The scattering of gases on solid surfaces plays a vital role in many advanced technologies. In this study, the scattering behavior of helium on graphene surfaces was investigated, including the thermal accommodation coefficient (TAC), outgoing zenith angle of helium, bounce number, and interaction time. First, we performed molecular dynamics simulations to describe the incident angle-resolved behaviors, and showed that the scattering is highly dependent on the zenith angle of incident helium but insensitive to the azimuthal angle. The contribution of the normal velocity component of the incident helium dominated the energy transfer. The nonlinear relationship of the parameters to the zenith angle of the incident helium could be suppressed by increasing the graphene temperature or decreasing the speed of the incident helium. Subsequently, the scattering performance considering all gas molecules in the hemispherical space was evaluated using the Monte Carlo method with angle-resolved results. The result showed that the TAC, its nominal components, and the zenith angle of the scattered helium increased with higher speeds of incident helium and lower temperatures of graphene. This study should provide a fundamental understanding of energy transfer between gas and two-dimensional materials and guidelines to tune the scattering behavior between them. The scattering dynamics of gas-phase molecules on the surface of solids ,2,3 play2 were found to be independent of the gas pressure and temperature  with a cutoff of 12.0 Å, where ε takes 1.6228 meV, and σ is 3.053 Å. Those values come from the OPLS-AA force field [A vacuum layer of 50 Å was added on each side of the graphene to avoid interaction between real helium atoms and the imaged carbon atoms of the graphene. The helium atom was initially placed at a plane 40 Å higher than the top surface of the graphene. The atomistic interactions of graphene were described using the modified AIREBO force field , which hce field  accordinBk is the Boltzmann constant, T is the thermodynamic temperature, and m is the mass of the helium atom. The incident zenith angle (polar angle) and azimuthal angle of helium were specified to evaluate the effect of the incident angle of the molecular beam. It is worth noting that samples with a polar angle of 90° correspond to the cases where the normal velocity component is zero. The helium atom could be attracted to the graphene surface purely by the van der Waals interactions. During the scattering of helium on graphene, helium gained kinetic energy from the graphene and eventually escaped from the attraction of the graphene surface. The simulation ceased when the outgoing helium was 15.0 Å from the graphene surface. The velocity and coordinates of the helium atom were recorded during the scattering process for further analysis.All molecular dynamics simulations were conducted with the LAMMPS code . A heliuE, v, m, and T denote the kinetic energy, speed, mass, and thermodynamic temperature of the helium atom, respectively. sT and gT indicate the temperature of the solid surface and the incident helium gas. Bk is the Boltzmann constant. The subscripts “in” and “o” indicate the incident and scattered helium, respectively.The Maxwell model has been widely applied for calculation of the thermal accommodation coefficient . This model indicates that the α fraction of gas molecules has diffuse scattering on the solid surface, and the remaining fraction has specular scattering. In this way, TAC is described asnα) and nominal tangential thermal accommodation coefficient  byin,xyv and in,zv denote the in-plane and normal components of the speed of the helium atom, respectively.To identify the contributions of the in-plane and out-of-plane components of the energy transfer, we decomposed the thermal energy accommodation into the nominal normal thermal accommodation coefficient  and real tangential thermal accommodation coefficient  may also be evaluated using the following definition, given the zenith angle inθ of the incident helium:According to the definition of TAC, the real normal thermal accommodation coefficient fi–(9), respectively. In this way, the relative frequencies in the various ranges of the incident angles can be obtained. Subsequently, the angle-resolved TAC was recalculated by replacing the denominator of Then, the Monte Carlo method was used to sample the velocity components of the helium gas. In detail, the Box–Muller transform method with the acceptance–rejection method was used, such that zv, of incident helium was zero, such that the helium atom was adsorbed onto the graphene surface by the van der Waals interactions. As shown in zv decreased from zero to the negative maximum, where the negative sign indicates helium moving towards the graphene surface. During this process, helium atoms initially moved slowly downward and then accelerated. Afterward, the interaction between helium and graphene changed from attraction to repulsion, and the normal velocity component of helium declined. When helium arrived at the first minimum position above the graphene surface, zv became zero. After that, the helium atom bounced back from the graphene surface due to the repulsion forces between helium and graphene. The zv of helium atom increased quickly to the local maximum, where the attraction and repulsion between helium and graphene were balanced. Then, zv decreased as the attraction of graphene became weaker, dominating the graphene–helium interaction as helium moved away from the graphene. There were several different following behaviors. As shown in sample 1, the helium was far away enough from the graphene surface and had enough kinetic energy to escape from attraction by the graphene, leading to a scattering process with a single bounce. Another case is that the kinetic energy stored in the graphene might not be large enough for the first bounce-back process, and the helium atom would be attracted to the graphene surface again until it obtained enough kinetic energy to escape from attraction by the graphene. This is illustrated by sample 2, in which there were five bounces of helium until it flew away from the interaction region. In this study, we did not find any cases where the helium atom was trapped on the graphene surface within the simulation time.The scattering process of gas molecules on solid surfaces can be composed of the adsorption, trapping, and escaping stages. One of the latter two stages may not show up during the scattering. The scattering behavior shown above varies randomly depending on the initial status of the graphene and the helium atom, such as the initial location, incident velocity, and incident angle of the helium atom. As shown in inθ) ranged from 0° to 90° with an increment of 10°, while the azimuthal angle (inφ) was specified at 0°, 30°, 60°, and 90°, respectively, as shown in φin, TAC values increased significantly with larger values of inθ. Furthermore, TAC was insensitive to the inφ with the given inθ. For instance, TAC was 0.127 for a inθ of 0° and 0.319 for a inθ of 90°, which was 2.525 times that of the former value. For inθ of 0°, the incident velocity of the helium atom was normal to the graphene surface, and it was parallel to the surface for inθ of 90°. To evaluate the contribution of the normal and in-plane velocity components, we decomposed the TAC into nominal normal thermal accommodation (NNTAC) and nominal tangential thermal accommodation coefficients (NTTAC) in Equations (2) and (3). inθ was greater than 60°, which means that in-plane kinetic energy was transferred from the helium to the graphene. As a result, we found that the kinetic energy component of the normal velocity contributed to a higher TAC and higher energy transfer along with a larger zenith angle. According to the definition in the Maxwell model, the real normal thermal accommodation coefficient  and real tangential thermal accommodation coefficient  were calculated by Equations (5) and (6), respectively. Bk·sT) was 0.086 eV, and the kinetic energy of the incident helium atom at 500 K was 0.0646 eV, which was 75.1% of the former. When the zenith angle was smaller than 30°, the normal kinetic energy transferred by ideal diffusive scattering was a small value, which is the denominator. The case was the same when the zenith angle was larger than 70°. Interestingly, the variance in RNTAC at a small inθ was larger than that of RTTAC at a high value of inθ, which also demonstrates the importance of the normal velocity of the incident helium and the large contribution of the normal kinetic energy transfer during the scattering process.Systems of monolayer graphene and a helium atom were simulated to elucidate the zenith-angle effect of the incident helium on the scattering process. The zenith angle  were set as the threshold planes of the scattering. Those curves showed that, similarly to the bounce number, the interaction time had a correlation with the zenith angle of the incident helium except for the special cases of a inθ of 90°. The interaction time gradually increased from 1.839 ps to 4.968 ps for a inθ from 0° to 80°. The TAC averaged by the interaction time changed slightly. For inθ of 90°, the value rose sharply to 16.681 ps. To evaluate the influence of the normal velocity of the incident helium, we evaluated the interaction time by setting the threshold planes as 7 Å above the graphene surfaces. The dashed curves represent the results in inθ of 90°, which decreased the efficiency of the heat energy transfer.The interaction time between helium atoms and the graphene surface provides another angle to understand the scattering process of helium on the surface, as shown in To understand why the zenith angle of incident helium significantly affected the TAC and scattering behaviors, we plotted the contour of the potential energy for the helium–graphene system. The potential energy was calculated by averaging the potential energy of the system in a dynamic run. First, a helium atom was introduced above the well-equilibrated monolayer graphene. Then, the potential energy was sampled by placing the helium atom in the x–z plane shown by an inlet with a resolution of 0.1Å. The reference potential energy was set when the helium atom was 20 Å above the graphene surface. Then, the system ran 1000 steps in the NVE ensemble with a timestep of 1.0 fs between each sample of the potential energy. In this way, the system was sampled 1000 times, and the averaged potential energies were plotted in the x–z plane in inθ of 0°. inθ of 10° and 90°, respectively. Those results confirm that the energy transfer of helium on graphene was insensitive to the azimuthal angle. inθ of 10°, the NNTAC values ranged from 0.043 to 0.079, while the NTTAC values fluctuated from 0.061 to 0.067. We found that the relative variance in the normal kinetic energy transfer was larger than that in the in-plane counterpart. The absolute values of NTTAC were comparable to those of the NNTAC. In the case of a θin of 90°, the NNTAC values ranged from 0.304 to 0.353, while the