Journal articles: 'Circus Self-perception in adolescence. Circus' – Grafiati (2024)

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AIMS: Circus is a physically demanding profession, but injury and help-seeking rates tend to be low. This qualitative interview study explored the perceptions and beliefs about injury and help-seeking of circus artists. METHODS: Ten professional circus artists (5 males, 5 females; mean age 33 yrs, range 27–42) were enrolled. Individual, semi-structured interviews were conducted until data saturation of themes was reached. Data were analysed thematically. FINDINGS: Four themes were identified: 1) the injured artist; 2) professionalism; 3) circus life; and 4) artists’ experience of healthcare. Most participants described the circus as central to their lives, and injuries had wide-ranging psychosocial consequences. Injury adversely affected participants’ mood and threatened their identity. Situational and personal factors (e.g., the belief that pain was normal) pushed participants to use adaptive strategies to perform when injured. Continuous touring and financial constraints affected help-seeking. Easy access to healthcare was rare and participants often self-managed injuries. Experiences of healthcare varied, and participants desired flexible and accessible approaches to prevention and injury management. A modified version of the integrated model of psychological response to injury and rehabilitation process and the concept of identity provided a framework to understand participants. CONCLUSION: Injuries had extensive negative consequences. Work schedules, financial factors, employer support, the artist’s perception of the importance of the show, and the relationship between circus and identity influenced injury management and help-seeking. Injury prevention and management strategies could be optimised by developing centres of expertise, online resources, and better regulations of the profession.

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We analyze the concepts of “social health” (based on sociocentric, utilitarian, medical and social approaches), consider concept of “social activity”; research data reflecting the relationship between the social health of adolescents and their social activity are presented. In the process of analysis, we conclude that the social activity of the adolescent acts as one of the main factors of his social health, contributing to the development of socially significant knowledge, skills necessary for their self-realization and social adaptation in society, reflects his desire and the ability to build relationships with others, the inclusion of the personality of a adolescent in society. In the process of the analysis, we conclude that one of the main tasks of developing an adolescent’s personality is the formation of harmonious relations between an adolescent and society, that is, the development of his social health, which is possible only if the adolescent is included in active work on the development of social norms, rules, values, duties, where he would act not just as an observer, but as an active participant in what is happening. In order to empirically study the impact of social activity on the adolescent’s social health, a preliminary study was conducted in which adolescents from the Moscow State Budgetary Institution of Family Education Promotion Center “Y.V. Nikulin School of Circus Art” of the Moscow Department of Labor and Social Protection.

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The Pediatric Cardiac Quality of Life Inventory (PCQLI) is a self-administered disease-specific quality of life (QOL) tool with patient and parent-proxy reporting (Child form 8 –12 yrs; Adolescent form 13–18 yrs), designed to assess the QOL of pediatric patients with congenital and acquired heart disease (CHD, AHD). Our purpose was to evaluate the reliability and validity of the PCQLI Seven centers recruited CHD and AHD patients age 8 –18 yrs. Patient-parent pairs completed the PCQLI, a generic QOL tool (PedsQL), and non-QOL questionnaires [Self Perception Profile for Children/Adolescents (SPPC/A); Youth Self Report and Child Behavioral Checklist (Achenbach)]. Test-retest reliability was evaluated by administering the PCQLI at 2 time points, and was assessed by Spearman correlation coefficient. Validity was tested by assessing: differences in PCQLI score among heart disease subgroups; associations between PCQLI score and the number of cardiac surgeries, catheterizations, hospitalizations, and doctor visits; the correlation between patient and parent PCQLI scores; and correlations between PCQLI score and the scores generated by generic QOL and non-QOL tools. The study was completed by 1486 patient-parent pairs. Heart disease subgroups included: biventricular repair (45.4%); Fontan palliation (12.6%); unrepaired CHD (12.0%); heart transplant (4.4%); and AHD (25.6%). Correlations evaluating test-retest reliability were high (r=0.78 – 0.90). Lower PCQLI score was associated with Fontan palliation (p<0.001), as well as a greater number of cardiac surgeries, catheterizations, hospitalizations, and doctor visits (all p<0.001). Disattenuated correlations between patient and parent PCQLI scores were moderate (r = 0.51– 0.69). The PCQLI score and generic QOL score were highly associated (r = 0.62– 0.77). Lower PCQLI score was strongly associated with lower Global Self-Worth score on the SPPC/A (p<0.001), and lower Total Competency score (p<0.001), higher Syndrome Scale scores, and higher DSM Oriented Scale scores on the Achenbach (p<0.001). The PCQLI is a new disease-specific pediatric cardiac QOL tool that produces reliable and valid scores in children and adolescents age 8 –18 yrs. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).

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Background: Birth weight and physical activity are independently associated with cardiometabolic health outcomes. Low or high birth weight are indicators of adverse prenatal development, which may alter physiological response to physical activity later in life. However, few studies have explored the potential interaction between birth weight and physical activity as determinants of cardiometabolic health. Objective: We evaluated the hypothesis that high or low birth weight modifies the association of early life physical activity with cardiovascular disease or diabetes later in life. Methods: We analyzed data from the National Longitudinal Study of Adolescent and Adult Health (Add Health), a nationally representative cohort of US adolescents followed into adulthood ( n =20,745) with four data collection waves between 1994 and 2008. Outcomes were assessed in early adulthood: (1) predicted 30-year cardiovascular disease (CVD) risk, computed by a validated algorithm based on objective measures, and (2) prevalent pre-diabetes and diabetes. Using gender-stratified multivariable regression on multiply imputed data, we modeled (1) log-transformed 30-year CVD risk (linear regression) and (2) prevalent pre-diabetes and diabetes (PDM/DM; ordinal regression) each as a function of birth weight (low, normal, high; LBW, NBW, HBW) and self-reported moderate-to-vigorous physical activity frequency (MVPA) in adolescence and young adulthood, adjusting for age, smoking, and sociodemographic factors. Results: A greater proportion of women born at LBW had diabetes than NBW and HBW women (10.8% versus 5.9% and 5.4%, respectively). In adjusted analyses, MVPA in adolescence (MVPA1) and early adulthood (MVPA3) were not significantly associated with predicted CVD risk and prevalent pre-diabetes diabetes in men or women overall. However, greater MVPA1 was associated with lower predicted 30-year CVD risk in HBW females (estimated effect coefficient -0.02 [95% CI: -0.03, -0.005, p =0.02], p =0.05 for HBWхMVPA1 interaction), and the HBWхMVPA1 interaction on PDM/DM approached significance in females ( p =0.12). In females and males of LBW or NBW, MVPA1 was not significantly associated with predicted 30-year CVD risk or PDM/DM and LBWхMVPA1 interactions were not significant. Conclusions: Greater adolescent physical activity was most strongly associated with lower 30-year CVD risk in young women born at HBW. A similar association with prevalent DM/PDM approached significance, with greater adolescent physical activity most strongly associated in HBW women. Females born at HBW may be especially sensitive to the effects of physical activity on reducing risk of cardiometabolic disease later in life, with important implications for disease prevention and health policy.

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Introduction: Adherence to dietary recommendations among Latinx adolescents is low, contributing to an increased risk for obesity and cardiometabolic disease. Parents play a crucial role in adolescents’ disease risk and diet quality due to their role in modeling healthful behaviors and providing food. However, information about how parental monitoring and eating-related parenting practices are associated to cardiovascular risk is scarce. Hypothesis: We hypothesized that unhealthful parenting practices would be associated with higher cardiometabolic risk factors among Latinx adolescents. Methods: We included 61 parent-adolescent (6 th -8 th grade) Latinx dyads. Parents self-reported information about parental monitoring, family eating habits (use of media during meals, inclusion of specific foods during dinner, fast food intake), parental feeding style, and parental energy index (whether parents have had conversations with their children regarding weight and healthful diet and physical activity behaviors). Adolescent cardiometabolic risk factors measured include blood pressure (BP), total cholesterol, and HbA1c. Age- and sex-adjusted BMI percentile (BMI%) and z-scores (BMIz) were calculated from weight and height measurements. Associations between parental practices and cardiometabolic risk factors were analyzed using linear regression (B) and correlation (r). Results: Adolescents’ measured risk factors were as follows: SBP=106±11 mm Hg, DBP=62±7 mm Hg, weight=61±15 kg, BMI%=83±20, BMIz=1.2±0.9, HbA1c=5.1±0.4 %, and total cholesterol=164±12 mg/dL. Use of media during meals (e.g., TV, electronic devices) was associated with higher adolescent weight (B=7.97; r=.31; p=.02) and BMIz (B=.37; r=.27, p=.05). Parental restrictive feeding style was associated with higher adolescent weight (B=5.54; r=.22; p=.03), BMI% (B=13.19; r=.52, p=.001) and diastolic BP (B=2.50; r=.27, p=.04). Adolescent children of parents reporting a greater parental energy index had a greater body weight (B=6.90; r=.46; p=.001) and BMI % (B=6.28; r=.33, p=.01). Parent-reported frequency of consuming family meals, frequency of fast food meals, importance of consuming family meals, and inclusion of vegetables, fruit and 100% juice, milk, and sugar-sweetened beverages during family meals were not associated with adolescents’ BMI or BP. Associations with other risk factors were not significant. Conclusions: Results suggest that unhealthful parenting practices such as restrictive feeding and allowing the use of media during meals may negatively influence cardiometabolic risk factors among Latinx adolescents. Parents of children with a greater BMI reported having more conversations about weight and healthful behaviors with their children. Future family-based behavioral interventions for this population should incorporate more parenting strategies as part of their curricula.

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Background: The metabolic syndrome prevalence in adolescents is still rising (with up to 8% in some populations); this increase is mainly attributable to the obesity epidemic. Consequently, the long-term cardiovascular risk of these adolescents is very high. Unfortunately, despite this elevated risk, motivation and adherence to weight reduction programs still remain very low. Hypothesis: To verify if the combination of motivational interviewing, nutritional and physical education, and a close follow-up in a multidisciplinary, family-based weight-reduction pediatric clinic is effective to initiate and sustain beneficial lifestyle changes at 6 months. Subjects and Method: Fifty (50) families with adolescents (10-17 years old) characterized by obesity and metabolic syndrome were recruited with their families. The cardiometabolic risk profile (including body mass index, waist circumference, blood pressure, glucose, insulin, lipids and apolipoprotein B levels) of every subject was evaluated and explained to the adolescent and his/her parents. With motivational interviewing techniques and educative approaches, adolescents were brought to set up, at the first visit, a one month, one health challenge change. In subsequent visits, anthropometric measurements were recorded and, based on their first month’s success, new healthy challenges were proposed by the adolescent. Results: Adolescents participating in this program were initially highly motivated to initiate a one month healthy challenge with an average score of 7/10. Eighty percent of them chose to stop drinking juice or soda beverages as their first challenge. At one month, over 80% of them observe a weight reduction or no weight gain. At this point, the adolescents’ perception of success is the main source of motivation to introduce new health challenges in their life. At 3 and 6 months, healthy habits are still present in over 70% of them. Interestingly, these changes are accompanied by modifications in anthropometric covariables. At 6 months, we observe a significant reduction of body mass index (p=0.027) and waist circumference (p=0.047) in addition to a trend towards a reduction of mean weight (p=0.054). Conclusion: With counselling based on education, motivational techniques and a family approach, a high proportion of adolescents have initiated and maintained healthy changes. At 6 months, waist circumference reduction was the strongest change. This combined familial approach appears promising to reduce metabolic syndrome prevalence in adolescents. The prospective data collection is still ongoing, with the first adolescents recruited now reaching the one-year follow-up.

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Background: Both high and low body mass index (BMI) are associated with heart disease (HD). However, data are relatively lacking regarding the relationship between life-course trends in BMI and HD in low- and middle-income countries (LMICs). Objective: To investigate the relationship between prevalent HD and anthropomorphic indices such as BMI, waist circumference (WC) and waist to hip ratio (WHR), as well as body size perception from adolescence to adulthood. Methods: Baseline data from the Golestan Cohort Study, a prospective population-based study in Iran, were used in this cross-sectional analysis. Current anthropometric indices were measured and body size perception using standard pictograms was assessed for age 15, age 30, and at the time of interview. We used logistic regression to evaluate associations of prevalent HD with anthropometric indices. Statistical analyses were performed using STATA version 11. Results: Complete data were available for 50,044 participants (age 40-75 years), of whom 6.1% reported a history of HD. For men and women, current BMI, WC, and WHR were associated with prevalent HD (p<0.001). Prevalence of HD increased with each quintile of WC and WHR (e.g. adjusted OR (95% CI) for highest WC quintile for men (≥105 cm) and women (≥108 cm) was 1.56 (1.28, 1.91) and 1.47 (1.24, 1.73), respectively). Among men, there was a U-shaped relationship between HD and body size perception at younger ages. Men also had a U-shaped relationship between HD and changes in body size perception over time, while women had a U-shaped relationship between HD and changes in body size perception from adolescence to early adulthood, but demonstrated a J-shaped pattern from early to late adulthood (Figure). Conclusion: Prevalent HD was associated with current anthropometric indices and temporal changes in body size perception for men and women. Public health interventions focused on the cumulative lifetime burden of risk factors such as obesity on cardiovascular morbidity and mortality are essential, particularly in LMICs.

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Introduction: A healthy diet is key in preventing chronic diseases and black adults have higher rates of hypertension, obesity, and heart disease death rates compared to their white counterparts. Because dietary habits track from adolescence to adulthood, it is important to understand dietary habits of adolescents. This study aimed to examine the dietary quality among adolescents who skip lunch compared to those who do not. Methods: Data were collected in 2012 from 718 adolescents attending schools in New Orleans, Louisiana. Schools were high-poverty and closed-campus. Adolescents participated in a 24-hour dietary recall using the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool and data were converted into Healthy Eating Index (HEI-10) scores (range 0-100; higher scores reflect higher quality diet). Mean scores were compared between students who skipped lunch and those who did not. Results: Of the 718 respondents, 88.3% were black and 15.3% of students skipped lunch. Students who ate lunch had a mean HEI score of 46.6 compared to a mean score of 41.7 for students who skipped lunch (p<0.001). Students who skipped lunch also had significantly lower intake of total vegetables, whole fruits, total dairy, total protein, and higher intake of empty calories (Solid fats, alcohols, and added sugars (SoFASS)). Conclusions: Skipping lunch was associated with lower quality diet, though diet quality was low among all students. Students who skip lunch are less likely to consume vegetables, whole fruits, whole grains, and proteins and have higher intake of SoFASS. Considering over 15% of the sample did not eat lunch in a closed-campus school setting, further research should consider how to encourage students to participate in the National School Lunch Program. Table 1. HEI score comparisons between those who skip and do not skip lunch.

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Introduction: Expansion of visceral adipose tissue (VAT) associates with adverse metabolic changes. While regular moderate-to-vigorous activity is associated with lower total body fat in children and adolescents, it is unknown how physical activity relates to other adiposity indices, including VAT. Hypothesis: We hypothesized that regular physical activity in children and adolescents associates with lower body fat, percent body fat, abdominal subcutaneous adipose tissue (SAT), and VAT. Methods: The sample included 393 boys and girls aged 5–18 years (45.6% White, 50.6% African American, and 3.8% Other). Body fat and percent body fat were measured by dual-energy x-ray absorptiometry. Abdominal SAT and VAT mass were measured by magnetic resonance imaging between the highest point of the liver and the lower pole of the right kidney (using 5 to 8 cross-sectional slices, 4.76 cm apart). Participants were categorized as being regularly active by self-report: moderate-to-vigorous physical activity of ≥ 60 minutes/day, ≥ 4 days/week. Those who were physically active fewer than 4 days/week were categorized as not regularly active. Results: In this sample of children and adolescents, 45.6% of participants were regularly active. One-way ANCOVAs adjusted for age and sex demonstrated that regularly active youth had significantly less body fat (p<0.01) and lower percent body fat (p<0.01) than those who were not regularly active. One-way ANCOVAs adjusted for age, gender, and body fat, revealed that regularly active children and adolescents had no difference in SAT but had significantly lower amounts of VAT (p<0.05) when compared to those who were not regularly active. Conclusion: Engagement in moderate-to-vigorous physical activity for at least 60 minutes on four or more days of the week in children and adolescents was related to lower body fat, percent body fat and VAT, when compared to those youth who were less active. The promotion of regular physical activity has significant public health implications for body fat accumulation and for controlling excess VAT during childhood and adolescence.

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Objective: Weight misperception (overestimation and underestimation) has been linked to health behaviors and overestimation in particular has been associated with higher psychological distress. Less is known about the relation between weight misperceptions and health-related quality of life (HRQoL) particularly among adolescents in Southern Appalachia. Hypothesis: We assessed the hypothesis that weight misperception would be associated with poorer HRQoL outcomes. Methods: Waves 1 (n=544) and 2 (n=965) baseline data collected between 2011-2012 were used from the Team Up for Healthy Living Project, a cluster-randomized trial targeting obesity prevention in adolescents through a cross-peer intervention among Appalachian school children. BMI percentiles for age and sex were calculated using measured height and weight. Participants were classified into 3 groups: (1) accurate weight perception (perceived weight corresponds with actual weight), (2) underestimators (perceived weight less than actual weight), and (3) overestimators (perceived weight more than actual weight). HRQoL was assessed using the 23-item Pediatric QoL Inventory 4.0 (PedsQL TM ). Multiple linear regression was performed with adjustment for age, gender, race/ethnicity and BMI to examine associations between weight misperception and HRQoL. Results: In total, 393 students (26.7%) underestimated their weight and 67 overestimated their weight (4.6%). Univariate analyses showed that compared to accurate perception, underestimation was associated with higher HRQoL in the following areas: total HRQoL score, physical health, psychosocial health, and emotional and social domains (all p<0.05); and overestimation was associated with a lower total HRQoL score and physical health, as well as emotional functioning (all p<0.05). After adjusting for covariates, compared to accurate perception, underestimation was associated with a higher total HRQoL score (β=2.73, P=0.002), physical health (β=3.09, P=0.001), and psychosocial health (β=2.62, P=0.008), as well as emotional (β=3.23, P=0.011) and social (β=2.79, P=0.011) functioning. Conclusion: Contrary to the hypothesized relationship, underestimation was associated with higher HRQoL across all domains except for school functioning among Appalachian adolescents; whereas, overestimation was not associated with HRQoL. Better understanding of these associations will be beneficial in developing interventions to improve adolescents’ health in Appalachia.

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We have learned from the past that interventions targeting health behavior change involve assisting participants to identify and make changes in the habitual systems in their daily routines. Although the skills to change these habitual systems involve systems thinking (the ability to recognize patterns, interactions and interdependencies in a set of activities), no current measure exists to assess the extent to which systems thinking influences health behavior change. Our team is currently investigating the mediating role of systems thinking in enhancing healthy eating and exercise in overweight and obese adolescents. The purpose of this study was to develop and conduct psychometric testing of the Systems Thinking Scale for Adolescent Behavior Change (STS-AB). In a first phase of this study, a panel of experts in systems thinking was used to develop an initial item set that was tested for understandability, content validity and stability in a small sample (N= 24) of adolescents enrolled in a weight management program. In a second phase, using a larger study of 359 urban adolescents enrolled in a weight management trail aged 10-13 (58% girls; 80% African American), factor analysis, reliability, and validity of the 16-item STS-AB were assessed. Results of an exploratory factor analysis of the STS-AB indicated a 1-factor solution with good factor loadings, ranging from .40 to .67. The internal consistency reliability coefficient was .87. Test-retest reliability of the STS-AB was .48, p<.05. Systems thinking scores were higher in children who received systems thinking training compared to children not receiving training. Evidence of construct validity was supported by significant correlations with established measures of other variables commonly associated with health behavior change (motivation and self-efficacy for diet and physical activity). These findings indicate that the STS-AB is a valid and reliable measure of systems thinking for health behavior change in adolescents that can assist investigators to examine the extent to which systems thinking is a mechanism in health behavior change.

