The Midwich Cuckoos (1957), which portrays identical-looking children born without sexual intercourse. I propose a reading strategy that focuses on the fictional spatial order and analyses how the construction of the children’s otherness interferes with the village’s demarcation. Furthermore, I interpret the mysterious pregnancies as a reference to basic embryo research in the 1950s – cloning. Finally, I scrutinize Wyndham’s negotiation of utilitarianism throughout the novel and his critique of truly utilitarian decisions that are based on constructions of Otherness.The British writer John Wyndham (1903–1969) explored societal effects of surprising or mystical events. A paradigmatic example is  This comes as a surprise, because some of his post-war works are well known. His novel, The Chrysalids (Wyndham [1955] 2008), for instance, was turned into a BBC radio broadcast twice in 1982 and 2012. His particularly famous novel is The Day of the Triffids (Wyndham [1951] 1984), which became a classic of British science fiction through its multiple adaptations.2 But, besides a small community of researchers, above all Ketterer  and most recently Määttää , John Wyndham is considered “the unread bestseller” (Rebellato 2010).Research on the British writer John WyndhamThe Midwich Cuckoos ([1957] 1980) against an ethical background, critically negotiating a utilitarian perspective, and against a scientific background, which emerged in the 1950s (i.e. by cloning frogs). Both topoi are, as I will show, connected through Otherness as one of the central elements in science fiction .In medical and health humanities, his name may be unknown for two reasons: first, Wyndham’s works were published two decades before the rise of academic and political discourses in applied ethics. In contrast, contemporary authors like Margaret Atwood are interpreted much more often. Second, it was only five years ago that Miller and McFarlane argued that we should consider “the ways in which science fiction proposes concrete alternatives to hegemonic narratives of medical progress and fosters critical self-awareness of the contingent activity which gives ‘the future’ substance in the here-and-now” . This quote illustrates that for a long time in medical and health humanities, science fiction may have been too far-fetched for ethical analysis. Following Miller and McFarlane, I will interpret Wyndham’s novel known not to be real and iconically so signaled. However, no work of SF can be of lasting value and interest unless it is in fact ultimately about something that is real, something of genuine concern to human beings. He wrote SF, a form which aims at the effects of realism while taking as its main plot device – its generic marker – an invention which is Throughout my analysis, I will follow Ketterer’s understanding of Wyndham’s fiction as “logical fantasies” or “reasoned fantasies” . Such “logical fantasies” are characterized by a combination of archetypical features of classical sci-fi, such as the exploration of new technologies and their effects on society, and mystical or fantastic elements:The Midwich Cuckoos.3.By bringing together advanced technologies and fantasy in an everyday life perspective, Wyndham’s novels seem plausible in the way societies are depicted although some parts of the novel are unrealistic. Through this deviation from reality, Wyndham “offers works rich in symbolic potential” , in which he morally and politically reflects on ideologies of his time: “As he blends Cold-War politics and imaginative elements, Wyndham consistently reaches to images from natural selection, in a bid to awaken in the reader the principles of survival, which have been momentarily usurped by a massified society that rewards weakness” (63) In what follows, the representation of technology is constitutive of many Wyndham plots, but it does not make up its central theme. The focus thus is not on technological progress itself but on the way characters and society are affected by it. This is a characterization also applies to the piece that Ketterer  calls “his best novel, No Entry to Midwich” (MC 9). From the beginning, the village is introduced as a peaceful, quiet place with little contact to an unknown, mostly irrelevant, outside. The relevance and the symbolic meaning of its spatial structure becomes even more evident when the village’s topography is introduced:At the heart of Midwich is a triangular Green ornamented by five elms and a white-railed pond. The war memorial stands in the churchward corner of the Green, and spaced out round the sides are the church itself, the vicarage, the inn, the smithy, the post office, Mrs Welt’s shop, and a number of cottages. Altogether, the village comprises some sixty cottages and small houses, a village hall, Kyle Manor, and The Grange. (11)The novel’s narrator, Richard Gayford and his wife, Janet, live a placid life in Midwich. Their life is, in fact, so quiet that Gayford tells the reader he would not be surprised if there “had […] been posts at the entrances to the village bearing a red triangle and a notice below: MIDWICH DO NOT DISTURB” (MC 11). Representing the prototypical utopian island, Midwich is a microcosm of its own, sealed off the rest of the world, as the heading of the chapter frames the novel: “While most of these buildings can be expected in a village or small town, three of them stand out. The green triangle can be read as a reference to female reproductivity, representing the color of fertility as well as the vulva. The reference of the war memorial indicates that the story unfolds in a period after World War II. The function of The Grange  is most unexpected since “the Ministry took it over for Research” (12). Since The Grange’s interior is inaccessible to all non-scientists, such as the narrator, we never gain insight into the laboratories or experiments. This depiction underscores Wyndham’s strategy of representing science and technology as the backdrop for the plot but not as its central theme: The Grange is introduced parenthetically although, from a certain point of view, it is highly involved in the events.Though Midwich’s spatial order becomes evident very early in the novel, it becomes even more relevant after what is called the ‘Dayout’ (61). When Richard and Janet return from a journey, they find the village inaccessible, resting under an invisible cupola with a radius of two miles. Everyone in the zone is unconscious. Midwich is then considered an “affected area” (37) although no one knows why or by whom it has been affected. The carefully uttered comment, “There’s The Grange,” (38) by an unknown protagonist, neither provokes any reaction nor provides an explanation.Sleeping Beauty. The results are more drastic, however, because several weeks later, “inexplicable pregnancies” (61) occur in the village. They affect all women of childbearing age independent of sexual intercourse. The children are born with supernatural abilities, such as the power to determine the inhabitants’ actions to share knowledge telepathically, thereby also forming a collective identity (122).The novel features a fantasy element here when the “prosaic English village” (175) finds itself in a strange situation reminiscent of the sleeping phase in the Grimm Brothers’ The Midwich Cuckoos was published , Wyndham’s scenario can be considered a form of traditional surrogacy. However, the ‘father(s)’ of the Midwich’s cuckoos remain undetected until the story’s end. After all, these surrogate mothers were impregnated unwillingly in what amounts to a type of rape (Ketterer 2011), since their bodies have become “victims of an imposition” (MC 106). The children are described as ‘cuckoos,’ which is an allegory for a species bringing another ‘strange’ species to life. Unlike surrogate mothers, however, the Midwich women are required to keep their babies constituting another imposition. Interestingly enough, abortion is not an option for the women, perhaps the result of it being both a taboo and a criminal act during the time the novel published.4Although the concept of gestational surrogacy was possible only in the mid 1980s, decades after The pregnancies become a serious social problem particularly for unmarried women (MC 62f.). Later in the plot, despite keeping the pregnancies hidden from the outside, the villagers themselves begin to accept the unmarried pregnant women. However, as a form of taking care of these women, keeping the press at bay is most important for Midwich, in order to decrease anxiety and keep the secret of the village. Consequently, the mothers must remain discreet about their situation: “‘You must all know how the cheap papers seize upon anything to do with birth, particularly anything unusual. They make a peepshow of it, as if the people concerned were freaks in a fairground. The parents’ lives, their homes, their children, are no longer their own’” (71). Thus, this special form of reproduction has to be kept secret: ‘[W]e must, every one of us, resolve not to mention, or even hint outside the village, at the present state of affairs’ (72). This special situation, as unexpected as it is, creates a space of social affiliation and acceptance that is separated from all surrounding communities: “It means that a newspaper is unlikely to get anything to go on unless it is directly informed by someone inside the village” (82). Everybody beyond Midwich’s borders who might receive information about the pregnancies is considered a threat to the community.Being part of the village as well as an unaffected witness of the Dayout, Richard observes Midwich and reports all remarkable events to the local military. Bernard Wescott, the army personnel who mediates between the military and the village, asks Richard to observe the village because of his insider position: “I want a regular report on Midwich’s state of health, mind, and morale so that I can keep a fatherly eye on it. […] I want it so that I can act for Midwich’s benefit, should it be necessary” (51). Richard’s observations make up the main part of the story, which he calls “Midwich’s story” (53) as a means of telling the villagers’ experiences in the localized society. Richard narrates from a perspective marked by a relatively high degree of distance to the events, which is a rare effect given that it is told in the autodiegetic mode (i.e. the first-person perspective). This narrative distance has the interesting effect of a quasi-personification of the village itself – Midwich almost becomes an individual character with emotions and a health status as represented by Richard. Through his monitoring, the village seems to be a self-sufficient subject with the ‘Children’ as its dark side.The Midwich Cuckoos. The first notion of otherness is a psychoanalytical one, interpreting “strangers, gods and monsters […] as tokens of fracture within the human psyche” . As Kearney notes, such literary figures of the other “speak to us of how we are split between conscious and unconscious, familiar and unfamiliar” (4). Following a psychoanalytical interpretation of The Midwich Cuckoos, Bruhm argues that these “children are not ‘children’ but the representation of the primary narcissistic fantasy of Children” . They remind us of the pleasure of raising expectations towards the other (and children in particular) and transferring expectations and desire towards them without recognizing their own identity.Broadly speaking, the topic of otherness can be scrutinized from two perspectives, which are relevant for the interpretation of The second notion of otherness is a political one, which aligns with postcolonial studies. Postcolonial scholars argue that “[t]he existence of others is crucial in defining what is ‘normal’ and in locating one’s own place in the world” . Here, ‘Other’ “can refer to the colonized others who are marginalized by imperial discourse, identified by their difference from the centre and, perhaps crucially, become the focus of anticipated mastery by the imperial ‘ego’” (155).To successfully position a character as the Other demands the a priori binary construct of center and periphery, as discussion of the Other is impossible without a primary definition of the self, which, in turn, rests upon where we see ourselves located. If we inhabit the center of our existence , then the Other, who cannot inhabit the same place, becomes marginalized by definition: they cannot be us. They are different and apart from us. They are outside. For both notions of otherness, the category of space is relevant. In the psychoanalytic and phenomenological tradition, space is the central category to differentiate subjects being-in-the world from other subjects. It allows one to discern one’s identity as separate from one’s own (Pinsky 2003). Thus, space prerequisites responsibility for the other (Moreno Márquez 1987). In the postcolonial tradition, the positioning of a person or group as ‘central’ and ‘marginal’ prerequisites the political and discursive exclusion:Representing, narrating and negotiating both understandings of otherness is the genuine merit of particularly British and Canadian science fiction , which transforms the concrete moral and political issues of time and place into an abstract ‘other.’ Within this process of transformation, spatial demarcations – like the topography in Midwich – represent previously constructed differences.Children’ as opposed to ‘children’ hints at the text’s dimension of social critique, characteristic of processes of ‘Othering,’ before – and that is actually the inspiring point and great merit of the novel – it was discussed academically.The children’s otherness is even marked textually: ‘the Children  (MC 103). This textual marker very much resembles the standpoint in Postcolonial Theory and Cultural Studies, where the pronounced ‘Other’  refers to politically and socially unaccepted, marginalized, or excluded persons in order to “connote an abstract and generalized but more symbolic representation of empire’s ‘others’” . This marker was later reflected precisely in postcolonial theory . Within the novel, the textual marker of the ‘The Midwich Cuckoos, the children’s striking feature is their “abstract foreignness, not calling to mind any particular race, or region” (MC 148). By expressing their strangeness as “abstract” and “untraceable,” Wyndham narrates otherness in both the psychoanalytical and the political forms. The women’s “incubation” (65) by a foreign species touches upon the ground-breaking features of otherness the psychoanalytical notion: the children become an ‘other’ (a subject) through birth; and the peculiar conditions of pregnancy, birth and infancy, which shape the villagers’ attitudes, result in a status of the Other, which is morally and politically different from the inhabitants.In The Midwich Cuckoos is a logical fantasy on Otherness in its multiple forms.The children’s maturity process is characterized by a collective experience of their Otherness as it is constructed by the Midwichers. They encounter a social non-acceptance by being called “intruders” (106), “invaders” (188) and even “monsters” (167). Here, it is important to keep in mind that Wyndham’s works can be characterized as ‘logical fantasies.’ By mentioning the Children’s “abstract foreignness” (148), The Midwich Cuckoos negotiates the social status of so-called ‘bastards’ in post-war rural Britain, which were – like their mothers’ – highly stigmatized and socially excluded. It is, for this reason, no less than Margaret Atwood (2015), who writes:In my opinion, Wyndham’s chef d’oeuvre is The Midwich Cuckoos; it was published in 1957, just as I was 17 and going off to university, so it was a good time for me to be thinking about the consequences of being impregnated by an alien while unconscious, then giving birth to an alien species that ruins your life. The Midwich Cuckoos was certainly a graphic metaphor for the fear of unwanted pregnancies as experienced by the teenage girls of that pre–birth-control era. I myself had a dream about a highly intelligent nonhuman baby after reading this book, although the infant was green; so Wyndham must have been connecting strongly with the collective unconscious.Even though the Midwich scenario might appear very far-fetched at first, the children’s ‘monstrosity’ seems almost commonplace when viewed against the historical background of the pregnant unmarried women in the 1950s . In one interpretation, This contextual interpretation illustrates that Wyndham’s novel can be seen as a moral standpoint concerning the social status of the ‘Other’ in that it problematizes its social status. Likewise, Midwich turns into a microcosm cut off from its surroundings. Other villages in this area see it as “a kind of mental home without bars” and a “local deficiency area” (133) to other villages. Compared to the neighboring villages, Midwich is considered the Other; the uncanny, strange and monstrous counterpart. However, through Richard’s point of view, it also becomes evident that Midwich’s perception as “daytouched” (133), i.e. affected by the ‘Dayout,’ corresponds to a perspective from the outside – the narrator, being part of the village, hardly finds anything strange in the people’s behavior. This, in turn, puts the reader in an ambivalent state because objectively the village is unusual, but the reader is drawn in due to the subjective, narrative perspective.After the children’s birth, the negotiation of Otherness continues when they perform telepathy and make people do things they otherwise would not do. For example, all children who were born outside Midwich are brought back to the place even if their mothers do not want to move. Even though the village mistrusts the children, it comes to accept their existence in the end. Although they finally decide to give birth to the children, doubts remain whether their decision is a right one as it is commented by Gordon Zellaby, the village’s novelist and the most educated inhabitant: “How is one to know with – strangers?” (167).The ambivalence prevails when the children are later offered to live at The Grange as “a group of their own kind” (132). Since their perspective is never a part of Richard’s narration, the reader remains clueless with regard to the concrete events in The Grange. Richard only imparts that at The Grange, Zellaby educates the children. The children’s collective position at this special place nearly turns out to be their fate in the end when Midwich decides to burn down The Grange. By using their telepathic capacities and ordering Midwich’s inhabitants to attack one another, the Children rescue themselves. Moreover, they isolate the community from the outside and stop all residents from leaving the village. This leads to incomprehension on the part of non-Midwichers; a bus driver, who observes passengers being inhibited from boarding by an invisible object, says: “In Oppley they’re smart, and in Stouch they’re smarmy, but Midwich folk are just plain barmy” (168).Likewise, the characters show attitudinal ambivalence towards the Children alternating between curiosity and suspicion or even fear while the reader is uncertain as to the reasons behind these events as Richard offers no explanation. Nevertheless, the vagueness of their actions is maintained since the children prevent neither the police from “coming inside” nor the ambulance from bringing the injured to hospitals, i.e. “the outside” (173). So, despite their peculiarities, the Children seem to share some sort of moral compass or intuition.The events in Midwich also attract the military, as the Intelligence Major assumes that the place is attacked by the opponent of its time, i.e. the “Ivans” (38), or an alien force. Accordingly, in contrast to the press and some villagers, the military is not interested in The Grange but rather focused on “a large dent in the ground which certainly looked as if something massive had rested there for a while” (47). Although it is not spelled out within the novel, this incident hints at the landing of a U.F.O.[I]t is possible, is it not, in some of the lower forms at any rate, to induce parthenogenesis?’ ‘But not, as far as is known, among any of the higher forms – certainly not among mammals.’ ‘Quite. Well then, there is artificial insemination.’ ‘There is,’ admitted the doctor. ‘But you don’t think so.’ ‘I don’t.’ ‘Nor do I. And that,’ Zellaby went on, a little grimly, ‘leaves the possibility of implantation, which could result in what someone – Huxley, I fancy – has called ‘xenogenesis’. That is the production of a form that could be unlike that of the parent – or, should one perhaps say, ‘host’? It would not be the true parent. (63f)Like the narrator, Richard, the novelist, Zellaby, has a special position in Midwich society since he is the one who tries to explain the pregnancies and gets closest to the children. In various references to novels and theories, Zellaby is portrayed as a very well- educated character, while other villagers and, especially, Bernard Wescott dismiss his explanations. Along with the village’s doctor, Zellaby tries to find a rational explanation for the pregnancies, which differ from the U.F.O. hypothesis:homo sapiens. The possibility of artificial insemination is also dismissed because all women in Midwich must have ovulated at the same time: “By the law of averages it simply is not possible in any sizeable group of women taken at random, for more than twenty-five per cent of them to be in the same stage of pregnancy at the same time” (MC 64). Methods, such as a “fertilizing gas” (83), are also discarded by Zellaby. According to him, one potential but very frightening explanation is a phenomenon that Thomas Henry Huxley (1908), the grandfather of the novelist Aldous and biologist Julian Huxley, called xenogenesis, referring to the growth and birth of an ‘alien’ species in the body of another. This possibility makes the village extremely anxious. The employees at The Grange, in turn, maintain their silence: “Either the researchers were of the opinion that the affair somehow came within the compass of their oaths of secrecy, or else they were of the opinion that it was safer to act as if they did” (MC 77). The text leaves open (until its end) who initiated the xenogenic pregnancies. Possible answers in the diegetic world are the researchers – staging the U.F.O. scenario to anesthetize and distract the village – or an actual U.F.O. landing, which would surely categorize The Midwich Cuckoos as a fantasy novel .The characters refer to those reproductive medical procedures, which correspond to the state of research in the mid-twentieth century: First, the phenomenon of parthenogenesis, and second artificial insemination, which was already practiced in the 1950s . The first option is considered unlikely since parthenogenesis is not known to happen in higher mammals, such as the The Midwich Cuckoos as logical fantasy in the style of Wyndham (see above). Despite some indications in the text, the alien invasion being the cause of the inexplicable pregnancies remains just one interpretation among others. Considering the overall symbolism of the novel, there is another explanation for the events, namely that The Midwich Cuckoos is one of the first novels on human cloning. Thus, I propose an interpretation that these fictional pregnancies resulting in children, who all look and behave the same, evoke techniques of reproductive medicine, which was growing as an academic discipline after WWII . From the narrated actions and events, this interpretation is not evident, but some parts of the novel and some contextual information support the hypothesis that The Midwich Cuckoos is one of the first novels on human cloning .In fact, it is precisely the text’s vagueness, which classifies As Spemann was aware, cellular fates might be sealed in at least two ways. The identity of individual cells might be established by their local environment – their positions relative to other tissues. But it was also possible that during development the nucleus underwent changes that progressively stifled its developmental capacity, making it less than totally potent. For some readers, this might come as a surprise since the technical possibility of cloning – transferring the nucleus DNA of any somatic cell from a full-grown mammal into an egg cell previously deprived of its nucleus DNA – is often connected to the birth of the sheep, Dolly, decades later . However, the history of cloning can be traced back much longer, as it was already part of basic research in the post-war period. As the application to mammals was very far-fetched, the goal was to obtain differentiated knowledge of cell development. Briggs and King (1952) at the Cancer Research Institute in Philadelphia wanted to specify the cells at a certain stage of development of the embryo. By Spemann’s (1938) results, it was already known that eight-cell embryos are totipotent. However, it was still unclear what development would lead to a later differentiation led by cells:First of all, researchers were eager to find out whether there were different cell nuclei in the embryo or whether the differentiation during the development process happened after fertilization.  