Journal articles on the topic 'Class Pass Intervention'

This exploratory trial evaluates the effect of a structured exercise (STEX) or lifestyle intervention (PASS) program upon cardiovascular (CV) disease risk factors in children. Sixty-one schoolchildren were randomly assigned by school to an intervention or control (CON) condition. The effect of the STEX (compared with CON) was a mean benefit of −0.018 mm for average maximum carotid intimamedia thickness. The PASS intervention did not result in clinically important effects, and no other substantial changes were observed. Relatively high probability of clinically beneficial effects of the STEX intervention suggests that a larger, definitive randomized trial with longer follow-up is warranted.

Students with early indicators of behavior risk have predictable, negative outcomes, and those with co-existing academic problems have significantly more negative outcomes. Identifying academic subclasses of students with behavior risk can inform integrated interventions and school-based problem-solving teams. In addition, identifying academic strengths among a population of children typically only differentiated by severity of maladaptive behaviors may offer insight into academic resiliency. Using a sample of 676 elementary school students identified as behaviorally at risk, latent class analysis of reading and math indicators was conducted. Results indicated a three-class structure was the best fit for these data, with Class 1 (25%) having the least academic risk, Class 2 (37%) as below average reading and math, and Class 3 (38%) with significant academic deficits. Class membership was found to significantly predict end of year statewide assessment performance. While those behaviorally at-risk students with co-occurring academic deficits were very likely to fail the end of year assessments (Class 3; 88%–99% failure rates), those with stronger academic skills (Class 1) were increasingly more likely to pass (47%–56% pass rates). Practical implications, including intervention selection, and future directions are discussed.

Two studies were conducted to examine the effects of a brief prompting intervention (verbal and visual reminder of classroom rules) to improve classroom behavior for an elementary student during small-group reading instruction in a special education classroom (Study 1) and for three high school students with mild disabilities in an inclusive general education classroom (Study 2). Using within-participant reversal designs, the teachers provided brief reminders of behavioral expectations just before class. Teachers were instructed to respond to the students’ appropriate and inappropriate behaviors in a typical manner to ensure no programmed changes in the contingencies for student behavior. Results indicated improvements in classroom behavior for all four students, and teachers and students indicated positive perceptions about the intervention and its effects. Implications for future research and practice are discussed.

AbstractLearners in different countries are currently being taught language at their functioning level irrespective of grade levels. District Evaluation Tests in Kenya indicate that Class Three prelingually deaf learners are not being taught English at their functioning level. During the period 2010 - 2012, the learners obtained mean scores of 19.1-29.9%. However, the results did not show their functioning level in grammar to facilitate suitable intervention The purpose of the study was to assess the leaners′ functioning level in English grammar.. Theory of Syntax by Noam Chomsky was adapted and used. The study employed qualitative and evaluative research designs Study population consisted of 337 prelingually deaf learners and 65 English teachers. Multi-Stage and purposive sampling techniques were used to select 178 learners and 16 teachers respectively for the study Data was collected using a questionnaire and a test. The instruments were verified for validity. and tested for reliability. Data was analyzed using descriptive statistics and error analysis. None (0.0%) of the 178 learners obtained the criterion pass mark of 50%. The learners′ functioning level in English grammar was found to be at Class One level at the beginning of the school year. It was recommended that the learners be taught English grammar from Class One level at the beginning of the school year. The findings may be used by schools and the Ministry of Education for intervention.

Language is the basic tool for the teacher's work. Meanwhile, pedagogues often forget that this tool becomes obsolete, just like the knowledge they pass on in class. The article is an attempt to draw attention to the need to learn the language spoken by young people. Thanks to this, teachers can often understand the student's statement, and thus – take appropriate intervention. It is necessary to know everyday expressions, know what the abbreviations used in text messages mean, and above all be sensitive to phrases that may indicate pathological behaviour. The article contains a few examples of words whose meaning is worth knowing when working with young people.

