan, identify as either bi-racial mixed-race or multi-racial (Chung and Ogura).Gunji claims:"Almost all top models in the their 20s are hafu, especially the top models of popular fashion magazines ... . [In] the Japanese media and market, a foreigner's flawless looks aren't as readily accepted -- they feel a little distant. But biracial models, who are taller, have bigger eyes, higher noses [and] Barbie-doll-like looks, are admired because they are dreamy looking but not totally different from the Japanese. That's the key to their popularity," she adds. (Qtd. in Chung and Ogura)The "dreamy look" that Gunji describes is attributed to a historical preference toward light skin and a kind of willingness and sensuality, that once, only white models could be seen to tout (Frith et al. 58). Frith et al. and O’Barr discuss that beauty in Japanese advertising mirrors “the way women are portrayed in advertising in the West” (qtd. in Frith et al. 58). The emergence of hafu in Japanese beauty advertising sees these two worlds, a mixture of doll-like and sensual beauty, converging to create a dream-like standard for Japanese consumers. The growing presence of Japanese-American models such as Kiko Mizuhara and Jun Hasegawa are both a direct example of the unattainable ‘dreamy look’ that pervades the Japanese beauty industry. Given this ongoing trend of mixed-race models in beauty advertising, a recent article on Refinery29 talks about the significance of how mixed-race models are disassembling their once marginalised status.A. Sengupta writes:In contrast to passing, in which mixedness was marginalized and hidden, visibly multiracial models now feature prominently in affirmative sites of social norms. Multiracial looks are normalized, and, by extension, mixed identity is validated. There’s no cohesive social movement behind it, but it’s a quiet sea change that’s come with broadened beauty standards and the slow dismantling of social hierarchies.Another example of the normalisation in multi-racial identity is Adwoa Aboah, a mixed-race British model and feminist activist who has been featured on the covers of numerous fashion publications and on runways worldwide. In British Vogue’s December 2017 issue, titled “Great BRITAIN”, Adwoa Aboah achieved front cover status, alongside her image featured other politically powerful names, perhaps suggesting that Aboah represents not only the changing face of a historically white publication but as an embodiment of an increasingly diverse consumer landscape. Not only is she seen as both as a voice for those disenfranchised by the industry, by which she is employed, but as a symbol of new dreams. To conclude this section, it seems the evolution of advertising’s inclusion of multi-racial models reveals a progressive step change for the beauty industry. However, relying simply on the faces of ethnically ambiguous talent has become a covert way to fulfil consumer’s desire for diversity without wholly dismantling the destructive hierarchies of white dominance. Over this time however, new beauty creations have entered the market and with it two modern day icons.Architecting Black Beauty through the American DreamAccording to Kiick, the conception of the ‘American Dream’ is born out of a desire to “seek out a more advantageous existence than the current situation” (qtd. in Manca et al. 84). As a result of diligent hard work, Americans were rewarded with an opportunity for a better life (Manca et al.). Kylie Jenner’s entry into the beauty space seemed like a natural move for the then eighteen-year-old; it was a new-age representation of the ‘American Dream’ (Robehmed 2018). In less than five years, Jenner has created Kylie Cosmetics, a beauty empire that has since amassed a global consumer base, helping her earn billionaire status. A more critical investigation into Jenner’s performance however illustrates that her eponymous range of beauty products sells dreams which have been appropriated from black culture (Phelps). The term cultural appropriation refers to the way dominant cultures “adopt and adapt certain aspects of another’s culture and make it their own” (qtd. in Han 9). In Jenner’s case, her connection to ethnic Armenian roots through her sisters Kourtney, Kim, and Khloe Kardashian have significantly influenced her expression of ‘othered’ culture and moreover ethnic beauty ideals such as curvier body shapes and textured hair. Jenner’s beauty advertisem*nts have epitomised what it means to be black in America, cherry picking racialised features of black women (namely their lips, hips/buttocks and afro-braided hairstyles) and rearticulated them through a white lens. The omission of the ‘black experience’ in her promotion of product is problematic for three reasons. Firstly, representing groups or people without invitation enables room for systemic stereotyping (Han). Secondly, this stereotyping can lead to continued marginalisation of minority cultures (Kulchyski). And finally, the over exaggeration of physical attributes, such as Jenner’s lips, hips and buttocks, reinforces her complicity in exoticising and fetishising the “other”. As a result, consumers of social media beauty advertising may pay less attention to cultural appropriation if they are already unaware that the beauty imagery they consume is based on the exploitation of black culture.Another perspective on Jenner’s use of black culture is in large part due to her cultural appreciation of black beauty. This meaning behind Jenner’s cultural appreciation can be attributed to the inherent value placed on another person’s culture, in the recognition of the positive qualities and the celebration of all aspects of that culture (Han). This is evidenced by her recent addition of cosmetic products for darker complexions (Brown). However, Jenner’s supposed fascination with black culture may be in large part due to the environment in which she was nurtured (Phelps). As Phelps reveals, “consider the cultural significance of the Kardashian family, and the various ways in which the Kardashian women, who are tremendously wealthy and present as white, have integrated elements of black culture as seemingly “natural” in their public bodily performances” (9). Although the Kardashian-Jenner family have faced public backlash for their collective appropriation they have acquired a tremendous “capital gain in terms of celebrity staying power and hyper-visibility” (Phelps 9). Despite the negative attention, Kylie Jenner’s expression of black culture has resurfaced the very issues that had once been historically deemed insignificant. In spite of Jenner’s cultural appropriation of black beauty, her promotion through Kylie Cosmetics continues to sell dreams of idealised beauty through the white lens.In comparison, Rihanna Fenty’s cosmetic empire has been touted as a celebration of diversity and inclusion for modern-age beauty. Unlike Kylie Cosmetics, Fenty’s eponymous brand has become popular for its broader message of inclusivity across both skin tone, body shape and gender. Upon her product release, Fenty Beauty acknowledged a growing body of diverse consumers and as a direct response to feature models of diverse skin tones, cultural background and racial heritage. Perhaps more importantly, Fenty Beauty’s challenge to the ongoing debate around diversity and inclusion has been in stark contrast to Kylie Jenner’s ongoing appropriation of black culture. Images featured at the first brand and product launch of Fenty Beauty and in present day advertising, show South Sudanese model Duckie Thot and hijab-wearing model Halima Aden as central characters within the Fenty narrative, illustrating that inclusion need not remain ambiguous and diversity need not be appropriated. Fenty’s initial product line up included ninety products, but most notably, the Pro Filt’r foundation caused the most publicity. Since its introduction in 2017, the foundation collection contained range of 40 (now 50) inclusive foundation shades, 13 of these shades were designed to cater for much darker complexions, an industry first (Walters). As a result of the brand’s inclusion of diverse product shades and models, Fenty Beauty has been shown to push boundaries within the beauty industry and the social media landscape (Walters). Capitalising on all races and expanding beauty ideals, Fenty’s showcase of beauty subscribes to the notion that for women everywhere in the world, their dreams can and do come true. In conclusion, Fenty Beauty has played a critical role in re-educating global consumers about diversity in beauty (Walters) but perhaps more importantly Rihanna, by definition, has become a true embodiment of the ‘American Dream’.Conclusion: Future Dreams in BeautyIt is undeniable that beauty advertising has remained complicit in selling unattainable dreams to consumers. 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Abstract:

Kangatarianism is the rather inelegant word coined in the first decade of the twenty-first century to describe an omnivorous diet in which the only meat consumed is that of the kangaroo. First published in the media in 2010 (Barone; Zukerman), the term circulated in Australian environmental and academic circles including the Global Animal conference at the University of Wollongong in July 2011 where I first heard it from members of the Think Tank for Kangaroos (THINKK) group. By June 2017, it had gained enough attention to be named the Oxford English Dictionary’s Australian word of the month (following on from May’s “smashed avo,” another Australian food innovation), but it took the Nine Network reality television series Love Island Australia to raise kangatarian to trending status on social media (Oxford UP). During the first episode, aired in late May 2018, Justin, a concreter and fashion model from Melbourne, declared himself to have previously been a kangatarian as he chatted with fellow contestant, Millie. Vet nurse and animal lover Millie appeared to be shocked by his revelation but was tentatively accepting when Justin explained what kangatarian meant, and justified his choice on the grounds that kangaroo are not farmed. In the social media response, it was clear that eating only the meat of kangaroos as an ethical choice was an entirely new concept to many viewers, with one tweet stating “Kangatarian isn’t a thing”, while others variously labelled the diet brutal, intriguing, or quintessentially Australian (see #kangatarian on Twitter).There is a well developed literature around the arguments for and against eating kangaroo, and why settler Australians tend to be so reluctant to do so (see for example, Probyn; Cawthorn and Hoffman). Here, I will concentrate on the role that ethics play in this food choice by examining how the adoption of kangatarianism can be understood as a bargain struck to help to manage grief in the Anthropocene, and the limitations of that bargain. As Lesley Head has argued, we are living in a time of loss and of grieving, when much that has been taken for granted is becoming unstable, and “we must imagine that drastic changes to everyday life are in the offing” (313). Applying the classic (and contested) model of five stages of grief, first proposed by Elisabeth Kübler-Ross in her book On Death and Dying in 1969, much of the population of the western world seems to be now experiencing denial, her first stage of loss, while those in the most vulnerable environments have moved on to anger with developed countries for destructive actions in the past and inaction in the present. The next stages (or states) of grieving—bargaining, depression, and acceptance—are likely to be manifested, although not in any predictable sequence, as the grief over current and future losses continues (Haslam).The great expansion of food restrictive diets in the Anthropocene can be interpreted as part of this bargaining state of grieving as individuals attempt to respond to the imperative to reduce their environmental impact but also to limit the degree of change to their own diet required to do so. Meat has long been identified as a key component of an individual’s environmental footprint. From Frances Moore Lappé’s 1971 Diet for a Small Planet through the United Nations’ Food and Agriculture Organisation’s 2006 report Livestock’s Long Shadow to the 2019 report of the EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems, the advice has been consistent: meat consumption should be minimised in, if not eradicated from, the human diet. The EAT–Lancet Commission Report quantified this to less than 28 grams (just under one ounce) of beef, lamb or pork per day (12, 25). For many this would be keenly felt, in terms of how meals are constructed, the sensory experiences associated with eating meat and perceptions of well-being but meat is offered up as a sacrifice to bring about the return of the beloved healthy planet.Rather than accept the advice to cut out meat entirely, those seeking to bargain with the Anthropocene also find other options. This has given rise to a suite of foodways based around restricting meat intake in volume or type. Reducing the amount of commercially produced beef, lamb and pork eaten is one approach, while substituting a meat the production of which has a smaller environmental footprint, most commonly chicken or fish, is another. For those willing to make deeper changes, the meat of free living animals, especially those which are killed accidentally on the roads or for deliberately for environmental management purposes, is another option. Further along this spectrum are the novel protein sources suggested in the Lancet report, including insects, blue-green algae and laboratory-cultured meats.Kangatarianism is another form of this bargain, and is backed by at least half a century of advocacy. The Australian Conservation Foundation made calls to reduce the numbers of other livestock and begin a sustainable harvest of kangaroo for food in 1970 when the sale of kangaroo meat for human consumption was still illegal across the country (Conservation of Kangaroos). The idea was repeated by biologist Gordon Grigg in the late 1980s (Jackson and Vernes 173), and again in the Garnaut Climate Change Review in 2008 (547–48). Kangaroo meat is high in protein and iron, low in fat, and high in healthy polyunsaturated fatty acids and conjugated linoleic acid, and, as these authors showed, has a smaller environmental footprint than beef, lamb, or pork. Kangaroo require less water than cattle, sheep or pigs, and no land is cleared to grow feed for them or give them space to graze. Their paws cause less erosion and compaction of soil than do the hooves of common livestock. They eat less fodder than ruminants and their digestive processes result in lower emissions of the powerful greenhouse gas methane and less solid waste.As Justin of Love Island was aware, kangaroo are not farmed in the sense of being deliberately bred, fed, confined, or treated with hormones, drugs or chemicals, which also adds to their lighter impact on the environment. However, some pastoralists argue that because they cannot prevent kangaroos from accessing the food, water, shelter, and protection from predators they provide for their livestock, they do effectively farm them, although they receive no income from sales of kangaroo meat. This type of light touch farming of kangaroos has a very long history in Australia going back to the continent’s first peopling some 60,000 years ago. Kangaroos were so important to Aboriginal people that a wide range of environments were manipulated to produce their favoured habitats of open grasslands edged by sheltering trees. As Bill Gammage demonstrated, fire was used as a tool to preserve and extend grassy areas, to encourage regrowth which would attract kangaroos and to drive the animals from one patch to another or towards hunters waiting with spears (passim, for example, 58, 72, 76, 93). Gammage and Bruce Pascoe agree that this was a form of animal husbandry in which the kangaroos were drawn to the areas prepared for them for the young grass or, more forcefully, physically directed using nets, brush fences or stone walls. Burnt ground served to contain the animals in place of fencing, and regular harvesting kept numbers from rising to levels which would place pressure on other species (Gammage 79, 281–86; Pascoe 42–43). Contemporary advocates of eating kangaroo have promoted the idea that they should be deliberately co-produced with other livestock instead of being killed to preserve feed and water for sheep and cattle (Ellicott; Wilson 39). Substituting kangaroo for the meat of more environmentally damaging animals would facilitate a reduction in the numbers of cattle and sheep, lessening the harm they do.Most proponents have assumed that their audience is current meat eaters who would substitute kangaroo for the meat of other more environmentally costly animals, but kangatarianism can also emerge from vegetarianism. Wendy Zukerman, who wrote about kangaroo hunting for New