For their experiment, Briggs and King gutted eggs from a frog larva and put them in the nuclei of a blastula, a very early embryonic stage of development. New larvae resulted from this nuclear transfer. Furthermore, nuclei from the gastrulation stage, the next step in embryonic development, were also transferred. From these cells, however, viable larvae were developed . By this, Briggs and King proved that different cells of the embryo had different genetic material. However, there was still an uncertainty because, due to technical circumstances in these experiments, not only the nucleus but also a small part of the cytoplasm was transferred. Following Briggs and King’s research, never living tadpoles emerged: “The implications for any proposal to clone from an adult cell are clear: Dolly was, by the understanding of the 1950s, a fiction, a mirage, an impossibility” .Although the transfer itself was successful, most attempts did not lead to cell division (Gurdon 2001). Assuming that this was due to technology, the embryologists henceforth used cells from the gastrula, which were developed even further. However, a contradiction arose: Many embryos did not develop or had severe anomalies. However, about twenty percent of the attempts were successful although with the most differentiated cells. Briggs and King had previously declared this to be impossible (1952).After American research left many questions unanswered, it was John Gurdon (born in 1933) in England, who continued the basic research on cloning. In fact, it was in Great Britain, where Dolly was born in 1996. Already in 1958, Gurdon succeeded in Oxford by creating not only tadpoles through the transfer of embryonic cells but also frogs. It was this research, which later refuted the theses of Briggs and King .The Midwich Cuckoos and the cloning experiments of its time is plausible by considering the children’s features more closely. After being born, all of them are healthy and inconspicuous apart from their very fair hair and golden eyes (MC 148). The children’s golden iris is reminiscent of the eye of a frog that Briggs and King tried to clone at Philadelphia University, the Rana pipiens. Moreover, the children’s remarkable features do not only include their eyes and telepathic capacities but also their resemblance to one another: “Sixty-one similars – so similar that most of their ostensible mothers cannot tell them apart” (MC 100). The perception of the children as ‘another species’ is not only suggested by their resemblance but also by their behavior as they learn, act, and talk in a similar manner. Hence, they share a collective identity, conscience and phenotype, even though they are all different individuals:[I]f I ask him to perform an action, I shall get more or less the same result, but it is likely to be more successful with some who happen to have better physical coordination than others – though, in point of fact, with such close similarity as there is among the Children the variation will be small. [...] [I]t will not be an individual who answers me, or performs what I ask, it will be an item of the group. (122)One link between 5 So, they evoke clones in a specific way.Even though the technique of cloning is not mentioned in the novel, the topoi of sameness and collective identity of a special group that dissociates from others, historically align with a list of cloning novels .One has to speculate, of course. Not very satisfactory, I’m afraid, and sometimes uncomfortably. It is, for instance, disquieting for a good rationalist, such as myself, to find himself wondering whether perhaps there is not some Outside Power arranging things here. When I look round the world, it does sometimes seem to hold a suggestion of a rather disorderly testing-ground. The sort of place where someone might let loose a new strain now and then, and see how it will make out in our rough and tumble. Fascinating for an inventor to watch his creations acquitting themselves, don’t you think? To discover whether this time he has produced a successful tearer-to-pieces, or just another torn-to-pieces and, too, to observe the progress of the earlier models, and see which of them have proved really competent at making life a form of hell for others. [...] Ah, well, […] the speculations tend to be uncomfortable. The Children form a special group of their own; talking and playing only with each other and rarely with other children in Midwich. Even Zellaby utters doubts about the U.F.O. thesis, assuming that the events and experiments at The Grange led to the pregnancies:Through its most educated character, Zellaby, the text again represents an uncertainty of the events in Midwich as well as the possibility of human intervention, an experiment. As a ‘testing-ground,’ The Grange might play a role inducing the experiment out of scientific curiosity, as Zellaby continues: “And when I say ‘Inventor,’ I don’t necessarily mean an individual, of course. It seems to me that if a team of our own biologists and geneticists were to take a remote island for their testing-ground they would find great interest and instruction in observing their specimens there in ecological conflict” (205).The Midwich Cuckoos as an early novel of reproductive cloning, or at least as an evocation of cloning, seems plausible. Even though it remains unclear in the conclusion of whether or not the children were the result of aliens or human experiments, the many allusions to medicine, biology, and genetics offer an interpretation yet unconsidered: It is reasonable to suggest that the insular village of Midwich refers to experiments that were first possible in the 1950s when technological progress formed the basis for cloning.Since Zellaby is presented as the most rational character, the interpretation of The Midwich Cuckoos is not the only one of Wyndham’s works, which draws upon cloning. Plan for Chaos (posthumously published in 2009)6 is another instance of Wyndham’s use of a version of cloning, which narrates how Nazis are cloning an Aryan race. According to Ketterer (2009), who edited the novel, it was the first, which “deals with the theme of cloned Nazis.” Here, clones are on a mission to dominate and control the world; a salient theme in Wyndham’s oeuvre. Indeed, Plan for Chaos can be seen as a companion piece to The Midwich Cuckoos.Besides, Like the war memorial and the green triangle, the shape of The Grange is highly symbolic. The descriptions of the building are significant on an interpretative level: “[U]tilitarian wings […] were added to The Grange when the Ministry took it over for Research” (MC 12). On the one hand, this shows that the building is complemented by additional space in the form of laboratories (215). The original agricultural function of the space is exceeded with the addition of ‘wings.’ On the other hand, the word ‘wings’ refers to the context of theater where ‘wings’ are the spatial scenery and background of the stage. In this sense, the fictional ‘utilitarian wings’ in the novel can be interpreted as the cultural background of the villagers’ attitudes, actions and aims. Herein lies a reference to the British cultural tradition of utilitarian ethics. In this sense, I interpret the ‘utilitarian wings’ as a pragmatically larger building and, in parallel to the novel’s symbolic dimension, as connected to ethical traditions that follow moral principles, such as the collective happiness of all people concerned by an action .In Britain, Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873) founded utilitarian ethics. They still form an important and influential tradition of moral theory and bioethical evaluations of technologies, as in the work of the Warnock-Commission that scrutinized the rise of new reproductive technologies in Britain . Utilitarianism is a consequentialist form of ethics, which aims at the prevention of suffering and the increase of happiness. Classic utilitarianism refers to the consequences resulting from actions to morally evaluate them; that is, it promotes actions providing happiness and condemns actions providing suffering .Utopia ([1516] 2010) already dealt with the question of how to achieve the greatest common good. Whereas Utopia was written in the Renaissance and was located insularly, the modern utilitarian discourse is oriented toward the future asking how the common good can be achieved (Macho 2005).Although the consequences of actions are also relevant to other ethical theories, classical utilitarianism especially follows the common good as its main principle. The discussion around utilitarianism is, in fact, only a continuation of a cultural discourse that had long been present in British literature. For instance, More’s The Midwich Cuckoos from an ethical perspective, we see how moral premises underlying utilitarianism emerge. Since the military knows that a similar incident occurred in Russia, it observes Midwich to ascertain whether this form of life consists of artificial intelligence (MC 190). When the Russian village is destroyed, the British military sees the children as a threat to the human species. The treatment of children in Russia finally leads to a contrast of two different systems: Russia, where the individual is subordinated to the state, and England, which considers the state an institution that serves individuals (198). Since the text mentions the “iron curtain” (189), the fear of strangers seems to be a negotiation of the cold war and the invasion of the Soviets. Thus, The Midwich Cuckoos also negotiates collective processes of Othering between the East and the West after WWII.Reading Implicitly, Zellaby contrasts England’s civilization with negative eugenics of National Socialism as he comments: “History has shown us to be more tolerant of minorities than most” (198). This statement, in turn, is contrasted with a claim by the children, who argue that even a civilized country like England could probably not tolerate a minority that one day might become too powerful and take over control (198). Through the children’s reflection, the situation becomes a political and moral issue: “They [left-wing forces] want to defend our rights as a threatened minority, and children, and that. Their leaders will glow with righteousness on our behalf. They will claim, without referendum, to be representing justice, compassion, and the great heart of the people” (199). Thus, the children are seen as a “national danger” (191) and become an ‘Other’ by being considered a “racial danger” (191).own kind” (158). Thus, their elimination is based on the necessary premise