NTTAC values fluctuated from −0.023 to −0.0006. It is notable that the in-plane energy transfers from helium to graphene and the change in NNTAC were much larger than those in NTTAC in absolute values. In terms of RNTAC and RTTAC, the red curve of RNTAC and blue cure of RTTAC show larger fluctuations in inθ of 10° and inθ of 90°, respectively. The reasons are the same as described above. On the other hand, we found that the variation in RNTAC with a inθ of 90˚ and RTTAC with a inθ of 10˚ was much lower than their counterparts, and the absolute values of those curves were much larger. We can conclude that energy transfer between helium and graphene is insensitive to the azimuth.oθ), average bounce number of helium, and interaction time of helium with graphene (t) were plotted with the various azimuthal angles in oθ for a inθ of 10° ranged between 21.056° and 21.932°, while the range of oθ for a inθ of 90° was from 57.463° to 59.042°. The variance in both cases was less than 4% and was much smaller than the change in TAC.The zenith angle of scattered helium  shown in inθ was larger than 30°, the zenith angle oθ became smaller with higher graphene temperatures. This change increased as inθ increased. In addition, the change in oθ with graphene temperature was much lower than that in TAC and TAC components, and changes at a high inθ were larger than those at a low inθ. In the cases of the three temperatures, the inθ of specular reflection was between 30° and 40° and became smaller with higher graphene temperatures. The linear region of inθ was between 30° and 60°, and the slope became smaller with higher graphene temperatures.The zenith angle of the scattered helium , the zenith angle of scattered helium, the bounce number, and the interaction time of helium with graphene. Performance was insensitive to the azimuthal angle of the incident helium but highly dependent on the zenith angle. Moreover, the nominal normal thermal accommodation coefficient (NNTAC) and nominal tangential thermal accommodation coefficient (NTTAC) were defined by decomposing the kinetic energy transfer into the in-plane and normal velocity components of helium. We found that TAC and NNTAC increased nonlinearly with larger zenith angles in the cases of incident helium at 500 K and graphene at 1000 K. In contrast, the NTTAC decreased with increasing zenith angle. However, NNTAC outweighed NTTAC, and kinetic energy transfer via the normal velocity of helium dominated the energy transfer between helium and graphene. The real normal thermal accommodation coefficient (RNTAC) and real tangential thermal accommodation coefficient (RTTAC) defined by the Maxwell Model were consistent with the NNTAC and NTTAC, respectively, except for larger fluctuations in RNTAC at a low zenith angle and RTTAC at a large zenith angle. The zenith angle of the scattered helium nonlinearly increased with a larger zenith angle of incident helium. The zenith angle of the scattered helium was linearly correlated with the zenith angle of the incident helium in the middle range from 30° to 60°. However, it deviated from a linear correlation significantly at either low or high zenith angles of incident helium. The scattered helium had the same zenith angle, approximately 44°, as the incident helium. The bounce number increased with higher zenith angles of incident helium. In the case of a constant incident helium speed and graphene temperature, it was consistent with our hypothesis that a higher bounce number corresponded to greater energy transfer between the gas and the solid surface. Helium took more time to interact with the graphene when the zenith angle of incident helium was larger. In particular, an extremely long flight time was required when the incident helium speed was parallel to the graphene surface. The effect of the zenith angle of the incident helium atom stemmed from a heterogeneous distribution of potential energy between helium and graphene, and the dynamic vibration of the graphene atoms mitigated the differences in the potential energy of the system given various in-plane locations of helium.When the incident helium speed was fixed and the graphene temperature was enhanced, the nonlinear behavior of the angle-resolved parameters of the TAC, NNTAC, NTTAC, RNTAC, and RTTAC, the zenith angle of the scattered helium, and the bounce number of helium were suppressed. The dependence of these parameters on the zenith angle of incident helium was different at low and high zenith angles of incident helium. For instance, TAC, NNTAC, and RNTAC increased with higher graphene temperatures at low zenith angles of incident helium, but decreased at higher zenith angles of incident helium. However, the NTTAC and RTTAC had opposite trends. The reduction in the zenith angle of scattered helium and the bounce number at higher graphene temperatures was much more severe at a higher zenith angle of the incident helium. The interaction time of helium decreased slightly with a higher graphene temperature. Relative potential analysis of the system showed a bigger potential-energy change at higher graphene temperatures due to a larger vibration among carbon atoms in the graphene, which resulted in a change in the scattering performance.When the graphene temperature was fixed and the incident helium speed was changed, the nonlinear behavior of the angle-resolved parameters of the TAC, NNTAC, NTTAC, RNTAC, and RTTAC, the zenith angle of the scattered helium, and the bounce number of helium could be suppressed by reducing the incident helium speed. The phenomena observed when increasing the graphene temperature regarding TAC, NNTAC, TTAC, RNTAC, RTTAC, bounce number and interaction time could also be achieved by decreasing the incident helium speed. Significantly, the TAC, NTAC, NNTAC, RNTAC, and RTTAC were insensitive to the zenith angle of incident helium at 100 K. In this section, we found that a large bounce number of helium and longer interaction time between helium and graphene could not guarantee a higher TAC and higher energy transfer.Integrated scattering performance was obtained through weighting the values of the parameters with various zenith angles of the incident helium via the relative frequencies of the zenith angles by Monte Carlo simulation, and showed the scattering performance of helium on graphene considering all molecules in the hemispherical space. The Monte Carlo simulations considered the fast atom effect of helium atoms. The result showed that the zenith angle of incident helium followed a normal distribution with an expected value of 45.55°. The integrated TAC, NNTAC, NTTAC, and bounce number of helium increased with higher incident helium speeds and decreased with higher graphene temperatures. Significantly, the NNTAC accounted for more than 90% of the TAC. The integrated bounce number of helium was consistent with the interaction time of helium with graphene. The intuition that larger bounce numbers and longer interaction times correspond to higher transfers of energy is only valid when disregarding the change in incident helium speed. As the incident helium speed changes, larger bounce numbers and longer interaction times could show lower TAC values. In this study, we provided a clear description of the scattering performance of helium on high-temperature graphene surfaces in both angle-resolved and integrated aspects. These findings can provide a better fundamental understanding and a new way, such as through incident angles, to tune the scattering behavior of gas molecules on 2D materials.


Assessments, in particular high stakes assessments, impact the nature of teaching and learning. Given this, the goal of citizenship if seen as important needs to feature within high stakes school exit assessments rather than only as part of curriculum and assessment policy rhetoric. South Africa’s Mathematical Literacy (ML) curriculum foregrounds critical democratic citizenship. We analyse the ML Grade 12 exit assessments from their start in 2008 to 2020 to understand the emphasis placed on critical citizenship and how this emphasis has shifted over time. The literature base links critical citizenship orientations with reasoning and reflecting questions, so we focused on examination questions in this category. Our findings show shifts away from critical citizenship related agendas towards foregrounding a life preparation orientation for the self-managing person. Linked with this shift, we note a move away from general societal contexts towards more personal/individual contexts and moves from almost entirely national contexts to inclusion of global contexts. We noted movement from more open-phrased questions towards closed ‘check figure calculated is valid’-type questions. Assessment memoranda suggest assessors view these questions as reasoning items, eroding the critical citizenship agenda. While increasing numbers of students are taking ML rather than Mathematics, average performance stands at around 40%. This points to limited and diminishing access to mathematical reasoning and reflecting for critical democratic citizenship. The paper highlights ways in which analysis of examinations over time can provide a window into the presence or absence of the citizenship agenda in mathematics education. Mathematical Literacy (ML) and within it the goal of preparing secondary learners for post school citizenship roles appears in various forms across a range of international curricula. In some countries it is implemented across curricular learning areas, while in others it is included within various mathematics offerings. South Africa has a relatively unique offering in that ML is a distinct subject from Mathematics in the upper secondary grades (Grades 10–12). ML is compulsory for, and only available to, students not taking Mathematics. While there are many differences in interpretations of the notion of Mathematical Literacy across countries, many, including South Africa, align closely with the PISA conceptualisation as needing to assist learners “to recognise the role that mathematics plays in the world and to make the well-founded judgments and decisions needed by constructive, engaged and reflective citizens.” OECD, , p.75.In this article, based on the notion that assessment is an ‘essential circuit’ of education Ball,  and, as We begin with a brief description of the particularities of the post-apartheid South African context that guides our conceptualisation of mathematics education for citizenship. Our context differs somewhat to countries that have integrated a mathematics for critical democratic citizenship approach in that South African democracy is relatively new. Education system transformation occurred in parallel with democratic transformation in 1994. In the aftermath of apartheid, the education system in general and mathematics education in particular were mandated to develop participating citizens who would contribute to building an equitable non-racist democratic society. These citizens would critically analyse the mathematics of societal, environmental, economic