Scientist in 2010, was motivated to conduct the research because she was considering becoming an early adopter of kangatarianism as the least environmentally taxing way to counter the longterm anaemia she had developed as a vegetarian. In 2018, George Wilson, honorary professor in the Australian National University’s Fenner School of Environment and Society called for vegetarians to become kangatarians as a means of boosting overall consumption of kangaroo for environmental and economic benefits to rural Australia (39).Given these persuasive environmental arguments, it might be expected that many people would have perceived eating kangaroo instead of other meat as a favourable bargain and taken up the call to become kangatarian. Certainly, there has been widespread interest in trying kangaroo meat. In 1997, only five years after the sale of kangaroo meat for human consumption had been legalised in most states (South Australia did so in 1980), 51% of 500 people surveyed in five capital cities said they had tried kangaroo. However, it had not become a meat of choice with very few found to eat it more than three times a year (Des Purtell and Associates iv). Just over a decade later, a study by Ampt and Owen found an increase to 58% of 1599 Australians surveyed across the country who had tried kangaroo but just 4.7% eating it at least monthly (14). Bryce Appleby, in his study of kangaroo consumption in the home based on interviews with 28 residents of Wollongong in 2010, specifically noted the absence of kangatarians—then a very new concept. A study of 261 Sydney university students in 2014 found that half had tried kangaroo meat and 10% continued to eat it with any regularity. Only two respondents identified themselves as kangatarian (Grant 14–15). Kangaroo meat advocate Michael Archer declared in 2017 that “there’s an awful lot of very, very smart vegetarians [who] have opted for semi vegetarianism and they’re calling themselves ‘kangatarians’, as they’re quite happy to eat kangaroo meat”, but unless there had been a significant change in a few years, the surveys did not bear out his assertion (154).The ethical calculations around eating kangaroo are complicated by factors beyond the strictly environmental. One Tweeter advised Justin: “‘I’m a kangatarian’ isn’t a pickup line, mate”, and certainly the reception of his declaration could have been very cool, especially as it was delivered to a self declared animal warrior (N’Tash Aha). All of the studies of beliefs and practices around the eating of kangaroo have noted a significant minority of Australians who would not consider eating kangaroo based on issues of animal welfare and animal rights. The 1997 study found that 11% were opposed to the idea of eating kangaroo, while in Grant’s 2014 study, 15% were ethically opposed to eating kangaroo meat (Des Purtell and Associates iv; Grant 14–15). Animal ethics complicate the bargains calculated principally on environmental grounds.These ethical concerns work across several registers. One is around the flesh and blood kangaroo as a charismatic native animal unique to Australia and which Australians have an obligation to respect and nurture. Sheep, cattle and pigs have been subject to longterm propaganda campaigns which entrench the idea that they are unattractive and unintelligent, and veil their transition to meat behind euphemistic language and abattoir walls, making it easier to eat them. Kangaroos are still seen as resourceful and graceful animals, and no linguistic tricks shield consumers from the knowledge that it is a roo on their plate. A proposal in 2009 to market a “coat of arms” emu and kangaroo-flavoured potato chip brought complaints to the Advertising Standards Bureau that this was disrespectful to these native animals, although the flavours were to be simulated and the product vegetarian (Black). Coexisting with this high regard to kangaroos is its antithesis. That is, a valuation of them informed by their designation as a pest in the pastoral industry, and the use of the carcasses of those killed to feed dogs and other companion animals. Appleby identified a visceral, disgust response to the idea of eating kangaroo in many of his informants, including both vegetarians who would not consider eating kangaroo because of their commitment to a plant-based diet, and at least one omnivore who would prefer to give up all meat rather than eat kangaroo. While diametrically opposed, the end point of both positions is that kangaroo meat should not be eaten.A second animal ethics stance relates to the imagined kangaroo, a cultural construct which for most urban Australians is much more present in their lives and likely to shape their actions than the living animals. It is behind the rejection of eating an animal which holds such an iconic place in Australian culture: to the dexter on the 1912 national coat of arms; hopping through the Hundred Acre Wood as Kanga and Roo in A.A. Milne’s Winnie-the-Pooh children’s books from the 1920s and the Disney movies later made from them; as a boy’s best friend as Skippy the Bush Kangaroo in a fondly remembered 1970s television series; and high in the sky on QANTAS planes. The anthropomorphising of kangaroos permitted the spectacle of the boxing kangaroo from the late nineteenth century. By framing natural kangaroo behaviours as boxing, these exhibitions encouraged an ambiguous understanding of kangaroos as human-like, moving them further from the category of food (Golder and Kirkby). Australian government bodies used this idea of the kangaroo to support food exports to Britain, with kangaroos as cooks or diners rather than ingredients. The Kangaroo Kookery Book of 1932 (see fig. 1 below) portrayed kangaroos as a nuclear family in a suburban kitchen and another official campaign supporting sales of Australian produce in Britain in the 1950s featured a Disney-inspired kangaroo eating apples and chops washed down with wine (“Kangaroo to Be ‘Food Salesman’”). This imagining of kangaroos as human-like has persisted, leading to the opinion expressed in a 2008 focus group, that consuming kangaroo amounted to “‘eating an icon’ … Although they are pests they are still human nature … these are native animals, people and I believe that is a form of cannibalism!” (Ampt and Owen 26). Figure 1: Rather than promoting the eating of kangaroos, the portrayal of kangaroos as a modern suburban family in the Kangaroo Kookery Book (1932) made it unthinkable. (Source: Kangaroo Kookery Book, Director of Australian Trade Publicity, Australia House, London, 1932.)The third layer of ethical objection on the ground of animal welfare is more specific, being directed to the method of killing the kangaroos which become food. Kangaroos are perhaps the only native animals for which state governments set quotas for commercial harvest, on the grounds that they compete with livestock for pasturage and water. In most jurisdictions, commercially harvested kangaroo carcasses can be processed for human consumption, and they are the ones which ultimately appear in supermarket display cases.Kangaroos are killed by professional shooters at night using swivelling spotlights mounted on their vehicles to locate and daze the animals. While clean head shots are the ideal and regulations state that animals should be killed when at rest and without causing “undue agonal struggle”, this is not always achieved and some animals do suffer prolonged deaths (NSW Code of Practice for Kangaroo Meat for Human Consumption). By regulation, the young of any female kangaroo must be killed along with her. While averting a slow death by neglect, this is considered cruel and wasteful. The hunt has drawn international criticism, including from Greenpeace which organised campaigns against the sale of kangaroo meat in Europe in the 1980s, and Viva! which was successful in securing the withdrawal of kangaroo from sale in British supermarkets (“Kangaroo Meat Sales Criticised”). These arguments circulate and influence opinion within Australia.A final animal ethics issue is that what is actually behind the push for greater use of kangaroo meat is not concern for the environment or animal welfare but the quest to turn a profit from these animals. The Kangaroo Industries Association of Australia, formed in 1970 to represent those who dealt in the marsupials’ meat, fur and skins, has been a vocal advocate of eating kangaroo and a sponsor of market research into how it can be made more appealing to the market. The Association argued in 1971 that commercial harvest was part of the intelligent conservation of the kangaroo. They sought minimum size regulations to prevent overharvesting and protect their livelihoods (“Assn. Backs Kangaroo Conservation”). The Association’s current website makes the claim that wild harvested “Australian kangaroo meat is among the healthiest, tastiest and most sustainable red meats in the world” (Kangaroo Industries Association of Australia). That this is intended to initiate a new and less controlled branch of the meat industry for the benefit of hunters and processors, rather than foster a shift from sheep or cattle to kangaroos which might serve farmers and the environment, is the opinion of Dr. Louise Boronyak, of the Centre for Compassionate Conservation at the University of Technology Sydney (Boyle 19).Concerns such as these have meant that kangaroo is most consumed where it is least familiar, with most of the meat for human consumption recovered from culled animals being exported to Europe and Asia. Russia has been the largest export market. There, kangaroo meat is made less strange by blending it with other meats and traditional spices to make processed meats, avoiding objections to its appearance and uncertainty around preparation. With only a low profile as a novelty animal in Russia, there are fewer sentimental concerns about consuming kangaroo, although the additional food miles undermine its environmental credentials. The variable acceptability of kangaroo in more distant markets speaks to the role of culture in determining how patterns of eating are formed and can be shifted, or, as Elspeth Probyn phrased it “how natural entities are transformed into commodities within a context of globalisation and local communities”, underlining the impossibility of any straightforward ethics of eating kangaroo (33, 35).Kangatarianism is a neologism which makes the eating of kangaroo meat something it has not been in the past, a voluntary restriction based on environmental ethics. These environmental benefits are well founded and eating kangaroo can be understood as an Anthropocenic bargain struck to allow the continuation of the consumption of red meat while reducing one’s environmental footprint. Although superficially attractive, the numbers entering into this bargain remain small because environmental ethics cannot be disentangled from animal ethics. The anthropomorphising of the kangaroo and its use as a national symbol coexist with its categorisation as a pest and use of its meat as food for companion animals. Both understandings of kangaroos made their meat uneatable for many Australians. Paired with concerns over how kangaroos are killed and the commercialisation of a native species, kangaroo meat has a very mixed reception despite decades of advocacy for eating its meat in favour of that of more harmed and more harmful introduced species. Given these constraints, kangatarianism is unlikely to become widespread and indeed it should be viewed as at best a temporary exigency. As the climate warms and rainfall becomes more erratic, even animals which have evolved to suit Australian conditions will come under increasing pressure, and humans will need to reach Kübler-Ross’ final state of grief: acceptance. In this case, this would mean acceptance that our needs cannot be placed ahead of those of other animals.ReferencesAmpt, Peter, and Kate Owen. Consumer Attitudes to Kangaroo Meat Products. Canberra: Rural Industries Research and Development Corporation, 2008.Appleby, Bryce. “Skippy the ‘Green’ Kangaroo: Identifying Resistances to Eating Kangaroo in the Home in a Context of Climate Change.” BSc Hons, U of Wollongong, 2010 <http://ro.uow.edu.au/thsci/103>.Archer, Michael. “Zoology on the Table: Plenary Session 4.” Australian Zoologist 39, 1 (2017): 154–60.“Assn. Backs Kangaroo Conservation.” The Beverley Times 26 Feb. 1971: 3. 22 Feb. 2019 <http://nla.gov.au/nla.news-article202738733>.Barone, Tayissa. “Kangatarians Jump the Divide.” Sydney Morning Herald 9 Feb. 2010. 13 Apr. 2019 <https://www.smh.com.au/lifestyle/kangatarians-jump-the-divide-20100209-gdtvd8.html>.Black, Rosemary. “Some Australians Angry over Idea for Kangaroo and Emu-Flavored Potato Chips.” New York Daily News 4 Dec. 2009. 5 Feb. 2019 <https://www.nydailynews.com/life-style/eats/australians-angry-idea-kangaroo-emu-flavored-potato-chips-article-1.431865>.Boyle, Rhianna. “Eating Skippy.” Big Issue Australia 578 11-24 Jan. 2019: 16–19.Cawthorn, Donna-Mareè, and Louwrens C. Hoffman. “Controversial Cuisine: A Global Account of the Demand, Supply and Acceptance of ‘Unconventional’ and ‘Exotic’ Meats.” Meat Science 120 (2016): 26–7.Conservation of Kangaroos. Melbourne: Australian Conservation Foundation, 1970.Des Purtell and Associates. Improving Consumer Perceptions of Kangaroo Products: A Survey and Report. Canberra: Rural Industries Research and Development Corporation, 1997.Ellicott, John. “Little Pay Incentive for Shooters to Join Kangaroo Meat Industry.” The Land 15 Mar. 2018. 28 Mar. 2019 <https://www.theland.com.au/story/5285265/top-roo-shooter-says-harvesting-is-a-low-paid-job/>.Garnaut, Ross. Garnaut Climate Change Review. 2008. 26 Feb. 2019 <http://www.garnautreview.org.au/index.htm>.Gammage, Bill. The Biggest Estate on Earth: How Aborigines Made Australia. Sydney: Allen and Unwin, 2012.Golder, Hilary, and Diane Kirkby. “Mrs. Mayne and Her Boxing Kangaroo: A Married Woman Tests Her Property Rights in Colonial New South Wales.” Law and History Review 21.3 (2003): 585–605.Grant, Elisabeth. “Sustainable Kangaroo Harvesting: Perceptions and Consumption of Kangaroo Meat among University Students in New South Wales.” Independent Study Project (ISP). U of NSW, 2014. <https://digitalcollections.sit.edu/isp_collection/1755>.Haslam, Nick. “The Five Stages of Grief Don’t Come in Fixed Steps – Everyone Feels Differently.” The Conversation 22 Oct. 2018. 28 Mar. 2019 <https://theconversation.com/the-five-stages-of-grief-dont-come-in-fixed-steps-everyone-feels-differently-96111>.Head, Lesley. “The Anthropoceans.” Geographical Research 53.3 (2015): 313–20.Kangaroo Industries Association of Australia. Kangaroo Meat. 26 Feb. 2019 <http://www.kangarooindustry.com/products/meat/>.“Kangaroo Meat Sales Criticised.” The Canberra Times 13 Sep. 1984: 14. 22 Feb 2019 <http://nla.gov.au/nla.news-article136915919>.“Kangaroo to Be Food ‘Salesman.’” Newcastle Morning Herald and Miners’ Advocate, 2 Dec. 1954. 22 Feb 2019 <http://nla.gov.au/nla.news-article134089767>.Kübler-Ross, Elisabeth. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and their own Families. New York: Touchstone, 1997.Jackson, Stephen, and Karl Vernes. Kangaroo: Portrait of an Extraordinary Marsupial. Sydney: Allen and Unwin, 2010.Lappé, Frances Moore. Diet for a Small Planet. New York: Ballantine Books, 1971.N’Tash Aha (@Nsvasey). “‘I’m a Kangatarian’ isn’t a Pickup Line, Mate. #LoveIslandAU.” Twitter post. 27 May 2018. 5 Apr. 2019 <https://twitter.com/Nsvasey/status/1000697124122644480>.“NSW Code of Practice for Kangaroo Meat for Human Consumption.” Government Gazette of the State of New South Wales 24 Mar. 1993. 22 Feb. 2019 <http://nla.gov.au/nla.news-page14638033>.Oxford University Press, Australia and New Zealand. Word of the Month. June 2017. <https://www.oup.com.au/dictionaries/word-of-the-month>.Pascoe, Bruce. Dark Emu, Black Seeds: Agriculture or Accident? Broome: Magabala Books, 2014.Probyn, Elspeth. “Eating Roo: Of Things That Become Food.” New Formations 74.1 (2011): 33–45.Steinfeld, Henning, Pierre Gerber, Tom Wassenaar, Vicent Castel, Mauricio Rosales, and Cees d Haan. Livestock’s Long Shadow: Environmental Issues and Options. Rome: Food and Agriculture Organisation of the United Nations, 2006.Trust Nature. Essence of Kangaroo Capsules. 26 Feb. 2019 <http://ncpro.com.au/products/all-products/item/88139-essence-of-kangaroo-35000>.Victoria Department of Environment, Land, Water and Planning. Kangaroo Pet Food Trial. 28 Mar. 2019 <https://www.wildlife.vic.gov.au/managing-wildlife/wildlife-management-and-control-authorisations/kangaroo-pet-food-trial>.Willett, Walter, et al. “Food in the Anthropocene: The EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems.” The Lancet 16 Jan. 2019. 26 Feb. 2019 <https://www.thelancet.com/commissions/EAT>.Wilson, George. “Kangaroos Can Be an Asset Rather than a Pest.” Australasian Science 39.1 (2018): 39.Zukerman, Wendy. “Eating Skippy: The Future of Kangaroo Meat.” New Scientist 208.2781 (2010): 42–5.