of Otherness:homo sapiens. Are we right to do this? [...] [A]re we not fully entitled – indeed, have we not perhaps the duty? – to fight them in order to protect our own species? After all, if we were to discover dangerous wild animals in our midst our duty would be clear. (158)At present, we are conceding them all the privileges of the true This political negotiation, as developed by the children themselves, is also mirrored in the village. Some people in Midwich argue that the children are “another species” (158), leading then to conclude that killing the children does not count as murder since “murder is, by definition, the killing of one’s outlaws lacking any juridical title. As a person of character, it is Zellaby who acts as their lawyer and moral advocate: “[I]t would appear that if they kill us it is murder, but if we were to kill them it would be just something else. One cannot help feeling that a jurist, lay or ecclesiastical, would find such a proposition ethically unsatisfactory” (158). In this scene, Zellaby understands morals as a protective function for the social ‘Other:’ If the children actually are ‘Other species’ and if murder only entails the killing of ‘one’s own kind,’ they cannot ‘murder’ the people in Midwich either.In this scene, Wyndham develops the central moral standpoint of the novel by expressing a harsh critique against instrumentalizing the argument of Otherness by legitimizing their elimination. Considering a strategy of self-defense, the majority favors killing them by regarding the children as savages without morals and rationality. On the contrary, the minority still considers a dialogue with the children in order to find a solution through deliberation. The children are – even if the term is not mentioned in the novel – The Midwich Cuckoos, are often used to illustrate varying moral principles as well as the difference between intentional harm and the side effects of a harmful action.7In the end, the children ironically point out “a moral dilemma of some niceness” (208): They cannot be killed without harming the village since they would always anticipate and counteract any such an attempt due to their telepathic capacities, whereas keeping them alive might bring harm to the village. Therefore, their existence not only raises the question of how to act but also whether the killing of some villagers is necessary  to save the rest of Midwich and eliminate the children. Again, Zellaby provides a solution: “In a quandary where every course is immoral, there still remains the ability to act for the greatest good of the greatest number” (158). This allusion to utilitarianism places the novel itself in the British tradition and makes it a literary form of classical thought experiments. These, in turn, as fictional as children, for the first time:For the first time since my return I was able to appreciate that the Children had ‘a small c’, too. [...] It was impossible to associate the Children, as I saw them now, with danger. I had a confused feeling that these could not be the Children, at all; that the theories, fears, and threats we had discussed must have to do with some other group of Children. [...] I was finding it harder every moment to believe that we had not all of us been somehow deluded by a sweeping misunderstanding about the Children[.] (MC 216)In the novel, Zellaby, who is terminally ill, not only reflects the dilemma but also acts according to his analysis. By committing suicide, he kills the children, an application of the utilitarianism: ‘the greatest good for the greatest number,’ i.e. the survival of the majority of Midwich’s population and the elimination of the threat. However, he acts on mere assumptions since it remains unclear whether the children would have been a real danger to society. As Richard, the narrator, helps Zellaby transport the film equipment and candy, he approaches the children as The Midwich Cuckoos. Instead, the narrator, who observes the village intensively, constantly perpetuates it.While mostly validating utilitarian ethics, Wyndham still manages to depict the children not as monstrous but as harmless, curious and friendly. During a daily encounter, Richard eventually transcends his own attitude, which makes the seemingly utilitarian act appear even more like a mere genocide. Similarly, the ambivalence between scientific experiments and an extraordinary event, such as the landing of an U.F.O., is never completely resolved in The Midwich Cuckoos not as a mere fiction but to take them seriously given their moral standpoint.With the final change in Richard’s point of view, the story ends on an ambiguous note, which makes room for an important ethical reflection; that is to say, to what extent is our moral judgment influenced by our experiences of prior assessments of ‘Others’? Does our appreciation and evaluation of the ‘Other’ have any influence on our moral judgement (Hansen and Cronjäger 2015)? In this paper, I proposed a strategy of novel reading that first and foremost opens up a perspective on science fiction for the discourse on science and technology with a critical perspective on otherness and othering. It is crucial to consider novels such as Typically, Wyndham’s ‘logical fantasies’ closely follow the events of the characters who, given the background, fall victim to a technological or scientific constellation. In doing so, he disregards the ethical problems of science and technology and, instead, discusses related social consequences. Moreover, his reproductive fantasy offers leeway for a wider reflection of the historical and social construction of otherness in the context of reproduction, e.g. the status of so-called ‘bastards’ or social taboos with regard to reproductive techniques.The Midwich Cuckoos is not a dystopia, such as Huxley’s Brave New World. Rather, it may count as a literary thought experiment focusing on a collective microcosm and its negotiation of unexpected events and persons. For medical humanities, novels such as The Midwich Cuckoos might provide an ethical perspective yet unconsidered. Particularly with the spatialized dynamics of inclusion and exclusion, The Midwich Cuckoos confronts its readers with a perspective of society’s ‘Others’ and the relevance of a community’s attitude when evaluating their status.Although each clone has a name – significantly marking them as individuals – the village mainly refers to them as ‘baby’ or ‘child’ since they are indistinguishable, at least for outsiders. However, from a perspective of otherness, the following reading strategy is plausible: They Children are perceived as ‘Other’ (a threat) in the political notion, and not as ‘other’ (a person) in the psychoanalytical sense. By seeing them as one threatening, strange, and uncanny entity, Midwich encounters the Children as one person, one individual. However, through the narration, it becomes clear that the development of their collective identity is a consequence of a very similar, if not the same socialization process, during which the villagers discursively construct their Otherness, which is then followed by fear. With these alternations and symbolism of Othering,


On the basis of Buber’s distinction between “I-It” and “I-Thou” relationships, this paper explores the role of sex in intimate relationships by analyzing research in the fields of psychoanalysis and attachment theory. In the “I-Thou” relationship mode, both parties are often able to fully participate in the current sexual behavior and respond wholeheartedly. When there is incoordination (or even conflict) in sexual activities, they can negotiate sincerely, and can even repair the relationship if it breaks down. In the “I-It” relationship mode, sex exists more as a tool to achieve a certain purpose , and the intersubjective relatedness is abnormal: either the boundary will be blurred and others become my vassal (control strategy) or I become others’ vassal (compliance strategy); or the relatedness will be cut off, leading to loneliness or false independence (avoidance strategy). It is a oneness that transcends all else. I feel overwhelmed and in a grand passion, and very close to the person I love.—a female interviewee , p.425.The warmth, the sight, smell, sound, feel, and taste of her body is exquisite. I’m sure I sound like a broken record to her, but every one of my senses all over transmits wonderful feelings to me when I’m inside her.—a male interviewee , p.325.Sex is not so important in contemporary psychoanalysis as it was in the early stages of the field. This decreasing emphasis can be seen in the significant slowing of the publication of relevant literature . NeverthAs a description of human relationships, Martin Buber’s intersubjective theory is enlightening and has influenced many psychoanalytic researchers. However, compared with its influence on humanistic psychology, the application of Buber’s theory to psychoanalysis continues to call for further study . In his According to Buber, in an “I-Thou” relationship, the other is treated as a relatively independent subject. This means that the subject is able to understand differences with others , and participants in such a relationship interact with each other with sincerity . In the synchrony sex. In this type of sex mode, the touch at the physical level and the opening and response at the emotional level can achieve coordination, bringing both sides into a self-evident and deep sense of fusion. Physically, the contact between skin is so close, and the switching between touch and being touched is so frequent, that the body boundary between individual and others becomes very blurred and even seems to be erased , as well as body movements  of each other ,b. This This undigested “difference” is especially obvious in “solitude after intercourse.” According to In this kind of synchrony sex, sex becomes “a safe adventure.” As a result, sexual coordination and emotional stability complement each other. Specifically, it brings the following positive effects in the unconscious and conscious field. First, because both sides can immerse themselves in it and get full sexual enjoyment, it can strengthen the emotional connection and bond, and make both sides feel closer . AccordiClearly, perfect cooperation in sexual behavior represents an idealized situation. In actual intimate interactions, some lack of coordination, out of step actions, interruption and even conflict are inevitable. In fact, there are many differences in sexual behavior between men and women. For example, studies have shown that men tend to have more sexual desire than women, specifically as follows: (1) men masturbate more frequently; (2) men desire sex more frequently and are more likely to feel unsatisfied; (3) in the process of intimacy promotion, men tend to be the party who wants to have sex earlier; (4) men have higher frequency of sexual fantasizing; (5) men are more willing to engage in sexual consumption, such as buying sex toys and pornographic materials; and (6) men are more willing to accept casual sexual behavior . In addiIn sexual activities dominated by the “I-Thou” relationship, even if there is an uncoordinated situation, both sides can often have good and effective sexual communication. For example, in the first story in Chapter 9 reported by Similarly, in another story of remarried women reported by In some difficult situations, the sexual relationship may break down; at this time, repair is particularly important. For instance, one of the partners may have a physical barrier that leads to the inability to have sex or the disharmony of the sexual relationship. Generally speaking, if both partners can enhance communication, improve some skills, overcome or solve physical problems, they can successfully tide over the “crisis” without seriously threatening the relationship . In moreIn fact, compared with “transient” sexual excitement, “lasting” emotional intimacy is a glue that