and political issues through understanding the formatting power of mathematics and challenging injustices. The curriculum introduction stated: “In the past the curriculum has perpetuated race, class, gender and ethnic divisions and has emphasised separateness, rather than common citizenship and nationhood. It is therefore imperative that the curriculum be restructured to reflect the values and principles of our new democratic society” DoE, .Mathematics was mandated to prepare learners for critical democratic citizenship. In Grades 0–9 the subject named Mathematics was replaced with the subject named ‘Mathematics, Mathematical Literacy and Mathematical Sciences’ (MLMMS) whose rationale emphasised empowering learners to “understand the contested nature of mathematical knowledge” preparing learners for participation in society in a democratic, non-racist and non-sexist manner DoE, , p. 1 anA similar trajectory of change followed in Grades 10–12 but differed in that this phase introduced two pathways for students: the option of taking Mathematics or taking Mathematical Literacy (ML). These were examined in Grade 12 for the first time in 2008. In the 2008 examinations, 47% of learners enrolled for the grade 12 examinations took ML. Over the years since 2008, with some fluctuations, increasing proportions of learners took ML. By 2020, 59% of all students enrolled for Grade12 examinations were taking ML. The curriculum description states ML: “provides learners with an awareness and understanding of the role that mathematics plays in the modern world. Mathematical Literacy is a subject driven by life-related applications of mathematics. It enables learners to develop the ability and confidence to think numerically and spatially in order to interpret and critically analyse everyday situations and to solve problems” DOE, , p. 9.Early analysis of the ML curriculum statement indicated an emphasis on critical democratic citizenship and practical relevance and applications in contrast to Mathematics which had less integration with contexts and included emphasis on preparing students for further mathematics related studies  engaging thoughtfully with local, national and global issues. However, the ML curriculum was also organised by mathematical content areas and the assessment specifications included mathematical skills , mathematical skills in context  alongside those framed by the notion of a self-managing person and by critical attention to societal issues. In the detail of the curriculum content the notion of ML for critical democratic citizenship was less foregrounded than in the introductory sections. This tension between the overall aims and conceptualisation of ML as a subject and the detailed specification of what was to be taught and assessed has been alluded to in relation to specific topic areas Gal, , the conBetween 2008 and 2013, the Grade 12 exit assessments were based on this initial ML curriculum. However, ongoing critiques of the complexity of the South African curriculum documents alongside the continued weak performance of South African students in standardized tests led to the appointment of a ministerial panel in mid 2009 to investigate implementation difficulties. A key panel recommendation was that a single Curriculum and Assessment Policy document for each subject in a phase be prepared to “help address the complexities and confusion created by curriculum and assessment policy vagueness and lack of specification, document proliferation and misinterpretation”  for the examination analysis of the critical citizenship agenda. Our perspective draws on the works of Skovsmose , 2021 onMany mathematics education researchers have drawn on critical perspectives for conceptualising mathematics teaching and learning, highlighting the importance of understanding the formatting power of mathematics across sociopolitical  or as individuals (either as self-managing persons or future workers). Both these positions are noted in the initial and revised ML curriculum. Thus, in wanting to understand the changes in the citizenship agenda over time, we sought to answer questions about the nature of the reasoning in the ML examinations, the nature of the contexts included and positioning of the student. The methodology section below explains our choice of sample and our coding system for questions addressing reasoning and reflecting along with the indicators used to assign codes.As our sample set is informed by the ML assessment taxonomy and policy guidelines for assessment we begin with a brief description of these.Level 1: Knowing (30%)Level 2: Applying routine procedures in familiar contexts (30%)Level 3: Applying multi-step procedures in a variety of contexts (20%)Level 4: Reasoning and reflecting (20%)The assessment guidelines DoE, , p. 8 acRR1: pose and identify questions about what mathematics they require to solve a problemRR2: interpret the solution they determine to a problem in the context of the problem and where necessary to adjust the mathematical solution to make sense in the contextRR3: critique solutions to problems and statements about situations made by othersRR4 generalise patterns observed in situations, make predictions based on these patterns and or other evidence and determine conditions that will lead to desired outcomesWith the literature pointing to reasoning and reflecting (RR) as key to critical citizenship orientations, we looked at the delineation of Level 4 in this document more closely. Level 4 was described with four sub-levels:RRa: “Questions that require a decision, opinion or prediction about a particular scenario based on calculations in a previous question or on given information” (p. 115)RRb: “Questions that require learners to pose and answer questions about which mathematics they require to solve a problem, select and use the mathematical content, recognise the limitations of using mathematics to solve the problem, and consider other non-mathematical techniques and factors that may define or determine a solution to the problem” (p. 116)The taxonomy of levels of cognitive demand was retained in the revised ML curriculum assessment specification, with ongoing allocation of 20% of the marks to the Reasoning and Reflecting level. However, the revised assessment guidelines  suggested only two sub-levels, rather than the four above:selection of a problem-solving approach was a background precursor to the marks allocated to the problem-solving process itself. RR2 and RR4 (RRa in the revised guidelines) both involved interpretation of calculated answers or patterns in presented information. We therefore found it useful to collect these sub-categories under the heading of Reasoning & Reflecting: Interpretation (RRI). This left the RR3 sub-category focus on the idea of critique—Reasoning & Reflecting: Critique (RRC).To analyse the presence of critical democratic citizenship in the ML Grade 12 exit assessments we looked to Level 4 as this was the level involving the reasoning and reflecting required for engaged citizenship. However, our analysis of the ML examinations (below) noted that no questions addressed the RR1/RRb sub-categories requiring learners to pose their own questions. Instead, much as in the mathematical problem-solving taxonomies of writers such as Polya , the selRRa’s emphasis on interpreting calculations points to a predominant focus in our RRI category, but the inclusion of the word ‘opinion’ suggested some openings for critique and therefore some RRC. RRb similarly has some connection with our Critique category (RRC) in its noting of recognising limitations to mathematics used and consideration of extra-mathematical issues—although the “critique” aspect is less explicitly stated. However, as our analysis later indicates, what we saw in the examination papers was an increasing prevalence of questions asking students to check/verify the correctness of a calculation. These were categorised by examiners as being Level 4 Reasoning and Reflecting items. This necessitated the inclusion of a ‘Check Calculation’ category in our analysis. Thus, aspects of RRa  fell into our RRI and RRC categories identified above while other aspects pointed to the Check Calculation category (based mostly on given information).The assessment guidelines for the initial and the revised ML curricula stipulate two exams at the end of grade 12. Exam 1 focuses on levels 1 and 2 of the cognitive demand taxonomy and Exam 2 on levels 3 and 4. This informed our decision to focus on Exam 2 in our analysis. Greater specificity of content and contexts in the revised ML curriculum followed through into the revised Grade 12 examinations structure with Exam 1 limited to familiar contexts and Exam 2 to both familiar and unfamiliar contexts.https://www.education.gov.za/Curriculum/NationalSeniorCertificate(NSC)Examinations.aspx) from the start of assessments in 2008 up to 2020. The 2021 exams were unavailable on the website at the time of writing. Furthermore, since the 2021 examinations were affected by the 2021 pandemic-related revisions made to the examination guidelines we excluded them from our data set. [By the time of the pandemic lockdowns in South Africa the 2020 examinations were already set.]We sourced all the Grade 12 ML Exam 2 s from the Department of Basic Education (DBE) website . Subsequent questions asked learners to calculate percentages spent on different categories of beneficiaries etc. This led to inclusion of attention to both the nature of the context, and specifically whether societal or individual contexts were foregrounded, and whether these involved national or global issues. A corollary aspect we noted was whether the issue raised positioned the learner more as a self-managing individual or a participating citizen. For example, we coded developing reasoning and reflecting in a range of possible work contexts as linked to being a self-managing person who would look to find employment.To summarise the data in a table we grouped the examinations into four phases corresponding with distinguishable periods of curriculum implementation. Phase 1 involved the first three years (2008–10) and marked a period where examiners and teachers were making sense of the new subject and aligning curriculum intentions with assessments. Phase 2 marked the revised curriculum coming into play. It began in 2011, when the revised ML document was released (with shifting emphasis on citizenship) for implementation in 2012 with Grade 10 s. While the first examination of this revised curriculum occurred in 2014, proposed shifts and discussions underway about focusing on learners as self-managing persons would have likely exerted influence from 2011. Phase 3 includes the examinations in the first three years of examination of the revised curriculum and Phase 4 focuses on the three most recent years (excluding 2021 as explained above). These four phases are shown in Table In analysing the exams, we each first (open) looked at Exams 1&2 of the first (2008) and last (2020) assessment to generate some possible questions to