Biomarkers are a characteristic that is objectively measured and eval-uated as an indicator of normal biological processes, pathogenic processes or phar-macological responses to a therapeutic intervention. The combination of dierentbiomarker modalities often allows an accurate diagnosis classication. In Alzheimer'sdisease (AD), biomarkers are indispensable to identify cognitively normal individ-uals destined to develop dementia symptoms. However, using the combination ofcanonical AD biomarkers, studies have repeatedly shown poor classication ratesto dierentiate between AD, mild cognitive impairment and control individuals.Furthermore, the design of classiers to access multiple biomarker combinationsincludes issues such as imbalance classes and missing data. Since the numberbiomarker combinations is large then wrappers are used to avoid multiple com-parisons. Here, we compare the ability of three wrappers feature selection methodsto obtain biomarker combinations which maximize classication rates. Also, ascriterion to the wrappers feature selection we use the k-nearest neighbor classi-er with balance aids, random undersampling and SMOTE. Overall, our analysesshowed how biomarkers combinations aects the classier accuracy and how imbal-ance strategy improve it. We show that non-dening and non-cognitive biomarkershave less accuracy than cognitive measures when classifying AD. Our approach sur-pass in average the support vector machine and the weighted k-nearest neighborsclassiers and reaches 94.34 ± 3.91% of accuracy reproducing class denitions.

Since English language teaching became a compulsory part of the curriculum in all institutes of higher education in Saudi Arabia, different syllabi and teaching methodologies have been experimented to help adult students learn the language effectively, particularly within first-year university preparatory programs. However, despite the huge efforts in aiding the educational process of English as a foreign language (EFL), there is a large turnout of students not meeting the criteria needed to pass their preparatory year. As students are enrolled in one EFL program with the same textbook and are expected to achieve the same benchmarks, there has arisen a need to reexamine the mode in which the curriculum is being delivered. The way forward seems to be remedial intervention that addresses the inadequacies of the non-progressing learners, and utilizes an instructional approach that modifies material and instruction to meet learners’ individual needs. The approach which takes into account individual differences has been known amongst educationalists as Differentiated Instruction (DI). This action research investigation seeks to explore DI as it is being implemented at an EFL remedial program, its procedures and outcomes. We hypothesize that students would benefit from the varied instruction, modified materials and flexible grouping within the class setup. Quantitative data was collected in the form of the grades of a pretest and a posttest. The differences in the results of the two sets of tests showed positive impact of implementing DI on learning, and were found to be statistically significant. Also, tutors' opinions were sought through a mini questionnaire consisting of open-ended questions. It is hoped that the action research thus conducted will contribute to answering pertinent questions and benefit the EFL remedial practice as well as future studies.

IntroductionMedical devices (MDs) differ regarding their risk class (I to III), operational area (in-, outpatient), intended use (diagnostic, monitoring, intervention), and with regard to available clinical evidence. Therefore, the market access processes as well as the approach of gaining reimbursement differ significantly. From a variety of potential approaches the underlying analysis illustrates five MD-specific processes.MethodsBased on a systematic search of publicly available regulations the main pathways of potential reimbursement for MDs were evaluated.ResultsMDs to be used in the in-patient setting can be divided into three categories: an innovative MD (a) is exceeding a current reimbursement framework (German Operations and Procedures Key (OPS) / diagnosis related groups (DRG)), (b) falls within an existing reimbursement rate, or (c) the MD is based on a known mode of action (MoA) for which already adequate reimbursement exists. Due to less empirical data from MDs for a) and b), a health technology assessment (HTA) is required before inclusion in a DRG, whereas a MD with known concept (c) will be grouped into existing price structures. Initiators of these processes are hospitals through a so-called NUB application. MDs entering the outpatient sector are covered by another reimbursement catalogue (EBM/GOÄ) and have to pass an assessment by the G-BA (rapid HTA) if based on new MoA (d). Such an assessment can only be initiated by respective umbrella organizations of service providers (e.g. KBV (National Association of Statutory Health Insurance Physicians)). MDs not being positively recommended by the G-BA are not reimbursable. For MDs (e) with known MoA no HTA is required.ConclusionsFor a successful market launch including sufficient reimbursement not only the market potential, but also the specific regulatory pathways have to be considered carefully. New and innovative MDs in the outpatient sector may have a longer application process to gain a positive reimbursement decision than MDs used in inpatient setting.