sustains intimate relationships for a longer time and tends to allow relationships of the “I-Thou” mode to be healthier. Research shows that there is a stage of retreat of passion in intimate relationship . The begAn additional healthy characteristic of “I-Thou” mode relationships, especially those with physical or mental sexual barriers, is adaptability. There are some couples who can accept the fact that each other has sexual barriers: they can live happily together even without good sexual behavior . In a caIn short, in intimate interactions dominated by the “I-Thou” relationship mode, both parties can often devote themselves to the current sexual activities, so sex becomes an important way for them to express their intimacy. In the words of In addition to the ideal situation in which a relationship is dominated by the “I-Thou” mode, many unsatisfactory situations also exist. As a result, sexual behavior dominated by the “I-It” mode has gradually emerged. In this kind of relationship mode, both sides often cannot regard each other as equal subjects. This kind of monological love is not “real outgoing to the other, reaching to the other, and companying with the other.” Instead, a monological man “tries to incorporate the other into himself… the withdrawal from accepting the other person in his particularity in favor of letting him exist only as one’s own experience, only as a part of oneself” , p.89. Ccontrol is the main theme, in one kind of situation, the other party is used to simply obtain sexual pleasure. The compliant party in this relationship has become a pure tool of catharsis, and the emotions and needs of this party have been ignored. In this case, the feelings of both sides are often empty. The dominant party often obtains a certain degree of satisfaction, whereas the compliant party is not respected and its value is devalued. Therefore, this kind of sexual behavior is harmful to the intimate relationship. sealed-off sex. For example, in one of the cases reported, Marie (the compliant party) described the relationship as follows: “I am a blow-up Barbie for him. Our sex is so empty. It takes me to the end of alone.” In contrast, Kyle (the dominant party) said: “Since all the fighting started. I stop feeling, and sex becomes mechanical. Then I see you as ‘the woman.’ It’s safer that way. At least I know how to do sex. Closeness is harder.” Similarly, in some cases described by In a sexual relationship in which According to In another kind of case, the physiological satisfaction brought by sex is not the focus, but the important thing is to gain psychological control over the relationship and partner. In In terms of specific mechanisms leading to control, the realization of sexual coercion can be divided into three categories: language, emotion and physical action. It can be direct or obscure. For instance, when a man wants to make his partner have sex with him when his partner is not willing, he can use language to influence his partner by saying, “If you satisfy me this time, I’ll buy you a necklace tomorrow.” If the partner wants to get this “reward,” she may match his sexual needs. In addition, he can also display negative emotions to complete this manipulation, such as glaring angrily or apathetically into the face of the partner without saying a word, forcing the other party to comply with his needs. In the form of physical action, he can also use the infliction of physical pain to make the latter yield to his own violence. Of course, this kind of coercion or manipulation can also be carried out in many ways at the same time, such as violence against a partner in anger, accompanied by verbal humiliation  for two major reasons: (1) to gain a feeling of absolute control over a woman I felt rejected me, and (2) to prove I was as worthless as my inner turmoil made me believe I was. When I raped, I felt a commitment to finish intercourse after initiating my approach, though I didn’t want sex (I was after that feeling of utter control and domination over someone else) . Because of the fear of abandonment, they tend to restrain their sexual needs, follow their partner’s preferences and try to please their partner . As a reIn more serious cases, compliance will tend toward the state of masochism. For those who tend to be abused, their autonomy has been greatly limited and impaired, and they must be in a “symbiotic state” with their partners to obtain a sense of security . As a re1 for a long time in a closed system, it is undoubtedly strengthening an interactive way of manipulating women.When using avoidance strategies, individuals often choose to cut off connection with their partners, showing indifference, independence and self-sufficiency in sexual behavior . These i2 In via fantasy to achieve sexual pleasure (and orgasm). In other words, this kind of individual is immersed in the internal loop instead of in the needs of the external others.Along with the stimulation of pornography, avoidant individuals often turn to masturbation. Many studies show that masturbation is an important way to get pleasure, and it generally occurs in many different countries and is performed by people of a variety of age and gender groups . Even inIn addition, even if some individuals who use avoidance strategies can have sex with their partners, they are often unable to devote themselves completely to the act. For example, when some avoidant attachment individuals have sex with their partners, they will experience a relatively strong sense of alienation and estrangement, while showing a lower level of physical emotion. Even in sexual fantasies, they show alienation from their partners . For theAnother way to fight a partner through sex is to show a certain degree of “split.” Specifically, on the one hand, these individuals show impotence or apathy in the face of their legal partner (“relationship one”), and on the other hand, they have sexual reactions with people other than their partner (“relationship two”) . For exaIn the “I-It” relationship dominated sexual mode, we distinguish three typical interactive strategies: control, compliance and avoidance. In these types of interaction, either sex becomes the purpose, turning people into a tool to vent their desires; or sex becomes a means where the purpose is to achieve economic guarantee or a sense of security and control. In these cases, a relatively independent subject does not exist: either the boundary is cleared and blurred, and others become my vassals (control strategy) or I become others’ vassals (compliance strategy); or the relatedness is cut off, resulting in loneliness or “false independence” (avoidance strategy). These sexual behaviors are in sharp contrast to what It is worth noting that the interaction strategy in sexual relations is not invariable, but will change in the specific relational matrix. On this point, we can draw an analogy with Sroufe’s point of view. As described by In addition, according to Buber’s point of view, the “I-It” relationship and the “I-Thou” relationship are both necessary parts of human survival, and they complement each other. On the one hand, living in the world, we must rely on others to provide me with materials, maintain basic needs, in order to make a living. At this point, relying on and using others is indispensable. On the other hand, people tend to transcend themselves, yearn for holiness and pursue deeper meaning, which can only be achieved through the “I-Thou” relationship. Therefore, human beings live in the dual world of “I-It” and “I-Thou” relationships . In thisOn the basis of Buber’s intersubjective theory, this paper discusses the role of sex in intimate relationships by reference to research in psychoanalysis and attachment theory. Under the mode of “I-Thou” relationships, the subjectivity of the partner can be fully demonstrated: both parties can often fully participate in the current sexual behavior and respond wholeheartedly. In this process, sex and love achieve a healthy combination. When there incoordination (or even conflict) arises in sexual activities, both parties can negotiate with each other sincerely and even repair the relationship after rupture. At this time, compared with sex, the role of affect is more prominent. In the mode of “I-It” relationships, sex acts more as a tool to achieve a certain purpose , so the intersubjective tie of partners is abnormal: either the boundary is cleared and blurred, others become my vassal (control strategy), or I become others’ vassal (compliance strategy); or the bone is cut off, leading to loneliness or “false independence” (avoidance strategy). It is not hard to see that intimacy dominated by “I-Thou” relationship is more adaptable. Thus, the guiding of lovers or couples who are trapped in the “I-It” relationship to the “I-Thou” relationship remains the goal of further work.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The perception of survivorship among the cancer communities of the Caribbean is largely unknown. This study focused on determining the perception and interest in cancer survivorship among breast cancer (BC) patients in Trinidad and Tobago, as a preliminary, to introducing a pilot survivorship program and evaluating its impact on this patient population. Participants were given a questionnaire to determine needs, expectations and interest in survivorship care. Baseline measurable outcomes reported in this article include the following: 1. Participants’ satisfaction with their medical care follow-up plan (if any), 2. Participants’ satisfaction with the amount of information provided by healthcare providers, and 3. Participants’ satisfaction with their physician’s overall concern about their well-being, ranked on a 5-point Likert scale. Participants also reported on the advice/ guidelines provided by their physicians, after surgery and/or on completion of treatment, what they did to cope with BC, and their expectations of what could have been done to improve the quality of care received. A second questionnaire was then used to measure the level of interest in participating in a Cancer Survivorship Program (CSP) with components such as: nutrition, psychosocial development, spiritual well-being, and yoga and mindfulness. The level of interest was ranked by participants on a 5-point Likert scale. Fifteen themes emerged from participants’ responses to the first questionnaire. Nutrition stood out as the module of highest interest, followed by psychosocial development among BC patients. Survivorship is a term used interchangeably with the term survival, but the definitions are quite distinct. Generally, survival after cancer is described as a function of time. But, integrating quality of life with time, now introduces the concept of survivorship. Survivorship, as defined by the National Cancer Institute  focuses What is evidently lacking in the literature on cancer survival is a focus on the self-reported needs of cancer patients. This study presents the needs and expectations of survivorship care support among BC survivors, in addition to their self-coping strategies, as described by a cohort of breast cancer survivors in Trinidad (T&T). We also measured patients’ interest in participating in a Cancer Survivorship Program (CSP) oriented towards improved knowledge and management of their health. Interest in educational modules, specifically nutrition, psychosocial well-being, spiritual well-being, and yoga and mindfulness were also evaluated.ParticipantsA prospective observational study was conducted. The participants were female patients between the ages of 18-69 years with resected breast cancer between December 2020 and June 2021, at the St. James Medical Complex (SJMC) in Trinidad and Tobago. Out of 129 eligible BC patients treated at SJMC, 60 participants agreed to participate in this study. Participation was voluntary, but written consent was mandatory in order to participate. They were each