guide qualitative content and orientation analysis. We asked: Which questions require reasoning and reflecting? What is the nature of these questions? What subclasses of reasoning and reflecting are there? What is the nature of the context? Is the context national or global? How is the learner positioned: Citizen-in-Society (PC- participating citizen) or Individual (SMP-self-managing person). We then developed a spreadsheet and placed all Level 4 Reasoning and Reflecting questions from all assessments into it. We checked agreement that we had captured all of these and not included those of lower levels of the taxonomy. Then two authors coded all the exams, guided by the above questions, cross checking each other’s codes and finalising codes based on agreement. There was general agreement across codes even while several questions were considered to border across categories. The following codes . Most RRI and RRC sub-questions were 2- or 3-mark questions with a few marks allocated to calculation or knowledge within these. In contrast, the Level 4 sub-questions of the CheckCalc type , reflected by marks allocated, feature in the examinations over time. This increases somewhat from 7.4% in the first phase to just over 15% in the latter three phases. However, looking across the sub-types of Level 4 questions we see that reasoning and reflecting (RRC and RRI jointly) remains under 10% of total assessment marks throughout all four phases. In contrast, the CheckCalc type questions that hardly featured in the first phase (under 1%) increase steadily over time making up 12.1% of total assessment marks in the most recent phase.Questions classified as RRC are of particular importance in answering the question about the extent to which critical democratic citizenship is foregrounded in our assessments. Across all phases the percentage of RRC questions as a total of Level 4 questions is low, but substantially higher in the first phase of examinations (24%) and negligible in the latter two phases. This absence is even more stark across the total marks across Exams 1 and 2 where the small percentage of marks awarded to critical reasoning and reflecting in the first two phases (1.8% and 1.5%) almost entirely disappears in the latter two phases (0% and 0.4%).The shift away from some critical reasoning and reflection questions is also visible in the nature of the scenarios and contexts that the reasoning and reflecting questions are linked to as seen in Table Table In our initial reading of both Exams 1 and 2 we noted a recent increase in questions that were set in international contexts. For example, information on the cost of studying nursing in England, or of holidaying in Australia, comparing Uber to other transport options in the USA, tourism in Scotland and so forth. Such foreign contexts were almost entirely absent in the first two phases of examinations (0% in Phase 1 and 5% in Phase 2) yet make up over a quarter of the marks in Phases 3 (41%) and 4 (26%). While analysis of the nature of these questions is beyond the scope of this article, we noted many of these contexts were likely to be of greater relevance to a wealthier minority of South African learners despite the majority (2/3) of ML learners coming from non-fee-paying schools in poor areas. We are not saying that global contexts per se are of more relevance to wealthier learners as issues such as global warming, pandemics, conflicts, environmental catastrophes, oil prices etc. are of relevance to all. However, holidaying to Australia, uber in the USA, etc. are somewhat different to these.We begin with two brief exemplar questions from the first and last phases respectively to illustrate subtle but noteworthy shifts in the aspect of engaging critically with presented manipulated graphical information. Thereafter we provide a fuller question with sub-parts from the most recent phase of examinations to illuminate the nature of shift in style of Level 4 questions from open towards closed phrasing in which all possibilities for correctness can be clearly stated in the memorandum removing the need for marker discretion on validity of the students’ arguments Fig. .In 1.2.3 it is explicitly stated that the purpose of the graphs was for the salesman to support his claim (to convince the viewer of his argument). The word ‘misleading’ is used in the latter part and students are asked to identify the misleading graph and to explain how it has been manipulated to mislead. This contrasts with the 2019 question in Fig. In the appendix we provide a set of Level 4 sub-questions that are part of a single question (Q2) that deals with South African Revenue Service (SARS) information, salaries and salary deductions of foreign earnings. This is an example of the way in which questioning style became increasingly closed – with the answer to calculations often being given, and interpretive and critical reasoning removed—though examiners consider reasoning and reflecting addressed by the terms ‘verify’ if ‘correct’ and ‘valid’. These terms are repeated in sub-questions. Only one mark in each sub-question is allocated to the yes-valid or no-invalid conclusion based on the answer of calculations. The coding of these questions is: 2.1.1  (Soc-Nat-PC) 2.3.2  (Soc-Nat-SMP) 2.4.3 b  (Soc-Glob-SMP).The marking memorandum shows these questions along with their full mark allocation counted as Level 4 – yet in each case only one mark is allocated to the interpretation of what the calculation means for evaluating the validity of the statement. An example of the marking schedule for one of these sub questions 2.4.3 is given in Fig. We see through this analysis of ML examinations since their start that the broad post-apartheid ML specific policy orientations to education for equity and critical citizenship, while somewhat visible in the first few years of examinations decreased substantially over time, giving way to a focus on performativity as a self-managing person. We have noted the broader political currents that fed into ML curriculum reform, with assessment shifts reflecting these changes in currents in a range of ways. In substantive terms, this was evident in the diminishing number of questions requiring critical reasoning and reflecting questions over time to a complete absence of such questions since the revised curriculum was examined in 2015. At a more technical level, and underlining the complexity of policy trajectories that Ball  describeOur analysis points to diminishing attention to critical democratic citizenship across the four phases of ML examinations (2008–2020). Within this diminishing attention, there were changes in the style of questions deemed to involve reasoning and reflecting, with an increasing proportion of marks allocated to working through a calculation rather than requiring the interpretation, judgement or critique that the research highlights as necessary for active citizenship from a mathematically literate perspective. The prevalence of items positioning the student as a self-managing person increased substantially over time, with a concomitant decrease in positioning relating to participant citizenship. Alongside and aligned with this shift, was an increase in individual-oriented contexts and a decrease in societal issues. Taken together, and linking back to the essential circuits, these shifts mirror what we noted at the level of ML curriculum specification: diminishing focus on critical citizenship and an increased emphasis on the self-managing person as marked in the introduction of revised ML curriculum.Our findings therefore suggest marked changes in the orientation of ML exit assessments over time, with increasing conflations of reasoning and reflecting on contextual and societal issues replaced with showing the relevant steps of a calculation and checking given answers. Check Calculation type questions have become the dominant type of ‘reasoning and reflecting’ question in examinations since the revised curriculum was first examined in 2014. While we do not consider such questions to involve reasoning and reflecting in any substantive way it is clear from the memoranda that examiners include such questions for their target of 20% reasoning and reflecting questions. This points to ML assessments receding from the initial aspirations for the subject in which goals of simultaneously developing individuals as self-managing persons and participating citizens in a young democracy were sought. Since it is widely acknowledged that assessment  drive teaching the absence of questions requiring critical engagement with broader societal issues in exit examinations is cause for concern to the citizenship agenda.Exacerbating this diminishing focus on critical democratic citizenship in the ML examinations, while also bringing this focus into sharp relief, are the broader patterns of participation and performance in ML over time. The proportion of Grade 12 students writing ML versus Mathematics increased from 47 to 59% over the period of our review. Government figures show that across the years less than 13% of students in schools situated in the bottom three quintiles (based on the socio-economic status of the communities in which they are situated), score above 60% on the ML exit examinations. In the wealthiest quintile of schools, this percentage has dropped from around 50% initially to 40%. The national average remained low across this period at around 40%. This suggests that competences at even the more basic levels of the ML taxonomy are not being successfully engendered for the vast majority, with higher prevalence of low performance, and more limited access to reasoning and reflecting for the poor than for the wealthy.Gal  has noteWhile we have focused on ML in our country, our findings suggest value in analysing exit assessments across other mathematics curricula to gauge the extent to which critical citizenship agendas feature currently and over time across different contexts. The COVID-19 pandemic brought massive changes to our world and placed a spotlight on (and in some cases exacerbated) existing problems and inequities   have pointed to the increased need for the development of critical mathematics education for supporting democratic citizenship. Yet Covid-19 disruptions to schooling in our own and we expect in many other contexts has seemed to push the focus of educational policy towards ‘catch-up’ involving a focus on ‘basics’ and ‘key skills and content’. Here concern for developing critical thinkers is increasingly backgrounded. Readers will judge the extent to which the findings in this paper that point to little (and reducing) attention to citizenship in mathematics examinations and broader education policy applies to their contexts. If, as many have argued, high stakes examinations drive teaching and learning then educators promoting mathematics for development of critically reflective and socially responsible citizens need to ask: How do we ensure quality opportunities for demonstrating mathematics for critical citizenship in examination contexts?