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Background: Short sleep duration (e.g., <9 hours (hrs) for 6-12 years and <8 hrs for 13-18 years) is highly prevalent and associated with cardiometabolic risk among adolescents. Significant racial disparities in sleep duration among adolescents have been found. Investigating mechanisms driving sleep disparities is important for informing interventions to reduce disparities. Neighborhood and household stressors may contribute to racial disparities in sleep among adolescents as prior literature have found them to be patterned by race/ethnicity and associated with sleep duration. This study examined neighborhood and household context as mediators in the association between race/ethnicity (a proxy for sociocultural factors such as racism) and sleep duration among adolescents. Methods: Participants (n=13,019) were from Waves I and II of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative multi-ethnic sample of adolescents and their health in adulthood. Sleep duration was self-reported in whole hours per day and categorized based on age-specific cut-offs for short sleep (6-12 years: <9 hrs, 13-18 years: <8 hrs, 19-25 years: <7 hrs) vs. recommended (6-13 years: 9-11 hrs, 14-17 years: 8-10 hrs, 18-25 years: 7-9 hrs). Neighborhood factors included neighborhood socioeconomic status (SES) (e.g. census tract measures: proportions of female-headed households, individuals below the poverty threshold, individuals receiving public assistance, adults with < high school education, and adults unemployed), perceived safety and social cohesion. Household factors included living in a single parent household and household SES (e.g. highest parental education, income, and occupation). Structural equation modeling (SEM) was used to simultaneously assess mediation of neighborhood and household context in the association between race/ethnicity and short sleep duration adjusting for age and sex. Results: The sample was 4% Asian, 15% African American (AA), 2% American Indian (AI), 12% Hispanic, and 66% non-Hispanic White (NHW) and mean age 15 years (SD=.1). In SEM, AAs (β=.055, p<.001) and Asians (β=.047, p=.047) were more likely to have short sleep duration than NHW. Higher household SES was associated with a greater probability for short sleep duration (β=.061, p=.004) in the total sample. Only household SES was a significant mediator, explaining 11.6%, 9.9%, and 42.4% of AA-NHW, AI-NHW, and Hispanic-NHW differences, respectively. Conclusion: Although household SES partially explained racial disparities, improving household SES conditions for racial/ethnic minority adolescents may not reduce disparities, given that higher household SES was positively associated with short sleep duration. Future studies should explore buffers for racial/ethnic minority adolescents in the context of SES to inform interventions and reduce disparities in sleep.

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Introduction: A decrease in sleep quantity and quality is a growing concern in the adolescent population. Concurrently, an increase in physical inactivity has been shown to be related to numerous health consequences. There is a lack of literature on the relationship between sleep, physical activity (PA) and sedentary behavior (SB) in the adolescent population, particularly looking at night-to-night sleep irregularity. Hypothesis: We hypothesized that increased PA and decreased SB in both objective and subject modalities would be associated with greater habitual sleep duration (HSD) and lesser habitual sleep variability (HSV) in this adolescent population. Methods: Objective and subjective sleep and activity measurements were collected from 295 adolescents in the Penn State Child Cohort follow-up examination. Objectively-measured variables were obtained through 7 consecutive days of actigraphy collection. HSD was calculated as the average sleep duration across 7 nights, and HSV was calculated as the standard deviation (SD) of intra-individual sleep duration. Subjects with <5 nights of sleep data were excluded from analysis. Self-administered questionnaires were used to collect subjectively-measured sleep, PA, and SB data. The relationships between sleep and behavior measures were assessed using linear regressions. All models were adjusted for age, sex, race and BMI percentile. Results: On average, our sample was 16.8 years, 52% male, and 79% white. We found that higher SB was associated with shorter HSD. With one SD change in objectively-measured SB (1014 minutes), HSD is reduced by 16 (3.6) minutes (p<0.05). Although not statistically significant, subjective SB showed a similar pattern. Unexpectedly, both objective and subjective measures of increased PA were associated with shorter HSD. In terms of HSV, we found that higher subjective SB was associated with greater HSV; specifically, with one SD change in subjectively-measured SB (8.64 points), HSV increased by 0.011 (0.004) minutes. None of the PA measures were significantly associated with HSV. Conclusions: In conclusion, objectively-measured sleep patterns are related to physical activity/inactivity. Our results emphasize the need of future studies to systematically assess the inter-relationship of sleep and physical activity in this population.

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Levels of systolic blood pressure (SBP) in youth tend to predict adult SBP levels, but whether the trajectory of SBP over time predicts adult HTN is not known. In the International Childhood CV Cohort (i3C) Consortium, we constructed SBP trajectories in 9515 participants who had ≥2 SBPs in youth, and who reported HTN status (by questionnaire) at mean age 47 years. We used measured SBP from age 3-19 years to form trajectories using a mixed model with spline for age and random intercept and slope. The intercept and slope form personal trajectories during age 3-19 after removing the overall curve (spline) common to all participants. Trajectory groupings were formed by stratifying the intercept and slope by tertiles, forming 9 nearly equal sized groups, each having a consistent intercept and slope combination, among either a low, mid or high intercept and low (declining), mid (flat) or high (increasing) slope. The average SBP for all measurements in 6 age categories characterized the trajectories (Figure left panel). This characterization is reiterated using ages 3-11 and 12-19 years in the right panel which displays the adult HTN prevalence across the trajectories. Logistic models evaluated whether SBP trajectory group predicted adult HTN after adjustment for age and year at first childhood SBP measurement, age and BMI at adult HTN, smoking, sex, cohort, and race. Overall adult HTN prevalence was 30.9% increasing across SBP trajectories. All SBP trajectories compared to the highest intercept/slope group remained significant predictors of adult HTN even after adjustments (odds ratios 0.24 for lowest intercept/slope trajectory and 0.75 for highest intercept/intermediate slope trajectory both compared to highest intercept/highest slope, all P<0.0001). We conclude that baseline (intercept) and slope of SBP changes from childhood to adolescence can assist providers in identifying potential for modifying the development of hypertension in adulthood.

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Introduction: Impaired cardiac autonomic modulation (CAM), as measured by heart rate variability (HRV), has been associated with increased risk of cardiovascular morbidity. Inadequate sleep has been shown to contribute to impaired CAM, however, it is not clear what sleep problems are independently associated with impaired CAM in adolescents, a population in which insomnia symptoms, short sleep duration and night-to-night sleep variability are highly prevalent. Hypothesis: Insomnia symptoms, objective short sleep duration and high sleep variability are independently associated with worse HRV indices in adolescents. Methods: Data from the Penn State Child Cohort, a randomly-selected sample of 421 adolescents (12-23y) was used. Insomnia symptoms were defined by the presence of self-reported difficulties falling and/or staying asleep on the Pediatric Sleep Questionnaire. All subjects underwent 9-hour, in-lab polysomnography (PSG) and wore an actigraphy (ACT) monitor in the non-dominant wrist for 7 days. Mixed-effect regression models predicting HRV indices included insomnia symptoms, PSG sleep duration and ACT sleep duration and its variability (standard deviation) adjusted for each other as well as for sex, race, age, body mass index, and apnea/hypopnea index. Results: Shorter PSG sleep duration and higher ACT sleep variability were independently associated with decreased parasympathetic and increased sympathetic nervous activity [e.g., SDNN: 2.05±0.70, p<0.01 and -4.50±1.14, p<0.01 and Log-HF: 0.10±0.03, p<0.0 and -0.10±0.05, p=0.05, respectively], while ACT sleep duration or self-reported insomnia symptoms were not [e.g., SDNN: -0.57±0.84, p=0.49 and 0.90±1.26, p=0.47 and Log-HF: -0.06±0.04, p=0.12 and 0.05±0.06, p=0.37, respectively]. Conclusions: Objective, but not subjective, measures of sleep are associated with impaired CAM in adolescents. Interestingly, short PSG sleep duration and high ACT sleep variability are independently associated with impaired CAM, which indicates that these two objective measures may help identify distinct sleep phenotypes associated with increased cardiovascular risk in adolescents. Future studies should examine whether a more severe type of insomnia symptoms, i.e., chronic insomnia, is associated with impaired CAM in adolescents.

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Background: The ACC/AHA currently recommend performing a 14-point cardiovascular (CV) evaluation when screening healthy student-athletes for CV disease. This includes a focused history to assess for cardiac symptoms including exertional chest pain, dyspnea, fatigue, palpitations, and syncope. Though the presence of these symptoms may suggest underlying CV disease, additional factors including hours of weekly physical activity may influence the prevalence of reported symptoms. The relationship between physical activity level and the prevalence of cardiac symptoms has not been fully studied in an adolescent population. Methods: We analyzed the results of 10683 consecutive athlete screenings (median age 15 years) from HeartBytes, a data registry of pre-participation youth CV screenings utilizing the 14-point AHA evaluation. Cardiac symptoms and hours of weekly physical activity were self-reported. Weekly activity level was reported as less than 2 hours, between 2 and 5 hours, between 5 and 10 hours, or as greater than 10 hours. A chi-squared analysis for independence was performed to evaluate the relationship between physical activity level and each cardiac symptom. Results: Chest pain was reported in 5.1% of athletes, and increasing hours of physical activity was associated with less reported pain ( X 2 = 73.01, p <.001). Exertional dyspnea was reported in 11.7% of individuals, and increasing activity was associated with less reported dyspnea ( X 2 = 120.53, p <.001). Easy fatigability was reported in 7.5% of individuals, with more activity associated with less reported fatigue ( X 2 = 376.61, p <.001). Palpitations were reported in 5.1% of those screened, with increasing activity was associated with less reported palpitations ( X 2 = 95.34, p <.001). Finally, syncope was reported in 1.1% of athletes, though there was no relationship between activity level and syncope ( X 2 = 5.53, p = 0.24). Conclusion: Increased physical activity is associated with lower rates of reported chest pain, exertional dyspnea, easy fatigability, and palpitations in adolescents. Further studies are needed to clarify the relationship in youth athletes between symptoms and CV health.

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Introduction: Single ventricle heart disease (SVHD) adolescents with a single right ventricle (RV) have worse cognition and mood function compared to single left ventricle (LV) which may result from variability in ventricular function or structure related sequela after Fontan completion. However, it is unclear whether RV SVHD has worse cerebral blood flow (CBF) in cognitive and mood regulatory areas over LV SVHD compared to healthy controls. Methods: Cross-sectional, comparative design, 14 adolescents with RV SVHD (age 16.1±1.5 years; 7 male), 6 LV SVHD (age, 16.3±1.0 years; 4 male), and 25 healthy controls (age, 15.9±1.4 years; 13 male) were studied. SVHD participants were recruited who have undergone surgical palliation with Fontan completion from local pediatric cardiology clinics. Self-reported healthy controls were recruited from the community. Brain MRI studies were performed using a 3.0-Tesla MRI scanner and 3D pseudo-continuous arterial spin labelling data were collected. We calculated whole-brain CBF maps, normalized to a common space, and assessed brain changes between RV and LV SVHD and controls [ANCOVA; covariates, age and sex; p<0.005]. Region of interest analyses were performed in cognitive and mood control brain sites. Results: Regional brain CBF was reduced in single RV over LV SVHD. Multiple brain sites showed more widespread reduced CBF values in RV over LV SVHD compared to controls (Figure 1, p<0.005), including the prefrontal cortices, caudate, insula (a, f), anterior (b, g), mid (c, h), and posterior (d, i) cingulate, and hippocampus (e, j). Conclusion: Single RV adolescents show more widespread reduced CBF than single LV in cognitive and mood regulatory sites, which may result from variable function or structure related sequela between ventricle types. The findings indicate that the therapeutic approach should recognize the differences in CBF based on ventricle type and investigate interventions to optimize CBF in single RV SVHD.

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Introduction: Although self-reported sleep duration has been associated with obesity, study of the association between objectively-measured habitual sleep pattern and the more metabolically relevant abdominal obesity, and the mediation factors for such an association, is limited. Hypothesis: We assessed the hypothesis that objectively-measured variability, mediated by excessive energy intake, is associated with abdominal obesity in adolescents. Methods: We used data from 421 adolescents in the Penn State Child Cohort follow-up examination. Actigraphy was used for 7 consecutive nights to calculate each participant’s mean sleep duration as habitual sleep duration (HSD) and the standard deviation of the mean as habitual sleep variability (HSV). Abdominal obesity was assessed by dual-energy x-ray absorptiometry as Android/Gynoid Fat Ratio and visceral fat area . Youth/Adolescents Food Frequency Questionnaire was used to obtain daily caloric, fat, carbohydrate, and protein intakes one year prior to the study. The R-based Mediation Effect Models were used to assess the association between sleep pattern and abdominal obesity, and quantitatively estimate the mediation effects of caloric intake and of other factors not analyzed in this report. Results: As shown in the table, after controlling for major confounders and BMI percentile, HSV was significantly and consistently associated with both abdominal obesity measures. The Mediation analysis consistently indicated a significant mediation effect of caloric intake, especially carbohydrate intake. For example, 20% of the association between HSV and visceral fat could be attributed to carbohydrate intake, while 80% by other factors not analyzed. HSD was not associated with abdominal obesity. Conclusions: Higher HSV, not HSD, is associated with abdominal obesity, which can be partially explained by increased caloric intake, especially from carbohydrate, in adolescents. More studies are needed to identify other mediation factors in the association.

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Introduction: Adolescent obesity is one of the leading public health concerns in the United States. Children who are overweight as adolescents are much more likely to become obese adults. Providing nutrition education is a powerful resource for dietary behavioral change among adolescents and children. Teen Battle Chef (TBC), a component of the HealthCorps Living Labs program, uses culinary and nutrition education to promote behavioral change by empowering youth on multiple levels. This study examines impact of the TBC component of HealthCorps on NYC high school students’ food behaviors, leadership skills, attendance and academic performance. Hypothesis: That participation in Teen Battle Chef will increase attendance, academic and food behavior indicators Methods: We examined several food behaviors, leadership traits, attendance and academic performance of TBC students in the 14 NYC HealthCorps high schools. The TBC curriculum was implemented all 14 schools and a total of 176 students participated in the intervention and 40 students in the comparison group. Pre and Post surveys were conducted. Students from both interventional and comparison groups completed the same survey. Additionally, school performance data in a subset of students from the previous school year in the same schools were examined to determine whether participation affected school performance. Academic data (2012-13) from a total of 88 TBC from 2012-13 were compared to the entire school population. These included attendance, SAT scores, and graduation. Results: The TBC intervention group had significantly greater improvements in key food behavior indicators. Students reported an increased “energy level” [t=+2.90; p<0.01]; more likely to consume fruit [t=-2.17; p<0.05], carrots [t=-2.56; p<0.05], and less likely to drink soda [t=2.30; p<0.05]. The TBC group significantly increased their overall dietary quality (0.114; p=0.03) compared with the control group (0.006; p=0.90). An indication of leadership development, participants had significantly greater improvement in discussing the value of local foods with others (t=-3.31; p<0.01). Compared with previous year’s cohort, the mean SAT scores for TBC participants were significantly higher than overall school scores. Additionally, TBC participants attendance rate was 95%, compared to the school attendance rate of 86%. Conclusion: This study provides strong evidence that TBC helps develop leadership, teamwork, culinary skills, nutrition knowledge, food systems and self-efficacy for high school students. In addition, our study explicitly shows that TBC students improve their academic performance and attendance and are motivated to succeed in school as a result of their participation in the TBC/HealthCorps programs.

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Objective: Transition is defined as “the process by which adolescents and young adults with chronic childhood illnesses are prepared to take charge of their lives and their health in adulthood”. We previously reported common knowledge deficits and lack of transition readiness (TR) in 13-25 year olds with congenital or acquired heart disease. The aims of this study were to re-evaluate TR in these patients at follow-up (F/U) and to examine the relationship between changes in TR and quality of life (QOL). Methods: Patients (n=106) completed the TR Assessment and Pediatric Quality of Life Inventory (PedsQL) utilizing an e-tablet, web-based format at a routine F/U clinic visit. Changes from initial to F/U scores were evaluated. Results: Median patient age was 18.7 yrs at a median F/U time of 1.02 yrs. Average perceived knowledge deficit score (% of items with no knowledge) at F/U was 18.0 ± 15.2%, decreased from 24.7 ± 16.5%, p<.0001. On a 100-point scale, the mean score for self-efficacy increased from 71.4 ± 17.0 to 76.7 ± 18.2 (p=.004) and for self-management increased from 47.9 ± 18.4 to 52.0 ± 20.7 (p=.0004). While physical QOL did not change, the mean psychosocial QOL score increased significantly from 80.2 ± 13.3 to 82.5 ± 12.0, p=.02. A decrease in knowledge deficit score at F/U was significantly associated with an increased psychosocial QOL score, p=.03. An increase in self-efficacy score was associated with an increase in psychosocial QOL score (p=.04), especially social QOL (p=.02). Among patients who reported receiving specific information after initial TR assessment, knowledge deficits decreased related to medication (p=.002), symptoms to call for (p=.02), how to contact heart doctor (p=.02), and health insurance (p=.10). Self-efficacy scores improved in patients reporting receipt of information regarding how to contact the heart doctor (p=.06) and how to communicate with healthcare team (p=.05). Conclusion: While deficits in knowledge and self-management skills persist, TR assessment and recognition of deficits can improve transition readiness with improved psychosocial QOL. Routine TR assessment is important to identify transition needs. Further studies are needed to examine the relationship between TR and outcomes in young adults with heart disease.

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Objective : This study was examined to identify the variables related to quality of life (QOL) in adolescents with congenital heart disease (CHD). Methods : The subjects were 266 adolescents with CHD under observation following cardiac surgery in three cardiac centers in Korea. The adolescents each completed twenty questionnaires. The exogenous variables in the model were individual risk factors, individual protective factors, family protective factors and social protective factors, while QOL and resilience were an endogenous variable. These six theoretical variables were assessed by 20 measurable variables (anxiety, depression, symptom distress, NYHA Functional class, oxygen saturation, number of operations, self-esteem, hope, attitude toward CHD, body image, academic achievement, family cohesion, family function, parental support, parental overprotection, socioeconomic status, friend support, teacher support, resilience and QOL) and 15 paths were established. Data were analysed using structural equation modelling. Results: The overall fit indices of the hypothetical model were χ2=26.63, GFI=.96, RMR=.02, NFI=.95, RFI=.85, IFI=.98 and PNFI=.87. All 15 paths in the hypothetical model were found to be significant(all, p<0.01). Higher resilience (t=11.93), family (t=7.88), individual (t=5.75), and social (t=4.14) protective factors were associated with increased QOL, as were lower individual risk factors (t=−5.30). Resilience had the greatest impact on QOL. Individual protective factors correlated positively with both family (t=8.88) and social (t=8.33) protective factors, while family factors correlated positively with social protective factors (t=9.31). Individual risk factors correlated negatively with family (t=−7.13), individual (t=−7.00) and social (t=−4.69) protective factors. Thus, the higher each of these protective factors was, the smaller the effect of individual risk factors. Conclusion: To increase the QOL of adolescents with CHD, it is important to develop a strategy to increase resilience. Furthermore, nursing interventions that will enhance individual, family, and social protective factors must be developed and implemented in order to reduce the negative effects of individual risk factors.