given approximately two weeks to complete a self-administered survivorship questionnaire. Patient demographics were collected from their clinical charts. Approval for this study was obtained from the Research Ethics Committee at the North-West Regional Health Authority, governing the St. James Medical Complex, and the Research Ethics Committee of The University of Trinidad & Tobago.Measurement instrumentsTwo questionnaires were designed to collect relevant baseline information from the sample population and to determine needs, expectations and interest in survivorship care. The participants’ responses described their current survivorship experiences. Baseline measurable outcomes reported in this article include participants’: 1. Knowledge about available support services, 2. Satisfaction with their medical care follow-up plan (MCFP) (if any), 3. Satisfaction with the amount of information provided by healthcare providers, and 4. Satisfaction with their physician’s overall concern about their well-being, ranked on a 5-point Likert scale. Participants also reported on the advice/guidelines provided by their physicians after surgery/completion of treatment, what they did to cope with BC and their expectations of what could have been done to improve the quality of care (QoC) received. Participants were then exposed to the concept of survivorship and the delivery of a CSP using a didactic model via virtual sessions conducted by the PI and research team. A second questionnaire was then used to measure the level of interest in participating in a CSP with components such as: nutrition, psychosocial development, spiritual well-being, and yoga and mindfulness. The level of interest was ranked by participants on a 5-point Likert scale.Statistical analysisThe responses from the 5-point Likert scale were used to compare higher levels of interest  with less interest . Univariate tests of association between participants’ demographic and clinical parameters were performed using Welch t-test and Chi-squared tests. For the three qualitative questions asked, participants' responses were manually coded in Microsoft Word  using an inductive approach [Sample descriptionDemographic InformationThe demographic data is reported in Table Clinical CharacteristicsEleven clinical parameters, defined in Table Needs, expectations and satisfaction with careFrom the analysis of participants’ responses on (1) what guidelines were provided during their care, (2) what could have been done to improve QoC, and 3) what they did to cope, 15 themes were identified , aftercare, surveillance, nutrition and coping mechanisms for themselves and caregivers. This is reinforced in the following quotes, taken verbatim, from their questionnaires:“I would like more information concerning my cancer situation and a general knowledge about cancer. They should be more informative.” “I would have liked an information booklet to take with me, as I was already overwhelmed with the diagnosis, and would have liked to be able to read the info once I got home, plus, have it for reference AND also include the places and services that I would need for my aftercare.” “The providers could have facilitators conducting in-house talks or have videos shown regarding coping strategies, health care tips, and how to help our family cope while we await our turn to be attended to by the doctor” “Was not told what I can eat or not. Did not know that BP and blood should not be taken from on the side that you had surgery. No one at the hospital told me.” Medical systems and treatment: Sixteen participants indicated that their QoC could have been better with improvements in wait time, the atmosphere at the facility, the availability of medication and follow-up care, clerical services for appointments and compassion and support by medical providers. This can be seen in the subsequent quotes taken directly from the participants:“More efficient service at the clinics that don’t result in such long days for patients.” “Process was too long to receive radiation. Medication took long to receive which caused some anxiety.” “Provide information and be willing to answer questions that patients may have. If medication is not available, patients should be given an appointment as soon as it becomes available. Long waits are certainly unacceptable. Persons are ill.” “I guess in terms of speaking more nicer and giving more encouragement, because going through that is scary and we at least want to hear something comforting, especially if it’s from the doctors who diagnose us.” Support services: Some participants indicated the need for counselling and stress management services as a means of coping. This was corroborated in the responses below:“They need a whole new plan. A system where qualified persons are assigned to different areas such as nutrition, coping skills, counselling, etc. so the burden is not on one person alone. You also need people with understanding and who are caring.” “Interact more, provide counselling services as stress is a leading cause of cancer.” Acquiescence: This theme was revealing because one-third of participants indicated their satisfaction with their providers’ care during their survivorship journey. The reflective question demonstrates that some participants are resigned to the systems and structures in place. For example:“I believe they are doing the best they can, with the tools available to them.” “I think the quality of care was fair enough, so I have no complaints.” “At present, the care is good because I am not experiencing any ill health.” Participants' Description of Advice and/or Guidelines Provided by Their Physicians During TreatmentWhen looking at the participants’ experiences with provided advice and guidelines during their care, four main themes became apparent. Provision of a medical care follow-up plan (MCFP), nutritional advice, stress management tools, with the concerning dominating theme of no guidelines provided. These themes are now expounded further below.No advice or guidelines provided: Alarmingly, the predominant theme, as reported by 65% of participants, was that no guidelines were provided by their physician or medical team. Participants reported feeling unsupported and having to enquire and search for available services . In addition, participants indicated that guidelines and coping mechanisms were provided by other BC patients compared to anything being proffered by their health providers. This theme is demonstrated in the following examples taken verbatim from the questionnaires.“None. A little more informative and follow-up support.” “No advice. This had me very concern.” “No one spoke about counselling. I had to enquire for myself. I felt unsupported.” Medical-care follow-up plan (MCFP): Most participants who reported on received guidelines indicated that it was specific to their MCFP, which primarily focused on cancer surveillance. It is interesting that not everyone had an MCFP, since this is an essential part of cancer treatment. Some of the most specific responses on this theme are as follows:“I have three follow-up visits for cancer surveillance which include periodic mammograms, scans, and blood work. No advice was given to me regarding psychological interventions and coping strategies.” “Follow-up visits have been scheduled every 6 months e.g., mammograms and breast ultrasounds.” “I have to continue with my mammograms for my other breast and be aware of any abnormalities that may develop.” .Stress management: Stress management advice was obscurely reported by the participants and included suggestions for rest and relaxation, maintaining a positive attitude, having a spiritual focus, and staying healthy and fit. It is important to note that this category of advice was delivered in a non-formal varied format. For example:“To stay positive, even though I am in remission, that as scary as it is as there is a chance it can come back, but I’m keeping strong and praying to God for the best.” “Maintain my positive attitude. Ensure that I get enough rest daily. Maintain my spiritual focus.” “Keeping healthy and fit, staying strong and positive.” Nutritional: The advice and guidelines on nutrition were very vague and unstructured. Only five participants reported to have been advised on nutrition during their survivorship journey. For example:“I was advised to limit my meat intake.” “Diet changes and cancer surveillance.” “Just to eat everything in moderation.” Mechanisms Disclosed by Participants to Help Them to Cope With Breast CancerThis section shows what mechanisms the participants used to cope with BC during their survivorship journey. Seven major themes emerged. Participants discussed: reliance on social support systems, spiritual beliefs/ practices and being proactive about acquiring knowledge, nutritional modifications, avoidance of negative triggers, in addition to, adopting an attitude of fortitude.Spiritual beliefs/practices: The most evident coping mechanism reported by participants was their faith and faith-based practices such as prayer, meditation, and devotion. As stated literatim,“It was tough there were times when I wanted to give up and not continue with chemo because of how it made me feel. The pain was agonizing and not something anyone wants to experience. But through it all, I tried to stay strong and prayed all the time, and God helped me get through it.” “I prayed a whole lot. I also had support from my Pastor and family. Strong faith in God and his word is what gave me strength during this journey.” “Spending time with the Lord was a tremendous help. Listening to online services, reading my bible and studying the Word of God.” “My attitude to this diagnosis is very clear, my attitude is that of a winner. My spiritual beliefs have bolstered my faith and by His stripes I am healed. In addition, I always dress up for my appointments because if you look good you feel better. I also do positive affirmations I will live and declare the works of God.” “I have definitely become more spiritual; could not get through a second of the day without talking to my Maker.” Social support systems: The second leading coping mechanism described among participants was their reliance on the support of family and friends, including other BC patients. Participants also depended on the support of their medical team to help manage their fears and anxiety. This is evidenced below.“I coped really well. I have a really supportive family which is a blessing. I spoke to other patients at the center who shared their stories and I read a lot of survivor stories.” “Initially, I felt overwhelmed but my doctor pacified my fears about dying. He encouraged me that I do not have to die from this disease. The fact that I was diagnosed early enough before it spread helped me to stay encouraged.” “I relied on the support of my family, especially my mother and sister who are both cancer survivors.” Acquiring knowledge: Self-directed information seeking on their BC condition specifically on diagnosis, treatment/side-effects, aftercare and learning more about their chances of survival, using online resources, including cancer survivors’ blogs/testimonies. These were fundamental methods of management among participants. To illustrate:“I coped pretty well as I Googled the different Cancer sites and read many patients' blogs.” “Doing my research on my stage of cancer and only listening to positive journeys of BC survivors.” Activities: Physical and recreational activities helped to keep participants distracted and pleasantly occupied. Some of those highlighted recreational activities were baking, reading, music, television, outdoor activities - breathing in the fresh air and being reminded about life; while others suggested that their daily routines of housework, continued employment and caring for their families helped them to manage. Some examples include:“I kept distracted by trying to keep up with my normal routine, as much as I could, when I could. Exercising, gardening, playing games on my phone, binge watching shows online, tv.... the little things help.” “I’ve found a new love for baking and I have been sewing as well, to occupy my time. I’m also spending time reading and studying the Bible.” Attitude: Participants indicated that having a positive, resilient attitude was helpful. They also expressed the benefits of accepting their diagnosis and being compliant with their treatment. This is demonstrated in the following statements:“Have a positive attitude and an open mind to treatment. Have a great desire to live. I never felt sorry for myself. I always try to see the positive side of what some may have seen as bad news. I solicit the advice of medical practitioners and I don’t allow the views of non-medical professionals to alter my thoughts, attitude or lifestyle.” “At the beginning, when I became aware of my condition, I was very frightened thinking I would pass on; but as time went on, with a lot of prayers, and with the treatment that was prescribed by the consultant, my feelings became more positive.” .