A considerable number of the questions (n = 19) included only a single nutrition-related answer option that was frequently incorrect and served as a distractor. About 0.5% of questions were entirely nutrition related. Despite undeniable barriers, the inclusion of additional nutrition-related examination questions could serve as an incentive to engage students and medical schools in enhancing medical nutrition education. The recently published competence-oriented learning objective catalog in Germany could play a pivotal role in this context, leading to better recognition of nutrition-related topics in medical education.The state of nutrition education in medicine is inadequate, with nutrition-related topics being poorly integrated into lectures. Most medical students receive only a few contact hours of nutrition instruction during their entire time at medical school. Identifying potential barriers that may explain the paucity of nutritional knowledge in medical students is thus of paramount importance. The extent of nutrition coverage in the second part of Germany’s nationwide medical licensing exam is currently unknown. We addressed this issue and assessed nutrition content, as well as students’ scores, in this pivotal test prior to their graduation. We performed a post hoc analysis of six nationwide medical licensing examinations (2018–2020) undertaken by 29,849 medical students and screened 1920 multiple-choice questions for nutrition-related content. Nutrition-related questions accounted for a minority of the questions (2.1%,  Nutrition is one of the cornerstones of a healthy lifestyle . NeverthOne potential strategy to promote healthier eating patterns is nutrition care provided by healthcare professionals . There iThere is now a general consensus that physicians should actively engage in providing nutritional advice  and mustIn the United Kingdom, the latest National Health Service (NHS) Long-Term Plan emphasized that “frontline staff need to feel equipped to talk about nutrition” ; howeverAlthough there is still room for improvement, it is of utmost importance to identify other barriers that may explain the paucity of nutritional knowledge in medical students. Identifying these factors could help to enhance nutrition education and support prospective physicians to play a meaningful role in a much-needed dietary shift towards a more sustainable treatment of chronic diseases .One approach to identifying the potentially mediating factors is to look beyond medical school curriculums. Very few studies have assessed the nutritional knowledge required in students’ final-year exams ,22. HarkComparable data from other countries is scarce but urgently warranted to potentially enhance the nutritional knowledge of medical students. For the very first time, we aimed to assess nutrition coverage in the second part of Germany’s medical licensing exam, a country with numerous medical faculties and a large student body. The main objectives of this study were twofold: (a) to assess nutrition coverage in the second part of Germany’s nationwide medical licensing exam, and (b) to examine how well students scored on the related questions in this pivotal test prior to graduation.Approbationsordnung für Ärzte) in Germany includes a written medical licensing examination for prospective physicians [Erster Abschnitt der Ärztlichen Prüfung) and the second part (termed Zweiter Abschnitt der Ärztlichen Prüfung) [Our study is based on a secondary data analysis of German medical licensing examination questions . The curysicians . This exPrüfung) ,26. The Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP)), located in Mainz, Germany [The exams take place twice annually in spring and autumn. One exam contains 320 multiple-choice questions with 5 possible answer options . The adm Germany ,27. All For this study, we analyzed 6 consecutive second-part medical licensing examinations (autumn and spring 2018–2020). Our analysis included 1920 multiple-choice questions in total. In the first step, we identified all multiple-choice questions with at least one nutrition-related answer option. For this, 3 independent reviewers  manually checked all available questions for suitability for inclusion. Each multiple-choice question had five possible answer options. The majority of questions (>90%) followed the so-called “Apos-design”, with 5 answer options (A through E) but only one correct answer. A minority of questions followed the Aneg-design, where 5 answer options exist for which the incorrect has to be identified. Thus, it often occurred that some answers covered nutrition-related aspects while others did not. In such cases, we included the respective questions if there was at least one nutrition-related answer option, irrespective of whether this answer was correct or not. We also categorized the eligible questions according to the number of answer options with nutrition-related content .In the second step, we assigned the questions to one of five pre-defined nutrition-related categories to gain a better understanding of the frequently covered topics in the examined exams. These topics included (1) “causes and treatment of nutrition-related endocrine and metabolic disorders”, (2) “dietary supplements”, (3) “dietary patterns”, (4) “nutrient content and preparation of dietary products”, and (5) “nutritional deficiencies”.Hochschulspezifische Itemanalyse). Moreover, we performed sub-analyses for each of the aforementioned nutrition-related categories. Finally, we stratified the results by gender .In the third step, we contrasted students’ ratings in the selected nutrition-related questions with the average exam rating. For this, we used nationwide statistics provided by the IMPP .We identified 1920 potentially eligible multiple-choice questions that were included in the 2018–2020 German medical licensing examinations. All questions were manually screened by 3 independent reviewers and a total of 1880 questions were excluded for not meeting the pre-specified inclusion criteria. Forty questions remained eligible for the final analysis  .n = 25/40) of questions covered “causes and treatment of nutrition-related endocrine and metabolic disorders”, followed by questions on “dietary supplements” ). The remaining categories each accounted for ≤10% of the total questions.The question classifications based on the pre-defined nutrition-related categories are shown in n = 4 in autumn 2019 and 2020  to n = 11 in spring 2020 .The number of nutrition-related questions per exam is shown in n = 9/40) of the included multiple-choice questions had five nutrition-related answer options. Almost half of those questions (n = 19/40) included only a single nutrition-related answer option. In 50% of cases, these answer options were incorrect . The remaining 30% of questions (n = 12/40) had more than one but less than five possible nutrition-related answers.Only 22.5% (n = 40), great caution is warranted in such comparisons as they are susceptible to bias.In all but one exam (spring 2018), students performed better in the nutrition-related questions compared to the rest of the exam. The average percentage of correct answers to the included nutrition-related question exceeded the 80% threshold in all but two exams (autumn 2020 and spring 2018). The best performance was found in the autumn 2019 exam, where more than 92.5% of students answered the included nutrition-related questions correctly. The worst performance was found in the spring 2018 exam, where less than 65% of students gave correct answers to the included nutrition-related questions. Given the low number of overall questions (We observed a large heterogeneity with regard to the content of the questions. The questions covered a wide array of topics including (but not limited to) vegetarian and vegan diets, ketogenic diets, gluten-free diets, high-fiber diets, high-fat diets, and histamine-free diets. The questions on supplements and nutritional deficiencies covered Vitamin B12 supplementation, iodine supplementation, Vitamin C supplementation, and Vitamin D supplementation. In light of the low number of total questions and the large heterogeneity in the content, we refrained from additional analyses stratified by question category.Finally, we observed that students scored far above average on all questions focusing on “dietary supplements”. On average, students answered these questions correctly in 94.08% of cases. When looking at all nutrition-related questions (2018–2020), this phenomenon was less pronounced. The average percentage of correct answers, in this case, was 81.63%. Notably, this percentage still exceeded the average percentage of correct answers in the remaining exam questions .n = 9), the average percentage of correct answers dropped to 76.78%. An analysis stratified by sex  revealed no substantial intergroup differences.When we analyzed the questions with five nutrition-related answer options only . A substantial number of questions included only a single nutrition-related answer option, which was frequently incorrect and served as a distractor. Less than n = 10 questions were entirely nutrition-related with five nutrition-related answer options. Students scored better on nutrition-related questions compared to the remainder of the exam. Students scored particularly well on questions about dietary supplements. The number of nutrition-related questions did not increase consistently over the investigated 3-year period.Despite the large heterogeneity in the content of the identified questions, we observed several trends worth discussing. Nutrition-related questions accounted for a minority of the total questions  did not allow for valid statistical calculations. Hence, we opted for a descriptive analysis. As discussed earlier, there is a concerning gap between the nutrition competencies required for doctors to provide effective nutrition care and the nutrition education provided in medical schools [The low number of entirely nutrition-related questions  legislative requirements. A comparison with the aforementioned study by Hark et al. thus appears to be more appropriate . The autInternationally, nutrition remains inadequately represented in accreditation and curriculum guidance for medical education at all levels . The facFurthermore, it may be difficult to construct clear and unambiguous questions in this field that are not open to interpretation from a juridical perspective. The field of nutrition is full of controversies as reflected in the recent diverging (or even contradictory) reports concerning the impact of certain food additives, foods, and nutrients on health that are published each year . This man = 9 questions were entirely nutrition-related. When restricting the analysis to these questions, students’ overall scoring was still slightly better compared to the overall exam scoring. This could be interpreted in multiple ways, e.g., as a high interest in nutrition-related topics, profound knowledge in this area, or simply easy-to-answer questions . Again, it must be mentioned that the limited number of questions might adversely affect the validity of our results, and caution is warranted when discussing our results.Students’ high scoring rates in the nutrition-related questions in our study are difficult to interpret, particularly with regard to the fact that only As discussed earlier, the small number of entirely nutrition-related questions shows that this topic only plays a minor role in German licensing exams. Whether this is justified with regard to the potential of medical nutrition education to reduce the health and economic burden of chronic diseases is subject to debate . ChallenNationaler Kompetenzbasierter Lernzielkatalog Medizin 2.0-NKLM) [kompetenzorientierten Gegenstandskatalog Medizin), which was published by the IMPP in December 2020 and is of paramount importance for licensing exam questions [A unique chance to improve nutrition-related education in German medical schools is the new national competency-based catalog of learning objectives for medicine (.0-NKLM) . This cauestions . UpdatedThe latter is an important step forward in the better recognition of nutrition-related topics in medical education in Germany.Previous studies have demonstrated that nutrition education in residency predicts the frequency of residents’ dietary counseling practices . This apThe present analysis has several strengths and weaknesses worth mentioning. As for the strengths, we present the results from a nationally representative and centralized licensing examination in Germany. As opposed to other studies, we did not ask students directly for their personal (subjective) opinion on nutritional education in Germany. Instead of relying on bias-susceptible questionnaires, we analyzed standardized data from a large central database comprising answers from 29,849 students who took the exam in the aforementioned time frame. This concept is probably the biggest strength and innovation of our study, particularly with regard to the high number of screened questions . The manual question screening process conducted by three independent reviewers is an additional strength and reduced the likelihood of missing relevant questions. Additional strengths include the stratified analyses by sex and the comparison to the general exam results.n = 40), which did not allow for a reliable statistical sub-analysis stratified by question category. Adding other exams would have been necessary to increase the number of questions eligible for analysis. Yet, we focused on the “current” state of nutritional education in medicine in Germany, and thus refrained from adding older exam cycles (2017 and older). Despite the modest number of eligible questions, we believe that the present work allows for important insights into the topic under discussion and is—to the best of our knowledge—the first German-based analysis in the literature.However, the present analysis also has limitations worth discussing. The major limitation is probably the modest number of identified nutrition-related questions (We explored the role of nutrition-related questions in the second part of the written medical licensing examination in Germany. Quantitatively, nutrition-related questions played a minor role in all exams and accounted for approximately 2% of the total questions. Approximately 0.5% of the questions were fully nutrition related.Although there are undeniable barriers to including additional nutrition-related questions, this could be an incentive for engaging students and medical schools in enhancing medical nutrition education. As suggested previously, this step should extend beyond counting dedicated teaching hours and mapping nutrition content to a more contextual understanding of the situated learning that occurs for medical students. The new national competency-based catalog of learning objectives for medicine may help to improve nutrition-related education in German medical schools. Attributing a higher value to nutritional education in German medical schools requires a tectonic shift in thinking but will certainly pay off in light of the large potential to reduce the health and economic burden of nutrition-related chronic health conditions.