There is considerable evidence that children in modern society are losing their contact with nature and, more precisely, with green plants. Is this also the case in Finland, a northern country famous for its forests and wild nature? This study examines the relationship of 9- to 10-year-old Finnish schoolchildren with the green environment and plants. The data were gathered by a questionnaire comprising structured and open-ended questions. The focus of the research was on two comparisons: first, on the nature and child relationship in rural and urban neighborhoods and, second, among boys and girls. Participants in the study amounted to a total of 76 children, 42 in the Helsinki suburb area and 34 in Paltamo. The results suggested that the children in rural surroundings had closer contact with nature than their urban associates. For example, the children of Paltamo reported to know the trees better, and considered human beings to be part of nature more often (100% vs. 76% of the pupils in Helsinki, P = 0,003). Similarly, the results showed that girls in the study (N = 48) were more interested in plants than boys (N = 28). For the girls, the beauty and joy of plants was important, whereas the boys appreciated plants as the source of life. After the pre-questioning, the children of Helsinki participated in an in-class horticultural intervention and 10 days later, answered a similar questionnaire again. The results of the open-ended questions revealed that equally to children in other Western countries, Finnish children may also be in danger of losing their direct contact with the natural environment. It was common to pass free time in organized sports such as hockey or football (boys), or by just walking and talking with friends (girls). Rural children told that they still built huts, pick berries, and climb trees, whereas urban children played in parks and city groves. The results suggest that it is essential to research further the children's own experiences if we are to understand, and subsequently, to enhance, the crucial role of the green environment in their lives. Horticultural interventions can be effective starting points to add to children's knowledge, affection, and interest toward greenery, but it is highly recommended that they take place outdoors rather than indoors.

Background and Purpose: The Tigertriever is a novel, radially adjustable, fully visible, stentriever that permits the operator to align radial expansion with target vessel diameters. This multicenter trial compared the Tigertriever’s effectiveness and safety compared with established stent retrievers. Methods: Single arm, prospective, multicenter trial comparing the Tigertriever to efficacy and safety performance goals derived from outcomes in 6 recent pivotal studies evaluating the Solitaire and Trevo stent-retriever devices with a lead-in and a main-study phase. Patients were enrolled if they had acute ischemic stroke with National Institutes of Health Stroke Scale score ≥8 due to large vessel occlusion within 8 hours of onset. The primary efficacy end point was successful reperfusion, defined as core laboratory-adjudicated modified Thrombolysis in Cerebral Ischemia score 2b-3 within 3 passes of the Tigertriever. The primary safety end point was a composite of 90-day all-cause mortality and symptomatic intracranial hemorrhage. Secondary efficacy end points included 3-month good clinical outcome (modified Rankin Scale score 0–2) and first-pass successful reperfusion. Results: Between May 2018 and March 2020, 160 patients (43 lead-in, 117 main phase) at 17 centers were enrolled and treated with the Tigertriever. The primary efficacy end point was achieved in 84.6% in the main-study phase group compared with the 63.4% performance goal and the 73.4% historical rate (noninferiority P <0.0001; superiority P <0.01). The first pass successful reperfusion rate was 57.8%. After all interventions, successful reperfusion (modified Thrombolysis in Cerebral Ischemia score ≥2b) was achieved in 95.7% and excellent reperfusion (modified Thrombolysis in Cerebral Ischemia score 2c-3) in 71.8%. The primary safety composite end point rate of mortality and symptomatic intracranial hemorrhage was 18.1% compared with the 30.4% performance goal and the 20.4% historical rate (noninferiority P =0.004; superiority P =0.57). Good clinical outcome was achieved in 58% at 90 days. Conclusions: The Tigertriever device was shown to be highly effective and safe compared with Trevo and Solitaire devices to remove thrombus in patients with large-vessel occlusive stroke eligible for mechanical thrombectomy. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03474549.