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Introduction. Cardiorespiratory fitness (CRF) is a powerful marker of current of CVD risk among youth. The goals of this study are to describe the prevalence of low CRF among US adolescents aged 12-19 years (N=4,955), determine its sociodemographic and physical activity (PA) behavioral correlates and explore its association with adiposity markers. We hypothesize some PA variables will be significantly associated with low CRF after controlling for adiposity and other confounders. Methods. Data from three rounds of NHANES from 1999-2004, the most recent nationally representative data available on CRF, were analyzed. CRF was estimated as maximal oxygen uptake via measured heart rate responses to a treadmill test and categorized as healthy or low based on CVD-validated FITNESSGRAM standards. The prevalence of low CRF across various sociodemographic and PA behavioral indicators were calculated in analyses stratified by gender. Chi-square or linear trend analyses were used to calculate differences across groups. BMI groups (normal vs. overweight/obese) and WC groups (high vs. normal) were coded for CRF-adiposity cross-tabulations. High WC was classified as ≥90 th age, gender and race-specific percentile for 12-18 year olds and >94 cm and >80 cm for 19 year olds males and females, respectively. Correlates of low CRF were examined using multivariable logistic regression models. All analyses were conducted in SUDAAN to account for the survey’s complex sampling design. Results . Overall 37% of US adolescents had low CRF. The prevalence of low CRF was higher in females (38.6%) than males (35.1%) (p=0.04) but did not differ across racial/ethnic or poverty-to-income ratio groups. There were significant bivariate associations between low CRF and self-reported active commuting (p<0.02), <2 hours/day screen time (p<0.001), higher MET-min/d of moderate-to-vigorous (p<0.001) and vigorous (p=0.001) PA. Among boys and girls, the prevalence of low CRF was lower among those normal weight (25.9%; 32.4%) vs. those overweight (42.3%; 46.9%) or obese (66.3%; 56%) (p for trend<0.001). Similarly the prevalence of low CRF was lower among those with normal (29.4%; 35%) vs. high WC (76.8%; 53.8%). Adolescents who did not actively commute via biking or walking were more likely to have low CRF compared to those who were active commuters (OR=1.39; 95% CI 1.00-1.93; p=0.05 for girls) and (OR:1.49; 95% CI 1.06-2.10; p=0.02 for boys). Similarly, among boys and girls, those who used ≥2hours/day screen-time were more likely to be low fit (p≤0.02). Conclusion . A significant portion (50-30%) of adolescents with high BMI or WC exhibit normal CRF while about 1 in 4 normal weight adolescents have low CRF and are at increased CVD risk. Promotion of PA among adolescents to improve CRF could help both normal weight and overweight adolescents with low CRF improve their CRF and lower CVD risk independently of adiposity.

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Objective: To examine sleep behaviors and their associations with health characteristics in a cohort of adolescents with severe obesity undergoing bariatric surgery at Children’s Hospital Colorado. Methods: A retrospective chart review of electronic medical records was performed. All patients receiving care at the Children’s Hospital Colorado (CHCO) Bariatric Surgery Center between 06/17-08/19 were included. Demographic, medical and family history, self-reported sleep behaviors, and laboratory measures were abstracted, including medical problem list (e.g., type 2 diabetes (T2D), hypertension) and body mass index (BMI). A sleep behavior risk score (SBRS) was developed using five criteria (short sleep defined as <8 hrs/night, variability of sleep timing greater than 60 minutes, daytime naps, bedtime past midnight, and mobile devices in bed). Participants were classified as having a high SBRS if they met three or more of the criteria. T-tests were used to examine the differences between baseline health characteristics by SBRS score. Results: Data from 78 patients, aged 16.82.1, were reviewed. The majority of patients were female (71%), Hispanic (52%) and in 10-12 th grade in school (64%). Prior to surgery, 24% of the patients were diagnosed with hypertension and 20% with type 2 diabetes. The majority of patients (60%) had a high SBRS at baseline. High SBRS was significantly associated with higher baseline BMI (49.2 vs 45.0; p=0.03). SBRS score was not significantly associated with diagnosis of hypertension, type 2 diabetes, hyperlipidemia, or obstructive sleep apnea. Conclusions: In a population of adolescents seen in the Bariatric Surgery Center at CHCO, a majority of patients met criteria for high risk sleep behaviors, and worse sleep behaviors preoperatively were related to higher baseline BMI. A high SBRS may adversely impact adolescents’ overall health prior to surgery, which may have implications for weight loss success post-surgery. The evaluation for sleep health should be more rigorously evaluated and standardized as part of efforts to improve health outcomes in patients undergoing bariatric surgery.

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Background: Sedentary screen time (including TV, computer and video games) has been correlated with childhood obesity and other health risks. The American Academy of Pediatrics (AAP) recommends that children limit their daily screen time to two hours in order to reduce the associated risk. Mobile device use has become increasingly popular amongst children and adolescents. However, mobile screen time (cell phone and tablet use) and its effect on physical activity in adolescents has yet to be thoroughly researched. Methods: Self-reported survey data were collected from 2,566 6th grade students enrolled in Project Healthy Schools during the 2013-2014 school year. Based on AAP guidelines, we split our sample into low mobile device users (≤2 hours/day) and high mobile device users (>2 hours/day). We compared physical activity, sports team participation and screen time habits between groups. Results: 20.73% (n=532) of the 6th graders surveyed reported being high mobile device users. 60.5% (n=322) of these were female; 39.5% (n=210) were male. In addition to >2 hours/day on a mobile device, these students spent significantly more time watching TV (2.30 v 1.70, p<0.001), on the computer (1.39 v 0.88, p<0.001), and playing video games (1.47 v 1.01, p<0.001) than low mobile device users. Low mobile device users participated in significantly more strengthening exercises (2.80 v 2.62, p=0.046) and outside of school sports teams (1.20 v 1.09, p=0.03) than high mobile device users. Conclusions: A large percentage of middle school students (20.73%) reported spending more time on a mobile device than recommended by the AAP. High mobile device usage appears to be associated with less physical activity and more sedentary behaviors. This illustrates the need to educate children and encourage the reduction of time spent on a mobile device.

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The relationship between single measures of systolic blood pressure (SBP) in youth and adult levels is weak. We sought to define trajectories of SBP over childhood to determine ability to predict adult hypertension (HTN). In the International Childhood CV Cohort (i3C) Consortium, we constructed SBP trajectories in 11,482 participants (mean age 8.0 + 2.0 years at time of first measure, 47% male, 25% non-Caucasian) who had at least 3 SBPs in youth between the ages of 4 and <20 years assessed with at least 5 years between measures. To account for differences in normal BP by age, sex and height, trajectories were constructed using SBP percentile as defined by the 2017 Clinical Practice Guideline for BP management in youth. We then assessed HTN status (by survey) at mean age 46.7 years in 5,357 of the participants (mean age at first assessment 8.1 + 1.9 years, at self-assessment of HTN 46.7 + 5.7 years. 41% male, 23% non-Caucasian). SAS Proc Traj was employed to construct models with differing numbers of trajectories where all individual trajectories were significant (whether linear, quadratic or cubic). Model fit for each number of trajectories (up to 9) was assessed and trajectories were examined for clinical relevance. The final model selected included 6 trajectories. The prevalence of adult HTN was lowest in the group with low SBP across childhood and adolescence (Low-Low = 20%) and was highest in the group with persistently high SBP (High-High, 49%, chi square <0.001). At first assessment, participants in the High-High group were slightly older (8.7 vs 7.7 years), heavier (BMI 65.2 vs 45.1%), had higher BP (112/61 vs 90/48 mmHg; 27% vs 86% for SBP) and, higher Tchol, LDL, TG, Insulin, Glucose and lower HDL although means were within normal limits (all p<0.001). We conclude that trajectories of BP across childhood may identify youth at high risk for development of HTN in adulthood.

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Introduction: Chronic diseases may result in growth impairment and delayed puberty that contribute to psychosocial maladjustment. There are no data on the prevalence of short stature or delayed puberty in children and adolescents after Fontan operation, a cohort characterized by chronic low cardiac output. Methods: This was a cross-sectional study of 299 Fontan patients (8-18 years) from 11 Pediatric Heart Network centers. We collected demographic data, anthropometric measurements and Tanner stage using a validated self-assessment questionnaire. Anthropometric measurements and pubertal stage were compared to United States normative data. Short stature was defined as height <5% and abnormal BMI as <5% or >95%. Delayed puberty was defined as failure to reach a stage of development at an age greater than the median age in the subsequent Tanner stage. Comparisons were made between study population and contemporary normal population data. Results: Of the 299 subjects [42% female, median age at enrollment 13.9 years (IQR: 11.3, 16.1)], 98 (33%) had hypoplastic left ventricle and 24 (8%) had heterotaxy syndrome. Median age at Fontan was 3 years (IQR: 2, 4). PLE was present in 16 subjects (5%). Fontan survivors had a higher prevalence of short stature relative to normative data (20% vs. 5%, p<0.0001) and an increased prevalence of abnormal BMI (18% vs. 10%, p<0.0001). Abnormal BMI were split between low BMI (43%) and high BMI (57%). Both males (58%) and females (58%) had delay in ≥1 Tanner stage parameter with at least 2 yr differences between Fontan patients and population norms for most parameters (Figure). Conclusion: Compared to the normal population, Fontan survivors have a 4-fold increase in the prevalence of short stature and nearly 2 fold abnormality in in BMI. Delayed puberty was common in both genders. As these factors may have a negative psychosocial impact, routine screening and management of short stature and delayed puberty should be a priority in Fontan survivors.

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Background: Metabolic syndrome (MetS) is a cluster of risk factors for CVD and DM2 that includes abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. While cigarette smoking has been associated with MetS risk factors in adults, young adulthood is an under-studied, susceptible period for developing long-term morbidity and mortality related to MetS. Objective: This study aims to examine the association between cigarette smoking and MetS in Chilean young adults. We hypothesized that cigarette smoking, even at low levels of exposure (< 30 per week), is associated with an increased risk of developing MetS in young adults. Methods: We studied 243 Chilean young adults who were part of infancy studies related to iron deficiency and recruited for a study of cardiovascular risk at age 16. Participant BMI, waist circumference, blood pressure, fasting serum glucose, cholesterol, triglycerides, and HDL were measured. MetS was defined using IDF and AHA/NHLBI criteria, and MetS risk z-scores were calculated using published equations. Participants self-reported smoking and drinking habits using standardized questionnaires. Logistic regressions examined associations between smoking and each MetS risk factor. All models were adjusted for sex, MetS at adolescence, and frequency of alcohol consumption. Results: Participants were mean 22.5 years old and 49.8% male (121 of 243). The prevalence of obesity and MetS was 24.3% (59 of 243) and 15.3% (37 of 243) respectively. Among smokers (125 of 243), mean age of smoking initiation was 14.6 years and mean consumption was smoking 28 cigarettes per week. Smokers had significantly higher fasting serum glucose levels, lower HDL, and higher MetS risk scores compared to non-smokers. Smoking was significantly associated with greater odds of fasting hyperglycemia (OR 2.41, CI 1.04 - 5.59) and low HDL (OR 1.87, CI 1.05 - 3.31). Conclusion: Cigarette smoking was associated with MetS risk factors, specifically fasting hyperglycemia and low HDL cholesterol levels, in a population-based sample of Chilean young adults. Since our sample had low levels of smoking exposure (< 30 cigarettes per week), these risk factors may herald the onset of MetS associated with light cigarette smoking. Increased emphasis should be placed on preventing the initiation of smoking or promoting cessation during this crucial risk period.

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Introduction: Childhood obesity is a global epidemic with implications of future health problems including dyslipidemia. Recent studies suggest that socioeconomic status (SES) is inversely associated with adolescent weight in developed countries. No such patterns have been found linking SES with Familial Hypercholesterolemia (FH), which is an inherited disorder of high low-density lipoproteins (LDL) cholesterol, associated with increased risk for cardiovascular disease. The goal of this study was to explore parental SES associations with childhood obesity and FH in a rural Appalachian population. Methods: Data included 52,002 5th grade children from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project. Body Mass Index (BMI) was defined as the percentage difference from median BMI (BMI%diff) corrected for age and gender. LDL was obtained via fasting lipid profiles. FH was defined as LDL ≥190mg/dl. SES was determined by self-reported head of household education level (including 8th grade education, some high school, high school graduate or GED, some college, college graduate, and completed graduate school). Analysis included ANOVAs with pairwise comparisons using Tukey’s HSD and nonparametric procedures. Results: There was a clear inverse relationship between SES and obesity as shown in Figure 1; all pairwise comparisons were significant (p<0.0001). The prevalence of FH was 0.2%; there were no significant association with the SES groups. Conclusion: There was a significant relationship between higher weight status (after controlling for age and gender) and lower SES, but no moderating relationship of SES on FH. The prevalence of obesity is generally higher in Appalachian children than the rest of the country; identifying modifiable risk factors play an important role in treatment. Targeting initiatives to combat childhood obesity within the context of SES may be the optimal approach leading to better future outcomes - especially in children with additional co- morbidities like FH.

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Introduction: Although the majority of sodium intake is estimated to come from commercially processed/restaurant foods, about 11% is estimated to come from discretionary salt added at the table or during home cooking/preparation. Marked changes in U.S. food habits/choices, such as eating out, as well as the demographic composition of the population could change the frequency of discretionary salt use and invalidate past estimates. Objectives: To evaluate U.S. temporal trends in, and demographic/health determinants of, self-reported frequency of discretionary salt use (excluding 4% of population who use salt substitutes or lite salt). Methods: We analyzed salt intake questions for 31,842 persons aged ≥2y from the 2003-10 National Health and Nutrition Examination Survey (NHANES). We used multiple logistic regression models to assess temporal trends in reported frequency of discretionary salt use from 2003-10, adjusting for age, sex and race/ethnicity. We used chi-square tests to assess current (2007-10) differences in discretionary salt use by demographic/health characteristics. Analyses were adjusted for complex sampling design. Results: Using salt “very often” at the table declined from 2003-04 to 2009-10 (18% to 14%, p<0.01 for trend). The percent decline was greatest among male adults aged ≥19y (21% to 16%, p<0.01). Using salt “very often” during home cooking/preparation decreased (41% to 37%, p=0.03), while using salt “occasionally” increased (34% to 37%, p=0.04). Temporal trends in “never” and “rarely” using salt at the table or during home cooking/preparation were not statistically significant. In the 2 recent cycles of NHANES (2007-10), 33% of persons aged ≥2y reported “never” added salt at the table, 31% “rarely,” 22% “occasionally” and 15% “very often.” Corresponding percentages for frequency of salt added during home cooking/preparation were 7%, 19%, 36% and 37%. Overall, being non-Hispanic black, lower income and self-reported hypertension or diabetes were associated with being more likely to report never adding salt at the table or during cooking/preparation (all p<0.01). Among adults, as age increased, the percentage reporting “never” using salt increased both at the table (23% for ages 19-30y to 43% for ≥71y) and during home cooking/preparation (5% to 14%). The opposite was observed for children/adolescents, as age increased from 2-18y, the percentage reporting “never” using salt decreased at the table (79% for ages 2-3y to 18% for 14-18y) and during home cooking/preparation (6% to 2.5%). Conclusions: Frequency of high levels of discretionary salt use decreased from 2003-10. In general, persons with higher risk of elevated blood pressure were more likely to report using discretionary salt less frequently. The association of discretionary salt use with food habits/choices and the amount of sodium intake from discretionary salt merits further investigation.