It is ethical in that “I” am answerable to the other, as a phenomenological reality, in the moment of intersubjectivity.In their article Little, Jordens, and Sayers developed the notion of “discourse communities”—as groups of people who share an ideology and common “language”—with the support of seminal ideas from M.M. Bakhtin. Such communities provide benefits although they may also impose constraints. An ethical community would open to others’ discourse and be committed to critique. Those commitments may counter the limitations of discourse communities. Since their paper was published in 2003, the notion of “discourse communities” has been widely adopted and applied in healthcare and beyond. Their ideas were influential in the founding of an ethics centre in Sydney and contributed to articulating the values which underpin this journal. This commentary notes that an ethical community is fragile in responding to current onslaughts on truth and meaning—potencies inherent in discourse communities. The essay takes Bakhtin’s ideas further to explore intrinsic forces at play in dialogue, language, and art. This leads to discussing the centrality of ethics in Bakhtin’s thought. For him, the essence of discourse is a dialogic exchange which comprises both art and ethics. It is  A.Travelling with the authors in exploring discourse communities;B.Exploring the nature of those communities, as the authors conceive of them, in terms of both the needs and purposes they serve and their constraints on members;C.Considering the extent to which discourse communities may have served the needs and ideals of the authors themselves—which leads into discussing “the possibility of an ethical community”—and what would be required of such a community;D.Discussing the ideologies and values (and fragility) of discourse communities in responding to a current onslaught on truth and meaning; andE.Returning to the Russian theorist—M.M. Bakhtin—from whom the authors drew seminal ideas in support of their approach to discourse communities.This Critical Response to “Discourse communities and the discourse of experience”  along with other professions and members of trade groups such as plumbers and electricians. Discourse communities also include less clearly defined groups such as racists or postmodernists; and followers of a particular religion, members of church groups, family groups, and those with sporting affiliations. Membership within each community is “defined by a particular use of language” (74). Understood in this way, it is apparent that most of us belong to many discourse communities: as family members, members of professional or trade groups, religious followers (or resolute atheists), and aficionados of one or more sporting codes.In the “Discourse communities” paper, the authors developed a notion of The authors observe that each of these communities “draw on the same linguistic resources, the same lexicon and grammar, but construe meanings in different ways” (80). Yet we move between these communities easily and understand the same words as having different meanings within the context of each discourse community. A word—such as “shock”—will be understood among family members and friends differently from the way it is understood by doctors, seismologists, or electricians.There is also a suggestion in this paper, that membership of different discourse communities may shape the way in which we experience events in our lives or at least the way in which we describe those experiences, although they step carefully around the “epistemological status of experience” whilst acknowledging experience is important as “the matrix upon which meaning and values are mounted” .The paper emerged from the authors’ work with cancer survivors and their carers. They observed different discourse communities in that context and differences in the discourse of those communities in speaking of cancer. Cancer patients and their lay-carers spoke of their experience as “victims of circumstance, people to whom things happen” (78) and as being caught in systems “over which they have little control” (78). By contrast Little et al. found that “Administrators, bureaucrats, business people, lawyers and insurance representatives” spoke “as agents of change to the systems in which they work” and of how “they made events into opportunities” (77-78). Doctors and other healthcare workers however, “tell stories which sit somewhere betwixt and between” (78). Whilst they are “clearly agents of change for their patients” and are “involved morally with the extreme experiences of their patients”, they are also “profoundly affected by the vagaries and demands of the administrative and economic systems within which they must work” (78). The proposition that emerges from this analysis is that the “basic division between discourse communities has to be recognized and understood before there can be any prospect of real dialogue between the representatives of different interests in health care” (79).Since this paper was published, the idea of discourse communities has been adopted widely in the literature. There have been numerous citations.Beyond health, the “Discourse communities” paper has been referred to across a wide variety of topics. These include the “troubles” in Ireland . However, there are also risks. As they put it, “Membership … potentially constrains what we should think” (74) or at least constrains what we say we think. The authors refer to this as a colonizing process in which we are obliged to understand and speak in words with fixed meanings and limited usages. In some cases, “discourse communities … can easily slip from benign intent into exploitation” (82) leading vulnerable people, such as those discussed above, to a sense of being “victims of circumstance” (73). This is also reported by patients with Type 2 diabetes . One might assume that Emma-Jane had opportunities to share her experience of cancer with others who had similar experiences—an opportunity which (in the authors’ words) “can be liberating, and even therapeutic” (83). This is an example of a benefit that derives from belonging to a discourse community.Emma-Jane was also uniquely placed to gain from speaking across discourse communities in that her work (with Miles Little and Christopher Jordens) included analysing interviews with cancer patients, clinical carers, and health policymakers. One benefit, from this broader view, is the “possibility of creative dialogue.” One can imagine that participating in their research provided Emma-Jane with the opportunity to understand what “care” meant within those different discourse communities, an understanding not easily gained by fellow members of a cancer survivor discourse community.Humane Medicine, a book which argued for a shift in emphasis from biomedicine to humane medicine . This has been my experience of the Centre also: conversation among colleagues sharing a common interest, conversation of the best kind—about important issues in medicine and healthcare—skilfully facilitated by Miles who invited and encouraged many perspectives within a supportive atmosphere.Professor Little, on retiring as a practising surgeon, set up the Centre for Values, Ethics and the Law in Medicine (VELiM) at the University of Sydney in 1996, as its Director (until 2003). It is apparent that the “Discourse Communities” paper is an expression of his deep commitment to open discourse. He had previously published e Little . The val Jordens . AlthougThese brief glimpses from the authors’ biographies provide some background and understanding of their commitment to the values expressed in the paper, most clearly in the section “The possibility of an ethical community.” An ethical community is presented as a “species of discourse community” which interrogates ideologies including its own. As an interdisciplinary community it would “not be committed to any one model of ethics” but would be committed to “processes of ethical examination using many models.” Its members would be open-minded and dedicated to examining “underlying values that sustain and justify ethical endeavour of all kinds.” It would also be practical in testing “its conclusions by political and social action … in the light of actual happenings and interactions” (82).It is a remarkable achievement that VELiM—recently renamed “Sydney Health Ethics” (SHE)—has been sustained as an ethical community (in just this way) for twenty-five years. All things change however. Recent events threaten to undermine the community as a discrete entity. SHE has lost its formal status as a Centre, and its staff members have been relocated from a separate building and combined with staff of the School of Public Health. Whether or not it survives as an entity, its manifestation and its maintenance for twenty-five years has “spread … its sphere of influence” . Whilst I applaud that as an ideal, it offers no firm foundation for determining a shared reality or even a basis for finding agreement over historical “facts” such as the holocaust or the ransacking of Capitol Hill. Admittedly, this is to raise fraught issues of epistemology and ontology going back to the beginnings of Greek philosophy. It is an issue that is well captured in the debate between Gadamer and Habermas last century  was a Russian philosopher, literary critic, and linguist who wrote voluminously, although much of his writing has been lost. That which has survived has garnered a late following among linguists and literary theorists beyond Russia. The lost material, and publication of his remaining texts, out of their chronological sequence, has however, “led to a partial view of Bakhtin, which obscured the centrality of ethics in his thought” Çalişkan , 2.The Dialogic Imagination . Discourse in the novel is heteroglossic in that the “novel orchestrates … the speech of characters” and many other elements and permits them to “enter the novel.” For Bakhtin, the “fundamental condition, that which makes a novel a novel … is the speaking person and his discourse” . This critique of literary analysis also extends to language itself. “Every concrete utterance of a speaking subject” contains a tension between conforming with normative standards of language (monoglossia) whilst also participating in “speech diversity” (heteroglossia) in that it is individualized . Subjected to these dynamic forces, language is constantly evolving and breaking from the moulds of conventional analysis. It refuses to be confined by rules . This critique is equally applicable to ethics.Little et al. quote from Bakhtin’s essay “Discourse in the novel” which was published in English as one of four essays in In the Introduction I proposed a further journey—to the interior of the terrain that Bakhtin explored—by drawing on his view of ethics and aesthetics in the moment of intersubjectivity.heteroglossia has a primary sense as a feature of any communicative exchange between two (or more) people. The word is a translation of the Russian raznorečie—from raznyĭ  and reč (meaning “word” or “speech”). Any “speech act” or “utterance” is understood by Bakhtin as one side of a dialogue with an other “I.” If one is to relate to another “I” as a subject, not just as an object, then there is an “aesthetic invention” or act of creativity “that occurs between subjects in actual dialogues” . Yet both are also objects to each other. My image of you, and yours of me, are influential and creative in the exchange.For Bakhtin,  Nielsen , 807. Moself is ever in flux: “I occupy a place in once-occurrent Being that is unique and never-repeatable, a place that cannot be taken by anyone else and is impenetrable for anyone else”  in dialogical exchanges. What makes that art profoundly ethical is that “I” am answerable to others in those exchanges, and continue to be answerable across a flux of time. In this sense, Bakhtin’s ideas are revolutionary. In putting them forward, I am emboldened by Little, Jordens, and Sayers’ open-minded commitment to examining many models of ethics. The influence of these authors and the values of the community they founded—along with the values of the Otago Bioethics Centre—are evident in the commitment of the Journal of Bioethical Inquiry to ethics as “dialogue” and to promoting understanding by listening to “diverse voices in a global conversation [across] geographical borders” (Journal of Bioethical InquiryI have previously argued for balancing normative ethics by sensing the aesthetic and by understanding ethics as art Macneill . Bakhin