“I had to accept the fact that I had BC and that I had to go through a treatment plan.” “I had to remind myself that my body was not 100% and to slow down . Allow my family to help me to do things. I had to stop being so self-conscious.” Avoidance: As a mechanism, avoidance can be related to the preceding theme of attitude, as participants described their determination, in ascribing to specific behavioural modifications, to improve survivorship. Three persons, quoted below, spoke about their need to avoid negative situations as a way to cope with their BC.“I solicit the advice of medical practitioners and I don’t allow the views of non-medical professionals to alter my thoughts, attitude or lifestyle.” “I also did not tell too many people of my situation, as their reaction was taking me back to how I felt, when I first got the diagnosis.” “I stayed away from negative situations and people.” Nutrition: Nutritional changes were also mentioned by just under 20% of participants, as a way to manage their BC. While most of these participants generally stated “diet changes or eating well”, two participants specified in more detail as follows:“I found joy in preparing healthy foods and used my time to learn about what causes cancer, how I can selfheal and nourish my body and prevent a reoccurrence.” “I became more aware of what I ate and eliminated some foods from my diet and get more disciplined with my daily exercise.” Satisfaction With Survivorship CareParticipants’ responses gave us an idea of how satisfied BC patients were with their standard of cancer care as shown in Table Table Interest among participants in a survivorship interventionThis section measures interest in a Cancer Survivorship Program (CSP), a didactic model with a nutritional module, a psychosocial module, a spiritual module and a yoga mindfulness module Table . Data anUnsurprisingly, 90% of the participants showed high interest in participating in a CSP Table . Only twThere was 87% interest in a didactic model of a CSP among the group of participants. Participants were exposed to the concept of a didactic model as being one that is educational, designed to achieve lifelong coping skills, by applying the principles of effective teaching and learning, referring to Bloom’s Taxonomy of the Cognitive Domain , KrathwoOverall, 97% of the participants were interested in a nutritional module, which was the highest recorded interest level, among participants for any module/parameter measured. This heightened interest could be due to recent research trending in nutrition and healthy living in the fight against cancer. In 2018, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) published the Third Expert Report entitled, Diet, Nutrition, Physical Activity and Cancer: A Global Perspective that extensively covers the role of nutrition in improving survival outcomes as well as its possible role towards cancer prevention [As expected, there was also high interest in the psychosocial module among the majority (90%) of participants. Depression and anxiety are often neglected areas of management in cancer patients, even though depression is a significant complication of cancer with higher occurrence than in the general population . PinquarThe lowest recorded interest, shown among participants, was for the yoga and mindfulness (67%) and spiritual (68%) modules respectively. Over a quarter of participants (25.6%) who identified with the Christian faith, as well as 75% of Jehovah Witnesses, showed less interest in yoga and mindfulness. Surprisingly, 62.5% of Hindus were also less interested in yoga and mindfulness, whereas 80% of Muslims showed interest in this module. Three persons were not interested in the yoga and mindfulness module. These results were most likely due to stigmatization and conflicting religious and spiritual beliefs about yoga. However, many studies have proven the tremendous benefits of yoga in improving rates of survivorship. In their review of evidence-based research, Agarwal and Maroko-Afek revealed that yoga improved physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing strong support for yoga’s integration into conventional cancer care .The lower levels of interest in the spiritual module can be attributed to the indication that all participants had already ascribed to a particular religious belief that seemed to work well for them. As such, they may not need further spiritual support. Spirituality in Cancer Care (PDQ®)-Patient Version, published by the National Cancer Institute, informs that many patients with cancer rely on spiritual or religious beliefs and practices to help them cope with their disease, coined “spiritual coping” . A meta-This aspect of the project used a combination of open-ended questions on expected, perceived, and current survivorship care among BC participants from Trinidad & Tobago (T&T). From this research, we were able to attain insights into the needs of participants during their BC journey. The need for information and knowledge was identified as an overarching theme. Generally, participants expected more information (38%) specifically at the point of diagnosis, to prepare them for their imminent BC journey. However, most of the information was acquired from their own research and other patients’ advice (23%). The participants revealed that more information during their journey would have improved their treatment regimens, nutritional choices, managing side effects of treatment, and more. It has been recognized that patient education and knowledge, at diagnosis and onwards, can improve patient outcomes .The need for support services such as mental health, stress management and nutrition, was another critical theme emerging from this study. Following a cancer diagnosis, just nine participants (15%) expected to receive counselling  from their care providers, while one-third of the participants were resigned and had no further expectations. It is well recognized in the literature on psycho-oncology that psychological interventions, not only at the time of a cancer diagnosis but throughout survivorship, can improve outcomes . It is wParticipants identified the need for nutritional advice during their survivorship journey. Participants expected that guidelines and dietary advice would have featured more prominently in their treatment plan. Nutritional guidelines should be a part of standard cancer care, considering the substantial impact of nutrition on patients’ survivorship rates .It is important to note that the practice of faith-based religion was largely prominent as the major coping mechanism among the majority of participants (82%) during their BC journey. This implies that a spiritual belief system improved coping with cancer, which is strongly supported in the literature. Spirituality is an effective adaptive coping strategy and a predictor of a better quality of life in cancer patients .This study acknowledges effective patient-directed coping strategies such as a resilient attitude, positive affirmations, adherence to clinical advice/treatment plans and avoidance of negative triggers (such as circumstances that caused them to relive their diagnosis). There were patient-oriented coping tools that stood out, such as religion, attitude and knowledge-seeking. Those were keystone factors in participants’ survivorship journey. Most participants described adopting these practices to be able to endure the hardships of their condition.Additionally, we used 5-point Likert scales to determine interest in a Cancer Survivorship Program which included interventions such as a didactic module, a nutritional module, a psychosocial module, a spiritual module, and a yoga and mindfulness module. The results convincingly showed that there was a high interest in a CSP (90%) among cancer patients. However, due to substantial interest in a CSP, significance among the various parameters that were tested showed little variation. Participants showed higher interest in nutrition and psychosocial modules compared to the spiritual and yoga and mindfulness modules. Generally, as analysed, there was considerable interest (≥60%) in all areas of the CSP.LimitationsThe responses were all self-reported by participants in the study. Self-reporting is associated with their own biases , howeverIn addition, the nature of perception reflects the participants' reality based on their background such as level of education and individual cultural differences and may not be the actual situation as is reported in this paper. The participants were all patients treated at one primary institution in T&T. However, the study site is the main cancer treatment center in Trinidad and Tobago and will capture a large proportion of BC patients. Lastly, this research was done during the COVID-19 pandemic whilst transitioning to lockdown which may have allowed for less access to public health facilities and perceptions may not be representative of the actual public health setting for past or future patients. This merits continued prospective insight into cancer care needs to better validate representative BC perceptions.This study demonstrated that BC patients have specific information needs that require attention by the primary cancer treatment center in T&T. This can be effectively achieved through the dissemination of informational booklets, at the point of diagnosis, to educate patients on their cancer to help manage expectations. Further to this, participants desire improvements in the medical system and structures, particularly in the lengthy wait time in the clinic, and at follow-up services. Other improvements mentioned were better support from the medical team and the need for support services such as counselling to manage stress/anxiety resulting from a BC diagnosis, as well as advice on nutrition to improve health management. Participants generally described the advice or guidelines provided by physicians as vague and non-standard, which could be attributed to patient-provider relationships and/or personal understanding. Notable was that the majority of patients indicated that no advice or guidelines were given specifically related to cancer surveillance for recurrence/secondary cancers, late effects of treatment, psychological interventions and coping strategies. Some participants suggested that because treatment was ongoing, they may not have yet received advice or guidelines for future management. However, participants who completed treatment also reported that no such advice/guidelines were given. Seven themes emerged from patient-directed coping strategies: spiritual support, knowledge-seeking, activities , attitude, avoidance and nutrition. These findings provide evidence for the establishment of a holistic survivorship program encompassing the unmet needs of cancer patients to enhance coping.