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Who can be represented in art? How can we make it? How can we experience it? [...] It has provided an open space of possibility for many to test their sense of self and how they might communicate this to a wider world. (Gormley)On Friday 17 July 2009, from 12.00 am to 1.00 am, I was on the Fourth Plinth in Trafalgar Square, London, as part of British sculptor Antony Gormley’s One & Other project. Over a period of 100 days, 2,400 people were randomly selected (from 34,000 applicants) to occupy this site for sixty minutes each. Gormley’s sculptures have mostly focused on explorations of the human form in relation to memory, environment and community and the questions they raise about existence, mortality and metaphysics resonate with my own personal concerns and performance work (see: Gormley). One & Other (2009), a participatory incarnation of his work, was, he claimed “about the democratisation of art.” It was also video-streamed live over the Internet and it became, particularly due to Sky Arts’s involvement as a project partner, a media event (Antony Gormley’s ‘One & Other’). Ever since I can remember, I have had a fear of heights. Without a sturdy barrier I either retreat rapidly to a safe distance, freeze or drop to the ground. The relationship between my private sense of self, myself as performer, an iconic public space, an unpredictable (and partly unseen) audience, the critical gaze of the media, and, not least, the artist’s intention, quickly became a complex web to negotiate. How much was I prepared to risk, reveal, or mask in desiring to serve another’s artistic purpose? This article explores the invitation to disclose/expose set against this set of circ*mstances, focusing on the tensions between the desire to perform, my deep personal fear of heights (acrophobia), the media’s greedy commodification of disclosure and the complicity of the participant. Also considered is the unstable notion of communicating authentic disclosure(s) within a performative framework, and, finally, the transformational possibilities of such disclosure. While recognising that claims to truth and authenticity—and to some degree transformation—within solo (autobiographical) performance are problematic (Heddon 26), I do not see my phobia as culturally-produced here; I use these terms to signify the actuality of a significant shift in levels of personal fear experienced whilst on the plinth. As a performer with a background in devising, acting, biographical theatre and site-specific performance, the framework for discussion centres on writing from these fields, and also draws on performance art, particularly Eelka Lampe’s examination of the work of Rachel Rosenthal (291), an interdisciplinary performance artist whose work has drawn significantly on autobiographical elements and on both Western and Asian performance trainings and vocabularies. Media sources directly relevant to Gormley’s project are also considered. Congratulations!Participation in One & Other was a matter of luck, offering a unique opportunity to become part of Gormley’s oeuvre. I placed myself in the draw and was thrilled when, on 6 June 2009, the congratulatory e-mail arrived. However, the reality of what I was to participate in soon began to dawn upon me. An hour, at midnight, on a plinth 4.4m x 1.7m at a height of 8m. Although there would be a safety net, there would be no barrier. Every move or sound that I made would also be watched by Webcams and transmitted live to unknowable individuals. The peculiarity of this event was bewildering, but I put my misgivings aside and focused on the question everybody asked me, “So what are you going to do?” (see fig. 1). Figure 1. Image: Adam J. Ledger. Performer: Jill Dowse. One & Other. 2009.Resorting to habit, I immediately regarded the opportunity as an artistic endeavour and started to create a performance piece, layering site- and time-specific discoveries with personal associations, memories and jokes about acrophobia. The use of autobiographical material as an aid to both understanding and devising biographical theatre is not foreign to me, but using it as a primary source was new, and I was wary of the potential for appearing self-indulgent, for the performance to be, to use Howell’s terminology, “ego show” rather than revelation (158). My first two ideas, which were subsequently abandoned, appear to me now as attempts to deflect the content of my performance away from myself, thereby resisting disclosure. Others planned a plinth-as-soapbox approach, drawing attention to various charitable and socio-political causes (“Participants, Oliver”; “Participants, Bushewacker”; “Participants, RachelW”). These seemed worthy and worthwhile, and forced me to re-consider my approach and examine my own ideals and concerns, but I was reluctant to advocate for a single cause. This reluctance was compounded by several further factors—the live coverage threatened a post hoc call to account for anything I might say or do, leaving me open to misinterpretation and criticism from the public or media. The experience of TV’s Big Brother participants, to which Gormley’s project has often been compared and criticised as a cheapening of cultural values (Brooker), is called to mind. Despite its limitations, however, one of the attractions of the soapbox performance is that it does at least refract attention away from the individual and onto the cause. The consideration of my acrophobia was renewed, leading me to consider withdrawing from the project. Gormley’s desire to “make a portrait of the UK now” is a complex proposition (qtd. in Antony Gormley’s ‘One & Other’). How might it be possible to be myself on an illuminated plinth, for a full hour, in public? Gormley, while acknowledging the performative nature of the project as “a combination of the stocks and the stage” also asserts that “whether acted or real…the inner condition of the individual will be revealed” (Gormley). While his point is debatable in a general sense, for me it was not the possible disclosure of this inner condition (via words) that was traumatic but the prospective public personal humiliation of both my private self (via irrational conduct in a public arena) as well as professional humiliation (an inability to perform) as a result of unforeseeable and potentially debilitating behavioural responses. This conflict—I “bottle out” if I withdraw, I face difficult challenges if I continue—led directly to the first consideration of tactics for survival. My notebook records, “I’d like to do something that allows me space to respond, to contemplate being up there. And something which allows me to be hidden” (Workbook 118). The paradoxical desire to be “hidden” on a raised plinth exposes the key tension within which tactics were discovered and structured. As I re-worked my first idea, I realized that I was straying once again from the theatre world I usually inhabit, which involves creating performances in which a role(s) or character is adopted, to the field of performance art, where autobiographical material and personal disclosure are often expressed and negotiated as central concerns. If acting is, as Joseph Chaikin proposes, “a demonstration of self with or without a disguise”, then my usual “disguise” of role/character would be (at least partially) shed, leaving my “demonstration of self” more exposed (2) (see fig. 2). Figure 2. Image: Adam J. Ledger. Performer: Jill Dowse. One & Other. 2009.Controlling the PerformanceNotions of “self” within acting and performance have been explored by many performance theorists (Schechner, Phelan and Lane, Auslander, Zarrilli, Carlson), but, here I draw on Lampe’s discussion of the work of Rachel Rosenthal, since her performances move beyond mimesis. Rosenthal often performs several “fragments” of herself (which she also identifies as differentiable personae) within a single performance (Lampe 296). These personae are at different distances from her “daily” self. Lampe’s “Model of Performing/Non-Performing” is an illustration of a matrix of performance modes which moves from the “not performing” Self which is self-contained, “feeling unobserved”, through to the “Self in Ritual”, which is also self-contained and may be observed/unobserved (Lampe 291). Lampe identifies the “not performing” self as having “least control over performative display” and the Self in Ritual as having the “most control over performative display” (300). The question of control, both of my fear and of the revelation and communication of that fear, and within an environment over which I had very limited control, was paramount. This model offers a way of understanding how and why I shifted through various modes of disclosure, creating, for example an “Aesthetic Persona,” (“performing a part of oneself”), as in the playing out of a “fantasy” of myself as a winged creature, and moving towards “Techniques of Virtuosity,” (which includes “transforming the self”) seen, for example, in my use of adornment, mask and ritualistic elements. In exploring the elements of martyrdom in the artist Orlan’s work (an artist who has described her work as “carnal art” and who sought to reinvent herself and ideas of beauty via often unusual plastic surgery), Tanya Augsburg (298) suggests thatto be a martyr […] involves self-sacrifice and loss of social status; one undergoes humiliation, pain, even death for the sake of a higher purpose. Martyrdom as a self-conscious loss of self is nevertheless the result of free choice – even if that choice stems from a sense of obligation or duty.Whilst I recognise all these ingredients in my process, I now identify my struggle as the struggle against martyrdom, the assembling of the tactics necessary to resist and minimize the possibility and impact of any quasi-martyrdom.PerspectivesEkow Eshun, Artistic Director of London’s Institute for Contemporary Art and Chair of the Fourth Plinth Commissioning Group, also acknowledged the project’s “performativity” and the media fuelled the pressure to “do” or perform (qtd. in Antony Gormley’s ‘One & Other’). Yet when the project began on 6 July and I viewed the live streaming, it became clear that this was not an easily manageable context for any kind of presentation. I realised that I could not organise my performance in any way that I am used to and that in regarding the site as some kind of stage I had earlier made several false assumptions. The spatial dynamic gives the on-site onlooker, as Patricia Bickers points out, “a depressingly foreshortened view from above or below which diminishes, in every sense, both audience and participant”, whereas the live feed offers a “privileged view” (12). In this spectatorial confusion, how would I know where to direct myself? Secondly, it would be impossible to speak to onlookers in Trafalgar Square with a conversational or natural tone—amplification would be necessary. Thirdly, I also noticed that most onlookers stayed for a short time and then left, probably at least partly as a result of these factors. Was it likely that on-line viewers would watch for a whole hour? What, therefore, was the point of creating a dramaturgically sound piece for an audience whose presence would be so unpredictable?Gormley’s partner in the project was Sky Arts, with the event produced by Artichoke. The weekly Sky Arts programme dedicated to presenting the week’s “highlights from the plinth” was unashamedly concerned with the level of “entertainment” offered, hosted by a condescending presenter (Antony Gormley’s ‘One & Other’). Celebrities and media pundits got their spot on the sofa to make their sound bites and choose their “Top 5 plinthers”. It was cheap TV, with participants routinely objectified, commodified and codified, labelled alternately crazy, funny, boring, and so on. This programme, as well as much of the media surrounding the project, failed to understand and respond in any meaningful way to what each individual brought to it.Given the unconducive performance arena, I made a radical shift of emphasis from word to image, from sound to silence, from script to improvisation. Many of the personal memories and associations I had explored in my first idea were subsumed into representative (but also personally associated) objects, symbols, adornments and actual signs. Although my clothing would be my own and I would look like “myself,” I would wear a pair of wings and a sign stating, “SCARED OF HEIGHTS.” I assembled a suitcase of objects for use in possible improvisations that would be unrehearsed and responsive to the given moment. Plan B, in case of disabling fear, was to ask to come down from the plinth. The sign drew attention to my fear, thereby diminishing, to some extent, its power to humiliate. It displayed my vulnerability and invited spectators to contextualise my behaviour and perhaps even to empathise. Wings have many symbolic cultural meanings, many of which overlap with my own interest in and fantasies of flight and “winged-ness.” Although these two elements were personally relevant, I also hoped that even a fleeting glance at this figure might engage the viewer momentarily with the irony in the juxtaposition of wings, which suggests the possibility or desire to fly, with the written message indicating a fear of heights, which would thereby limit the possibility or pleasure of flight. There are various modes of disclosure. Words, gesture and expression are three. Since a camera’s tendency is to focus on the face, and in particular the eyes, as the site of reading emotion, my instinct was to have in my arsenal some means of disguising, masking or otherwise concealing my eyes, thus partially withholding the full expression of emotion. My desire to hide, which might be interpreted as a desire for privacy, could at least be partially brought about. I took a joke “disguise” mask (spectacles, nose and moustache) and glow-in-the-dark Halloween skeleton spectacles (associated with my fear of death), both of which belong to my son. I set up the potential for other small, wry acts of resistance, including in my suitcase a pair of binoculars and a Polaroid camera, for turning the tables on those who looked upon and made images of me. Rather than using these personal objects to evoke or represent emotional memory, as performance artists such as Cristina Castrillo do (Aston 177), my personal objects acted primarily as both public sign or symbol, and as a comfort blanket of familiarity for my period of extremis—literally, props.The HourIn the “Welcome Lounge” I signed a Mephistopholean contract with Sky Arts, effectively handing over copyright of this hour of my life, agreed to an interview with an interviewer who had trouble listening, and allowed them to take photos of me, “for Antony”. The hour itself, however, proved quietly revelatory (see: http://www.oneandother.co.uk/participants/Jill.).The first few minutes were exhausting as I acclimatised to my bizarre surroundings. But this intensity subsided somewhat as I realised my fear was manageable and that it would be neither traumatic nor debilitating. Oddly, I could not even see the Webcams out in the darkness. To return to Lampe’s analysis, I identify, throughout the hour, a shifting between different registers of performance, or personae, recognising myself as performer, my private self, my masked self (transformable) and an impossible fantasy of myself (adorned). Elements of ritual—repetition, mask, heightened awareness and responses—permeated the hour. These different registers seem to indicate different levels and means of disclosure dependent on the degree of control exercised through them. The self-contained episode of dancing while wearing the child’s disguise spectacles, while possibly amusing, might, for example, suggest an attitude towards my disclosure, an ironic stance towards the situation. Furthermore, and paradoxically, the feigning, or performing of control, in that dance, led to an actual increase of confidence. Whilst dancing, I felt a distancing between my outer, communicating self, which danced happily, enjoying the repetitive action as well as a sense of the odd figure I cut, and my private self, relieved to be behind a mask able to take this time to process and recover from what had been happening up until this point (see fig. 3). Figure 3. Image: Adam J. Ledger. Performer: Jill Dowse. One & Other. 2009.A few minutes before leaving the plinth, I took out the marker pen and added the words “A BIT LESS…” to the beginning of the sign. I realised that a real transformation had taken place, and marked it for myself, while simultaneously disclosing it to the observer. Yet after the event, I was astonished to discover that the veracity of my public self-disclosure was called into question. Some people, including the security guard who was only a few feet from me, asked me if I was really scared of heights. Clearly, my “inner condition” was not revealed, or rather, perhaps, it was not trusted because “performance is not the real world” (Heddon 28). If it is true that to act means “to feign, to simulate, to represent, to impersonate,” then mine was not a predominantly “acted” performance (Kirby 40). Claire MacDonald claims that “when a performance artist stands up in front of an audience she is assumed to be performing as herself” (189), but does that also suggest that their statements are to be believed or that their gestures might not be feigned? Perhaps this simply reveals a contemporary distrust of anyone placed on a pedestal and putting on a “show,” be it plinther or politician. The relationship between the power and control I have over myself to the power and control exercised by other agencies remains ambivalent. At many points during the process, I was complicit in perpetuating the commodification of myself and the project: my small acts of resistance—deciding against uploading a photo to my “profile”, refusing the “Sky Arts” emblazoned umbrella offered on the day in favour of my own anonymous one (though this was partly an aesthetic choice), refusing the radio mike so that those on the Internet could not easily hear any voluntary or involuntary sound I may make—are hardly radical. It was dangerously easy, within this heightened period, for me to succumb to a carefully orchestrated media machine which performed interest in the individual while mitigating against the possibility of gaining deeper insights or connections. I have been surprised to discover how deeply I care what others think of me. I still recognise the desire that I remember from adolescence to be, through performance, more visible, applauded, approved of. Although it is vital to learn not to attach undue importance to judgements with questionable value, the media has a certain (albeit highly contested) authority, and it can therefore be difficult to ignore opinions, and particularly negative ones, when they are broadcasted or published for anyone to hear or read. I feel fortunate that my vulnerability (and disclosure of such) was manageable, as if one willingly steps into a public arena, one must expect to be judged and be prepared not to be given a public right of reply.Nonetheless, if one strips back the negative aspects of the media circus which surrounded it, One & Other was a meaningful event in which to have taken part. The public exposure against which I had armed myself proved unexpectedly peaceful and empowering and I experienced Gormley’s assertion that One & Other offered participants the opportunity to “test their sense of self and how they might communicate this to a wider world” (qtd. in Antony Gormley’s “One & Other”). Artistically, I discovered that my attraction to certain performance styles and methodologies is implicitly and deeply linked to aspects of my own personality and how I desire to communicate. Finally, it has forced me to re-think and re-imagine my relationship with fear and challenge, recognising, even in the core of fear, the potential for transformation. ReferencesAntony Gormley’s “One & Other”. Pres. Clive Anderson. Dir. Peter Dick. Prod. Liberty Bell Productions. British Sky Broadcasting Ltd, London. 24 July, 1 Aug., 8 Aug., 23 Aug., 28 Aug., 4 Sep., 11 Sep., 18 Sep., 26 Sep., 10 Oct., and 16 Oct. 2009. Aston, Elaine. Feminist Theatre Practice: A Handbook. London: Routledge, 1999.Augsburg, Tanya. “Orlan’s Performative Transformations.” The Ends of Performance. Eds. Peggy Phelan and Jill Lane. New York: New York University Press, 1998. 5–314. Auslander, Philip. Performance. 2. London: Routledge, 2003. Bickers, Patricia. Editorial. Art Monthly 9 Sep. 2009. 12.Brooker, Charlie. “Charlie Brooker’s screen burn”. Guardian Newspaper 11 July 2009. 13 Sep. 2009. < http://www.guardian.co.uk/culture/2009/jul/11/screenburn-antony-gormley >.Carlson, Marvin. Performance. 2nd ed. London: Routledge, 2004.Chaikin, Joseph. The Presence of the Actor. New York: Atheneum, 1980. Dowse, Jill. Workbook. MS.Gormley, Antony. “Conclusion of ‘One & Other’ October 2009”. antonygormley.com 2009. 29 Nov. 2009 < http://antonygormley.com >.Gormley, Antony. “Sculptures”. antonygormley.com. 2009. 7 Dec. 2009 < http://antonygormley.com/#/sculptures/chronology >.Heddon, Deirdre. Autobiography and Performance. Basingstoke: Palgrave, 2008.Howell, John. "Solo in Soho." Performance Art Journal IV. 1 and 2 (1979/80): 152–159.Kirby, Michael. “On Acting and Not-Acting.” Acting (Re)Considered. 2nd ed. Ed. Phillip B. Zarrilli. London: Routledge, 2002. 40–52. Lampe, Eelka. “Rachel Rosenthal Creating Her Selves.” Acting (Re)Considered. 2nd ed. Ed. Phillip B. Zarrilli. London: Routledge, 2002. 291–304.MacDonald, Claire. “Assumed Identities: Feminism, Autobiography and Performance Art.” The Uses of Autobiography. Ed. Julia Swindells. London: Taylor and Frances, 1995. 187–95One & Other. Artichoke, Headshift and Sky Arts. 2009. 6 May 2009 < http://www.oneandother.co.uk/ >.“Participants, Oliver”. One & Other. Artichoke, Headshift and Sky Arts. 2009. 6 May 2009 < http://www.oneandother.co.uk/participants/Oliver >.“Participants, Bushewacker ”. One & Other. Artichoke, Headshift and Sky Arts. 2009. 6 May 2009 < http://www.oneandother.co.uk/participants/Bushewacker >.“Participants, Jill”. One & Other. Artichoke, Headshift and Sky Arts. 2009. 6 May 2009 < http://www.oneandother.co.uk/participants/Jill >.“Participants, RachelW”. One & Other. Artichoke, Headshift and Sky Arts. 2009. 6 May 2009 < http://www.oneandother.co.uk/participants/RachelW >.Phelan, Peggy, and Jill Lane, eds. The Ends of Performance. New York: New York University Press, 1998.Schechner, Richard. Performance Theory. 2nd ed. London: Routledge, 1988.Zarrilli, Phillip B., ed. Acting (Re)Considered. 2nd ed. London: Routledge, 2002.

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Objective: To determine whether twice daily intake of a low-calorie (110 kcal), high-fiber, fruit and dark chocolate based nutrient-dense bar with supplemental vitamins/minerals, β-glucan, and docosahexaenoic acid might serve as an effective adjunct to lifestyle counseling for weight management in an inner city population. Methods: 18 overweight, predominantly female adolescent/parent guardian dyads and 2 triads (21 adults, 22 teens, randomized as 12 intervention (INT, with bars), 8 control (C) family units were recruited from a pediatric obesity clinic. The cohort was 48.7% Nonhispanic Black, 34.1% Hispanic, and 17.0% Caucasian. Two adults dropped out. The remaining 41 subjects participated in six identical weekly exercise and nutrition sessions by group. Full assessment of physical (BMI, blood pressure), behavioral (diet, activity), metabolic (cardiovascular and diabetes risk biomarkers), and metabolomic status was conducted at baseline and end-of-study. Results: There was excellent attendance in both INT and C groups with all family units participating in more than 80% of group sessions and 100% of baseline and follow-up assessment visits. Compliance with nutrition bar intake was 86 ± 11% and 87 ± 14% among INT group adults and teens respectively. There was considerable obesity, hypertension, dyslipidemia, inflammation, and insulin resistance in all subjects and baseline diets were universally poor. Self-report activity increased and dietary habits improved in both INT and C groups, adults and teens, most notably decreased saturated fat and total carbohydrates (especially added sugars). Weight was stable, even in the INT group despite the addition of 220 additional kcal in two daily nutrition bars. In paired analyses, systolic blood pressure (SBP) improved significantly in INT teens (-6.7 ± 9.2 mm Hg, p = 0.02), and worsened in C teens (+6.3 ± 7.7 mm Hg, p = 0.04); p = 0.002 for unpaired comparison by teen group. Plasma hom*ocysteine levels and two amino acids, citrulline and sarcosine, implicated in the arginine-urea cycle pathway fell in both INT parents and teens, but not in controls. The drop in citrulline was more significant in INT teens ( p = 0.005) than in adults ( p = 0.047). In a diet-induced obesity mouse model, elevated plasma citrulline has been associated with cardiometabolic complications attributed to decreased systemic arginine bioavailability that may affect capacity to produce nitric oxide. The observed metabolomic changes are consistent with more efficient mitochondrial processing and may relate to the systolic BP improvement observed in teens. Conclusions: A nutritional supplement bar may be a valuable adjunct for weight management, resulting in early favorable metabolomic changes.