Abstract:

Everyone thinks I named my cat Mango because of his orange eyes but that’s not the case. I named him Mango because the sounds of his purrs and his wheezes and his meows are all various shades of yellow-orange. (Mass 3) Synaesthesia, a condition where stimulus in one sense is perceived in that sense as well as in another, is thought to be a neurological fluke, marked by cross-sensory reactions. Mia, a character in the children’s book A Mango-Shaped Space, has audition colorée or coloured hearing, the most common form of synaesthesia where sounds create dynamic coloured photisms in the visual field. Others with the condition may taste shapes (Cytowic 5), feel colours (Duffy 52), taste sounds (Cytowic 118) or experience a myriad of other sensory combinations. Most non-synaesthetes have never heard of synaesthesia and many treat the condition with disbelief upon learning of it, while synaesthetes are often surprised to hear that others don’t have it. Although there has been a resurgence of interest in synaesthesia recently in psychology, neuroscience and philosophy (Ward and Mattingley 129), there is no widely accepted explanation for how or why synaesthetic perception occurs. However, if we investigate what meaning this particular condition may offer for rethinking not only what constitutes sensory normalcy, but also the ocular-centric bias in cultural studies, especially media studies, synaesthesia may present us with very productive coalitions indeed.Some theorists posit the ultimate role of media of all forms “to transfer sense experiences from one person to another” (Bolter and Grusin 3). Alongside this claim, many “have also maintained that the ultimate function of literature and the arts is to manifest this fusion of the senses” found in synaesthesia (Dann ix). If the most primary of media aims are to fuse and transfer sensory experiences, manifesting these goals would be akin to transferring synaesthetic experience to non-synaesthetes. In some cases, this synaesthetic transfer has been the explicit goal of media forms, from the invention of kaleidoscopes as colour symphonies in 1818 (Dann 66) to the 2002 launch of the video game Rez, the packaging for which reads “Discover a new world. A world of sound, visuals and vibrations. Release your instincts, open your senses and experience synaesthesia” (Rez). Recent innovations such as touch screen devices, advances in 3D film and television technologies and a range of motion-sensing video gaming consoles extend media experience far beyond the audio-visual and as such, present both serious challenges and important opportunities for media and culture scholars to reinvigorate ways of thinking about media experience, sensory embodiment and what might be learned from engaging with synaesthesia. Fleshing out the Field While acknowledging synaesthesia as a specific condition that enhances and complicates the lives of many individuals, I also suggest that synaesthesia is a useful mode of interference into our current ocular-centric notions of culture. Vision and visual phenomena hold a particularly powerful role in producing and negotiating meanings, values and relationships in the contemporary cultural arena and as a result, the eye has become privileged as the “master sense of the modern era” (Jay Scopic 3). Proponents of visual culture claim that the majority of modern life takes place through sight and that “human experience is now more visual and visualized than ever before ... in this swirl of imagery, seeing is much more than believing. It is not just a part of everyday life, it is everyday life” (Mirzoeff 1). In order to enjoy this privilege as the master sense, vision has been disentangled from the muscles and nerves of the eyeball and relocated to the “mind’s eye”, a metaphor that equates a kind of disembodied vision with knowledge. Vision becomes the most non-sensual of the senses, and made to appear “as a negative reference point for the other senses...on the side of detachment, separation” (Connor) or even “as the absence of sensuality” (Haraway). This creates a paradoxical “visual culture” in which the embodied eye is, along with the ear, skin, tongue and nose, strangely absent. If visual culture has been based on the separation of the senses, and in fact, a refutation of embodied senses altogether, what about that which we might encounter and know in the world that is not encompassed by the mind’s eye? By silencing the larger sensory context, what are we missing? What ocular-centric assumptions have we been making? What responsibilities have we ignored?This critique does not wish to do away with the eye, but instead to re-embrace and extend the field of vision to include an understanding of the eye and what it sees within the context of its embodied abilities and limitations. Although the mechanics of the eye make it an important and powerful sensory organ, able to perceive at a distance and provide a wealth of information about our surroundings, it is also prone to failures. Equipped as it is with eyelids and blind spots, reliant upon light and gullible to optical illusions (Jay, Downcast 4), the eye has its weaknesses and these must be addressed along with its abilities. Moreover, by focusing only on what is visual in culture, we are missing plenty of import. The study of visual culture is not unlike studying an electrical storm from afar. The visually impressive jagged flash seems the principal aspect of the storm and quite separate from the rumbling sound that rolls after it. We perceive them and name them as two distinct phenomena; thunder and lightning. However, this separation is a feature only of the distance between where we stand and the storm. Those who have found themselves in the eye of an electrical storm know that the sight of the bolt, the sound of the crash, the static tingling and vibration of the crack and the smell of ozone are mingled. At a remove, the bolt appears separate from the noise only artificially because of the safe distance. The closer we are to the phenomenon, the more completely it envelops us. Although getting up close and personal with an electrical storm may not be as comfortable as viewing it from afar, it does offer the opportunity to better understand the total experience and the thrill of intensities it can engage across the sensory palette. Similarly, the false separation of the visual from the rest of embodied experience may be convenient, but in order to flesh out this field, other embodied senses and sensory coalitions must be reclaimed for theorising practices. The senses as they are traditionally separated are simply put, false categories. Towards SynaestheoryAny inquiry inspired by synaesthesia must hold at its core the idea that the senses cannot be responsibly separated. This notion applies firstly to the separation of senses from one another. Synaesthetic experience and experiment both insist that there is rich cross-fertility between senses in synaesthetes and non-synaesthetes alike. The French verb sentir is instructive here, as it can mean “to smell”, “to taste” or “to feel”, depending on the context it is used in. It can also mean simply “to sense” or “to be aware of”. In fact, the origin of the phrase “common sense” meant exactly that, the point at which the senses meet. There also must be recognition that the senses cannot be separated from cognition or, in the Cartesian sense, that body and mind cannot be divided. An extensive and well-respected study of synaesthesia conducted in the 1920s by Raymond Wheeler and Thomas Cutsforth, non-synaesthetic and synaesthetic researchers respectively, revealed that the condition was not only a quirk of perception, but of conception. Synaesthetic activity, the team deduced “is an essential mechanism in the construction of meaning that functions in the same way as certain unattended processes in non-synaesthetes” (Dann 82). With their synaesthetic imagery impaired, synaesthetes are unable to do even a basic level of thinking or recalling (Dann, Cytowic). In fact, synaesthesia may be a universal process, but in synaesthetes, “a brain process that is normally unconscious becomes bared to consciousness so that synaesthetes know they are synaesthetic while the rest of us do not” (166). Maurice Merleau-Ponty agrees, claiming:Synaesthetic perception is the rule, and we are unaware of it only because scientific knowledge shifts the centre of gravity of experience, so that we unlearn how to see, hear, and generally speaking, feel in order to deduce, from our bodily organisation and the world as the physicist conceives it, what we are to see, hear and feel. (229) With this in mind, neither the mind’s role nor the body’s role in synaesthesia can be isolated, since the condition itself maintains unequivocally that the two are one.The rich and rewarding correlations between senses in synaesthesia prompt us to consider sensory coalitions in other experiences and contexts as well. We are urged to consider flows of sensation seriously as experiences in and of themselves, with or without interpretation and explanation. As well, the debates around synaesthetic experience remind us that in order to speak to phenomena perceived and conceived it is necessary to recognise the specificities, ironies and responsibilities of any embodied experience. Ultimately, synaesthesia helps to highlight the importance of relationships and the complexity of concepts necessary in order to practice a more embodied and articulate theorising. We might call this more inclusive approach “synaestheory”.Synaestheorising MediaDystopia, a series of photographs by artists Anthony Aziz and Sammy Cucher suggests a contemporary take on Decartes’s declaration that “I will now close my eyes, I will stop my ears, I will turn away my senses from their objects” (86). These photographs consist of digitally altered faces where the subject’s skin has been stretched over the openings of eyes, nose, mouth and ears, creating an interesting image both in process and in product. The product of a media mix that incorporates photography and computer modification, this image suggests the effects of the separation from our senses that these media may imply. The popular notion that media allow us to surpass our bodies and meet without our “meat” tagging along is a trope that Aziz and Cucher expose here with their computer-generated cover-up. By sealing off the senses, they show us how little we now seem to value them in a seemingly virtual, post-embodied world. If “hybrid media require hybrid analyses” (Lunenfeld in Graham 158), in our multimedia, mixed media, “mongrel media” (Dovey 114) environment, we need mongrel theory, synaestheory, to begin to discuss the complexities at hand. The goal here is producing an understanding of both media and sensory intelligences as hybrid. Symptomatic of our simple sense of media is our tendency to refer to media experiences as “audio-visual”: stimuli for the ear, eye or both. However, even if media are engineered to be predominately audio and/or visual, we are not. Synaestheory examines embodied media use, including the sensory information that the media does not claim to concentrate on, but that is still engaged and present in every mediated experience. It also examines embodied media use by paying attention to the pops and clicks of the material human-media interface. It does not assume simple sensory engagement or smooth engagement with media. These bumps, blisters, misfirings and errors are just as crucial a part of embodied media practice as smooth and successful interactions. Most significantly, synaesthesia insists simply that sensation matters. Sensory experiences are material, rich, emotional, memorable and important to the one sensing them, synaesthete or not. This declaration contradicts a legacy of distrust of the sensory in academic discourse that privileges the more intellectual and abstract, usually in the form of the detached text. However, academic texts are sensory too, of course. Sound, feeling, movement and sight are all inseparable from reading and writing, speaking and listening. We might do well to remember these as root sensory situations and by extension, recognise the importance of other sensual forms.Indeed, we have witnessed a rise of media genres that appeal to our senses first with brilliant and detailed visual and audio information, and story or narrative second, if at all. These media are “direct and one-dimensional, about little, other than their ability to commandeer the sight and the senses” (Darley 76). Whereas any attention to the construction of the media product is a disastrous distraction in narrative-centred forms, spectacular media reveals and revels in artifice and encourages the spectator to enjoy the simulation as part of the work’s allure. It is “a pleasure of control, but also of being controlled” (MacTavish 46). Like viewing abstract art, the impact of the piece will be missed if we are obsessed with what the artwork “is about”. Instead, we can reflect on spectacular media’s ability, like that of an abstract artwork, to impact our senses and as such, “renew the present” (Cubitt 32).In this framework, participation in any medium can be enjoyed not only as an interpretative opportunity, but also as an experience of sensory dexterity and relevance with its own pleasures and intelligences; a “being-present”. By focusing our attention on sensory flows, we may be able to perceive aspects of the world or ourselves that we had previously missed. Every one of us–synaesthete or nonsynaesthete–has a unique blueprint of reality, a unique way of coding knowledge that is different from any other on earth [...] By quieting down the habitually louder parts of our mind and turning the dial of our attention to its darker, quieter places, we may hear our personal code’s unique and usually unheard “song”, needing the touch of our attention to turn up its volume. (Duffy 123)This type of presence to oneself has been termed a kind of “perfect immediacy” and is believed to be cultivated through meditation or other sensory-focused experiences such as sex (Bolter and Grusin 260), art (Cubitt 32), drugs (Dann 184) or even physical pain (Gromala 233). Immersive media could also be added to this list, if as Bolter and Grusin suggest, we now “define immediacy as being in the presence of media” (236). In this case, immediacy has become effectively “media-cy.”A related point is the recognition of sensation’s transitory nature. Synaesthetic experiences and sensory experiences are vivid and dynamic. They do not persist. Instead, they flow through us and disappear, despite any attempts to capture them. You cannot stop or relive pure sound, for example (Gross). If you stop it, you silence it. If you relive it, you are experiencing another rendition, different even if almost imperceptibly from the last time you heard it. Media themselves are increasingly transitory and shifting phenomena. As media forms emerge and fall into obsolescence, spawning hybrid forms and spinoffs, the stories and memories safely fixed into any given media become outmoded and ultimately inaccessible very quickly. This trend towards flow over fixation is also informed by an embodied understanding of our own existence. Our sensations flow through us as we flow through the world. Synaesthesia reminds us that all sensation and indeed all sensory beings are dynamic. Despite our rampant lust for statis (Haraway), it is important to theorise with the recognition that bodies, media and sensations all flow through time and space, emerging and disintegrating. Finally, synaesthesia also encourages an always-embodied understanding of ourselves and our interactions with our environment. In media experiences that traditionally rely on vision the body is generally not only denied, but repressed (Balsamo 126). Claims to disembodiment flood the rhetoric around new media as an emancipatory element of mediated experience and somehow, seeing is superimposed on embodied being to negate it. However phenomena such as migraines, sensory release hallucinations, photo-memory, after-images, optical illusions and most importantly here, the “crosstalk” of synaesthesia (Cohen Kadosh et al. 489) all attest to the co-involvement of the body and brain in visual experience. Perhaps useful here for understanding media involvement in light of synaestheory is a philosophy of “mingled bodies” (Connor), where the world and its embodied agents intermingle. There are no discrete divisions, but plenty of translation and transfer. As Sean Cubitt puts it, “the world, after all, touches us at the same moment that we touch it” (37). We need to employ non-particulate metaphors that do away with the dichotomies of mind/body, interior/exterior and real/virtual. A complex embodied entity is not an object or even a series of objects, but embodiment work. “Each sense is in fact a nodal cluster, a clump, confection or bouquet of all the other senses, a mingling of the modalities of mingling [...] the skin encompasses, implies, pockets up all the other sense organs: but in doing so, it stands as a model for the way in which all the senses in their turn also invagin*te all the others” (Connor). The danger here is of delving into a nostalgic discussion of a sort of “sensory unity before the fall” (Dann 94). The theory that we are all synaesthetes in some ways can lead to wistfulness for a perfect fusion of our senses, a kind of synaesthetic sublime that we had at one point, but lost. This loss occurs in childhood in some theories, (Maurer and Mondloch) and in our aboriginal histories in others (Dann 101). This longing for “original syn” is often done within a narrative that equates perfect sensory union with a kind of transcendence from the physical world. Dann explains that “during the modern upsurge in interest that has spanned the decades from McLuhan to McKenna, synaesthesia has continued to fulfil a popular longing for metaphors of transcendence” (180). This is problematic, since elevating the sensory to the sublime does no more service to understanding our engagements with the world than ignoring or degrading the sensory. Synaestheory does not tolerate a simplification of synaesthesia or any condition as a ticket to transcendence beyond the body and world that it is necessarily grounded in and responsible to. At the same time, it operates with a scheme of senses that are not a collection of separate parts, but blended; a field of intensities, a corporeal coalition of senses. It likewise refuses to participate in the false separation of body and mind, perception and cognition. More useful and interesting is to begin with metaphors that assume complexity without breaking phenomena into discrete pieces. This is the essence of a new anti-separatist synaestheory, a way of thinking through embodied humans in relationships with media and culture that promises to yield more creative, relevant and ethical theorising than the false isolation of one sense or the irresponsible disregard of the sensorium altogether.ReferencesAziz, Anthony, and Sammy Cucher. Dystopia. 