Non-covalent π-π and dipolar interactions with small aromatic molecules have been widely demonstrated to be a valid option to tune graphene work functions without adding extrinsic scattering centers for charge carriers. In this work, we investigated the interaction between a CVD-graphene monolayer and a thermally evaporated sub-monolayer and the following few-layer thin films of similar perylene diimide derivatives: PDI8-CN2 and PDIF-CN2. The molecular influence on the graphene work function was estimated by XPS and UPS analysis and by investigating the surface potentials via scanning Kelvin probe force microscopy. The perfluorinated decoration and the steric interaction in the early stages of the film growth determined a positive work function shift as high as 0.7 eV in the case of PDIF-CN2, with respect to the value of 4.41 eV for the intrinsic graphene. Our results unambiguously highlight the absence of valence band shifts in the UPS analysis, indicating the prevalence of dipolar interactions between the graphene surface and the organic species enhanced by the presence of the fluorine-enriched moieties. Its hexagonal carbon monolayer structure exhibits a superior electronic quality such that charge carriers can travel ballistically at the micrometer scale with hole and electron mobilities of more than 102 V−1s−1 . Several2 V−1s−1 , electro2 V−1s−1 . Graphen2 V−1s−1 , creatin2 V−1s−1 ,9,10,11.2 V−1s−1 .This framework has given particular attention to its application as a source-drain electrode in organic electronic devices . SeveralF) above (n-type) or below (p-type) the Dirac point (ED ≈ 4.5 eV). The magnitude of the EF shift controls the static excess of holes or electrons without external field-effect gating. This directly impacts the intrinsic conductivity of a graphene sheet and its effective energetic compatibility with an active material in the final device. Graphene is a two-dimensional material sensitive to virtually any intentional and unintentional exposure to external contamination [Given the versatility of graphene when applied as an electrode material, precise control over its doping state is an absolute necessity for tailoring the transport properties and optimizing its integration into a specific device’s architecture. Namely, the doping conditions of graphene are given by the relative position of the Fermi energy  [2) [F shift as being electrostatically mediated by the presence of fluorine (F) atoms [Surface functionalization with polymeric and molecular layers can reliably control graphene’s (Na-NH2) , vanadyl(Na-NH2) , or moleNH2) [2) . On the NH2) [2)  and paraNH2) [2)  have beeNH2) [2) ,32. AnglF) atoms . Despiten-type organic semiconductors [2-C3F7), for the PDIF-CN2 against the alkyl chain-decorated PDIF8-CN2 (C8H17). Both materials share the same electron-withdrawing cyano insertions on the perylene cores. We probed the graphene work function shift and molecule–graphene interaction with PES analysis, supported by an investigation of the surface potential maps retrieved via scanning Kelvin probe force microscopy (SKPFM). This latter technique is based on determining the contact potential difference between a conductive AFM tip and a sample surface with high spatial resolution, unraveling the additional role of the molecular ordering over the total electrostatic interaction at a nanoscopic level.This work will follow this path, investigating in more detail the role of the fluorine-rich molecular end groups over the doping state of the CVD-graphene surfaces. For the scope, we chose two perylene tetracarboxy diimides derivatives (PDI8-CN2 and PDIF-CN2) that have widely been employed as top-performing environmentally stable nductors . The two2(300 nm)/Si multilayered substrates. PDI8-CN2 and PDIF-CN2  were evaporated from powder precursors via organic molecular beam deposition (OMBD) in high vacuum conditions (P ≈ 10−7 mbar). Deposition rates of R = 0.3 nm/min for PDIF-CN2 and R = 0.4 nm/min for PDI8-CN2, respectively, were employed. Before deposition, the graphene substrates were carefully cleaned in an acetone bath and rinsed with ethanol . During the OMBD process, the substrates were kept at 100 °C via an external PID temperature control system. The organic thin film thickness was monitored through a quartz crystal thickness monitor .Samples were fabricated starting from commercial monolayer CVD-graphene  and transferred onto SiOPhotoelectron spectroscopies (PES) were carried out in an ultra-high-vacuum (UHV) system using a VSW HA100 hemispherical electron energy analyzer with a PSP power supply and control  . UV photVcpd) between a sample and a conductive AFM tip when the two are brought into close contact (≈nm) [surfV) through:We inferred the samples’ morphologies and surface potential mappings via non-contact atomic force microscopy (NC-AFM) and amplitude-modulation scanning Kelvin probe force microscopy (AM-SKPFM) using a XE-100 Park Systems  AFM. The SKPFM technique is based on acquiring the contact potential difference (ct (≈nm) ,37,38. T 4.65 eV , the worVAC amplitude of between 1.8 V and 1.9 V.The analysis was carried out in air using an XE-100 Park atomic force microscope respectively equipped with a PPP-NCHR by NanoSensors  for standard NC topographies and NSC14 Cr/Au conductive cantilevers by MikroMash  for the potential mapping via SKPFM. The potential profile signal was demodulated by employing an external Stanford Research System SR830 DSP Lock-in amplifier  using a sinusoidal reference with a frequency of 18 kHz and a t = 1 nm) on the graphene substrate. For both materials . The atomic percentages from the XPS analysis for PDI8-CN2 were C 83.2%, N 8.2%, and O 8.6%, which were in agreement with the theoretical values of 84.0%, 8.0%, and 8.0%, respectively. The C1 core level  deposited on 200 nm SIOPDIF-CN2 showed electronic properties different from those of PDI8-CN2. The atomic percentages were C 60.6%, N 6.4%, O 6.5%, and F 26.5%, in agreement with the theoretical values of 60.6%, 7.2%, 7.2%, and 25.0%, respectively. The C1s core level . As expe2 substrate, while the peak at 533.22 eV was related to the C−O groups [We performed PES analysis on the PDI8-CN2 and PDIF-CN2 thin films deposited on graphene at nominal thicknesses of 2, 4, and 8 nm, and 2, 3, and 10 nm, respectively. The long-range spectra  showed tO groups . AlthougO groups .2 substrate, two additional components related to the imide group in PDI8-CN2, and CO from the graphene substrate. The N1s core levels showed the two known peak structures  energy shifts suggested the presence of band bending, possibly with charge accumulation at the interface, but no new structures due to LUMO orbital filling were present in the HOMO-LUMO gap. The −0.12 eV shift was achieved only at the highest film thickness  in the determination of the energy level alignment at the heterointerface. The low difference between the SKPFM and the UPS values suggests the perfluoroalkyl chains prevent, to a great extent, the intrusion or the adsorption of contaminants [Specifically, the graphene WF moves downwards with respect to the Dirac point up to 5.19 eV when interacting with the PDIF-CN2, i.e., a 0.39 eV difference if compared with the SKPFM analysis performed in air on a bare graphene surface  led to subsequent organic island growth, also with evidence of a de-wetting mechanism at higher coverages. We found the presence of a surface dipole (approximately +0.5 eV), while a weak band-bending (0.1–0.2 eV) occurred at the highest coverage of 10 nm and was likely related to the differently tilted orientations of the molecules.We analyzed the role of two perylenes tetracarboxy diimides derivatives (PDI8-CN2 and PDIF-CN2) in tuning monolayer graphene electronic properties. Using photoelectron spectroscopies and scanning Kelvin probe force microscopy, we investigated the film growth mechanisms, the interface chemical features, and the work function vs. organic film thickness. PDI8-CN2 showed a typical island growth, with molecules tilted on the graphene surface with a mild organic–inorganic interaction, likely modulated by the organic cyano groups. We evidenced the formation of a surface dipole for all film thicknesses, leading to a WF increase of approximately +0.4 eV (at 8 nm) from the pristine graphene and p-type doping conditions. In-vacuum and air analysis techniques led to very similar qualitative results, even if we found a nearly constant quantitative gap between the work function values, likely related to the different working conditions. The stability, diffusion, and possibility to tune the perylenes’ chemical groups make these organic molecules promising for controlling graphene electronic properties, given the possible industrial scale-up and exploiting the OMBD deposition technique compatibility with in-vacuum large-scale production systems. To this aim, we intend to check our systems’ morphologic and electronic properties with time to verify their stability.Our results highlight the role of the perfluoro-alkyl substitution in unambiguously favoring a dipolar graphene–molecule interaction, which significantly tuned the inorganic electronic properties towards