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Little is known about the biomarker-based prevalence of diabetes among U.S. adults aged 24-32 years, an age group historically characterized by low cardiovascular disease risk. We addressed the paucity of information within this age group among 15,701 participants at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health, 2008), a study including nationally representative oversamples of racial / ethnic groups underrepresented by the National Health and Nutrition Examination Survey (NHANES). Capillary whole blood was collected via finger prick onto Whatman 903® Protein Saver cards by trained and certified field interviewers, desiccated, then shipped to central laboratories for assay and archival. Sensitivity of the glucose assay was 22 mg/dl. Assayed values in the lowest half percentile of the distribution were re-assayed. Re-assayed and original values were averaged. The within- and between-assay coefficients of variation (CVs) were 4.4% and 4.8%. For HbA 1c , the corresponding sensitivity, within- and between-assay CVs were 3%, 2.2%, and 2.4%. In paired serum and blood spots, glucose concentrations (mg/dl) were strongly associated (n = 83; Pearson r = 0.97). Associations were equally strong for HbA 1c (%) in paired whole blood and blood spots (n = 80; Pearson r = 0.99). In a race/ethnicity- and sex-stratified random sample of 100 Add Health participants among whom capillary whole blood was collected twice, one to two weeks apart, reliability of random (fasting ≥ 8 hr or non-fasting) glucose and HbA 1c was estimated as an intra-class correlation coefficient and 95% confidence interval, ICC (95% CI): 0.39 (0.21, 0.58) and 0.97 (0.96-0.98). Add Health participants were more likely than similarly aged NHANES (2007-2008) participants to be native-born, insured, college educated, and overweight or obese. After weighting for unequal sampling probabilities and clustering, mean (standard deviation) HbA 1c and fasting glucose were higher in Add Health than NHANES: 5.6% (0.8%) and 107 (35) mg/dl vs. 5.2% (0.5%) and 97 (14) mg/dl. The weighted prevalence (95% CI) of HbA 1c ≥ 6.5% and fasting glucose ≥ 126 mg/dl also were higher in Add Health than NHANES: 3.6% (2.9-4.3) and 10.3% (8.7%-12.2%) vs. 1.7% (0.9%-3.2%) and 2.1% (0.8%-5.5%). Corresponding odds ratios (95% CIs) were: 2.1 (1.1-3.9) and 5.2 (2.1-13.3). Adjustment for sociodemographic, clinical and behavioral risk factors attenuated the associations: 1.5 (0.8-3.1) and 4.2 (1.7-10.4). However, the addition of self-reported history of diabetes and use of anti-diabetics had relatively little effect on them. Carefully standardized, in-home collection of whole blood spots can yield valid and reliable estimates of glucose and HbA 1c . Their interpretation in context of the prevalent obesity and hypertension at Add Health Wave IV reinforces suggestions that young, U.S. adults face a historically high risk of cardiovascular disease.

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IntroductionClowns can be seen as enacting catastrophe with a small “c.” They are experts in “failing better” who perhaps live on the cusp of turning catastrophe into a metaphorical whirlwind while ameliorating the devastation that lies therein. They also have the propensity to succumb to the devastation, masking their own sense of the void with the gestures of play. In this paper, knowledge about clowns emerges from my experience, working with circus clowns in Circus Knie (Switzerland) and Circo Tihany (South America), observing performances and films about clowns, and reading, primarily in European fiction, of clowns in multiple guises. The exposure to a diverse range of texts, visual media and performance, has led me to the possibility that clowning is not only a conceptual discipline but also a state of being that is yet to be fully recognised.Diminutive CatastropheI have an idea (probably a long held obsession) of the clown as a diminutive figure of catastrophe, of catastrophe with a very small “c.” In the context of this incisive academic dialogue on relationships between catastrophe and creativity where writers are challenged with the horrendous tragedies that nature and humans unleash on the planet, this inept character appears to be utterly insignificant and, moreover, unworthy of any claim to creativity. A clown does not solve problems in the grand scheme of society: if anything he/she simply highlights problems, arguably in a fatalistic manner where innovation may be an alien concept. Invariably, as Eric Weitz observes, when clowns depart from their moment on the stage, laughter evaporates and the world settles back into the relentless shades of oppression and injustice. In response to the natural forces of destruction—earthquakes, tsunamis, cyclones, and volcanic eruptions—as much as to the forces of rage in war and ethnic cleansing that humans inflict on one another, a clown makes but a tiny gesture. Curiously, though, those fingers brushing dust off a threadbare jacket may speak volumes.Paradox is the crux of this exploration. Clowns, the best of them, project the fragility of human value on a screen beyond measure and across many layers and scales of metaphorical understanding (Big Apple Circus; Stradda). Why do odd tramps and ordinary inept people seem to pivot against the immense flows of loss and outrage which tend to pervade our understanding of the global condition today? Can Samuel Beckett’s call to arms of "failing better” in the vein of Charles Chaplin, Oleg Popov, or James Thiérrée offer a creative avenue to pursue (Bala; Coover; Salisbury)? Do they reflect other ways of knowing in the face of big “C” Catastrophes? Creation and CatastropheTo wrestle with these questions, I wish to begin by proposing a big picture view of earth-life wherein, across inconceivable aeons, huge physical catastrophes have wrought unimaginable damage on the ecological “completeness” of the time. I am not a palaeontologist or an evolutionary scientist but I suspect that, if human life is taken out of the equation, the planet since time immemorial has been battered by “disaster” which changed but ultimately did not destroy the earth. Evolution is replete with narratives of species wiped out by ice-ages, volcanoes, earthquakes, and meteors and yet the organism of this planet has survived and even regenerated. In metaphorical territory, the Sanskrit philosophers have a wise take on this process. Indian concepts are always multiple, crowded with possibilities, but I find there is something intriguing in the premise (even if it is impossible to tie down) of Shiva’s dance:Shiva Nataraja destroys creation by his Tandava Dance, or the Dance of Eternity. As he dances, everything disintegrates, apparently into nothingness. Then, out of the thin vapours, matter and life are recreated again. Shiva also dances in the hearts of his devotees as the Great Soul. As he dances, one’s egotism is consumed and one is rendered pure in soul and without any spiritual blemish. (Ghosh 109–10)For a dancer, the central location of dance in life’s creation forces is a powerful idea but I am also interested in how this metaphysical perspective aligns with current scientific views. How could these ancient thinkers predict evolutionary processes? Somehow, in the mix of experiential observation and speculation, they foresaw the complexity of time and, moreover, appreciated the necessary interdependence of creation and destruction (creativity and catastrophe). In comparison to western thought which privileges progression—and here evolution is a prime example—Hindu conceptualisation appears to prefer fatalism or a cyclical system of understanding that negates the potential of change to make things better. However, delving more closely into scientific narratives on evolution, the progression of life forms to the human species has involved the decimation of an uncountable number of other living possibilities. Contrariwise, Shiva’s Dance of Eternity is premised on endless diachronic change crossed vertically by reincarnation, through which progression and regression are equally expressed. I offer this simplistic view of both accounts of creation merely to point out that the interdependency of destruction and creation is deeply embodied in human knowledge.To introduce the clown figure into this idea, I have to turn to the minutiae of destruction and creation; to examples in the everyday nature of regeneration through catastrophe. I have memories of touring in the Northern Territory of Australia amidst strident green shoots bursting out of a fire-tortured landscape or, earlier in Paris, of the snow-crusted earth being torn asunder by spring’s awakening. We all have countless memories of such small-scale transformations of pain and destruction into startling glimpses of beauty. It is at this scale of creative wrestling that I see the clown playing his/her role.In the tension between fatalism and, from a human point of view, projections of the right to progression, a clown occupying the stage vacated by Shiva might stamp out a slight rhythm of his/her own with little or no meaning in the action. The brush on the sleeve might be hard to detect in an evolutionary or Hindu time scale but zoom down to the here and now of performance exchange and the scene may be quite different?Turning the Lens onto the Small-ScaleSmall-scale, clowns tend to be tiny bundles or, sometimes, gangly unbundles of ineptitude, careering through the simplest tasks with preposterous incompetence or, alternatively, imbibing complexity with the virtuosic delicacy—take Charles Chaplin’s shoe-lace spaghetti twirling and nibbling on nail-bones as an example. Clowns disrupt normalcy in small eddies of activity which often wreak paths of destruction within the tightly ordered rage of social formations. The momentum is chaotic and, not dissimilar to storms, clownish enactment bears down not so much to threaten human life but to disrupt what we humans desire and formulate as the natural order of decorum and success. Instead of the terror driven to consciousness by cyclones and hurricanes, the clown’s chaos is superficially benign. When Chaplin’s generous but unrealistic gesture to save the tightrope-act is thwarted by an escaped monkey, or when Thiérrée conducts a spirited debate with the wall of his abode in the midst of an identity crisis (Raoul), life is not threatened. Such incongruous and chaotic trajectories generate laughter and, sometimes, sadness. Moreover, as Weitz observes, “the clown-like imagination, unfettered by earthly logic, urges us to entertain unlikely avenues of thought and action” (87). While it may seem insensitive, I suggest that similar responses of laughter, sadness and unlikely avenues of thought and action emerge in the aftermath of cataclysmic events.Fear, unquestionably, saturates big states of catastrophe. Slide down the scale and intriguing parallels between fear and laughter emerge, one being a clown’s encapsulation of vulnerability and his/her stoic determination to continue, to persevere no matter what. There are many ways to express this continuity: Beckett’s characters are forever waiting, fearful that nothing will arrive, yet occupy themselves with variations of cruelty and amusem*nt through the interminable passage of time. A reverse action occurs in Grock’s insistence that he can play his tiny violin, in spite of his ever-collapsing chair. It never occurs to him to find another chair or play standing up: that, in an incongruous way, would admit defeat because this chair and his playing constitute Grock’s compulsion to succeed. Fear of failure generates multiple innovations in his relationship with the chair and in his playing skills. Storm-like, the pursuit of a singular idea in both instances triggers chaotic consequences. Physical destruction may be slight in such ephemeral storms but the act, the being in the world, does leave its mark on those who witness its passage.I would like to offer a mark left in me by a slight gesture on the part of a clown. I choose this one among many because the singular idea played out in Circus Knie (Switzerland) back in the early 1970s does not conform to the usual parameters. This Knie season featured Dimitri, an Italian-Swiss clown, as the principal attraction. Following clown conventions, Dimitri appeared across the production as active glue between the various circus acts, his persona operating as an odd-jobs man to fix and clean. For instance, he intervened in the elephant act as a cleaner, scrubbing and polishing the elephant’s skin with little effect and tuned, with much difficulty, a tiny fiddle for the grand orchestration to come. But Dimitri was also given moments of his own and this is the one that has lodged in my memory.Dimitri enters the brightly lit and empty circus ring with a broom in hand. The audience at this point have accepted the signal that Dimitri’s interludes prepare the ring for the next attraction—to sweep, as it were, the sawdust back to neutrality. He surveys the circle for a moment and then takes a position on the periphery to begin what appears to be a regular clean-up. The initial brushes over the sawdust, however, produce an unexpected result—the light rather than the sawdust responds to his broom stokes. Bafflement swiftly passes as an idea takes hold: the diminutive figure trots off to the other side of the ring and, after a deep breath and a quick glance to see if anyone is looking (we all are), nudges the next edge of light. Triumphantly, the pattern is pursued with increasing nimbleness, until the figure with the broom stands before a pin-spot of light at the ring’s centre. He hesitates, checks again about unwanted surveillance, and then, in a single strike (poof), sweeps light and the world into darkness.This particular clown gesture contradicts usual commentaries of ineptitude and failure associated with clown figures but the incongruity of sweeping light and the narrative of the little man who scores a win lie thoroughly in the characteristic grounds of clownish behaviour. Moreover, the enactment of this simple idea illustrates for me today, as much as it did on its initial viewing, how powerful a slight clown gesture can be. This catastrophe with a very small “c:” the little man with nothing but a broom and an idea destroyed, like the great god Shiva, the world of light.Jesse McKnight’s discussion of the peculiar attraction of two little men of the 20th century, James Joyce’s Bloom and Charles Chaplin, could also apply to Dimitri:They are at sixes and sevens here on earth but in tune with the stars, buffoons of time, and heroes of eternity. In the petty cogs of the causal, they appear foolish; in the grand swirl of the universe, they are wise, outmaneuvering their assailants and winning the race or the girl against all odds or merely retaining their skins and their dignity by nightfall. (496) Clowning as a State of Mind/ConsciousnessAnother perspective on a clown’s relationship to ideas of catastrophe which I would like to examine is embedded in the discussion above but, at the same time, deviates by way of a harsh tangent from the beatitude and almost sacred qualities attributed by McKnight’s and my own visions of the rhythmic gestures of these diminutive figures. Beckett’s advice in Worstward Ho (1983) is a fruitful starting place wherein the directive is “to keep on trying even if the hope of success is dashed again and again by failure: ‘Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better’” (Le Feuvre 13). True to the masterful wordsmith, these apparently simple words are not transparent; rather, they deflect a range of contradictory interpretations. Yes, failure can facilitate open, flexible and alternative thought which guards against fanatical and ultra-orthodox certitude: “Failure […] is free to honour other ways of knowing, other construals of power” (Werry & O’Gorman 107). On the other hand, failure can mask a horrifying realisation of the utter meaninglessness of human existence. It is as if catastrophe is etched lightly in external clown behaviour and scarred pitilessly deep in the psyches that drive the comic behaviour. Pupils of the pre-eminent clown teacher Jacques Lecoq suggest that theatrical clowning pivots on “finding that basic state of vulnerability and allowing the audience to exist in that state with you” (Butler 64). Butler argues that this “state of clowning” is “a state of anti-intellectualism, a kind of pure emotion” (ibid). From my perspective, there is also an emotional stratum in which the state or condition involves an adult anxiety desiring to protect the child’s view of the world with a fierceness equal to that of a mother hen protecting her brood. A clown knows the catastrophe of him/herself but refuses to let that knowledge (of failure) become an end. An obstinate resilience, even a frank acknowledgement of hopelessness, makes a clown not so much pure emotion or childlike but a kind of knowledgeable avenger of states of loss. Here I need to admit that I attribute the clowning state or consciousness to an intricate lineage inclusive of the named clowns, Grock, Chaplin, Popov, Dimitri, and Thiérrée, which extends to a whole host of others who never entered a circus or performance ring: Mikhail Dostoyevsky’s Mushkin (the holy Russian fool), Henry Miller’s Auguste, Salman Rushdie’s Saleem, Jacques Tati, Joan Miro, Marc Chagall, Jean Cocteau, Eric Satie’s sonic whimsy, and Pina Bausch’s choreography. In the following observation, the overlay of catastrophe and play is a crucial indication of this intricate lineage:Heiner Müller compared Pina Bausch's universe to the world of fairy tales. “History invades it like trouble, like summer flies [...] The territory is an unknown planet, an emerging island product of an ignored (forgotten or future) catastrophe [...] The whole is nothing but children's play”. (Biro 68)Bausch clearly recognises and is interested in the catastrophic moments or psychological wiring of life and her works are not exempt from comic (clownish) modulations in the play of violence and despair that often takes centre stage. In fact, Bausch probably plays on ambivalence between despair and play more explicitly than most artists. From one angle, this ambivalence is generational, as her adult performers bear the weight of oppression within the structures (and remembering of) childhood games. An artistic masterstroke in this regard is the tripling reproduction over many years of her work exploring gender negotiations at a social dance gathering: Kontakhof. Initially, the work was performed by Bausch’s regular company of mature, if diverse, dancers (Bausch 1977), then by an elderly ensemble, some of whom had appeared in the original production (Kontakhof), and, finally, by a group of adolescents in 2010. The latter version became the subject of a documentary film, Dancing Dreams (2010), which revealed the fidelity of the re-enactment, subtly transformed by the brashness and uncertainty of the teenage protagonists playing predetermined roles and moves. Viewing the three productions side-by-side reveals socialised relations of power and desire, resonant of Michel Foucault’s seminal observations (1997), and the catastrophe of gender relations subtly caught in generational change. The debility of each age group becomes apparent. None are able to engage in communication and free-play (dream) without negotiating an unyielding sexual terrain and, more often than not, the misinterpretation of one human to another within social conventions. Bausch’s affinity to the juxtaposition of childhood aspiration and adult despair places her in clown territory.Becoming “Inhuman” or SacrificialA variation on this condition of a relentless pursuit of failure is raised by Joshua Delpech-Ramey in an argument for the “inhuman” rights of clowns. His premise matches a “grotesque attachment to the world of things” to a clown’s existence that is “victimized by an excessive drive to exist in spite of all limitation. The clown is, in some sense, condemned to immortality” (133). In Delpech-Ramey’s terms:Chaplin is human not because his are the anxieties and frustrations of a man unable to realize his destiny, but because Chaplin—nearly starving, nearly homeless, a ghost in the machine—cannot not resist “the temptation to exist,” the giddiness of making something out of nothing, pancakes out of sawdust. In some sense the clown can survive every accident because s/he is an undead immortal, demiurge of a world without history. (ibid.)The play on a clown’s “undead” propensity, on his/her capacity to survive at all costs, provides a counterpoint to a tragic lens which has not been able, in human rights terms, to transcend "man’s inhumanity to man.” It might also be argued that this capacity to survive resists nature’s blindness to the plight of humankind (and visa versa). While I admire the skilful argument to place clowns as centrepieces in the formulation of alternative and possibly more potent human rights legislations, I’m not absolutely convinced that the clown condition, as I see it, provides a less mysterious and tragic state from which justice can be administered. Lear and his fool almost become interchangeable at the end of Shakespeare’s tragedy: both grapple with but cannot resolve the problem of justice.There is a little book written by Henry Miller, The Smile at the Foot of the Ladder (1948), which bears upon this aspect of a clown’s condition. In a postscript, Miller, more notorious for his sexually explicit fiction, states his belief in the unique status of clowns:Joy is like a river: it flows ceaselessly. It seems to me this is the message which the clown is trying to convey to us, that we should participate through ceaseless flow and movement, that we should not stop to reflect, compare, analyse, possess, but flow on and through, endlessly, like music. This is the gift of surrender, and the clown makes it symbolically. It is for us to make it real. (47)Miller’s fictional Auguste’s “special privilege [was] to re-enact the errors, the foibles, the stupidities, all the misunderstandings which plague human kind. To be ineptitude itself” (29). With overtones of a Christian resurrection, Auguste surrenders himself and, thereby, flows on through death, his eyes “wide open, gazing with a candour unbelievable at the thin sliver of a moon which had just become visible in the heavens” (40). It may be difficult to reconcile ineptitude with a Christ figure but those clowns who have made some sort of mark on human imagination tend to wander across territories designated as sacred and profane with a certain insouciance and privilege. They are individuals who become question marks: puzzles not meant to be solved. Maybe similar glimpses of the ineffable occur in tiny, miniscule shifts of consciousness, like the mark given to me by Dimitri and Chaplin and...—the unending list of clowns and clown conditions that have gifted their diminutive catastrophes to the problem of creativity, of rebirth after and in the face of destruction.With McKnight, I dedicate the last word to Chaplin, who speaks with final authority on the subject: “Be brave enough to face the veil and lift it, and see and know the void it hides, and stand before that void and know that within yourself is your world” (505).Thus poised, the diminutive clown figure may not carry the ferment of Shiva’s message of destruction and rebirth, he/she may not bear the strength to creatively reconstruct or re-birth normality after catastrophic devastation. But a clown, and all the humanity given to the collisions of laughter and tears, may provide an inept response to the powerlessness which, as humans, we face in catastrophe and death. Does this mean that creativity is inimical with catastrophe or that existing with catastrophe implies creativity? As noted at the beginning, these ruminations concern small “c” catastrophes. They are known otherwise as clowns.ReferencesBala, Michael. “The Clown.” Jung Journal: Culture & Psyche 4.1 (2010): 50–71.Bausch, Pina. Kontakthof. Wuppertal Dance Theatre, 1977.Big Apple Circus. Circopedia. 27 Feb. 2013 ‹http://www.circopedia.org/index.php/Main_Page›.Biro, Yvette. “Heartbreaking Fragments, Magnificent Whole: Pina Bausch’s New Minimyths.” PAJ: A Journal of Performance and Art 20.2 (1998): 68–72.Butler, Lauren. “Everything Seemed New: Clown as Embodied Critical Pedagogy.” Theatre Topics 22.1 (2012): 63–72.Coover, Robert. “Tears of a Clown.” Critique: Studies in Contemporary Fiction 42.1 (2000): 81–83.Dancing Dreams. Dirs. Anne Linsel and Rainer Hoffmann. First Run Features, 2010.Delpech-Ramey, Joshua. “Sublime Comedy: On the Inhuman Rights of Clowns.” SubStance 39.2 (2010): 131–41.Foucault, Michel. “The Ethics of the Concern for Self as Practice of Freedom.” Michel Foucault: Ethics: Subjectivity and Truth. Ed. Paul Rabinow. New York: The New Press, 1997. 281–302. Ghosh, Oroon. The Dance of Shiva and Other Tales from India. New York: New American Library, 1965.Kontakthof with Ladies and Gentlemen over ’65. Dir. Pina Bausch. Paris: L’Arche Editeur, 2007.Le Feuvre, Lisa. “Introduction.” Failure: Documents of Contemporary Art. Ed. Lisa Le Feuvre. London: Whitechapel Gallery, 2010. 12–21.McKnight, Jesse H. “Chaplin and Joyce: A Mutual Understanding of Gesture.” James Joyce Quarterly 45.3–4 (2008): 493–506.Miller, Henry. The Smile at the Foot of the Ladder. New York: New Directions Books, 1974.Raoul. Dir. James Thiérrée. Regal Theatre, Perth, 2012.Salisbury, Laura. “Beside Oneself Beckett, Comic Tremor and Solicitude.” Parallax 11.4 (2005): 81–92.Stradda. Stradda: Le Magazine de la Creation hors les Murs. 27 Feb. 2013 ‹http://www.horslesmurs.fr/-Decouvrez-le-magazine-.html›.Weitz, Eric. “Failure as Success: On Clowns and Laughing Bodies.” Performance Research: A Journal of the Performing Arts 17.1 (2012): 79–87.Werry, Margaret, and Róisín O'Gorman. “The Anatomy of Failure: An Inventory.” Performance Research: A Journal of the Performing Arts 17.1 (2012): 105–10.