1994. 15 Sep. 2010 ‹http://www.azizcucher.net/1994.php>. Balsamo, Anne. “The Virtual Body in Cyberspace.” Technologies of the Gendered Body: Reading Cyborg Women. Durham: Duke UP, 1997. 116-32.Bolter, Jay David, and Richard Grusin. Remediation: Understanding New Media. Cambridge: MIT Press, 1999.Cohen Kadosh, Roi, Avishai Henik, and Vincent Walsh. “Synaesthesia: Learned or Lost?” Developmental Science 12.3 (2009): 484-491.Connor, Steven. “Michel Serres’ Five Senses.” Michel Serres Conference. Birkbeck College, London. May 1999. 5 Oct. 2010 ‹http://www.bbk.ac.uk/eh/skc/5senses.htm>. Cubitt, Sean. “It’s Life, Jim, But Not as We Know It: Rolling Backwards into the Future.” Fractal Dreams: New Media in Social Context. Ed. Jon Dovey. London: Lawrence and Wishart, 1996. 31-58.Cytowic, Richard E. The Man Who Tasted Shapes: A Bizarre Medical Mystery Offers Revolutionary Insights into Emotions, Reasoning and Consciousness. New York: Putnam Books, 1993.Dann, Kevin T. Bright Colors Falsely Seen: Synaesthesia and the Search for Transcendental Knowledge. New Haven: Yale UP, 1998.Darley, Andrew. Visual Digital Culture: Surface Play and Spectacle in New Media Genres. London: Routledge, 2000.Descartes, Rene. Discourse on Method and the Meditations. Trans. Johnn Veitch. New York: Prometheus Books, 1989.Dovey, Jon. “The Revelation of Unguessed Worlds.” Fractal Dreams: New Media in Social Context. Ed. Jon Dovey. London: Lawrence and Wishart, 1996. 109-35. Duffy, Patricia Lynne. Blue Cats and Chartreuse Kittens: How Synesthetes Color Their Worlds. New York: Times Books, 2001.Graham, Beryl. “Playing with Yourself: Pleasure and Interactive Art.” Fractal Dreams: New Media in Social Context. Ed. Jon Dovey. London: Lawrence and Wishart, 1996. 154-81.Gromala, Diana. "Pain and Subjectivity in Virtual Reality." Clicking In: Hot Links to a Digital Culture. Ed. Lynn Hershman Leeson. Seattle: Bay Press, 1996. 222-37.Haraway, Donna. “At the Interface of Nature and Culture.” Seminar. European Graduate School. Saas-Fee, Switzerland, 17-19 Jun. 2003.Jay, Martin. Downcast Eyes: The Denigration of Vision in Twentieth Century French Thought. Berkeley: University of California P, 1993.Jay, Martin. "Scopic Regimes of Modernity." Hal Foster, Ed. Vision and Visuality. New York: Dia Art Foundation, 1988. 2-23.MacTavish. Andrew. “Technological Pleasure: The Performance and Narrative of Technology in Half-Life and other High-Tech Computer Games.” ScreenPlay: Cinema/Videogames/Interfaces. Eds. Geoff King and Tanya Krzywinska. London: Wallflower P, 2002. Mass, Wendy. A Mango-Shaped Space. Little, Brown and Co., 2003.Maurer, Daphne, and Catherine J. Mondloch. “Neonatal Synaesthesia: A Re-Evaluation.” Eds. Lynn C. Robertson and Noam Sagiv. Synaesthesia: Perspectives from Cognitive Neuroscience. Oxford: Oxford UP, 2005.Merleau-Ponty, Maurice. Phenomenology of Perception. Trans. Colin Smith. London: Routledge, 1989.Mirzoeff, Nicholas. “What Is Visual Culture?” The Visual Culture Reader. Ed. Nicholas Mirzoeff. London: Routledge, 1998. 3-13.Rez. United Game Artists. Playstation 2. 2002.Stafford, Barbara Maria. Good Looking: Essays on the Virtue of Images. Cambridge: MIT Press, 1996.Ward, Jamie, and Jason B. Mattingley. “Synaesthesia: An Overview of Contemporary Findings and Controversies.” Cortex 42.2 (2006): 129-136.

Abstract:

Why do politicians wear what they wear? Social conventions and parliamentary rules largely shape how politicians dress. Clothing is about power, especially if we think about clothing as uniforms. Uniforms of judges and police are easily recognised as symbols of power. Similarly, the business suit of a politician is recognised as a form of authority. But what if you are a female politician: what do you wear to work or in public? Why do we expect politicians to wear suits and ties? While we do expect a certain level of behaviour of our political leaders, why does the professionalised suit and tie signal this? And what happens if a politician challenges this convention? Female politicians, and largely any women in a position of power in the public sphere, are judged when they don’t conform to the social conventions of appropriate dress. Arguably, male politicians are largely not examined for their suit preferences (unless you are Paul Keating wearing Zenga suits or Anthony Albanese during an election make-over), so why are female politicians’ clothes so scrutinised and framed as reflective of their abilities or character? This article interrogates the political uniform and its gendered contestations. It does so via the ways female politicians are challenging gender norms and power relations in how they dress in public, political, and parliamentary contexts. It considers how rules and conventions around political clothing are political in themselves, through a discussion on how female politicians and political figures choose to adhere to or break these rules. Rules about what dress is worn by parliamentarians are often archaic, often drawn from rules set by parliaments largely made up of men. But even with more women sitting in parliaments, dress rules still reflect a very masculine idea of what is appropriate. Dress standards in the Australian federal parliament are described as a “matter for individual judgement”, however the Speaker of the House of Representatives can make rulings on members’ attire. In 1983, the Speaker ruled dress was to be neat, clean, and decent. In 1999, the Speaker considered dress to be “formal” and “similar to that generally accepted in business and professional circles”. This was articulated by the Speaker to be “good trousers, a jacket, collar and tie for men and a similar standard of formality for women”. In 2005, the Speaker reinforced this ruling that dress should be “formal” in keeping with business and professional standards, adding there was no “dignity of the House for Members to arrive in casual or sportswear” (“Dress”). Clothes with “printed slogans” are not considered acceptable and result in a warning from the Speaker for Australian MPs to “dress more appropriately”. Previous dress rulings also include that members should not remove their jackets in parliament, “tailored safari suits without a tie were acceptable, members could wear hats in parliament but had to remove them while entering or leaving the chamber and while speaking”. The safari suit rule likely refers to the former Foreign Affairs Minister Gareth Evans’s wearing of the garment during the 1980s and 1990s. The Speaker can also rule on what a member of the federal parliament can’t do. While in parliament, members can’t smoke, can’t read a newspaper, can’t distribute apples, may not climb over seats, and can’t hit or kick their desks. Members of parliament can however use their mobile phones for text messaging, and laptops can be used for emails (“Dress”). These examples suggest an almost old-fashioned type of school rules juxtaposed with modern sensibilities, positing the ad-hoc nature of parliamentary rules, with dress rules further evidence of this. While a business suit is considered the orthodoxy of the political uniform for male politicians, this largely governs rules about what female politicians wear. The business suit, the quasi-political uniform for male MPs, is implicit and has social consensus. The suit, which covers the body, is comprised of trousers to the ankle, well cut in muted colours of blue, grey, brown, and black, with contrasting shirts, often white or light colours, ties that may have a splash of colour, often demonstrating allegiances or political persuasions, mostly red or blue, as in the case of Labor and Liberal or Republicans and Democrats. The conventions of the suit are largely proscribed onto women, who wear a female version of the male suit, with some leeway in colour and pattern. Dress for female MPs should be modest, as with the suit, covering much of the body, and especially have a modest neckline and be at least knee length. In the American Congress, the dress code requires “men to wear suit jackets and ties ... and women are not supposed to wear sleeveless tops or dresses without a sweater or jacket” (Zengerle). In 2017, this prompted US Congresswomen to wear sleeveless dresses as a “right to bare arms” (Deutch and Karl). In these two Australian and American examples of a masculine parliamentary wear it is reasonable to suppose a seeming universality about politicians’ dress codes. But who decides what is the correct mode of political uniform? Sartorial rules about what are acceptable clothing choices are usually made by the dominant group, and this is the case when it comes to what politicians wear. Some rules about what is worn in parliament are archaic to our minds today, such as the British parliament law from 1313 which outlaws the wearing of armour and weaponry inside the chamber. More modern rulings from the UK include the banning of hats in the House of Commons (although not the Lords), and women being permitted handbags, but not men (Simm). This last rule reveals how clothing and its performance is gendered, as does the Australian parliament rule that a “Member may keep his hands in his pockets while speaking” (“Dress”), which assumes the speaker is likely a man wearing trousers. Political Dress as Uniform While political dress may be considered as a dress ‘code’ it can also be understood as a uniform because the dress reflects their job as public, political representatives. When dress code is considered as a uniform, hom*ogenisation of dress occurs. Uniformity, somewhat ironically, can emphasise transgressions, as Jennifer Craik explains: “cultural transgression is a means of simultaneously undermining and reinforcing rules of uniforms since an effective transgressive performance relies on shared understandings of normative meanings, designated codes of conduct and connotations” (Craik 210). Codified work wear usually comes under the umbrella of uniforms. Official uniforms are the most obvious type of uniforms, clearly denoting the organisation of the wearer. Military, police, nurses, firefighters, and post-office workers often have recognisable uniforms. These uniforms are often accompanied by a set of rules that govern the “proper” wearing of these items. Uniforms rules do not just govern how the clothing is worn, they also govern the conduct of the person wearing the uniform. For example, a police officer in uniform, whether or not on duty, is expected to maintain certain codes of behaviour as well as dress standards. Yet dress, as Craik notes, can also be transgressive, allowing the wearer to challenge the underpinning conventions of the dress codes. Both Australian Senator Sarah Hanson-Young and US Congresswoman Alexandria Ocasio-Cortez, to name just two, leveraged social understandings of uniforms when they used their clothing to communicate political messages. Fashion as political communication or as ‘fashion politics’ is not a new phenomenon (Oh 374). Jennifer Craik argues that there are two other types of uniform; the unofficial and the quasi-uniform (17). Unofficial uniforms are generally adopted in lieu of official uniforms. They generally arise organically from group members and function in similar ways to official uniforms, and they tend to be identical in appearance, even if hierarchical. Examples of these include the yellow hi-vis jackets worn by the French Gilets Jaunes during the 2018 protests against rising costs of living and economic injustice (Coghlan). Quasi-uniforms work slightly differently. They exist where official and unofficial rules govern the wearing of clothes that are beyond the normal social rules of clothing. For example, the business suit is generally considered appropriate attire for those working in a conservative corporate environment: some workplaces restrict skirt, trouser, and jacket colours to navy, grey, or black, accompanied by a white shirt or blouse. In this way we can consider parliamentary dress to be a form of “quasi-uniform”, governed by both official and unofficial workplaces rules, but discretionary as to what the person chooses to wear in order to abide by these rules, which as described above are policed by the parliamentary Speaker. In the Australian House of Representatives, official rules are laid down in the policy “Dress and Conduct in the Chamber” which allows that “the standard of dress in the Chamber is a matter for the individual judgement of each Member, [but] the ultimate discretion rests with the Speaker” (“Dress”). Clothing rules within parliamentary chambers may establish order but also may seem counter-intuitive to the notions of democracy and free speech. However, when they are subverted, these rules can make clothing statements seem even more stark. Jennifer Craik argues that “wearing a uniform properly ... is more important that the items of clothing and decoration themselves” (4) and it is this very notion that makes transgressive use of the uniform so powerful. As noted by Coghlan, what we wear is a powerful tool of political struggle. French revolutionaries rejected the quasi-uniforms of the French nobility and their “gold-braided coat, white silk stockings, lace stock, plumed hat and sword” (Fairchilds 423), and replaced it with the wearing of the tricolour co*ckade, a badge of red, blue, and white ribbons which signalled wearers as revolutionaries. Uniforms in this sense can be understood to reinforce social hierarchies and demonstrate forms of power and control. Coghlan also reminds us that the quasi-uniform of women’s bloomers in the 1850s, often referred to as “reform dress”, challenged gender norms and demonstrated women’s agency. The wearing of pants by women came to “symbolize the movement for women’s rights” (Ladd Nelson 24). The wearing of quasi-political uniforms by those seeking social change has a long history, from the historical examples already noted to the Khadi Movement led by Gandhi’s “own sartorial choices of transformation from that of an Englishman to that of one representing India” (Jain), to the wearing of sharecropper overalls by African American civil rights activists to Washington to hear Martin Luther King in 1963, to the Aboriginal Long March to Freedom in 1988, the Tibetan Freedom Movement in 2008, and the 2017 Washington Pink puss* Hat March, just to name a few (Coghlan). Here shared dress uniforms signal political allegiance, operating not that differently from the shared meanings of the old-school tie or tie in the colour of political membership. Political Fashion Clothing has been used by queens, female diplomats, and first ladies as signs of power. For members of early royal households, “rank, wealth, magnificence, and personal virtue was embodied in dress, and, as such, dress was inherently political, richly materialising the qualities associated with the wearer” (Griffey 15). Queen Elizabeth I (1558-1603), in order to subvert views that she was unfit to rule because of her sex, presented herself as a virgin to prove she was “morally worthy of holding the traditionally masculine office of monarch” (Howey 2009). To do this she dressed in ways projecting her virtue, meaning her thousands of gowns not only asserted her wealth, they asserted her power as each gown featured images and symbols visually reinforcing her standing as the Virgin Queen (Otnes and Maclaren 40). Not just images and symbols, but colour is an important part of political uniforms. Just as Queen Elizabeth I’s choice of white was an important communication tool to claim her right to rule, Queen Victoria used colour to indicate status and emotion, exclusively wearing black mourning clothes for the 41 years of her widowhood and thus “creating a solemn and pious image of the Queen” (Agnew). Dress as a sign of wealth is one aspect of these sartorial choices, the other is dress as a