Research data management (RDM) requires standards, policies, and guidelines. Findable, accessible, interoperable, and reusable (FAIR) data management is critical for sustainable research. Therefore, collaborative approaches for managing FAIR‐structured data are becoming increasingly important for long‐term, sustainable RDM. However, they are rather hesitantly applied in bioengineering. One of the reasons may be found in the interdisciplinary character of the research field. In addition, bioengineering as application of principles of biology and tools of process engineering, often have to meet different criteria. In consequence, RDM is complicated by the fact that researchers from different scientific institutions must meet the criteria of their home institution, which can lead to additional conflicts. Therefore, centrally provided general repositories implementing a collaborative approach that enables data storage from the outset In a biotechnology research network with over 20 tandem projects, it was demonstrated how FAIR‐RDM can be implemented through a collaborative approach and the use of a data structure. In addition, the importance of a structure within a repository was demonstrated to keep biotechnology research data available throughout the entire data lifecycle. Furthermore, the biotechnology research network highlighted the importance of a structure within a repository to keep research data available throughout the entire data lifecycle. FAIRfindable, accessible, interoperable, re‐ssableRDMresearch data management1Research data management (RDM) is a complex and dynamic process that guides researchers through the various stages of the data lifecycle and enables scientists and other stakeholders to effectively and responsibly manage community‐generated research data . The expHowever, modern tools and techniques for managing research data are still hesitantly used by the research community . Public Investigations suggests that there is often irritation for researchers what research data sharing means and how terms such as “data repositories, FAIR and RDM” should be understood . Many reDue to the huge and growing amount of data, the importance of findable, accessible, interoperable, and reusable (FAIR) research data management (RDM) is becoming increasingly important, but is still rather hesitantly considered in bioengineering. One of the reasons may be the specific character of bioengineering, where two disciplines – life sciences and engineering – have to meet different criteria and have to fulfil different expectations of the communities. Here, we present the example of a bioengineering research network with tandem projects each comprising researchers of the two disciplines. It is demonstrated, how important a structure within a data repository is, to keep research data available throughout the entire data life cycle.FAIR criteria, conflicts can arise because data management with duplicate data storage can be confusing and requires more resources [Today's data driven science community, publishers, and funders rely on sustainable data . Researcesources , 15. Eacesources . Fundersesources , 19.RDM as a collaborative approach and team effort can address issues such as the need for a sustainable research data structure needed by all stakeholders and required by publishers, funders, or policy makers , 20, 21.In life sciences, as a part of biotechnology, standards and more than 400 databases and repositories are available for research community , 11. EleIn engineering science, many standards are already set by the technology industry . In engiCross discipline science like bioengineering has to meet a different mindset, tools and solutions for research . New minAs an integral part of the “InterZell” priority program, the Dataverse DaRUS has already been available to the 50 biotechnology researchers from the fields of life sciences, process optimization and engineering since the beginning of the research network. The research focus of the priority program is on cell–cell or cell–bioreactor interactions, in which enormous amounts of research data (Big Data) will be generated in experiments or in simulations and modeling. In order to structure these data in a FAIR‐compliant manner, the coordinator provided the prerequisites in the initial phase of the program. Therefore, a concept was created how the life cycle of the data can be structured Figure , in ordeA top‐down strategy could support FAIR data management  from theCross‐disciplinary collaborative approaches in biotechnology require universally accessible repositories open to all disciplines worldwide. The DaRUS repository met these conditions and was therefore applied to the “InterZell” program. However, FAIR data management in biotechnology can only be successful as a collaborative approach. RDM, which started with a top‐down strategy, that is, providing infrastructure and training, will fail if it is not accepted by teams as part of a bottom‐up strategy. A collaborative approach requires that all researchers manage their data FAIR throughout the lifecycle.As a cross‐cutting discipline, data management in bioengineering must meet the different requirements of the life sciences and process engineering, and must therefore be continuously adapted as the two individual disciplines evolve. Therefore, responsible experts, coordinators, and data curators are needed to continuously adapt the structure of data storage to meet the challenges, especially in these heterogeneous frontier areas. However, RDM is only effective in everyday research if FAIR is accepted as a collaborative community approach.The authors have declared no conflicts of interest.


The news credibility detection task has started to gain more attention recently due to the rapid increase of news on different social media platforms. This article provides a large, labeled, and diverse Arabic Fake News Dataset (AFND) that is collected from public Arabic news websites. This dataset enables the research community to use supervised and unsupervised machine learning algorithms to classify the credibility of Arabic news articles. AFND consists of 606912 public news articles that were scraped from 134 public news websites of 19 different Arab countries over a 6-month period using Python scripts. The Arabic fact-check platform, Misbar, is used manually to classify each public news source into credible, not credible, or undecided. Weak supervision is applied to label news articles with the same label as the public source. AFND is imbalanced in the number of articles in each class. Hence, it is useful for researchers who focus on finding solutions for imbalanced datasets. The dataset is available in JSON format and can be accessed from Mendeley Data repository. Also, there is a high variation in the number of tokens/words within articles. Therefore, different NLP techniques and machine learning algorithms can use the dataset to solve these problems.1Although the 134 news websites are free and public, we have replaced the identity (Uniform Resource Locator URL) of each website with “source_1”, “source_2”, “source_3”, etc. in the JSON objects in a file named “sources.json” under the main directory to anonymize the news source websites. Each object has an anonymous name of the news source and a label for the news source . The scraped public Arabic articles are stored in 134 sub-directories within the directory named “Dataset”. Each sub-directory is named according to the anonymous names (e.g. “source_1”) of the 134 news sources. Each sub-directory has a file named “scraped_articles.json” which contains the information of the articles that were scraped from the public news source and stored as an array of JSON objects. Each object stores the title, text, and the publication date of the article. 2Here, we present the issues that we encountered during the collection of the dataset and the methods that we used to handle them.Many of the public news websites have separate link pages that are related to local news of some Arab countries. The local pages were selected rather than the main page for each source to avoid international news and to scrape more public news articles. Out of the 134 news sources, 82 public websites support the RSS feed of local news. Thereby, the public news articles for these sources were scraped from the RSS feed and the local page links.The public news articles were scraped for six months starting from February 1, 2021 to July 30, 2021. During this period, we have continuously checked the collected public articles to ensure the soundness of the data scraping. Duplicated articles, unrelated articles of the public source , articles in non-Arabic languages, articles supported by videos rather than text, and articles that are unrelated to events or news were all eliminated. Moreover, no pre-processing methods were performed on the articles text. It is worth mentioning that all these articles are available in the public domain.Misbar, the public Arabic fact check platform, uses a rating system that labels published articles in public news websites. There are eight labels which are: True, Fake, Misleading, Selective, Suspicious, Myth, Commotion, and Satire. We used Misbar and searched manually for all Arabic news that were already labeled in the previous 9 months. Also, during the scraping phase, Misbar was continuously checked for new articles from any of the 134 public news websites. Some of these news articles were published by one or more of the chosen news websites. When all public news articles (based on Misbar) of a news website were classified as True, then the website was classified as credible. On the other hand, when all public news articles (based on Misbar) of a news website were not-True (belong to one of the remaining seven categories), then the website was classified as not credible. Finally, public news websites that have articles that belong to both categories (True and not-True) were classified as undecided. After that, all scraped articles from a credible websites were labeled as credible, scraped articles from not credible website were labeled as not credible, and scraped articles from an undecided website were labeled as undecided. This distant labeling method can result in errors and noise and our analysis has shown that. Hence, natural language processing techniques can be used by researchers to find errors and correct them.We have investigated the AFND dataset and it is found that it is imbalanced in terms of the number of news websites and the number of articles in each class. The percentage of public websites within the undecided class is less than credible and not credible classes. However, the number of public articles that belong to the undecided class is the largest. This observation opens a research problem on using natural language processing techniques to mine the articles text to find correlations and semantic similarities that can automatically detect public Arabic fake news. The dataset was used in a research paper, titled “Detecting Arabic Fake News Using Machine Learning” no human subjects, no animal experiments, and data was not collected from social media platforms.•Terms of service (ToS): The public and free Arabic news websites are available for any one and allow the news articles to be scraped. We are not using the data for any fraudulent activities such as making profit (e.g.business), DDoS, data theft, or any other sort of bad intention.•Copyright: The data does NOT belong to users . The data are published on free and public news sites that can be consumed by any one who has access to the Internet. This is similar to search engines that use bots to index web pages.•Privacy: Although the data is free and published in the public domain, we have replaced the identity (Uniform Resource Locator URL) of each website with “source 1”, “source 2”, “source 3”, etc. to anonymize the websites and the news articles.•Scraping policies: There is no special scraping policy.This work involved Ashwaq Khalil: Methodology, Software, Data curation, Formal analysis, Investigation, Validation, Writing – original draft, Visualization. Moath Jarrah: Conceptualization, Validation, Resources, Writing – review & editing, Supervision, Project administration, Funding acquisition. Monther Aldwairi: Conceptualization, Supervision, Funding acquisition. Manar Jaradat: Writing – review & editing.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.