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Abstract:

The past two decades have seen the publication of at least half a dozen books that consider the part that fairs, circuses, sideshows and freakshows play in the continuing cultural labour to define, categorise and control the human body, including Robert Bogdan’s Freakshow, Rosemarie Garland-Thomson’s Extraordinary Bodies, and her edited collection Freakery, and Rachel Adams’s Sideshow USA. These writers cast the freakshow as a theatre of culture, worthy of critical attention precisely because of the ways in which it has provided a popular forum for staging, solidifying and transforming ideas about the body and bodily difference, and because of its prominence in the project of modernity (Garland-Thomson “From Wonder to Error” 2-13). They point to the theatrical mechanisms by which the freakshow maps cultural anxieties about corporeal difference across ‘suitable’ bodies. For, as Bogdan (3) says, being a freak is far more than a fact of biology. The freak personae that populate the Western cultural imaginary—the fat lady, the bearded lady, the hermaphrodite and the geek—can only be produced by a performative isolation, manipulation and exaggeration of the peculiar characteristics of particular human bodies. These peculiarities have to be made explicit, in Rebecca Schneider’s (1) terms; the horror-inducing tropes of the savage, the bestial and the monstrous have to be cast across supposedly suitable and compliant flesh. The scopic mechanisms of the freakshow as a theatre, as a cabinet of corporeal curiosities in which spectators are excited, amazed and edified by the spectacle of the extraordinary body, thus support the specific forms of seeing and looking by which freak bodies are produced. It would, however, be a mistake to suggest that the titillating threat of this face-to-face encounter with the Levinasian other fully destabilises the space between signifier and signified, between the specific body and the symbolic framework in which it sits. In a somewhat paradoxical cultural manoeuvre, the ableist, sexist and racist symbolic frameworks of the freakshow unfold according to what Deleuze and Guattari (178) would call a logic of sameness. The roles, relationships and representational mechanisms of the freakshow—including the ‘talkers’ that frame the spectator’s engagement with the extraordinary body of the freak—in fact function to delineate “degrees of deviance” (178) or difference from an illusory bodily norm. So configured, the monstrous corporeality of the freak is also monstrously familiar, and is made more so by the freak spectacle’s frequent emphasis on the ways in which non-normative bodies accommodate basic functions such as grooming and eating. In such incarnations, the scenography and iconography of the freakshow in fact draws spectators into performative (mis)recognitions that manage the difference of other bodies by positioning them along a continuum that confirms the stability of the symbolic order, and the centrality of the able, white, male self in this symbolic order. Singular, specific, extraordinary bodies are subject to what might, in a Levinasian paradigm, be called the violence of categorisation and comprehension (“Is Ontology Fundamental?” 9). The circ*mstances of the encounter reduce the radical, unreadable difference of the other, transporting them “into the horizon of knowledge” (“Transcendence and Height” 12), and transforming them into something that serves the dominant cultural logic. In this sense, Petra Kuppers suggests, “the psychic effects of the freak spectacle have destabilizing effects, assaulting the boundaries of firm knowledge about self, but only to strengthen them again in cathartic effect” (45). By casting traits they abhor across the freak body (Garland-Thomson Extraordinary Bodies 55-56), spectators become complicit in this abhorrence; comforted, cajoled and strangely pleasured by a sense of distance from what they desire not to be. The subversive potential of the prodigious body evaporates (Garland-Thomson “From Wonder to Error” 3; Extraordinary Bodies 78). An evaporation more fully effected, writers on the freakshow explain, as the discursive construct of the freak was drawn into the sphere of medical spectacle in the late nineteenth century. As the symbolic framework for understanding disabled bodies ‘advances’ from the freak, the monster and the mutant to the medical specimen (Garland-Thomson “From Wonder to Error” 13; Extraordinary Bodies 70, 78-80; Synder and Mitchell 370-373; Stephens 492), the cultural trajectory away from extraordinary bodies with the capacity to expand the classes and categories of the human is complete. The medical profession finally fulfils the cultural compulsion to abstract peculiar bodily characteristics into symptoms, and, as Foucault says in The Birth of the Clinic, these symptoms become surveillable, and controllable, within an objective schema of human biology. Physical differences and idiosyncrasies are “enclosed within the singularity of the patient, in that region of ‘subjective symptoms’ that—for the doctor—defines not only the mode of knowledge, but the world of objects to be known” (xi). The freak body becomes no more than an example of human misfortune, to be examined, categorised and cared for by medical experts behind closed doors, and the freakshow fades from the stage of popular culture (Garland-Thomson Extraordinary Bodies 70). There can, of course, be no denying the need to protect people with disabilities from exploitation at the service of a cultural fetish that enacts a compulsion to define and control bodily difference. However, recent debates in disability, cultural and performance studies have been characterised by the desire to reconsider the freakshow as a site for contesting some of the cultural logics it enacts. Theorists like Synder and Mitchell argue that medical discourse “disarms the [disabled] body of its volatile potency” (378), in the process denying people with disabilities a potentially interesting site to contest the cultural logics by which their bodies are defined. The debate begins with Bogdan’s discussion of the ways in which well-meaning disability activists may, in their desire to protect people with disabilities from exploitative practices and producers, have overlooked the fact that freakshows provided people with disabilities a degree of independence and freedom otherwise impossible (280-81). After all, as disabled performer Mat Fraser says in his documentary Born Freak, The Victorian marvels found fame and some fortune, and this actually raised the visibility, even the acceptability, of disabled people in general during a time when you could be attacked on the streets just for looking different. These disabled performers found independence and commanded respect.… If I had been born a hundred years ago, given the alternatives of—what? living the life of a village monster or idiot or being poked or prodded for cataloguing by medical types—there’s no doubt about it, I would have wanted to be in show business. (Born Freak) This question of agency extends to discussion of whether disabled performers like Fraser can, by consciously appropriating the figures, symbols and scenography of the freakshow, start to deconstruct the mechanisms by which this contested sphere of cultural practice has historically defined them, confronting spectators with their own complicity in the construction of the freak. In her analysis of Coney Island’s Sideshows by the Seashore, Elizabeth Stephens reflects on this contemporary sideshow’s capacity to reclaim the political currency of the freak. For Stephens, sideshows are sites in which norms about the body, its limits and capabilities, are theatricalized and transformed into spectacle, but, in which, for this very reason, they can also be contested. Non-normative bodies are not simply exhibited or put on display on the sideshow stage, but are rather performed as the unstable—indeed, destabilising—product of the dynamic interrelationship between performer, audience and theatrical space. (486) Theorists like Stephens (487) point to disabled performers who manipulate the scopic and discursive mechanisms of the sideshow, street performance and circus, setting them against more or less personal accounts of the way their bodies have historically been seen, to disrupt the modes of subjection the freak spectacle makes possible and precipitate a crisis in prescribed categories of meaning. Stephens (485-498) writes of Mat Fraser, who reperformed the historical personal of the short-armed Sealo the Sealboy, and Jennifer Miller, who reperformed the persona of Zenobia the bearded lady, at Sideshows by the Seashore. Sharon Mazer (257-276) writes of Katy Dierlam, who donned a Dolly Dimples babydoll dress to reperform the clichéd fat lady figure Helon Melon, again at Sideshows by the Seashore, counterposing Melon’s monstrous obesity with comments affirming her body’s potent humanity, and quotes from feminist scholars and artists such as Suzy Orbach, Karen Finley and Annie Sprinkle. Sharon Synder and David Mitchell (383) write of Mary Duffy, who reperforms the armless figure of the Venus de Milo. These practices constitute performative interventions into the cultural sphere, aligned with a broader set of contemporary performance practices which contest the symbolic frameworks by which racial and gender characteristics are displayed on the popular stage in similar ways. Their confrontational performance strategies recall, for instance, the work of American performance artist Guillermo Gómez-Peña, who reappropriates colonial and pop cultural figurations of the racialised body in works like Two Undiscovered Amerindians Visit…, in which he and Coco Fusco cast themselves as two caged savages. In such works, Gómez-Peña and his collaborators use parallel performance strategies to engage the “spectacle of the Other-as-freak” (297). “The idea is to exaggerate the features of fear and desire in the Anglo imagination and ‘spectacularize’ our ‘extreme identities’, so to speak, with the clear understanding that these identities have been invented by the surgery of the global media” (297) Gómez-Peña says. These remobilisations of the monstrous operate within the paradigm of the explicit, a term Schneider coined a decade ago to describe the performance art practices of women who write the animalised, sexualised characteristics with which they are symbolically aligned across their own corporeally ‘suitable’ bodies, replaying their culturally assigned identities “with a voluble, ‘in your face’ vengeance” (100), “a literal vengeance” (109). Such practices reclaim the destablising potential of the freak spectacle, collapsing, complicating or exploding the space between signifier and signified to show that the freak is a discursive construct (22-23), and thus for Schneider, following Benjamin, threatening the whole symbolic system with collapse (2, 6). By positioning their bodies as a ground that manifestly fails to ground the reality they represent, these performers play with the idea that the reality of the freak is really just part of the order of representation. There is nothing behind it, nothing beyond it, nothing up the magician’s sleeve—identity is but a sideshow hall of mirrors in which the ‘blow off’ is always a big disappointment. Bodies marked by disability are not commodified, or even clearly visible, in the Western capitalist scopic economy in the same way as Schneider’s women performers. Nevertheless, disabled performers still use related strategies to reclaim a space for what Schneider calls a postmodern politics of transgression (4), exposing “the sedimented layers of signification themselves” (21), rather than establishing “an originary, true or redemptive body” (21) beneath. The contestational logic of these modes of practice notwithstanding, Stephens (486) notes that performers still typically cite a certain ambivalence about their potential. There are, after all, specific risks for people with disabilities working in this paradigm that are not fully drawn out in the broader debate about critical reappropriation of racist and sexist imagery in performance art. Mobilisations of the freak persona are complicated by the performer’s own corporeal ‘suitability’ to that persona, by the familiar theatrical mechanisms of recognition and reception (which can remain undertheorised in meta-level considerations of the political currency of the freakshow in disability and cultural—rather than performance—studies), and by a dominant cultural discourse that insists on configuring disability as an individual problem detached from the broader sphere of identity politics (Sandahl 598-99). In other words, the territory that still needs to be addressed in this emergent field of practice is the ethics of reception, and the risk of spectatorial (mis)recognitions that reduce the political potency of the freak spectacle. The main risk, of course, is that mobilisations of the freak persona may still be read by spectators as part of the phenomenon they are trying to challenge, the critical counterpositions failing to register, or failing to disrupt fully the familiar scopic and discursive framework. More problematically, the counterpositions themselves may be reduced by spectators to a rhetorical device that distances them from the corporeal reality of the encounter with the other, enabling them to interpret or explain the experience of disability as a personal experience by which an individual comes to accommodate their problems. Whilst the human desire to construct narrative and psychological contexts for traumatic experience cannot be denied, Carrie Sandahl (583) notes that there is a risk that the encounter with the disabled body will be interpreted as part of the broader phenomenon Synder and Mitchell describe in Narrative Prosthesis, in which disability is little more than a metaphor for the problems people have to get past in life. In this interpretative paradigm, disability enters a discursive and theoretical terrain that fails to engage fully the lived experience of the other. Perhaps most problematically, mobilisations of the freak persona may be read as one more manifestation of the distinctively postmodern desire to break free from the constraints of culturally condoned identity categories. This desire finds expression in the increasingly prevalent cultural phenomenon of voluntary enfreakment, in which people voluntarily differentiate, or queer their own experience of self. As Fraser says when he finds out that a company of able-bodied freaks is competing with him for audiences at the Edinburgh Fringe Festival, “[t]he irony is, these days, everyone is trying to get in on our act” (Born Freak). In a brave new world where everybody wants to be a freak, activist artists “must be watchful”, Gómez-Peña warns, “for we can easily get lost in the funhouse of virtual mirrors, epistemological inversions, and distorted perceptions” (288). The reclamation of disability as a positive metaphor for a more dispersed set of human differences in the spectacle of daily life (287-98), and in theoretical figurations of feminist philosophy that favour the grotesque, the monstrous and the mechanical (Haraway Simians, Cyborgs and Women; Braidotti Nomadic Subjects), raises questions for Garland-Thomson (“Integrating Disability, Transforming Feminist Theory” 9) and Sandahl (581-83). If “disability serves as a master trope for difference,” Sandahl says, then anybody can adopt it “…to serve as a metaphor expressing their own outsider status, alienation and alterity, not necessarily the social, economic and political concerns of actual disabled people” (583). The work of disabled performers can disappear into a wider sphere of self-differentiated identities, which threatens to withdraw ‘disability’ as a politically useful category around which a distinctive group of people can generate an activist politics. To negotiate these risks, disabled performers need to work somewhere between a specific, minoritarian politics and a universal, majoritarian politics, as Sedgwick describes in Epistemology of the Closet (91; cf. Garland-Thompson “Integrating Disability, Transforming Feminist Theory” 5; cf. Stephens 493). Performers need to make their experience of otherness explicit, so that their corporeal specificity is not abstracted into a symbolic system that serves the dominant cultural logic. Performers need to contextualise this experience in social terms, so that it is not isolated from the sphere of identity politics. But performers cannot always afford to allow the freak persona to become one more manifestation of the myriad idiosyncratic identities that circulate in the postmodern popular imaginary. It is by negotiating these risks that performers encourage spectators to experience—if only fleetingly, and provisionally—a relationship to the other that is characterised not by generalisation, domestication and containment (Levinas “Substitution” 80, 88), but by respect for the other’s radical alterity, by vulnerability, and, in Derrida’s reformation of Levinasian ethics, by a singular, reciprocal and undecidable responsibility towards the other (Derrida 60-70). This is what Levinas would call an ethical relationship, in which the other exists, but as an excess, a class of being that can be recognised but never seized by comprehension (“Is Ontology Fundamental?” 7, “Transcendence and Height” 17), or sublimated as a category of, or complement to, the same (13, “Meaning and Sense” 51). Mat Fraser’s mobilisation of Sealo the Sealboy is one of the most engaging examples of the way disabled performers negotiate the complexities of this terrain. On his website, Fraser says he has always been aware of the power of confrontational presentations of his own body, and has found live forms that blur the boundaries between freakshow, sideshow and conventional theatre the best forums for “the more brutal and confrontational aspect of my investigation into disability’s difficult interface with mainstream cultural concerns” (MatFraser.co.uk). Fraser’s appropriation of Sealo was born of a fascination with the historical figure of Stanley Berent. “Stanley Berent was an American freakshow entertainer from the 1940s who looked like me,” Fraser says. “He had phocomelia. That’s the medical term for my condition. It literally means seal-like limbs. Berent’s stage name was Sealo the Sealboy” (Born Freak). Fraser first restaged Sealo after a challenge from Dick Zigun, founder of the modern Sideshows by the Seashore. He restaged Berant’s act, focused on Berant’s ability to do basic things like shaving and sawing wood with his deformed hands, for the sideshow’s audiences. While Fraser had fun playing the character on stage, he says he felt a particular discomfort playing the character on the bally platform used to pull punters into the sideshow from the street outside. “There is no powerful dynamic there,” Fraser laments. “It’s just ‘come look at the freak’” (Born Freak). Accordingly, after a season at Sideshows by the Seashore, Fraser readapted the experience as a stage play, Sealboy: Freak, in which Sealo is counterposed with the character Tam, “a modern disabled actor struggling to be seen as more than a freak” (Born Freak). This shift in the theatrical mechanisms by which he stages the freak gives Fraser the power to draw contemporary, politically correct spectators at the Edinburgh Fringe Festival into the position of sideshow gawkers, confronting them with their own fascination with his body. A potent example is a post-audition scene, in which Tam says I read this book once that said that the mainstream will only see a disabled performer in the same way they view a performing seal. Very clever, but just mimicry. No. No it can’t be like that anymore. We’ve all moved on. People are no longer more fascinated by how I do things, rather than what I say. I am an actor, not a f*cking freak. (Born Freak) But, as Tam says this, he rolls a joint, and spectators are indeed wrapped up in how he does it, hardly attending to what he says. What is interesting about Fraser’s engagement with Sealo in Sealboy: Freak is the way he works with a complicated—even contradictory—range of presentational strategies. Fraser’s performance becomes explicit, expositional and estranging by turns. At times, he collapses his own identity into that of the freak, the figure so stark, so recognisable, so much more harshly drawn than its real-life referent, that it becomes a simulacrum (cf. Baudrillard 253-282), exceeding and escaping the complications of the human corporeality beneath it. Fraser allows spectators to inhabit the horror, and the humour, his disabled identity has historically provoked, reengaging the reactions they hide in everyday life. And, perhaps, if they are an educated audience at the Fringe, applauding themselves for their own ability to comprehend the freak, and the crudity of sideshow display. However, self-congratulatory comprehension of the freak persona is interrupted by the discomforting encounter with Tam, suspending—if only provisionally—spectators’ ability to reconcile this reaction with their credentials as a politically correct audience. What a closer look at mobilisations of the freak in performances such as Fraser’s demonstrates is that manipulating the theatrical mechanisms of the stage, and their potential to rapidly restructure engagement with the extraordinary body, enables performers to negotiate the risk of (mis)recognition embedded in the face-to-face encounter between self and spectator. So configured, the stage can become a site for contesting the cultural logic by which the disabled body has historically been defined. It can challenge spectators to experience—if fleetingly—the uncertainties of the face-to-face encounter with the extraordinary body, acknowledging this body’s specificity, without immediately being able to abstract, domesticate or abdicate responsibility for it—or abdicate responsibility for their own reaction to it. Whilst spectators’ willingness to reflect further on their complicity in the construction of the other remains an open and individual question, these theatrical manipulations can at least increase the chance that the cathartic effect of the encounter with the so-called freak will be disrupted or deferred. References Adams, Rachel. Sideshow USA: Freaks and the American Cultural Imagination. Chicago, IL: University of Chigaco Press, 2001. Baudrillard, Jean. “The Precision of Simulacra”. Art After Modernism: Rethinking Representation. Ed. Brian Wallis. Boston, MA: David R. Godine, 1984, 253-282. Born Freak. Dir. Paul Sapin. Written Paul Sapin and Mat Fraser. Planet Wild for Channel 4 UK, 2001. Braidotti, Rosi. Nomadic Subjects: Embodiment and Sexual Difference in Contemporary Feminist Thought. New York, NY: Columbia University Press, 1994. Bogdan, Robert. Freakshow: Presenting Human Oddities for Amusem*nt and Profit. Chicago, IL: University of Chicago Press, 1988. Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. Trans. Brian Massumi. Minneapolis, MN and London: University of Minnesota Press, 1987. Derrida, Jacques. Gift of Death. Trans. David Wills. Chicago IL: University of Chicago Press, 1995. Fraser, Mat. “Live Art”. MatFraser.co.uk. n.date. 30 April 2008 ‹http://www.matfraser.co.uk/live_art.php›. Foucault, Michel. The Birth of the Clinic: An Archeology of Medical Perception. Trans. AM Sheridan Smith. London: Routledge, 1976. Garland-Thomson, Rosmarie. “Integrating Disability, Transforming Feminist Theory”. NSWA Journal 14.3 (2002): 1-33. ———. Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature. New York, NY: Columbia University Press, 1997. ———. “Introduction: From Wonder to Error—A Genealogy of Freak Discourse”. Freakery: Cultural Spectacles of the Extraordinary Body. Ed. Rosmarie Garland-Thomspon. New York, NY and London: New York University Press, 1996. Gómez-Peña, Guillermo. “Culture-in-extremis: Performing Against the Cultural Backdrop of the Mainstream Bizarre”. The Performance Studies Reader. Ed. Henry Bial. London and New York: Routledge, 2004, 287-298. Haraway, Donna. Simians, Cyborgs and Women. New York, NY: Routledge, 1991. Kuppers, Petra. Disability and Contemporary Performance: Bodies on Edge. New York, NY: Routledge, 2004. Levinas, Emmanuel. “Is Ontology Fundamental?”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 1-10. ———. “Transcendence and Height”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 11-31. ———. “Meaning and Sense”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 33-64. ———. “Substitution”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 79-95. Mazer, Sharon. “‘She’s so fat…’ Facing the Fat Lady at Coney Island’s Sideshows by the Seashore”. Bodies Out of Bounds: Fatness and Transgression. Ed. Jana Evens Braziel and Kathryn LeBesco. Berkeley, CA: University of California Press, 2001, 257-276. Sandahl, Carrie. “Black Man, Blind Man: Disability Identity Politics and Performance”. Theatre Journal 56 (2004): 597-602. Schneider, Rebecca. The Explicit Body in Performance. New York, NY and London: Routledge, 1997. Sedgwick, Eve Kosofsky. Epistemology of the Closet. Berkeley, CA: University of California Press, 1990. Snyder, Sharon L. and David T Mitchell. “Re-engaging the Body: Disability Studies and the Resistance to Embodiment”. Public Culture, 13.3 (2001): 367-389. ———. Narrative Prosthesis: Disability and the Dependencies of Discourse. Ann Arbor, MI: University of Michigan Press, 2000. Stephens, Elizabeth. “Cultural Fixations of the Freak Body: Coney Island and the Postmodern Sideshow”. Continuum: Journal of Media and Cultural Studies 20.4 (2006): 485-498. Acknowledgements An earlier version of this paper was presented at “Extreme States: Issues of Scale—Political, Performative, Emotional”, the Australasian Association for Drama Theatre and Performance Studies Annual Conference 2007.