sign of power. Today, argues Mansel, royal dress is as much political as it is performative, embedded with a “transforming power” (Mansel xiiv). With the “right dress”, be it court dress, national dress, military or civil uniform, royals can encourage loyalty, satisfy vanity, impress the outside world, and help local industries (Mansel xiv). For Queen Elizabeth II, her uniform rendered her visible as The Queen; a brand rather than the person. Her clothes were not just “style choices”; they were “steeped with meaning and influence” that denoted her role as ambassador and figurehead (Atkinson). Her wardrobe of public uniforms was her “communication”, saying she was “prepared, reliable and traditional” (Atkinson). Queen Elizabeth’s other public uniform was that of the “tweed-skirted persona whose image served as cultural shorthand for conservative and correct manner and mode” (Otnes and Maclaren 19). For her royal tours, the foreign dress of Queen Elizabeth was carefully planned with a key “understanding of the political semantics of fashion … with garments and accessories … pay[ing] homage to the key symbols of the host countries” (Otnes and Maclaren 49). Madeline Albright, former US Secretary of State, engaged in sartorial diplomacy not with fashion but with jewellery, specifically pins (Albright). She is quoted as saying on good days, when I wanted to project prosperity and happiness, I'd put on suns, ladybugs, flowers, and hot-air balloons that signified high hopes. On bad days, I'd reach for spiders and carnivorous animals. If the progress was slower than I liked during a meeting in the Middle East, I'd wear a snail pin. And when I was dealing with crabby people, I put on a crab. Other ambassadors started to notice, and whenever they asked me what I was up to on any given day, I would tell them, “Read my pins”. (Burack) Two American first ladies, Hillary Rodham Clinton and Michelle Obama, demonstrate how their fashion acted as a political uniform to challenge the ideal notions of American womanhood that for generations were embedded in the first lady (Rall et al.). While modern first ladies are now more political in their championing of causes and play an important role in presidential election, there are lingering expectations that the first lady be the mother of the nation (Caroli). First Lady Hillary Rodham Clinton’s eclectic style challenged the more conservative tone set by prior Republican first ladies, notably Barbara Bush. Rodham Clinton is a feminist and lawyer more interested in policy that the domesticity of White House functions and décor. Her fashion reflects her “independence, individuality and agency”, providing a powerful message to American women (Rall et al. 274). This was not that much of a shift from her appearance as the wife of a Southern Governor who wouldn’t wear makeup and kept her maiden name (Anderson and Sheeler 26). More recently, as Democratic Presidential nominee, Rodham Clinton again used fashion to tell voters that a woman could wear a suit and become president. Rodham Clinton’s political fashion acted to contest the gender stereotypes about who could sit in the White House (Oh 374). Again, the pantsuit was not new for Rodham Clinton; “when I ran for Senate in 2000 and President in 2008, I basically had a uniform: a simple pantsuit, often black” (Mejia). Rodham Clinton says the “benefit to having a uniform is finding an easy way to fit in … to do what male politicians do and wear more or less the same thing every day”. As a woman running for president in 2016, the pantsuit acted as a “visual cue” that she was “different from the men but also familiar” (Mejia). Similarly, First Lady Michelle Obama adopted a political uniform to situate her role in American society. Gender but also race and class played a role in shaping her performance (Guerrero). As the first black First Lady, in the context of post-9/11 America which pushed a “Buy American” retail campaign, and perhaps in response to the novelty of a black First Lady, Obama expressed her political fashion by returning the First Lady narrative back to the confines of family and domesticity (Dillaway and Paré). To do this, she “presented a middle-class casualness by wearing mass retail items from popular chain stores and the use of emerging American designers for her formal political appearances” (Rall et al. 274). Although the number of women elected into politics has been increasing, gender stereotypes remain, and female representation in politics still remains low in most countries (Oh 376). Hyland argues that female politicians are subject to more intense scrutiny over their appearance … they are held to higher standards for their professional dress and expected to embody a number of paradoxes — powerful yet demure, covered-up but not too prim. They’re also expected to keep up with trends in a way that their male counterparts are not. Sexism can too easily encroach upon critiques of what they wear. How female politicians dress is often more reported than their political or parliamentary contributions. This was the case for Australia’s first female Prime Minister Julia Gillard. Jansens’s 2019 research well demonstrates the media preoccupation with political women’s fashion in a number of ways, be it the colours they choose to wear, how their clothing reveals their bodies, and judgements about the professionalism of their sartorial choices and the number of times certain items of clothing are worn. Jansens provides a number of informative examples noting the media’s obsession with Gillard’s choices of jackets that were re-worn and tops that showed her cleavage. One Australian Financial Review columnist reported, I don’t think it’s appropriate for a Prime Minister to be showing her cleavage in Parliament. It’s not something I want to see. It is inappropriate to be in Parliament, it is disrespectful to yourself and to the Australian community and to the parliament to present yourself in a manner that is unprofessional. (Jansens) The media preoccupation with female politicians’ clothing is noted elsewhere. In the 2012 Korean presidential election, Geun-hye Park became the first female president of Korea, yet media reports focussed largely on Park’s fashion: a 2013 newspaper published a four-page analysis titled “Park Geun-hye Fashion Project”. Another media outlet published a review of the 409 formal function outfits worn by Park (Oh 378). The larger focus, however, remains on Park’s choice to wear a suit, referred to as her “combat uniform” (Cho), for her daily parliamentary and political duties. This led Oh to argue that Korean female politicians, including Park, wear a “male suit as a means for benefit and survival”; however, with such media scrutiny “female politicians are left under constant surveillance” (382). As Jansens argues, clothing can act as a “communicative barrier between the body and society”, and a narrative that focusses on how clothes fit and look “illustrates women’s bodies as exceptional to the uniform of the political sphere, which is a masculine aesthetic” (212). Drawing on Entwistle, Jansens maintains that the the uniform “serves the purpose in policing the boundaries of sexual difference”, with “uniforms of gender, such as the suit, enabl[ing] the repetitious production of gender”. In this context, female politicians are in a double bind. Gillard, for example, in changing her aesthetic illustrates the “false dichotomy, or the ‘double bind’ of women’s competency and femininity that women can be presented with regarding their agency to conform, or their agency to deviate from the masculine aesthetic norm” (Jansens 212). This was likely also the experience of Jeannette Rankin, with media reports focusing on Rankin’s “looks and “personal habits,” and headlines such “Congresswoman Rankin Real Girl; Likes Nice Gowns and Tidy Hair” (“Masquerading”). In this article, however, the focus is not on the media preoccupation with female politicians’ political fashion; rather, it is on how female politicians, rather than conforming to masculine aesthetic norms of wearing suit-like attire, are increasingly contesting the political uniform and in doing so are challenging social and political boundaries As Yangzom puts it, how the “embodiment of dress itself alters political space and civic discourse is imperative to understanding how resistance is performed in creating social change” (623). This is a necessary socio-political activity because the “way the media talks about women affects the way women are perceived in society. If women’s appearances are consistently highlighted in the media, inequality of opportunity will follow from this inequality of treatment” (Jansens 215). Contesting the Political Uniform Breaking fashion norms, or as Entwistle argues, “bodies which flout the conventions of their culture and go without the appropriate clothes are subversive of the most basic social codes and risk exclusion, scorn and ridicule” (7), hence the price may be high to pay for a public figure. American Vice-President Kamala Harris’s penchant for comfy sneakers earned her the nickname “the Converse candidate”. Her choice to wear sneakers rather than a more conventional low-heel shoe didn’t necessarily bring about a backlash; rather, it framed her youthful image (possibly to contrast against Trump and Biden) and posited a “hit the ground running” approach (Hyland). Or, as Devaney puts it, “laced up and ready to win … [Harris] knew her classic American trainers signalled a can-do attitude and a sense of purpose”. Increasingly, political women, rather than being the subject of social judgments about their clothing, are actively using their dressed bodies to challenge and contest a range of political discourses. What a woman wears is a “language through which she can send any number of pointed messages” (Weiss). In 2021, US Congresswoman Alexandria Ocasio-Cortez wore a ‘Tax the rich’ dress to the Met Gala. The dress was designed by social activist designers Brother Vellies and loaned to Ocasio-Cortez to attend the $30,000 ticket event. For Ocasio-Cortez, who has an Instagram following of more than eight million people, the dress is “about having a real conversation about fairness and equity in our system, and I think this conversation is particularly relevant as we debate the budget” (“Alexandria”). For Badham, “in the blood-spattered garments of fighting class war” the “backlash to Alexandria Ocasio-Cortez’s … dress was instant and glorious”. At the same event, Congresswomen Carolyn Maloney wore an ‘Equal Rights for Women’ suffragette-themed floor length dress in the suffragette colours of purple, white, and gold. Maloney posted that she has “long used fashion as a force 4 change” (Chamlee). US Senator Kyrsten Sinema is known for her “eccentric hipster” look when sitting in the chamber, complete with “colourful wigs, funky glasses, gold knee-high boots, and a ring that reads ‘f*ck off”’ (Hyland). Simena has been called a “Prada Socialist” and a “fashion revolutionary” (Cauterucci). Similarly, UK politician Harriet Harmen received backlash for wearing a t-shirt which read “This is what a feminist looks like” when meeting PM David Cameron (Pilote and Montreuil). While these may be exceptions rather than the rule, the agency demonstrated by these politicians speaks to the patriarchal nature of masculine political environments and the conventions and rules that maintain gendered institutions, such as parliaments. When US Vice-President Kamala Harris was sworn in, she was “not only … the first woman, Black woman, and South Asian-American woman elected to the position, but also … the first to take the oath of office wearing something other than a suit and tie”, instead wearing a feminised suit consisting of a purple dress and coat designed by African-American designer Christopher John Rogers (Naer). Harris is often photographed wearing Converse sneakers, as already noted, and Timberland work boots, which for Naer is “quietly rebellious” because with them “Harris subverts expectations that women in politics should appear in certain clothing (sleek heels, for instance) in order to compete with men — who are, most often, in flats”. For Elan, the Vice-President’s sneakers may be a “small sartorial detail, but it is linked to the larger cultural moment in which we live. Sneakers are a form of footwear finding their way into many women’s closets as part of a larger challenge to outmoded concepts of femininity” as well as a nod to her multiracial heritage where the “progenitors of sneaker culture were predominantly kids of colour”. Her dress style can act to disrupt more than just gender meanings; it can be extended to examine class and race. In 2022, referencing the Alexandria Ocasio-Cortez 2021 Met dress, Claudia Perkins, the wife of Australian Greens leader Adam Bandt, wore a “white, full-length dress covered in red and black text” that read “coal kills” and “gas kills”, with slick, long black gloves. Bandt wore a “simple tux with a matching pocket square of the same statement fabric” to the federal parliament Midwinter Ball. Joining Perkins was Greens Senator Sarah Hanson-Young, wearing an “hourglass white dress with a statement on the back in black letters” that read: “end gas and coal”. The trim on the bottom was also covered in the same text. Hanson-Young posted on social media that the “dress is made from a 50-year-old damask table cloth, and the lettering is made from a fast fashion handbag that had fallen apart” (Bliszczyk). Federal MP Nicolle Flint posted a video on Twitter asking a political commentator what a woman in politics should wear. One commentator had taken aim at Flint’s sartorial choices which he described “pearl earrings and a pearly smile” and a “vast wardrobe of blazers, coats and tight, black, ankle-freezing trousers and stiletto heels”. Ending the video, Flint removes her black coat to reveal a “grey bin bag cinched with a black belt” (Norman). In 2018, Québec politician Catherine Dorian was criticised for wearing casual clothes, including Dr Marten boots, in parliament, and again in 2019 when Dorian wore an orange hoodie in the parliamentary chamber. The claim was that Dorian “did not respect decorum” (Pilote and Montreuil). Dorian’s response was “it’s supposed to be the people’s house, so why can’t we look like normal people” (Parrillo). Yet the Québec parliament only has dress rules for men — jacket, shirt and ties — and has no specifics for female attire, meaning a female politician can wear Dr Martens or a hoodie, or meaning that the orthodoxy is that only men will sit in the chamber. The issue of the hoodie, somewhat like Kamala Harris’s wearing of sneakers, is also a class and age issue. For Jo Turney, the hoodie is a “symbol of social disobedience” (23). The garment is mass-produced, ordinary, and democratic, as it can be worn by anyone. It is also a sign of “criminality, anti-social behaviour and out of control youth”. If the media are going to focus on what female politicians are wearing rather than their political actions, it is unsurprising some will use that platform to make social and political comments on issues relating to gender, but also to age, class, and policies. While this may maintain a focus on their sartorial choices, it does remind us of the double bind female politicians are in. With parliamentary rules and social conventions enamoured with the idea of a ‘suit and tie’ being the appropriate uniform for political figures, instances when this ‘rule’ is transgressed will risk public ridicule and social backlash. However, in instances were political women have chosen to wear garments that are not the conventional political uniform of the suit and tie, i.e. a dress or t-shirt with a political slogan, or a hoodie or sneakers reflecting youth, class, or race, they are challenging the customs of what a politician should look like. Politicians today are both men and women, different ages, abilities, sexualities, ethnicities, religions, and demographics. To narrowly suppose what a politician is by what they wear narrows public thinking about a person’s contribution or potential contribution to public life. 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Abstract:

Introduction In this article, we hypothesise how mainstream media coverage can promote the spread of disinformation about Covid-19. Mainstream media are often discussed as opposed to disinformation (Glasser; Benkler et al.). While the disinformation phenomenon is related to the intentional production and spread of misleading and false information to influence public opinion (Fallis; Benkler et al.), mainstream media news is expected to be based on facts and investigation and focussed on values such as authenticity, accountability, and autonomy (Hayes et al.). However, journalists might contribute to the spread of disinformation when they skip some stage of information processing and reproduce false or misleading information (Himma-Kadakas). Besides, even when the purpose of the news is to correct disinformation, media coverage might contribute to its dissemination by amplifying it (Tsfati et al.). This could be particularly problematic in the context of social media, as users often just read headlines while scrolling through their timelines (Newman et al.; Ofcom). Thus, some users might share news from the mainstream media to legitimate disinformation about Covid-19. The pandemic creates a delicate context, as journalists are often pressured to produce more information and, therefore, are more susceptible to errors. In this research, we focussed on the hypothesis that legitimate news can contribute to the spread of disinformation on social media through headlines that reinforce disinformation discourses, even though the actual piece may frame the story differently. The research questions that guide this research are: are URLs with headlines that reinforce disinformation discourses and other mainstream media links shared into the same Facebook groups? Are the headlines that support disinformation discourses shared by Facebook users to reinforce disinformation narratives? As a case study, we look at the Brazilian disinformation context on Covid-19. The discussion about the disease in the country has been highly polarised and politically framed, often with government agents and scientists disputing the truth about facts on the disease (Araújo and Oliveira; Recuero and Soares; Recuero et al.). Particularly, the social media ecosystem seems to play an important role in these disputes, as Brazilian President Jair Bolsonaro and his supporters use it as a key channel to spread disinformation about the virus (Lisboa et al.; Soares et al.). We use data from public groups on Facebook collected through CrowdTangle and a combination of social network analysis and content analysis to analyse the spread and the content of URLs and posts. Theoretical Background Disinformation has been central to the Covid-19 “infodemic”, created by the overabundance of information about the pandemic, which makes it hard for people to find reliable guidance and exacerbates the outbreak (Tangcharoensathien et al.). We consider disinformation as distorted, manipulated, or false information intentionally created to mislead someone (Fallis; Benkler et al.). Disinformation is often used to strengthen radical political ideologies (Benkler et al.). Around the world, political actors politically framed the discussion about the pandemic, which created a polarised public debate about Covid-19 (Allcott et al., Gruzd and Mai; Recuero and Soares). On social media, contexts of polarisation between two different political views often present opposed narratives about the same fact that dispute public attention (Soares et al.). This polarisation creates a suitable environment for disinformation to thrive (Benkler et al.) The polarised discussions are often associated with the idea of “bubbles”, as the different political groups tend to share and legitimate only discourses that are aligned with the group's ideological views. Consequently, these groups might turn into ideological bubbles (Pariser). In these cases, content shared within one group is not shared within the other and vice versa. Pariser argues that users within the bubbles are exposed exclusively to content with which they tend to agree. However, research has shown that Pariser’s concept of bubbles has limitations (Bruns), as most social media users are exposed to a variety of sources of information (Guess et al.). Nevertheless, polarisation might lead to different media diets and disinformation consumption (Benkler et al.). That is, users would have contact with different types of information, but they would choose to share certain content over others because of their political alignment (Bruns). Therefore, we understand that bubbles are created by the action of social media users who give preference to circulate (through retweets, likes, comments, or shares) content that supports their political views, including disinformation (Recuero et al.). Thus, bubbles are ephemeral structures (created by users’ actions in the context of a particular political discussion) with permeable boundaries (users are exposed to content from the outside) in discussions on social media. This type of ephemeral bubble might use disinformation as a tool to create a unique discourse that supports its views. However, it does not mean that actors within a “disinformation bubble” do not have access to other content, such as the news from the mainstream media. It means that the group acts to discredit and to overlap this content with an “alternative” story (Larsson). In addition, the mainstream media might disseminate false or inaccurate disinformation (Tsfati et al.). Particularly, we focus on inaccurate headlines that reinforce disinformation narratives, as social media users often only read news headlines (Newman et al.; Ofcom). This is especially problematic because a large number of social media users are exposed to mainstream media content, while exposure to disinformation websites is heavily concentrated on only a few users (Guess et al.; Tsfati et al.). Therefore, when the mainstream media disseminate disinformation, it is more likely that a larger number of social media users will be exposed to this content and share it into ideological bubbles. Based on this discussion, we aim to understand how the mainstream media contribute to the spread of disinformation discourses about Covid-19. Methods This study is about how mainstream media coverage might contribute to the spread of disinformation about Covid-19 on Facebook. We propose two hypotheses, as follows: H1: When mainstream media headlines frame the information in a way that reinforces the disinformation narrative, the links go into a “disinformation bubble”. H2: In these cases, Facebook users might use mainstream media coverage to legitimate disinformation narratives. We selected three case studies based on events that created both political debate and high media coverage in Brazil. We chose them based on the hypothesis that part of the mainstream media links could have produced headlines that support disinformation discourses, as the political debate was high. The events are: On 24 March 2020, Brazilian President Jair Bolsonaro made a public pronouncement on live television. In the week before the pronouncement, Brazilian governors decided to follow World Health Organisation (WHO) protocols and closed non-essential business. In his speech, Bolsonaro criticised social distancing measures. The mainstream media reproduced some of his claims and claims from other public personalities, such as entrepreneurs who also said the protocols would harm the economy. On 8 June 2020, a WHO official said that it “seems to be rare that an asymptomatic person transmits [Covid-19] onward to a secondary individual”. Part of the mainstream media reproduced the claim out of context, which could promote the misperception that both asymptomatic and pre-symptomatic persons (early stages of an illness, before the first symptoms) do not transmit Covid-19 at all. On 9 November 2020, Brazil’s national sanitary watchdog Anvisa reported that they had halted the clinical studies on the CoronaVac vaccine, developed by the Chinese company Sinovac. Bolsonaro often criticised CoronaVac because it was being produced in partnership with São Paulo’s Butantan Institute and became the subject of a political dispute between Bolsonaro and the Governor of São Paulo, João Dória. Bolsonaro said the halt of the CoronaVac trial was "another victory for Jair Bolsonaro". Anvisa halted the trail after a "severe adverse event". The mainstream media rapidly reverberated the decision. Later, it was revealed that the incident was a death that had nothing to do with the vaccine. Before we created our final dataset that includes links from the three events together, we explored the most shared URLs in each event. We used keywords to collect posts shared in the public groups monitored by CrowdTangle, a tool owned by Facebook that tracks publicly available posts on the platform. We collected posts in a timeframe of three days for each event to prevent the collection of links unrelated to the cases. We collected only posts containing URLs. Table 1 summarises the data collected. Table 1: Data collected Dates March 24-26 2020 June 8-10 2020 November 9-11 2020 Keywords “Covid-19” or “coronavirus” and “isolation” or “economy” “Covid-19” or “coronavirus” and “asymptomatic” “vaccine” and “Anvisa” or “CoronaVac” Number of posts 4780 2060 3273 From this original dataset, we selected the 60 most shared links from each period (n=180). We then filtered for those which sources were mainstream media outlets (n=74). We used content analysis (Krippendorff) to observe which of these URLs headlines could reinforce disinformation narratives (two independent coders, Krippendorff’s Alpha = 0.76). We focussed on headlines because when these links are shared on Facebook, often it is the headline that appears to other users. We considered that a headlined reinforced disinformation discourses only when it was flagged by both coders (n=21 – some examples are provided in Table 3 in the Results section). Table 2 provides a breakdown of this analysis. Table 2: Content analysis Event Mainstream media links Headlines that support disinformation discourses Number of links Number of posts Economy and quarantine 24 7 112 Asymptomatic 22 7 163 Vaccine trial 28 7 120 Total 74 21 395 As the number of posts that shared URLs with headlines that supported disinformation was low (n=395), we conducted another CrowdTangle search to create our final dataset. We used a sample of the links we classified to create a “balanced” dataset. Out of the 21 links with headlines that reinforced disinformation, we collected the 10 most shared in public groups monitored by CrowdTangle (this time, without any particular timeframe) (n=1346 posts). In addition, we created a “control group” with the 10 most shared links that neither of the coders considered could reinforce disinformation (n=1416 posts). The purpose of the “control group” was to identify which Facebook groups tend to share mainstream media links without headlines that reinforce disinformation narratives. Therefore, our final dataset comprises 20 links and 2762 posts. We then used social network analysis (Wasserman and Faust) to map the spread of the 20 links. We created a bipartite network, in which nodes are (1) Facebook groups and (2) URLs; and edges represent when a post within a group includes a URL from our dataset. We applied a modularity metric (Blondel et al.) to identify clusters. The modularity metric allows us to identify “communities” that share the same or similar links in the network map. Thus, it helped us to identify if there was a “bubble” that only shares the links with headlines that support disinformation (H1). To understand if the disinformation was supporting a larger narrative shared by the groups, we explored the political alignments of each cluster (H2). We used Textometrica (Lindgreen and Palm) to create word clouds with the most frequent words in the names of the cluster groups (at least five mentions) and their connections. Finally, we also analysed the posts that shared each of the 10 links with headlines that reinforced disinformation. This also helped us to identify how the mainstream media links could legitimate disinformation narratives (H2). Out of the 1346 posts, only 373 included some message (the other 973 posts only shared the link). We used content analysis to see if these posts reinforced the disinformation (two independent coders – Krippendorff’s Alpha = 0.723). There were disagreements in the categorisation of 27 posts. The two coders reviewed and discussed the classification of these posts to reach an agreement. Results Bubbles of information In the graph (Figure 1), red nodes are links with headlines that support disinformation discourses, blue nodes are the other mainstream media links, and black nodes are Facebook groups. Our first finding is that groups that shared headlines that support disinformation rarely shared the other mainstream media links. Out of the 1623 groups in the network, only 174 (10.7%) shared both a headline that supports disinformation discourse, and another mainstream media link; 712 groups (43.8%) only shared headlines that support disinformation; and 739 groups (45.5%) only shared other links from the mainstream media. Therefore, users’ actions created two bubbles of information. Figure 1: Network graph The modularity metric confirmed this tendency of two “bubbles” in the network (Figure 2). The purple cluster includes seven URLs with headlines that support disinformation discourse. The green cluster includes three headlines that support disinformation discourse and the other 10 links from the mainstream media. This result partially supports H1: When mainstream media headlines frame the information in a way that reinforces the disinformation narrative, the links go into a “disinformation bubble”. As we identified, most of the headlines that support disinformation discourse went into a separate “bubble”, as users within the groups of this bubble did not share the other links from the mainstream media. Figure 2: Network graph with modularity This result shows that users’ actions boost the creation of bubbles (Bakshy et al.), as they choose to share one type of content over the other. The mainstream media are the source of all the URLs we analysed. However, users from the purple cluster chose to share only links with headlines that supported disinformation discourses. This result is also related to the political framing of the discussions, as we explore below. Disinformation and Political Discourse We used word clouds (Lindgreen and Palm) to analyse the Facebook groups’ names to explore the ideological affiliation of the bubbles. The purple bubble is strongly related to Bolsonaro and his discourse (Figure 3). Bolsonaro is the most frequent word. Other prevalent words are Brazil, patriots (both related to his nationalist discourse), right-wing, conservative, military (three words related to his conservative discourse and his support of the military dictatorship that ruled Brazil from 1964 to 1985), President, support, and Alliance [for Brazil] (the name of his party). Some of the most active groups within the purple bubble are “Alliance for Brazil”, “Bolsonaro 2022 [next presidential election]”, “Bolsonaro’s nation 2022”, and “I am right-wing with pride”. Figure 3: Purple cluster word cloud Bolsonaro is also a central word in the green cluster word cloud (Figure 4). However, it is connected to other words such as “against” and “out”, as many groups are anti-Bolsonaro. Furthermore, words such as left-wing, Workers’ Party (centre-left party), Lula and Dilma Rousseff (two Workers’ Party ex-presidents) show another ideological alignment in general. In addition, there are many local groups (related to locations such as Rio de Janeiro, São Paulo, Rio Grande do Sul, Minas Gerais, and others), and groups to share news (news, newspaper, radio, portal). “We are 70 per cent [anti-Bolsonaro movement]”, “Union of the Left”, “Lula president”, and “Anti-Bolsonaro” are some of the most active groups within the green cluster. Figure 4: Green cluster word cloud Then, we analysed how users shared the mainstream media links with headlines that support disinformation discourses. In total, we found that 81.8% of the messages in the posts that shared these links also reproduced disinformation narratives. The frequency was higher (86.2%) when considering only posts that shared one of the seven links from the purple cluster (based on the modularity metric). Consequently, it was lower (64%) in the messages that shared one of the other three links. The messages often showed support for Bolsonaro; criticised other political and health authorities (the WHO, São Paulo Governor João Dória, and others), China, and the “leftists” (all opposition to Bolsonaro); claimed that quarantine and social distancing measures were unnecessary; and framed vaccines as dangerous. We provide some examples of headlines and posts in Table 3 (we selected the most-shared URL for each event to illustrate). This result supports H2 as we found that users shared mainstream media headlines that reinforce disinformation discourse to legitimate the disinformation narrative; and that it was more prevalent in the purple bubble. Table 3: Examples of headlines and posts Headline Post "Unemployment is a crisis much worse than coronavirus", says Bolsonaro Go to social media to support the President. Unemployment kills. More than any virus... hunger, depression, despair and everything UNEMPLOYMENT, THE DEPUTIES CHAMBER, THE SENATE AND THE SUPREME COURT KILL MORE THAN COVID19 Asymptomatic patients do not boost coronavirus, says WHO QUARANTINE IS FAKE #StayHome, the lie of the century! THIS GOES TO THE PUPPETS OF THE COMMUNIST PARTIES THE AND FUNERARY MEDIA Anvisa halts Coronavac vaccine trial after "serious adverse event" [The event] is adverse and serious, so the vaccine killed the person by covid And Doria [Governor of São Paulo and political adversary of Bolsonaro] wants to force you to take this sh*t This result shows that mainstream media headlines that support disinformation narratives may be used to reinforce disinformation discourses when shared on Facebook, making journalists potential agents of disinformation (Himma-Kadakas; Tsfati et al.). In particular, the credibility of mainstream news is used to support an opposing discourse, that is, a disinformation discourse. This is especially problematic in the context of Covid-19 because the mainstream media end up fuelling the infodemic (Tangcharoensathien et al.) by sharing inaccurate information or reverberating false claims from political actors. Conclusion In this article, we analysed how the mainstream media contribute to the spread of disinformation about Covid-19. In particular, we looked at how links from the mainstream media with headlines that support disinformation discourse spread on Facebook, compared to other links from the mainstream media. Two research questions guided this study: Are URLs with headlines that reinforce disinformation discourses and other mainstream media links shared into the same Facebook groups? Are the headlines that support disinformation discourses shared by Facebook users to reinforce disinformation narratives? We identified that (1) some Facebook groups only shared links with headlines that support disinformation narratives. This created a “disinformation bubble”. In this bubble, (2) Facebook users shared mainstream media links to reinforce disinformation – in particular, pro-Bolsonaro disinformation, as many of these groups had a pro-Bolsonaro alignment. In these cases, the mainstream media contributed to the spread of disinformation. Consequently, journalists ought to take extra care when producing news, especially headlines, which will be the most visible part of the stories on social media. This study has limitations. We analysed only a sample of links (n=20) based on three events in Brazil. Other events and other political contexts might result in different outcomes. Furthermore, we used CrowdTangle for data collection. CrowdTangle only provides information about public posts in groups monitored by the tool. Therefore, our result does not represent the entire Facebook. References Allcott, Hunt, et al. “Polarization and Public Health: Partisan Differences in Social Distancing during the Coronavirus Pandemic.” National Bureau of Economic Research, Working Paper No. 26946 (2020). 