The individual composite endpoints consistently showed a higher incidence in the lower quartiles of L1 SMI (p < 0.001). In multivariable analysis, the lower L1 SMI quartiles independently predicted 3-year all-cause mortality and MACEs , p = 0.007; and OR 12.3 (95% CI 4.99–30.4), p < 0.001). In conclusion, CT-based L1 SMI demonstrated a distinct dose-dependent relationship with future MACEs in CAD patients undergoing percutaneous coronary intervention, thereby enhancing cardiovascular risk stratification.Sarcopenia is as a non-traditional risk factor for atherosclerotic cardiovascular disease. Further investigation is required to elucidate the prognostic significance of computed tomography (CT)-based sarcopenia assessment in coronary artery disease (CAD). We prospectively enrolled 475 patients, who underwent coronary stent implantation and peri-procedural CT scans within one month. Skeletal muscle index (SMI) was assessed cross-sectionally at the first lumbar vertebra (L1) level. The participants were grouped based on sex-specific L1 SMI quartiles. The primary endpoint was all-cause mortality, and the secondary composite endpoint was major adverse cardiovascular events (MACEs) over a 3-year follow-up period. Three-year all-cause mortality and MACE incidence increased significantly in patients in the lower L1 SMI quartiles compared to those of patients in the higher quartiles ( Sarcopenia has gained recognition as a prominent indicator of both frailty and the aging process, often coinciding with functional and metabolic impairments ,2. This Recently, our group demonstrated the prognostic significance of identifying low skeletal muscle mass using CT in patients who underwent successful coronary stent implantation . MoreoveThe study population was prospectively enrolled from the percutaneous coronary intervention (PCI) registry at Korea University Guro Hospital  between January 2004 and April 2014. Data were analyzed retrospectively. The present study was newly conducted as an extended comparative subgroup analysis derived from a previous cohort  to  to 2) ofWe conducted a clinical follow-up for all participants over a duration of up to three years. The primary endpoint in our study was the occurrence of all-cause mortality over 3-year period. The secondary endpoint was 3-year major adverse cardiovascular events (MACEs), defined as a composite of all-cause mortality, non-fatal myocardial infarction (MI), and repeat revascularization. Within the definition of mortality, we differentiated between those attributed to cardiovascular and non-cardiovascular causes, which were categorized as cardiac and non-cardiac deaths, respectively. MI was defined as a substantial increase in cardiac biomarkers along with concurrent symptoms or electrocardiogram findings suggestive of coronary ischemia. Repeat revascularization included all cases of clinically driven revascularization, which could involve either coronary artery bypass surgery or PCI and occurred after discharge from the initial procedure. For further clarification, repeat revascularization was specified in relation to the previously treated vessels or lesions. Finally, a landmark analysis at 1-year follow-up was performed to examine the prognostic significance of L1 SMI quartiles over both short- and long-term periods.p-value < 0.05. All analyses were two-tailed. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software version 20.0 .Categorical variables were expressed as frequencies (percentages), and continuous variables were presented as means ± standard deviations or as medians with interquartile ranges. To compare groups across the L1 SMI quartiles, we used Pearson’s chi-square or Fisher’s exact test for categorical variables and one-way analysis of variance or the Kruskal–Wallis test for continuous variables. Pearson’s correlation coefficient was used to examine the correlations between various skeletal muscle measurements. The cumulative incidence rates for the primary and secondary endpoints were examined using the Kaplan–Meier method and compared using the log-rank test. Patients were censored at the time of the initial occurrence of the specific outcome measurement, with survival analysis conducted independently for both the individual outcome and the composite endpoints. Stepwise Cox-proportional hazards regression analysis was performed to assess the prognostic significance of the lower L1 SMI quartiles along with confounding factors. Four models were constructed by incorporating statistically significant or clinically relevant variables with the highest L1 SMI quartile used as the reference group. Statistical significance was defined as a 2/m2 for men and 21.37 ± 2.56, 26.89 ± 1.34, 30.61 ± 0.92, and 35.76 ± 2.87 cm2/m2 for women (both p < 0.001). The lower L1 SMI quartile groups were associated with older age , lower body mass index , and higher burden of atherosclerotic disease for peripheral artery disease . Those with a lower L1 SMI exhibited worse renal and left ventricular systolic function (both p < 0.001), higher levels of inflammatory marker (p = 0.035) and frailty (p = 0.010). The present study enrolled 475 patients who underwent successful coronary stent implantation for CAD with a median follow-up duration of 4.04 (1.25–3.00) years, and 82.3% of the patients completed the clinical visit at 3 years. The median time interval between the index PCI and CT imaging was −2.0 (−10.0–3.0) days, showing no significant difference between the L1 SMI quartile groups. p < 0.001). Notably, both SMA  of the overall study participants. The L3 SMA and L3 SMI measurements showed significantly higher levels with increasing quartiles of L1 SMI (both p = 0.049) and inserted stents (p = 0.043) marginally increased in the lower quartiles compared to those in the higher quartiles of L1 SMI, the overall disease extent, target/culprit lesion complexity, or coronary stent profiles, including the average diameter and total length, did not differ significantly between the L1 SMI quartile groups. The prescription patterns for secondary prevention medications after PCI were mostly consistent, except for higher statin use in the lower L1 SMI quartiles .p < 0.001; p < 0.001), implicating a potential association between non-cardiac medical comorbidities and sarcopenia. p = 0.081). The secondary composite endpoint of 3-year MACE showed a significantly higher incidence in the lower L1 SMI quartiles than in the higher quartiles  and repeat revascularization , also significantly increased in the lower L1 SMI quartiles compared to those in the higher quartiles. Additional stratified analysis based on individual patients’ frailty status showed consistent trends for a higher incidence of 3-year all-cause mortality and MACE  and an 8.45-fold higher risk of MACE , p < 0.001) compared to the risks associated with the highest L1 SMI quartile. These associations remained consistent after adjusting for the constitutional factors of age, sex, and BMI (Model 2) as well as other significant confounding factors observed at index admission (Model 3). On multivariate analysis with full adjustment (Model 4), the L1 SMI quartiles continued to serve as significant predictors of both the primary and secondary endpoints. Specifically, the lowest L1 SMI quartile was associated with a 4.90-fold higher risk of 3-year all-cause mortality , p = 0.007) and a 12.3-fold higher risk of MACE , p < 0.001) compared to the highest L1 SMI quartile. Further details of this stepwise multivariate analysis are provided in The results of the stepwise multivariate analysis are presented in In this prospective all-comer registry study, we used CT-based measurements of L1 SMI and demonstrated a clear association between the future risk of 3-year all-cause mortality and MACE in patients who underwent successful PCI for CAD. Quantitative assessment of skeletal muscle mass using peri-procedural CT revealed a distinct dose–response relationship with future cardiovascular outcomes. This association was particularly pronounced for predicting 3-year all-cause mortality and MACE, underscoring the clinical significance of assessing skeletal muscle mass using L1 SMI. Notably, individuals in the lowest quartile of L1 SMI1 at baseline showed a 4.9-fold and 12.3-fold higher risk of 3-year all-cause mortality and MACE, respectively, than those in the highest quartile. Our stepwise multivariate analysis robustly confirmed the presence of a dose-response association between L1 SMI and 3-year adverse clinical outcomes. Furthermore, landmark analysis at one-year follow-up indicated that L1 SMI has the potential to predict both short- and long-term prognoses. Taken together, CT-based L1 SMI assessment may serve as a compelling quantitative prognostic marker for assessing future cardiovascular risk in CAD patients undergoing PCI.Compared to previously suggested indirect measurement modalities, CT-based skeletal muscle assessment has the key advantage of ensuring precise measurements with a wide range of clinical availability. The measurement of the SMA using CT scans for a specific anatomical region provides an accurate reflection of the muscle mass in a particular area . Traditi2/m2 in males and 25.00 cm2/m2 in females for defining sarcopenia. However, skeletal muscle mass and the diagnostic threshold for defining sarcopenia vary across races, ethnicities, and study populations [Our group recently validated the feasibility of CT-based L1 SMI measurements and demonstrated their prognostic significance in CAD patients undergoing successful PCI for the first time . The CT-ulations ,8,32. AlSarcopenia is a clinical condition with multifactorial causes and associated risk factors. Sarcopenia often coexists with chronic medical conditions, including malignancies, endocrine disorders, chronic kidney diseases, respiratory diseases, autoimmune disorders, and ASCVD ,33. SeveThe current study’s findings suggest that assessing skeletal muscle mass in patients undergoing PCI during the periprocedural period could offer complementary insights along with conventional risk factors. More specifically, the significantly increased risk of non-cardiac mortality implies that sarcopenia is a complex clinical condition frequently associated with various underlying medical comorbidities. Therefore, it may be relevant to conduct a comprehensive assessment of coexisting modifiable medical factors in individuals with sarcopenia to improve overall clinical outcomes. Furthermore, addressing sarcopenia could offer an additional theoretical basis for secondary prevention strategies, including cardiac rehabilitation and non-pharmacological physical intervention in CAD patients. Contemporary guidelines for the management of CAD strongly recommend multidisciplinary cardiovascular rehabilitation as a Class I recommendation based on its favorable impact on overall health ,42. IncrFirst, this study was based on a secondary analysis of non-randomized all-comer registry data. Although we implemented a multiple-stepwise Cox proportional hazards regression analysis, we must acknowledge that residual confounding factors might have influenced the clinical outcomes. Second, measurement of skeletal muscle mass was not the main objective of the CT scans performed in our study. Although our previous study demonstrated that L1 SMI measurements from different CT scan protocols are highly reproducible, future prospective studies should be conducted using a uniform and standardized image acquisition protocol to ensure a more precise and consistent assessment. Additionally, the integration of an artificial intelligence-assisted automated quantification algorithm has the potential to improve the clinical applicability of CT-based skeletal muscle assessments . Third, The skeletal muscle mass, as assessed using L1 SMI, demonstrated a distinct dose-dependent relationship with future adverse clinical outcomes in CAD patients who underwent successful PCI. Integrating CT-based sarcopenia assessment into routine daily clinical practice has the potential to enhance risk stratification and provide valuable prognostic insights for guiding therapeutic decisions in patients with established ASCVD.