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Cookbooks can be interpreted as sites of exchange and transformation. This is not only due to their practical use as written instructions that assist in turning ingredients into dishes, but also to their significance as interconnecting mediums between teacher and student, perceiver and perceived, past and present. Hinging on inescapable notions of apprenticeship, occasion, and the passing of time—and being at once familiar and unfamiliar to both the reader and the writer—the recipe “as text” renders a specific brand of culinary uncanny. In outlining the function of cookbooks as chronicles of the everyday, Janet Theophano points out that they “are one of a variety of written forms, such as diaries and journals, that [people] have adapted to recount and enrich their lives […] blending raw ingredients into a new configuration” (122). The cookbook unveils the peculiar ability of the ephemeral “text” to find permanence and materiality through the embodied framework action and repetition. In view of its propensity to be read, evaluated, and reconfigured, the cookbook can be read as a manifestation of voice, a site of interpretation and communication between writer and reader which is defined not by static assessment, but by dynamic and often incongruous exchanges of emotions, mysteries, and riddles. Taking the in-between status of the cookbook as point of departure, this paper analyses the cookbook as a “living dead” entity, a revenant text bridging the gap between the ephemerality of the word and the tangibility of the physical action. Using Joanne Harris’s fictional treatment of the trans-generational cookbook in Five Quarters of the Orange (2001) as an evocative example, the cookbook is read as a site of “memory, mourning and melancholia” which is also inevitably connected—in its aesthetic, political and intellectual contexts—to the concept of “return.” The “dead” voice in the cookbook is resurrected through practice. Re-enacting instructions brings with it a sense of transformative exchange that, in both its conceptual and factual dimensions, recalls those uncanny structural principles that are the definitive characteristic of the Gothic. These find particular resonance, at least as far as cookbooks are concerned, in “a sense of the unspeakable” and a “correspondence between dreams, language, writing” (Castricano 13). Understanding the cookbook as a “Gothic text” unveils one of the most intriguing aspects of the recipe as a vault of knowledge and memory that, in an appropriately mysterious twist, can be connected to the literary framework of the uncanny through the theme of “live burial.” As an example of the written word, a cookbook is a text that “calls” to the reader; that call is not only sited in interpretation—as it can be arguably claimed for the majority of written texts—but it is also strongly linked to a sense of lived experience on the writer’s part. This connection between “presences” is particularly evident in examples of cookbooks belonging to what is known as “autobiographical cookbooks”, a specific genre of culinary writing where “recipes play an integral part in the revelation of the personal history” (Kelly 258). Known examples from this category include Alice B. Toklas’s famous Cook Book (1954) and, more recently, Nigel Slater’s Toast (2003). In the autobiographical cookbook, the food recipes are fully intertwined with the writer’s memories and experiences, so that the two things, as Kelly suggests, “could not be separated” (258). The writer of this type of cookbook is, one might venture to argue, always present, always “alive”, indistinguishable and indivisible from the experience of any recipe that is read and re-enacted. The culinary phantom—understood here as the “voice” of the writer and how it re-lives through the re-enacted recipe—functions as a literary revenant through the culturally prescribed readability of the recipes as a “transtextual” (Rashkin 45) piece. The term, put forward by Esther Rashkin, suggests a close relationship between written and “lived” narratives that is reliant on encrypted messages of haunting, memory, and spectrality (45). This fundamental concept—essential to grasp the status of cookbooks as a haunted text—helps us to understand the writer and instructor of recipes as “being there” without necessarily being present. The writers of cookbooks are phantomised in that their presence—recalling the materiality of action and motion—is buried alive in the pages of the cookbook. It remains tacit and unheard until it is resurrected through reading and recreating the recipe. Although this idea of “coming alive” finds resonance in virtually all forms of textual exchange, the phantomatic nature of the relationship between writer and reader finds its most tangible expression in the cookbook precisely because of the practical and “lived in” nature of the text itself. While all texts, Jacques Derrida suggests, call to us to inherit their knowledge through “secrecy” and choice, cookbooks are specifically bound to a dynamic injunction of response, where the reader transforms the written word into action, and, in so doing, revives the embodied nature of the recipe as much as it resurrects the ghostly presence of its writer (Spectres of Marx 158). As a textual medium housing kitchen phantoms, cookbooks designate “a place” that, as Derrida puts it, draws attention to the culinary manuscript’s ability to communicate a legacy that, although not “natural, transparent and univocal”, still calls for an “interpretation” whose textual choices form the basis of enigma, inhabitation, and haunting (Spectres of Marx 16). It is this mystery that animates the interaction between memory, ghostly figures and recipes in Five Quarters of the Orange. Whilst evoking Derrida’s understanding of the written texts as a site of secrecy, exchange and (one may argue) haunting, Harris simultaneously illustrates Kelly’s contention that the cookbook breaks the barriers between the seemingly common everyday and personal narratives. In the story, Framboise Dartigen—a mysterious woman in her sixties—returns to the village of her childhood in the Loire region of France. Here she rescues the old family farm from fifty years of abandonment and under the acquired identity of the veuve Simone, opens a local crêperie, serving simple, traditional dishes. Harris stresses how, upon her return to the village, Framboise brings with her resentment, shameful family secrets and, most importantly, her mother Mirabelle’s “album”: a strange hybrid of recipe book and diary, written during the German occupation of the Loire region in World War II. The recipe album was left to Framboise as an inheritance after her mother’s death: “She gave me the album, valueless, then, except for the thoughts and insights jotted in the margins alongside recipes and newspaper cuttings and herbal cures. Not a diary, precisely; there are no dates in the album, no precise order” (Harris 14). It soon becomes clear that Mirabelle had an extraordinary relationship with her recipe album, keeping it as a life transcript in which food preparation figures as a main focus of attention: “My mother marked the events in her life with recipes, dishes of her own invention or interpretations of old favourites. Food was her nostalgia, her celebration, its nurture and preparation the sole outlet for her creativity” (14). The album is described by Framboise as her mother’s only confidant, its pages the sole means of expression of events, thoughts and preoccupations. In this sense, the recipes contain knowledge of the past and, at the same time, come to represent a trans-temporal coordinate from which to begin understanding Mirabelle’s life and the social situations she experienced while writing the album. As the cookery album acts as a medium of self-representation for Mirabelle, Harris also gestures towards the idea that recipes offer an insight into a person that history may have otherwise forgotten. The culinary album in Five Quarters of the Orange establishes itself as a bonding element and a trans-temporal gateway through which an exchange ensues between mother and daughter. The etymological origin of the word “recipe” offers a further insight into the nature of the exchange. The word finds its root in the Latin word reciperere, meaning simultaneously “to give and to receive” (Floyd and Forster 6). Mirabelle’s recipes are not only the textual representation of the patterns and behaviours on which her life was based but, most importantly, position themselves in a process of an uncanny exchange. Acting as the surrogate of the long-passed Mirabelle, the album’s existence as a haunted culinary document ushers in the possibility of secrets and revelations, contradictions, and concealment. On numerous occasions, Framboise confesses that the translation of the recipe book was a task with which she did not want to engage. Forcing herself, she describes the reading as a personal “struggle” (276). Fearing what the book could reveal—literally, the recipes of a lifetime—she suspects that the album will demand a deep involvement with her mother’s existence: “I had avoided looking at the album, feeling absurdly at fault, a voyeuse, as if my mother might come in at any time and see me reading her strange secrets. Truth is, I didn’t want to know her secrets” (30). On the one hand, Framboise’s fear could be interpreted as apprehension at the prospect of unveiling unpleasant truths. On the other, she is reluctant to re-live her mother’s emotions, passions and anxieties, feeling they may actually be “sublimated into her recipes” (270). Framboise’s initial resistance to the secrets of the recipe book is quickly followed by an almost obsessive quest to “translate” the text: “I read through the album little by little during those lengthening nights. I deciphered the code [and] wrote down and cross-referenced everything by means of small cards, trying to put everything in sequence” (225). As Harris exposes Framboise’s personal struggle in unravelling Mirabelle’s individual history, the daughter’s hermeneutic excavation into the past is problematised by her mother’s strange style: “The language […] in which much of the album was written was alien to me, and after a few abortive attempts to decipher it, I abandoned the idea […] the mad scrawlings, poems, drawings and accounts […] were written with no apparent logic, no order that I could discover” (31). Only after a period of careful interpretation does Framboise understand the confused organisation of her mother’s culinary thoughts. Once the daughter has decoded the recipes, she is able to use them: “I began to make cakes [...] the brioche and pain d’épices of the region, as well as some [...] Breton specialties, packets of crêpes dentelle, fruit tarts and packs de sablés, biscuits, nutbread, cinnamon snaps [...] I used my mother’s old recipes” (22). As Framboise engages with her mother’s album, Mirabelle’s memory is celebrated in the act of reading, deciphering, and recreating the recipes. As a metaphorically buried collection waiting to be interpreted, the cookbook is the catalyst through which the memory of Mirabelle can be passed to her daughter and live on. Discussing the haunted nature of texts, Derrida suggests that once one interprets a text written by another, that text “comes back” and “lives on” (‘Roundtable on Translation’ 158). In this framework of return and exchange, the replication of the Mirabelle’s recipes, by her daughter Framboise, is the tangible expression of the mother’s life. As the collective history of wartime France and the memory of Mirabelle’s life are reaffirmed in the cookbook, the recipes allow Framboise to understand what is “staring [her] in the face”, and finally see “the reason for her [mother’s] actions and the terrible repercussions on [her] own” life (268). As the process of culinary translating takes place, it becomes clear that her deceased mother’s album conceals a legacy that goes beyond material possessions. Mirabelle “returns” through the cookbook and that return, in Jodey Castricano’s words, “acts as inheritance.” In the hauntingly autobiographical context of the culinary album, the mother’s phantom and the recipes become “inseparable” (29). Within the resistant and at times contradictory framework of the Gothic text, legacy is always passed on through a process of haunting which must be accepted in order to understand and decode the writing. This exchange becomes even more significant when cookbooks are concerned, since the intended engagement with the recipes is one of acceptance and response. When the cookbook “calls”, the reader is asked “to respond to an injunction” (Castricano 17). In this framework, Mirabelle’s album in Five Quarters of the Orange becomes the haunted channel through which the reader can communicate with her “ghost” or, to be more specific, her “spectral signature.” In these terms, the cookbook is a vector for reincarnation and haunting, while recipes themselves function as the vehicle for the parallel consciousness of culinary phantoms to find a status of reincarnated identification through their connection to a series of repeated gestures. The concept of “phantom” here is particularly useful in the understanding put forward by Nicholas Abraham and Maria Torok—and later developed by Derrida and Castricano—as “the buried speech of another”, the shadow of perception and experience that returns through the subject’s text (Castricano 11). In the framework of the culinary, the phantom returns in the cookbook through an interaction between the explicit or implied “I” of the recipe’s instructions, and the physical and psychological dimension of the “you” that finds lodging in the reader as re-enactor. In the cookbook, the intertextual relationship between the reader’s present and the writer’s past can be identified, as Rashkin claims, “in narratives organised by phantoms” (45). Indeed, as Framboise’s relationship with the recipe book is troubled by her mother’s spectral presence, it becomes apparent that even the writing of the text was a mysterious process. Mirabelle’s album, in places, offers “cryptic references” (14): moments that are impenetrable, indecipherable, enigmatic. This is a text written “with ghosts”: “the first page is given to my father’s death—the ribbon of his Légion d’Honneur pasted thickly to the paper beneath a blurry photograph and a neat recipe for buck-wheat pancakes—and carries a kind of gruesome humour. Under the picture my mother has pencilled 'Remember—dig up Jerusalem artichokes. Ha! Ha! Ha!'” (14). The writing of the recipe book is initiated by the death of Mirabelle’s husband, Yannick, and his passing is marked by her wish to eradicate from the garden the Jerusalem artichokes which, as it is revealed later, were his favourite food. According to culinary folklore, Jerusalem artichokes are meant to be highly “spermatogenic”, so their consumption can make men fertile (Amato 3). Their uprooting from Mirabelle’s garden, after the husband’s death, signifies the loss of male presence and reproductive function, as if Mirabelle herself were rejecting the symbol of Yannick’s control of the house. Her bittersweet, mocking comments at this disappearance—the insensitive “Ha! Ha! Ha!”—are indicative of Mirabelle’s desire to detach herself from the restraints of married life. Considering women’s traditional function as family cooks, her happiness at the lack of marital duties extends to the kitchen as much as to the bedroom. The destruction of Yannick’s artichokes is juxtaposed with a recipe for black-wheat pancakes which the family then “ate with everything” (15). It is at this point that Framboise recalls suddenly and with a sense of shock that her mother never mentioned her father after his death. It is as if a mixture of grief and trauma animate Mirabelle’s feeling towards her deceased husband. The only confirmation of Yannick’s existence persists in the pages of the cookbook through Mirabelle’s occasional use of the undecipherable “bilini-enverlini”, a language of “inverted syllables, reversed words, nonsense prefixes and suffices”: “Ini tnawini inoti plainexini [...] Minini toni nierus niohwbi inoti” (42). The cryptic language was, we are told, “invented” by Yannick, who used to “speak it all the time” (42). Yannick’s presence thus is inscribed in the album, which is thereby transformed into an evocative historical document. Although he disappears from his wife’s everyday life, Yannick’s ghost—to which the recipe book is almost dedicated on the initial page—remains and haunts the pages. The cryptic cookbook is thus also a “crypt.” In their recent, quasi-Gothic revision of classical psychoanalysis, Nicholas Abraham and Maria Torok write about the trauma of loss in relation to psychic crypts. In mourning a loved one, they argue, the individual can slip into melancholia by erecting what they call an “inner crypt.” In the psychological crypt, the dead—or, more precisely, the memory of the dead—can be hidden or introjectively “devoured”, metaphorically speaking, as a way of denying its demise. This form of introjection—understood here in clear connection to the Freudian concept of literally “consuming” one’s enemy—is interpreted as the “normal” progression through which the subject accepts the death of a loved one and slowly removes its memory from consciousness. However, when this process of detachment encounters resistance, a “crypt” is formed. The crypt maps, as Abraham and Torok claim, the psychological topography of “the untold and unsayable secret, the feeling unfelt, the pain denied” (21). In its locus of mystery and concealment, the crypt is haunted by the memory of the dead which, paradoxically, inhabits it as a “living-dead.” Through the crypt, the dead can “return” to disturb consciousness. In Five Quarters of the Orange, the encoded nature of Mirabelle’s recipes—emerging as such on multiple levels of interpretation—enables the memory of Yannick to “return” within the writing itself. In his preface to Abraham and Torok’s The Wolf-Man’s Magic Word, Derrida argues that the psychological crypt houses “the ghost that comes haunting out the Unconscious of the other” (‘Fors’ xxi). Mirabelle’s cookbook might therefore be read as an encrypted reincarnation of her husband’s ghostly memory. The recipe book functions as the encrypted passageway through which the dead re-join the living in a responsive cycle of exchange and experience. Writing, in this sense, re-creates the subject through the culinary framework and transforms the cookbook into a revenant text colonised by the living-dead. Abraham and Torok suggest that “reconstituted from the memories of words, scenes and affects, the objective correlative of loss is buried alive in the crypt” (130). With this idea in mind, it is possible to suggest that, among Mirabelle’s recipes, the Gothicised Yannick inhabits a culinary crypt. It is through his associations with both the written and the practical dimension food that he remains, to borrow Derrida’s words, a haunting presence that Mirabelle is “perfectly willing to keep alive” within the bounds of the culinary vault (‘Fors’ xxi). As far as the mourning crypt is concerned, the exchange of consciousness that is embedded in the text takes place by producing a level of experiential concealment, based on the overarching effect of Gothicised interiority. Derrida remarks that “the crypt from which the ghost comes back belongs to someone else” (‘Fors’ 119). This suggestion throws into sharp relief the ability of the cookbook as a haunted text to draw the reader into a process of consciousness transmission and reception that is always and necessarily a form of “living-dead” exchange. In these terms, the recipe itself—especially in its embodiment as instructed actions—needs to be understood as a vector for establishing the uncanny barriers of signification erected by the bounds of the cookbook itself as a haunted site of death, enchantment, and revenant signs. In this way, eating, a vital and animated activity, is “disturbingly blended with death, decomposition and the corpse” (Piatti-Farnell 146). And far from simply providing nourishment for the living, Mirabelle’s encrypted recipes continue to feed the dead through cycles of mourning and melancholia. Mirabelle’s cookbook, therefore, becomes a textual example of “cryptomimeses”, a writing practice that, echoing the convention of the Gothic framework, generates its ghostly effects through embodying the structures of remembrance and the dynamics of autobiographic deconstructive writing (Castricano 8). As heimliche and unheimliche collide in practices of culinary reading and writing, the cookbook acts as quasi-mystical, haunted space through which the uncanny frameworks of language and experience can become actualised. ReferencesAbraham, Nicolas, and Maria Torok, The Shell and the Kernel: Renewals of Psychoanalysis. Chicago: U of Chicago P, 1994. Amato, Joseph. The Great Jerusalem Artichoke Circus. Minneapolis: U of Minnesota P, 1993. Castricano, Jodey. Cryptomimesis: The Gothic and Jacques Derrida’s Ghost Writing. London: McGill-Queen’s UP, 2003. Derrida, Jacques. “Fors: the Anglish words of Nicolas Abraham and Maria Torok.” Eds. Nicholas Abraham, and Maria Torok. The Wolf Man’s Magic Word: A Cryptonomy. Minneapolis: U of Minnesota Pr, 1986. xi–xlviii ---. “Roundtable on Translation.” The Ear of the Other: Otobiography, Transference, Translation. London: U of Nebraska P, 1985. 91–161. Floyd, Janet, and Laurel Foster. The Recipe Reader: Narratives–Contexts–Traditions. Aldershot: Ashgate, 2003. Harris, Joanne. Five Quarters of the Orange. Maidenhead: Black Swan, 2002. Kelly, Traci Marie. “‘If I Were a Voodoo Priestess’: Women’s Culinary Autobiographies.” Kitchen Culture in America: Popular Representations of Food, Gender and Race. Ed. Sherrie A. Inness. Philadelphia: U of Pennsylvania P, 2001. 251–70. Piatti-Farnell, Lorna. Food and Culture in Contemporary American Fiction. New York: Routledge, 2011. Rashkin, Esther. Family Secrets and the Psychoanalysis of Narrative. Princeton: Princeton UP, 1992. Slater, Nigel. Toast: The Story of a Boy’s Hunger. London: Harper Perennial, 2004. Theophano, Janet. Eat My Words: Reading Women’s Lives Through The Cookbooks They Wrote. New York: Palgrave, 2002. Toklas, Alice B. The Alice B. Toklas Cook Book. New York: Perennial,1984.