6 Jan. 2021 <https://doi.org/10.3386/w26946>. Araújo, Ronaldo Ferreira, and Thaiane Moreira Oliveira. “Desinformação e Mensagens Sobre a Hidroxicloroquina no Twitter: Da Pressão Política à Disputa Científica.” Atoz – Novas Práticas em Informação e Conhecimento 9.2 (2020). 6 Jan. 2021 <http://dx.doi.org/10.5380/atoz.v9i2.75929>. Bakshy, Eytan, et al. “Exposure to Ideologically Diverse News and Opinion on Facebook.” Science 348.6239 (2015). 6 Jan. 2021 <https://science.sciencemag.org/content/348/6239/1130>. Benkler, Yochai, et al. Network Propaganda: Manipulation, Disinformation, and Radicalization in American Politics. New York: Oxford University Press, 2018. Blondel, Vincent D., et al. “Fast Unfolding of Communities in Large Networks.” Physics.soc-ph (2008). 6 Jan. 2021 <http://lanl.arxiv.org/abs/0803.0476>. Bruns, Axel. Are Filter Bubbles Real?. Cambridge: Polity Press, 2019. CrowdTangle Team. CrowdTangle. Menlo Park, Calif.: Facebook, 2020. <https://apps.crowdtangle.com/search/>. Fallis, Don. “What Is Disinformation?” Library Trends 63.3 (2015): 401-426. Glasser, Susan B. “Covering Politics in a ‘Post-Truth’ America.” Brookings Institution Press, 2 Dec. 2016. 22 Feb. 2021 <https://www.brookings.edu/essay/covering-politics-in-a-post-truth-america/>. Gruzd, Anatoliy, and Philip Mai. “Going Viral: How a Single Tweet Spawned a COVID-19 Conspiracy Theory on Twitter.” Big Data & Society, 7.2 (2020). 6 Jan. 2021 <https://doi.org/10.1177/2053951720938405>. Guess, Andrew, et al. Avoiding the Echo Chamber about Echo Chambers: Why Selective Exposure to Like-Minded Political News Is Less Prevalent than You Think. Miami: John S. and James L. Knight Foundation, 2018. Hayes, Arthur S., et al. “Shifting Roles, Enduring Values: The Credible Journalist in a Digital Age.” Journal of Mass Media Ethics 22.4 (2007): 262-279. 22 Feb.2021 <https://doi.org/10.1080/08900520701583545>. Himma-Kadakas, Marju. “Alternative Facts and Fake News Entering Journalistic Content Production Cycle”. Cosmopolitan Civil Societies: An Interdisciplinary Journal 9.2 (2017). 6 Jan. 2021 <https://doi.org/10.5130/ccs.v9i2.5469>. Kripendorff, Klaus. Content Analysis: An Introduction to Its Methodology. California: Sage Publications, 2013. Larsson, Anders Olof. “News Use as Amplification – Norwegian National, Regional and Hyperpartisan Media on Facebook.” Journalism & Mass Communication Quarterly 96 (2019). 6 Jan. 2021 <https://doi.org/10.1177/1077699019831439>. Lindgreen, Simon, and Fredrik Palm. Textometrica Service Package (2011). 6 Jan. 2021 <http://textometrica.humlab.umu.se>. Lisboa, Lucas A., et al. “A Disseminação da Desinformação Promovida por Líderes Estatais na Pandemia da COVID-19.” Proceedings of the Workshop Sobre as Implicações da Computação na Sociedade (WICS), Porto Alegre: Sociedade Brasileira de Computação, 2020. 6 Jan. 2021 <https://doi.org/10.5753/wics.2020.11042>. Newman, Nic, et al. Reuters Institute Digital News Report 2018. Oxford: Oxford University, 2018. Ofcom. “Scrolling News: The Changing Face of Online News Consumption.” 2016. 23 Feb. 2021 <https://www.ofcom.org.uk/__data/assets/pdf_file/0022/115915/Scrolling-News.pdf>. Pariser, Eli. The Filter Bubble. New York: Penguin, 2011. Recuero, Raquel, and Felipe Soares. “O Discurso Desinformativo sobre a Cura do COVID-19 no Twitter: Estudo de Caso.” E-Compós (2020). 23 Feb. 2021 <https://doi.org/10.30962/ec.2127>. Recuero, Raquel, et al. “Polarization, Hyperpartisanship, and Echo Chambers: How the Disinformation about COVID-19 Circulates on Twitter.” Contracampo (2021, in press). 23 Feb. 2021 <https://doi.org/10.1590/SciELOPreprints.1154>. Soares, Felipe Bonow, et al. “Disputas discursivas e desinformação no Instagram sobre o uso da hidroxicloroquina como tratamento para o Covid-19.” Proceedings of the 43º Congresso Brasileiro de Ciências da Comunicação, Salvador: Intercom, 2020. 23 Feb. 2021 <http://www.intercom.org.br/sis/eventos/2020/resumos/R15-0550-1.pdf>. Tangcharoensathien, Viroj, et al. “Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online Crowdsourced WHO Technical Consultation.” J Med Internet Res 22.6 (2020). 6 Jan. 2021 <https://doi.org/10.2196/19659>. Tsfati, Yariv, et al. “Causes and Consequences of Mainstream Media Dissemination of Fake News: Literature Review and Synthesis.” Annals of the International Communication Association 44.2 (2020): 157-173. 22 Feb. 2021 <https://doi.org/10.1080/23808985.2020.1759443>. Wasserman, Stanley, and Katherine Faust. Social Network Analysis: Methods and Applications. Cambridge: Cambridge UP, 1994.

Abstract:

Introduction Many people interpret the word ‘cult’ through specific connotations, including, but not limited to, a community of like-minded people on the edge of civilization, often led by a charismatic leader, with beliefs that are ‘other’ to societal ‘norms’. Cults are often perceived as deviant, regularly incorporating elements of crime, especially physical and sexual violence. The adoption by some cults of a special uniform or dress code has been readily picked up by popular culture and has become a key ‘defining’ characteristic of the nature of a cult. In this article, we use the semiotic framework of myth, as discussed by Barthes, to demonstrate how cult uniforms become semiotic myths of popular culture. Narratively, the myth of the cult communicates violence, deviance, manipulation, and brainwashing. The myth of on-screen cults has derived itself from a reflexive pop culture foundation. From popular culture inspiring cults to cults inspiring popular culture and back again, society generates its cult myth through three key mechanisms: medicalisation, deviance amplification, and convergence. This means we are at risk of misrepresenting the true nature of cults, creating a definition incongruent with reality. This article traces the history of cults, the expectations of cult behaviour, and the semiotics of uniforms to start the discussion on why society is primed to accept a confusion between nature and the semiotic messaging of “what-goes-without-saying” (Barthes Mythologies 11). Semiotics and Myth Following the basic groundwork of de Saussure in the early 1900s, semiotics is the study of signs and how we use signs to derive meaning from the external world (de Saussure). Barthes expanded on this with his series of essays in Mythologies, adding a layer of connotation that leads to myth (Barthes Mythologies). Connotation, as described by Barthes, is the interaction between signs, feelings, and values. The connotations assigned to objects and concepts become a system of communication that is a message, the message becomes myth. The myth is not defined by the object or concept, but by the way society collectively understands it and all its connotations (Barthes Elements of Semiology 89-91). For scholars like Barthes, languages and cultural artifacts lend themselves to myth because many of our concepts are vague and abstract. Because the concept is vague, it is easy to impose our own values and ideologies upon it. This also means different people can interpret the same concept in different ways (Barthes Mythologies 132). The concept of a cult is no exception. Cults mean different things to different people and the boundaries between cults and religious or commercial organisations are often contested. As a pop culture artifact, the meaning of cults has been generated through repeated exposure in different media and genres. Similarly, pop culture (tv, films, news, etc.) often has the benefit of fiction, which separates itself from the true nature of cults (sensu Barthes Mythologies). Yet, through repeated exposure, we begin to share a universal meaning for the term and all the behaviours understood within the myth. Our repeated exposure to the signs of cults in pop culture is the combined effect of news media and fiction slowly building upon itself in a reflexive manner. We hear news reports of cults behaving in obscure ways, followed by a drama, parody, critique, or satire in a fictitious story. The audience then begins to see the repeated narrative as evidence to the true nature of cults. Over time the myth of the cult naturalises into the zeitgeist as concretely as any other sign, word, or symbol. Once the myth is naturalised, it is better used as a narrative device when affixed to a universally recognised symbol, such as the uniform. The uniform becomes an efficient device for communicating meaning in a short space of time. We argue that the concept of cult as myth has entered a collective understanding, and so, it is necessary to reflect on the mechanisms that drove the correlations which ultimately created the myth. Barthes’s purpose for analysing myth was “to track down, in the decorative display of what-goes-without-saying, the ideological abuse which, in my view, is hidden there” (Barthes Mythologies 11). For this reason, we must briefly look at the history of cults and their relationship with crime. A Brief History of Cults ‘Cult’ derives from the Latin root, cultus, or cultivation, and initially referred to forms of religious worship involving special rituals and ceremonies directed towards specific figures, objects, and/or divine beings. Early to mid-twentieth century sociologists adopted and adapted the term to classify a kind of religious organisation and later to signal new forms of religious expression not previously of primary or singular interest to the scholar of religion (Campbell; Jackson and Jobling; Nelson). The consequences were such that ‘cult’ came to carry new weight in terms of its meaning and reception, and much like other analytical concepts developed an intellectual significance regarding religious innovation it had not previously possessed. Unfortunately, this was not to last. By the early 1990s, ‘cult’ had become a term eschewed by scholars as pejorative, value-laden, and disparaging of its supposed subject matter; a term denuded of technical and descriptive meaning and replaced by more value-neutral alternatives (Dillon and Richardson; Richardson; Chryssides and Zeller). Results from well-published surveys (Pfeifer; Olson) and our own experience in teaching related subject matter revealed predominantly negative attitudes towards the term ‘cult’, with the inverse true for the alternative descriptors. Perhaps more importantly, the surveys revealed that for the public majority, knowledge of ‘cults’ came via media reportage of particularly the sensational few, rather than from direct experience of new religions or their members more generally (Pfeifer). For example, the Peoples Temple, Branch Davidian, and Heaven’s Gate groups featured heavily in news and mass media. Importantly, reporting of each of the tragic events marking their demise (in 1978, 1993, and 1997 respectively) reinforced a burgeoning stereotype and escalated fears about cults in our midst. The events in Jonestown, Guyana (Peoples Temple), especially, bolstered an anticult movement of purported cult experts and deprogrammers offering to save errant family members from the same fate as those who died [there]. The anticult movement portrayed all alleged cults as inherently dangerous and subject only to internal influences. They figured the charismatic leader as so powerful that he could take captive the minds of his followers and make them do whatever he wanted. (Crockford 95) While the term ‘new religious movement’ (NRM) has been used in place of cults within the academic sphere, ‘cult’ is still used within popular culture contexts precisely because of the connotations it inspires, with features including charismatic leaders, deprogrammers, coercion and mind-control, deception, perversion, exploitation, deviance, religious zealotry, abuse, violence, and death. For this reason, we still use the word cult to mean the myth of the cult as represented by popular culture. Representations of Cults and Expectations of Crime Violence and crime can be common features of some cults. Most NRMs “stay within the boundaries of the law” and practice their religion peacefully (Szubin, Jensen III, and Gregg 17). Unfortunately, it is usually those cults that are engaged in violence and crime that become newsworthy, and thus shape public ‘knowledge’ about the nature of cults and drive public expectations. Two of America’s most publicised cults, Charles Manson and the Manson Family and the Peoples Temple, are synonymous with violence and crime. Prior to committing mass suicide by poison in Jonestown, the Peoples Temple accumulated many guns as well as killing Congressman Leo Ryan and members of his party. Similarly, Charles Manson and the Manson Family stockpiled weapons, participated in illegal drug use, and murdered seven people, including Hollywood actor Sharon Tate. The high-profile victims of both groups ensured ongoing widespread media attention and continuous popular culture interest in both groups. Other cults are more specifically criminal in nature: for example, the Constanzo group in Matamoros, while presenting as a cult, are also a drug gang, leading to many calling these groups narco-cults (Kail 56). Sexual assault and abuse are commonly associated with cults. There have been numerous media reports worldwide on the sexual abuse of (usually) women and/or children. For example, a fourteen-year-old in the Children of God group alleged that she was raped when she disobeyed a leader (Rudin 28). In 2021, the regional city of Armidale, Australia, became national news when a former soldier was arrested on charges of “manipulating a woman for a ‘cult’ like purpose” (McKinnell). The man, James Davis, styles himself as the patriarch of a group known as the ‘House of Cadifor’. Police evidence includes six signed “slavery contracts”, as well as 70 witnesses to support the allegation that Mr Davis subjected a woman to “ongoing physical, sexual and psychological abuse and degradation” as well as unpaid prostitution and enslavement (McKinnell). Cults and Popular Culture The depiction of cults in popular culture is attracting growing attention. Scholars Lynn Neal (2011) and Joseph Layco*ck (2013) have initiated this research and identified consistent stereotypes of 'cults’ being portrayed throughout popular media. Neal found that cults began to be featured in television shows as early as the 1950s and 1960s, continually escalating until the 1990s before dropping slightly between 2000 and 2008 (the time the research was concluded). Specifically, there were 10 episodes between 1958-1969; 19 in the 1970s, which Neal attributes to the “rise of the cult scare and intense media scrutiny of NRMs” (97); 25 in the 1980s; 72 in the 1990s; and 59 between 2000 and 2008. Such academic research has identified that popular culture is important in the formation of the public perception, and social definition, of acceptable and deviant religions (Layco*ck 81). Layco*ck argues that representations of cults in popular culture reinforces public narratives about cults in three important ways: medicalisation, deviance amplification, and convergence. Medicalisation refers to the depiction of individuals becoming brainwashed and deprogrammed. The medicalisation of cults can be exacerbated by the cult uniform and clinical, ritualistic behaviours. Deviance amplification, a term coined by Leslie Wilkins in the 1960s, is the phenomenon of ‘media hype’, where the media selects specific examples of deviant behaviour, distorting them (Wilkins), such that a handful of peripheral cases appears representative of a larger social problem (Layco*ck 84). Following the deviance amplification, there is then often a 'moral panic' (a term coined by Stanley Cohen in 1972) where the problem is distorted and heightened within the media. Cults are often subject to deviance amplification within the media, leading to moral panics about the ‘depraved’, sexual, criminal, and violent activities of cults preying on and brainwashing innocents. Convergence “is a rhetorical device associated with deviance amplification in which two or more activities are linked so as to implicitly draw a parallel between them” (Layco*ck 85). An example of convergence occurred when the Branch Davidians were compared to the Peoples Temple, ultimately leading the FBI “to end the siege through an aggressive ‘dynamic entry’ in part because they feared such a mass suicide” (Layco*ck 85). The FBI transferred responsibility for the deaths to ‘mass suicide’, which has become the common narrative of events at Waco. Each of the three mechanisms have an important role to play in the popular culture presentation of cults to audiences. Popular media sources, fictional or not, are incentivised to present the most diabolical cult to the audience – and this often includes the medicalised elements of brainwashing and manipulation. This presentation reinforces existing deviance amplification and moral panics around the depraved activities of cults, and in particular sexual and criminal activities. And finally, convergence acts as a 'cultural script’ where the portrayal of these types of characteristics (brainwashing, criminal or violent behaviour, etc.) is automatically associated with cults. As Layco*ck argues, “in this way, popular culture has a unique ability to promote convergence and, by extension, deviance amplification” (85). The mechanisms of medicalisation, deviance amplification and convergence are important to the semiotic linking of concepts, signs, and signifiers in the process of myth generation. In efficiently understanding the message of the myth, the viewer must have a sign they can affix to it. In the case of visual mediums this must be immediate and certain. As many of the convergent properties of cults are behavioural (acts of violence and depravity, charismatic leaders, etc.), we need a symbol that audiences can understand immediately. Uniforms achieve this with remarkable efficiency. Upon seeing a still, two-dimensional image of people wearing matching garb it can be made easily apparent that they are part of a cult. Religious uniforms are one of the first visual images one conjures upon hearing the word cult: “for most people the word ‘cult’ conjures up ‘60s images of college students wearing flowing robes, chanting rhythmically and spouting Eastern philosophy” (Salvatore cited in Petherick 577; italics in original). The impact is especially pronounced if the clothes are atypical, anachronistic, or otherwise different to the expected clothes of the context. This interpretation then becomes cemented through the actions of the characters. In Rick and Morty, season 1, episode 10, Morty is imprisoned with interdimensional versions of himself. Despite some morphological differences, each Morty is wearing his recognisable yellow top and blue pants. While our Morty’s back is turned, five hooded, robed figures in atypical garb with matching facial markings approach Morty. The audience is immediately aware that this is a cult. The comparison between the uniform of Morty and the Morty cult exemplifies the use of cult uniform in the myth of Cults. The cult is then cemented through chanting and a belief in the “One true Morty” (Harmon et al.). Semiotics, Clothes, and Uniforms The semiotics of clothes includes implicit, explicit, and subliminal signs. The reasons we choose to wear what we wear is governed by multiple factors both within our control and outside of it: for instance, our body shape, social networks and economic status, access to fashion and choice (Barthes The Fashion System; Hackett). We often choose to communicate aspects of our identity through what we wear or what we choose not to wear. Our choice of clothing communicates aspects of who we are, but also who we want to be (Hackett; Simmel; Veblen) Uniforms are an effective and efficient communicative device. Calefato’s classification of uniforms is not only as those used by military and working groups, but also including the strictly coded dress of subcultures. Unlike other clothes which can be weakly coded, uniforms differentiate themselves through their purposeful coded signalling system (Calefato). To scholars such as Jennifer Craik, uniforms intrigue us because they combine evident statements as well as implied and subliminal communications (Craik). Theories about identity predict that processes similar to the defining of an individual are also important to group life, whereby an individual group member's conceptualisation of their group is derived from the collective identity (Horowitz; Lauger). Collective identities are regularly emphasised as a key component in understanding how groups gain meaning and purpose (Polletta and Jasper). The identity is generally constructed and reinforced through routine socialisation and collective action. Uniforms are a well-known means of creating collective identities. They restrict one’s clothing choices and use boundary-setting rituals to ensure commitment to the group. In general, the more obvious the restriction, the easier it is to enforce. Demanding obvious behaviours from members, unique to the community, simultaneously generates a differentiation between the members and non-members, while enabling self-enforcement and peer-to-peer judgments of commitment. Leaders of religious movements like cults and NRMs will sometimes step back from the punitive aspects of nonconformity. Instead, it falls to the members to maintain the discipline of the collective (Kelley 109). This further leads to a sense of ownership and therefore belonging to the community. Uniforms are an easy outward-facing signal that allows for ready discrimination of error. Because they are often obvious and distinctive dress, they constrain and often stigmatise members. In other collective situations such as with American gangs, even dedicated members will deny their gang affiliation if it is advantageous to do so (Lauger Real Gangstas). While in uniform, individuals cannot hide their membership, making the sacrifice more costly. Members are forced to take one hundred percent of the ownership and participate wholly, or not at all. Through this mechanism, cults demonstrate the medicalisation of the members. Leaders may want their members to be unable to escape or deny affiliation. Similarly, their external appearances might invite persecution and therefore breed resilience, courage, and solidarity. It is, in essence, a form of manipulation (see for instance Iannaccone). Alternatively, as Melton argues, members may want to be open and proud of their organisation, as displayed through them adopting their uniforms (15). The uniform of cults in popular media is a principal component of medicalisation, deviance amplification, and convergence. The uniform, often robes, offers credence to the medicalisation aspect: members of cults are receiving ‘treatment’ — initially, negative treatment while being brainwashed, and then later helpful/saving treatment when being deprogrammed, providing they survive a mass suicide attempt and/or, criminal, sexual, or violent escapades. Through portraying cult members in a distinctive uniform, there is no doubt for the audience who is receiving or in need of treatment. Many of the cults portrayed on screen can easily communicate the joining of a cult by changing the characters' dress. Similarly, by simply re-dressing the character, it is communicated that the character has returned to normal, they have been saved, they are a survivor. In Unbreakable Kimmy Schmidt, while three of the four ‘Mole women’ integrate back into society, Gretchen Chalker continues to believe in their cult; as such she never takes of her cult uniform. In addition, the employment of uniforms for cult members in popular culture enables an instant visual recognition of ‘us’ and ‘them’, or ‘normal’ and ‘abnormal’, and reinforces stereotypical notions of social order and marginalised, deviant (religious) groups (Neal 83). The clothing differences are obvious in The Simpsons season 9, episode 13, “Joy of Sect”: ‘Movementarian’ members, including the Simpsons, don long flowing robes. The use of cult uniform visualises their fanatical commitment to the group. It sets them apart from the rest of Springfield and society (Neal 88-89). The connection between uniforms and cults derives two seemingly paradoxical meanings. Firstly, it reduces the chances of the audience believing that the cult employed ‘deceptive recruiting’ techniques. As Melton argues, because of the association our society has with uniforms and cults, “it is very hard for someone to join most new religions, given their peculiar dress and worship practices, without knowing immediately its religious nature” (14). As such, within popular media, the presence of the uniform increases the culpability of those who join the cult. Contrarily, the character in uniform is a sign that the person has been manipulated and/or brainwashed. This reduces the culpability of the cult member. However, the two understandings are not necessarily exclusive. It is possible to view the cult member as a naïve victim, someone who approached the cult as an escape from their life but was subsequently manipulated into behaving criminally. This interpretation is particularly powerful because it indicates cults can prey on anyone, and that anyone could become a victim of a cult. This, in turn, heightens the moral panic surrounding cults and NRMs. The on-screen myth of the cult as represented by its uniform has a basis in the real-life history of NRMs. Heaven’s Gate members famously died after they imbibed fatal doses of alcohol and barbiturates to achieve their ‘final exit’. Most members were found laid out on beds covered in purple shrouds, all wearing matching black shirts, black pants, and black and white Nike shoes. The famous photos of Warren Jeffs’s polygamous Fundamentalist Church of Jesus Christ of Latter-Day Saints, the subject of Netflix’s Keep Sweet: Pray and Obey, depict multiple women in matching conservative dresses with matching hairstyles gathered around a photo of Jeffs. The image and uniform are a clear influence on the design of Unbreakable’s ‘Mole women’. A prime example of the stereotype of cult uniforms is provided by the Canadian comedy program The Red Green Show when the character Red tells Harold “cults are full of followers, they have no independent thought, they go to these pointless meetings ... they all dress the same” (episode 165). The statement is made while the two main characters Red and Harold are standing in matching outfits. Blurring Nature and Myth Importantly, the success of these shows very much relies on audiences having a shared conception of NRMs and the myth of the cult. This is a curious combination of real and fictional knowledge of the well-publicised controversial events in history. Fictional cults frequently take widely held perspectives of actual religious movements and render them either more absurd or more frightening (Layco*ck 81). Moreover, the blurring of fictional and non-fictional groups serves to reinforce the sense that all popular culture cults and their real-world counterparts are the same; that they all follow a common script. In this, there is convergence between the fictional and the real. The myth of the cult bleeds from the screen into real life. The Simpsons’ “The Joy of Sect” was televised in the year following the suicide of the 39 members of the Heaven’s Gate group, and the storyline in part was influenced by it. Importantly, as a piercing, satirical critique of middle-class America, the “Joy of Sect” not only parodied traditional and non-traditional religion generally (as well as the ‘cult-like’ following of mass media such as Fox); scholars have shown that it also parodied the ‘cult’ stereotype itself (Feltmate). While Heaven’s Gate influenced to a greater or lesser extent each of the TV shows highlighted thus far, it was also the case that the group incorporated into its eschatology aspects of popular culture linked primarily to science fiction. For example, group members were known to have regularly watched and discussed episodes of Star Trek (Hoffmann and Burke; Sconce), adopting aspects of the show’s vernacular in “attempts to relate to the public” (Gate 163). Words such as ‘away-team’, ‘prime-directive’, ‘hologram’, ‘Captain’, ‘Admiral’, and importantly ‘Red-Alert’ were adopted; the latter, often signalling code-red situations in Star Trek episodes, appeared on the Heaven’s Gate Website in the days just prior to their demise. Importantly, allusions to science fiction and Star Trek were incorporated into the group’s self-styled ‘uniform’ worn during their tragic ritual-suicide. Stitched into the shoulders of each of their uniforms were triangular, Star Trek-inspired patches featuring various celestial bodies along with a tagline signalling the common bond uniting each member: “Heaven’s Gate Away Team” (Sconce). Ironically, with replica patches readily for sale online, and T-shirts and hoodies featuring modified though similar Heaven’s Gate symbolism, this ‘common bond’ has been commodified in such a way as to subvert its original meaning – at least as it concerned ‘cult’ membership in the religious context. The re-integration of cult symbols into popular culture typifies the way we as a society detachedly view the behaviours of cults. The behaviour of cults is anecdotally viewed through a voyeuristic lens, potentially exacerbated by the regular portrayals of cults through parody. Scholars have demonstrated how popular culture has internationally impacted on criminological aspects of society. For instance, there was a noted, international increase in unrealistic expectations of jurors wanting forensic evidence during court cases after the popularity of forensic science in crime dramas (Franzen; Wise). After the arrest of James Davis in Armidale, NSW, Australia, the Sydney Morning Herald reported that Davis was the patriarch of the “House of Cadifor” and he was part of a “cult” (both reported in inverted commas). The article also includes an assumption from Davis's lawyer that, in discussing the women of the group, “the Crown might say ‘they’ve been brainwashed’”. Similarly, the article references the use of matching collars by the women (Mitchell). Nine News reported that the “ex-soldier allegedly forced tattooed, collared sex slave into prostitution”, bringing attention to the clothing as part of the coercive techniques of Davis. While the article does not designate the House of Cadifor as a cult, they include a quote from the Assistant Commissioner Justine Gough, “Mr Davis' group has cult-like qualities”, and included the keyword ‘cults’ for the article. Regrettably, the myth of cults and real-world behaviours of NRMs do not always align, and a false convergence is drawn between the two. Furthermore, the consistent parodying and voyeuristic nature of on-screen cults means we might be at fault of euphemising the crimes and behaviours of those deemed to be part of a ‘cult’. Anecdotally, the way Armidale locals discussed Davis was through a lens of excitement and titillation, as if watching a fictional story unfold in their own backyard. The conversations and news reporting focussed on the cult-like aspects of Davis and not the abhorrence of the alleged crimes. We must remain mindful that the cinematic semiology of cults and the myth as represented by their uniform dress and behaviours is incongruent with the nature of NRMs. However, more work needs to be done to better understand the impact of on-screen cults on real-world attitudes and beliefs. Conclusion The myth of the cult has entered a shared understanding within today’s zeitgeist, and the uniform of the cult stands at its heart as a key sign of the myth. Popular culture plays a key role in shaping this shared understanding by following the cultural script, slowly layering fact with fiction, just as fact begins to incorporate the fiction. The language of the cult as communicated through their uniforms is, we would argue, universally understood and purposeful. The ubiquitous representation of cults portrays a deviant group, often medicalised, and subject to deviance amplification and convergence. When a group of characters is presented to the audience in the same cult dress, we know what is being communicated to us. Fictional cults in popular culture continue to mirror the common list of negative features attributed to many new religious movements. Such fictional framing has come to inform media-consumer attitudes in much the same way as news media, reflecting as they do the cultural stock of knowledge from which our understandings are drawn, and which has little grounding in the direct or immediate experience of the phenomena in question. In short, the nature of NRMs has become confused with the myth of the cult. More research is needed to understand the impact of the myth of the cult. However, it is important to ensure “what-goes-without-saying” is not obfuscating, euphemising, or otherwise misrepresenting nature. References Barthes, Roland. Elements of Semiology. London: Jonathon Cape, 1967. ———. The Fashion System. U of California P, 1990. ———. Mythologies. Trans. 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