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Our thesis is that the city’s ambience is now an unstable dialectic in which we are watchers and watched, mirrored and refracted in a landscape of iPhone auteurs, eTags, CCTV and sousveillance. Embrace ambience! Invoking Benjamin’s spirit, this article does not seek to limit understanding through restriction to a particular theme or theoretical construct (Buck-Morss 253). Instead, it offers snapshots of interactions at the dawn of the postmodern city. That bricolage also engages how people appropriate, manipulate, disrupt and divert urban spaces and strategies of power in their everyday life. Ambient information can both liberate and disenfranchise the individual. This article asks whether our era’s dialectics result in a new personhood or merely restate the traditional spectacle of ‘bright lights, big city’. Does the virtualized city result in ambient anomie and satiation or in surprise, autonomy and serendipity? (Gumpert 36) Since the steam age, ambience has been characterised in terms of urban sound, particularly the alienation attributable to the individual’s experience as a passive receptor of a cacophony of sounds – now soft, now loud, random and recurrent–from the hubbub of crowds, the crash and grind of traffic, the noise of industrial processes and domestic activity, factory whistles, fire alarms, radio, television and gramophones (Merchant 111; Thompson 6). In the age of the internet, personal devices such as digital cameras and iPhones, and urban informatics such as CCTV networks and e-Tags, ambience is interactivity, monitoring and signalling across multiple media, rather than just sound. It is an interactivity in which watchers observe the watched observing them and the watched reshape the fabric of virtualized cities merely by traversing urban precincts (Hillier 295; De Certeau 163). It is also about pervasive although unevenly distributed monitoring of individuals, using sensors that are remote to the individual (for example cameras or tag-readers mounted above highways) or are borne by the individual (for example mobile phones or badges that systematically report the location to a parent, employer or sex offender register) (Holmes 176; Savitch 130). That monitoring reflects what Doel and Clark characterized as a pervasive sense of ambient fear in the postmodern city, albeit fear that like much contemporary anxiety is misplaced–you are more at risk from intimates than from strangers, from car accidents than terrorists or stalkers–and that is ahistorical (Doel 13; Scheingold 33). Finally, it is about cooption, with individuals signalling their identity through ambient advertising: wearing tshirts, sweatshirts, caps and other apparel that display iconic faces such as Obama and Monroe or that embody corporate imagery such as the Nike ‘Swoosh’, Coca-Cola ‘Ribbon’, Linux Penguin and Hello Kitty feline (Sayre 82; Maynard 97). In the postmodern global village much advertising is ambient, rather than merely delivered to a device or fixed on a billboard. Australian cities are now seas of information, phantasmagoric environments in which the ambient noise encountered by residents and visitors comprises corporate signage, intelligent traffic signs, displays at public transport nodes, shop-window video screens displaying us watching them, and a plethora of personal devices showing everything from the weather to snaps of people in the street or neighborhood satellite maps. They are environments through which people traverse both as persons and abstractions, virtual presences on volatile digital maps and in online social networks. Spectacle, Anomie or Personhood The spectacular city of modernity is a meme of communication, cultural and urban development theory. It is spectacular in the sense that of large, artificial, even sublime. It is also spectacular because it is built around the gaze, whether the vistas of Hausmann’s boulevards, the towers of Manhattan and Chicago, the shopfront ‘sea of light’ and advertising pillars noted by visitors to Weimar Berlin or the neon ‘neo-baroque’ of Las Vegas (Schivelbusch 114; Fritzsche 164; Ndalianis 535). In the year 2010 it aspires to 2020 vision, a panoptic and panspectric gaze on the part of governors and governed alike (Kullenberg 38). In contrast to the timelessness of Heidegger’s hut and the ‘fixity’ of rural backwaters, spectacular cities are volatile domains where all that is solid continues to melt into air with the aid of jackhammers and the latest ‘new media’ potentially result in a hypereality that make it difficult to determine what is real and what is not (Wark 22; Berman 19). The spectacular city embodies a dialectic. It is anomic because it induces an alienation in the spectator, a fatigue attributable to media satiation and to a sense of being a mere cog in a wheel, a disempowered and readily-replaceable entity that is denied personhood–recognition as an autonomous individual–through subjection to a Fordist and post-Fordist industrial discipline or the more insidious imprisonment of being ‘a housewife’, one ant in a very large ant hill (Dyer-Witheford 58). People, however, are not automatons: they experience media, modernity and urbanism in different ways. The same attributes that erode the selfhood of some people enhance the autonomy and personhood of others. The spectacular city, now a matrix of digits, information flows and opportunities, is a realm in which people can subvert expectations and find scope for self-fulfillment, whether by wearing a hoodie that defeats CCTV or by using digital technologies to find and associate with other members of stigmatized affinity groups. One person’s anomie is another’s opportunity. Ambience and Virtualisation Eighty years after Fritz Lang’s Metropolis forecast a cyber-sociality, digital technologies are resulting in a ‘virtualisation’ of social interactions and cities. In post-modern cityscapes, the space of flows comprises an increasing number of electronic exchanges through physically disjointed places (Castells 2002). Virtualisation involves supplementation or replacement of face-to-face contact with hypersocial communication via new media, including SMS, email, blogging and Facebook. In 2010 your friends (or your boss or a bully) may always be just a few keystrokes away, irrespective of whether it is raining outside, there is a public transport strike or the car is in for repairs (Hassan 69; Baron 215). Virtualisation also involves an abstraction of bodies and physical movements, with the information that represents individual identities or vehicles traversing the virtual spaces comprised of CCTV networks (where viewers never encounter the person or crowd face to face), rail ticketing systems and road management systems (x e-Tag passed by this tag reader, y camera logged a specific vehicle onto a database using automated number-plate recognition software) (Wood 93; Lyon 253). Surveillant Cities Pervasive anxiety is a permanent and recurrent feature of urban experience. Often navigated by an urgency to control perceived disorder, both physically and through cultivated dominant theory (early twentieth century gendered discourses to push women back into the private sphere; ethno-racial closure and control in the Black Metropolis of 1940s Chicago), history is punctuated by attempts to dissolve public debate and infringe minority freedoms (Wilson 1991). In the Post-modern city unprecedented technological capacity generates a totalizing media vector whose plausible by-product is the perception of an ambient menace (Wark 3). Concurrent faith in technology as a cost-effective mechanism for public management (policing, traffic, planning, revenue generation) has resulted in emergence of the surveillant city. It is both a social and architectural fabric whose infrastructure is dotted with sensors and whose people assume that they will be monitored by private/public sector entities and directed by interactive traffic management systems – from electronic speed signs and congestion indicators through to rail schedule displays –leveraging data collected through those sensors. The fabric embodies tensions between governance (at its crudest, enforcement of law by police and their surrogates in private security services) and the soft cage of digital governmentality, with people being disciplined through knowledge that they are being watched and that the observation may be shared with others in an official or non-official shaming (Parenti 51; Staples 41). Encounters with a railway station CCTV might thus result in exhibition of the individual in court or on broadcast television, whether in nightly news or in a ‘reality tv’ crime expose built around ‘most wanted’ footage (Jermyn 109). Misbehaviour by a partner might merely result in scrutiny of mobile phone bills or web browser histories (which illicit content has the partner consumed, which parts of cyberspace has been visited), followed by a visit to the family court. It might instead result in digital viligilantism, with private offences being named and shamed on electronic walls across the global village, such as Facebook. iPhone Auteurism Activists have responded to pervasive surveillance by turning the cameras on ‘the watchers’ in an exercise of ‘sousveillance’ (Bennett 13; Huey 158). That mirroring might involve the meticulous documentation, often using the same geospatial tools deployed by public/private security agents, of the location of closed circuit television cameras and other surveillance devices. One outcome is the production of maps identifying who is watching and where that watching is taking place. As a corollary, people with anxieties about being surveilled, with a taste for street theatre or a receptiveness to a new form of urban adventure have used those maps to traverse cities via routes along which they cannot be identified by cameras, tags and other tools of the panoptic sort, or to simply adopt masks at particular locations. In 2020 can anyone aspire to be a protagonist in V for Vendetta? (iSee) Mirroring might take more visceral forms, with protestors for example increasingly making a practice of capturing images of police and private security services dealing with marches, riots and pickets. The advent of 3G mobile phones with a still/video image capability and ongoing ‘dematerialisation’ of traditional video cameras (ie progressively cheaper, lighter, more robust, less visible) means that those engaged in political action can document interaction with authority. So can passers-by. That ambient imaging, turning the public gaze on power and thereby potentially redefining the ‘public’ (given that in Australia the community has been embodied by the state and discourse has been mediated by state-sanctioned media), poses challenges for media scholars and exponents of an invigorated civil society in which we are looking together – and looking at each other – rather than bowling alone. One challenge for consumers in construing ambient media is trust. Can we believe what we see, particularly when few audiences have forensic skills and intermediaries such as commercial broadcasters may privilege immediacy (the ‘breaking news’ snippet from participants) over context and verification. Social critics such as Baudelaire and Benjamin exalt the flaneur, the free spirit who gazed on the street, a street that was as much a spectacle as the theatre and as vibrant as the circus. In 2010 the same technologies that empower citizen journalism and foster a succession of velvet revolutions feed flaneurs whose streetwalking doesn’t extend beyond a keyboard and a modem. The US and UK have thus seen emergence of gawker services, with new media entrepreneurs attempting to build sustainable businesses by encouraging fans to report the location of celebrities (and ideally provide images of those encounters) for the delectation of people who are web surfing or receiving a tweet (Burns 24). In the age of ambient cameras, where the media are everywhere and nowhere (and micro-stock photoservices challenge agencies such as Magnum), everyone can join the paparazzi. Anyone can deploy that ambient surveillance to become a stalker. The enthusiasm with which fans publish sightings of celebrities will presumably facilitate attacks on bodies rather than images. Information may want to be free but so, inconveniently, do iconoclasts and practitioners of participatory panopticism (Dodge 431; Dennis 348). Rhetoric about ‘citizen journalism’ has been co-opted by ‘old media’, with national broadcasters and commercial enterprises soliciting still images and video from non-professionals, whether for free or on a commercial basis. It is a world where ‘journalists’ are everywhere and where responsibility resides uncertainly at the editorial desk, able to reject or accept offerings from people with cameras but without the industrial discipline formerly exercised through professional training and adherence to formal codes of practice. It is thus unsurprising that South Australia’s Government, echoed by some peers, has mooted anti-gawker legislation aimed at would-be auteurs who impede emergency services by stopping their cars to take photos of bushfires, road accidents or other disasters. The flipside of that iPhone auteurism is anxiety about the public gaze, expressed through moral panics regarding street photography and sexting. Apart from a handful of exceptions (notably photography in the Sydney Opera House precinct, in the immediate vicinity of defence facilities and in some national parks), Australian law does not prohibit ‘street photography’ which includes photographs or videos of streetscapes or public places. Despite periodic assertions that it is a criminal offence to take photographs of people–particularly minors–without permission from an official, parent/guardian or individual there is no general restriction on ambient photography in public spaces. Moral panics about photographs of children (or adults) on beaches or in the street reflect an ambient anxiety in which danger is associated with strangers and strangers are everywhere (Marr 7; Bauman 93). That conceptualisation is one that would delight people who are wholly innocent of Judith Butler or Andrea Dworkin, in which the gaze (ever pervasive, ever powerful) is tantamount to a violation. The reality is more prosaic: most child sex offences involve intimates, rather than the ‘monstrous other’ with the telephoto lens or collection of nastiness on his iPod (Cossins 435; Ingebretsen 190). Recognition of that reality is important in considering moves that would egregiously restrict legitimate photography in public spaces or happy snaps made by doting relatives. An ambient image–unposed, unpremeditated, uncoerced–of an intimate may empower both authors and subjects when little is solid and memory is fleeting. The same caution might usefully be applied in considering alarms about sexting, ie creation using mobile phones (and access by phone or computer monitor) of intimate images of teenagers by teenagers. Australian governments have moved to emulate their US peers, treating such photography as a criminal offence that can be conceptualized as child p*rnography and addressed through permanent inclusion in sex offender registers. Lifelong stigmatisation is inappropriate in dealing with naïve or brash 12 and 16 year olds who have been exchanging intimate images without an awareness of legal frameworks or an understanding of consequences (Shafron-Perez 432). Cameras may be everywhere among the e-generation but legal knowledge, like the future, is unevenly distributed. Digital Handcuffs Generations prior to 2008 lost themselves in the streets, gaining individuality or personhood by escaping the surveillance inherent in living at home, being observed by neighbours or simply surrounded by colleagues. Streets offered anonymity and autonomy (Simmel 1903), one reason why heterodox sexuality has traditionally been negotiated in parks and other beats and on kerbs where sex workers ply their trade (Dalton 375). Recent decades have seen a privatisation of those public spaces, with urban planning and digital technologies imposing a new governmentality on hitherto ambient ‘deviance’ and on voyeuristic-exhibitionist practice such as heterosexual ‘dogging’ (Bell 387). That governmentality has been enforced through mechanisms such as replacement of traditional public toilets with ‘pods’ that are conveniently maintained by global service providers such as Veolia (the unromantic but profitable rump of former media & sewers conglomerate Vivendi) and function as billboards for advertising groups such as JC Decaux. Faces encountered in the vicinity of the twenty-first century pissoir are thus likely to be those of supermodels selling yoghurt, low interest loans or sportsgear – the same faces sighted at other venues across the nation and across the globe. Visiting ‘the mens’ gives new meaning to the word ambience when you are more likely to encounter Louis Vuitton and a CCTV camera than George Michael. George’s face, or that of Madonna, Barack Obama, Kevin 07 or Homer Simpson, might instead be sighted on the tshirts or hoodies mentioned above. George’s music might also be borne on the bodies of people you see in the park, on the street, or in the bus. This is the age of ambient performance, taken out of concert halls and virtualised on iPods, Walkmen and other personal devices, music at the demand of the consumer rather than as rationed by concert managers (Bull 85). The cost of that ambience, liberation of performance from time and space constraints, may be a Weberian disenchantment (Steiner 434). Technology has also removed anonymity by offering digital handcuffs to employees, partners, friends and children. The same mobile phones used in the past to offer excuses or otherwise disguise the bearer’s movement may now be tied to an observer through location services that plot the person’s movement across Google Maps or the geospatial information of similar services. That tracking is an extension into the private realm of the identification we now take for granted when using taxis or logistics services, with corporate Australia for example investing in systems that allow accurate determination of where a shipment is located (on Sydney Harbour Bridge? the loading dock? accompanying the truck driver on unauthorized visits to the pub?) and a forecast of when it will arrive (Monmonier 76). Such technologies are being used on a smaller scale to enforce digital Fordism among the binary proletariat in corporate buildings and campuses, with ‘smart badges’ and biometric gateways logging an individual’s movement across institutional terrain (so many minutes in the conference room, so many minutes in the bathroom or lingering among the faux rainforest near the Vice Chancellery) (Bolt). Bright Lights, Blog City It is a truth universally acknowledged, at least by right-thinking Foucauldians, that modernity is a matter of coercion and anomie as all that is solid melts into air. If we are living in an age of hypersocialisation and hypercapitalism – movies and friends on tap, along with the panoptic sorting by marketers and pervasive scrutiny by both the ‘information state’ and public audiences (the million people or one person reading your blog) that is an inevitable accompaniment of the digital cornucopia–we might ask whether everyone is or should be unhappy. This article began by highlighting traditional responses to the bright lights, brashness and excitement of the big city. One conclusion might be that in 2010 not much has changed. Some people experience ambient information as liberating; others as threatening, productive of physical danger or of a more insidious anomie in which personal identity is blurred by an ineluctable electro-smog. There is disagreement about the professionalism (for which read ethics and inhibitions) of ‘citizen media’ and about a culture in which, as in the 1920s, audiences believe that they ‘own the image’ embodying the celebrity or public malefactor. Digital technologies allow you to navigate through the urban maze and allow officials, marketers or the hostile to track you. Those same technologies allow you to subvert both the governmentality and governance. You are free: Be ambient! References Baron, Naomi. Always On: Language in an Online and Mobile World. New York: Oxford UP, 2008. Bauman, Zygmunt. 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