Abstract P21-activated serine/threonine kinase 4 (PAK4) is a major effector of Cdc42 and is essential for cytoskeleton reorganization. PAK4 is activated in cancer cells, promotes cell migration and anchorage-independent cell growth, and protects against apoptosis induction. With cellular migration playing a significant role in multiple myeloma (MM) cell growth and survival, we investigated the expression and subcellular localization of PAK4 in MM cells. We observed a high level of un-phosphorylated PAK4 in the cytoplasm and high levels of phosphorylated PAK4 in the nucleus. In a gain-of-function study, over-expression of PAK4-eGFP in PAK4-deficient MM cells (RPMI8226) significantly increased cell proliferation and survival. Conversely, in a loss-of-function study, conditional knock-down of PAK4 expression with TRIPZ-lentiviral vectors decreased MM cell proliferation and survival proportionally to the reduction in PAK4. With a significant impact of PAK4 on MM cell growth, we identified a class of orally bioavailable PAK4 allosteric modulators (PAMs; e.g. KPT-6604, -7189, -7657, -8752). We observed inhibition of MM cell growth and survival after treatment with PAMs even in the presence of bone marrow microenvironment. In addition, there is a significant correlation between PAK4 expression and the inhibition concentration (IC50s) of PAMs in proliferation assays. Moreover, inhibition of PAK4 induced receptor and mitochondrial-mediated apoptotic pathways via Caspase-3, -8, and -9 activation. PAMs had no significant effect on normal PBMCs, suggesting a favorable therapeutic index in MM treatment. Finally, in two murine models of human myeloma, orally bioavailable KPT-8752 given daily was able to inhibit tumor growth in vivo and prolong overall survival. In summary, PAK4 plays an important cellular and molecular function in myeloma and its inhibition with a new class of PAK4 allosteric modulators provides a novel therapeutic approach for the treatment of MM. Disclosures Senapedis: Karyopharm: Employment. Baloglu:Karyopharm: Employment. Anderson:Celgene: Consultancy; Sanofi-Aventis: Consultancy; Onyx: Consultancy; Acetylon: Scientific Founder, Scientific Founder Other; Oncoprep: Scientific Founder Other; Gilead Sciences: Consultancy.

<p class="AbstractContent"><strong>Objective:</strong> Low back pain client may have an alteration in their job and had a grieving process with anxiety. Client who experienced it will feel anxiety with certain level and grieving with certain phases. This writing discuss about Mrs. RL’s case about low back pain with anxiety and grieving as psychosocial problems.</p><p class="AbstractContent"><strong>Methods: </strong>This case study aimed to evaluate nursing management given to patient with low back pain to pass grieving process and decrease their anxiety. Nursing management in grieving and anxiety was relaxation techniques and exploring feelings.</p><p class="AbstractContent"><strong>Results:</strong> The evaluation for nursing management was the resolved nursing problem either anxiety or grieving with the teaching interventions. <strong></strong></p><p class="AbstractContent"><strong>Conclusion: </strong>Application of the relaxation techniques with adjusted time for patients in daily living to keep patient’s psychosocial conditions can be performed by nurse.</p><div><p class="Keywords"><strong>Keywords: </strong>Anxiety; Grieving; Low Back Pain; Relaxation Technique</p></div>

<p class="abstract"><strong>Background:</strong> Tympanic membrane perforations occurring due to mucosal COM usually require surgical interventions for repair (myringoplasty or tympanoplasty) depending on the size and site of the perforation and the ossicular chain continuity. Various studies have shown TCA cautery as an efficacious non surgical method for repairing small and medium sized TM perforations. This technique was successfully used and popularized for repairing small and medium sized perforations by Derlacki in 1953.</p><p class="abstract"><strong>Methods:</strong> In this study we included dry pars tensa perforations in 100 patients occurring due to trauma or unresolved cases after inflammation/infection of middle ear. 50% w/v trichloro acetic acid was used for a maximum number of 5 applications at the margins of the perforations which were followed up for the next one year. </p><p class="abstract"><strong>Results:</strong> In this study, involving a total of 125 perforations (75 unilateral and 50 bilateral), success rate was high among the patients with traumatic perforations and small sized perforations while a few number of perforations only reduced in size, which were later corrected with surgical approaches (myringoplasty/tympanoplasty). The overall success rate achieved in this study was 72.16%.</p><p class="abstract"><strong>Conclusions:</strong> Though there are various materials and methods available for this procedure, the principle remains the same. This technique should be attempted for patients that fit the criteria for undergoing this procedure before being undertaken for surgical approaches to minimize the risks and cost burden associated with surgery and anesthesia.</p>

ObjectiveExploration of healthcare utilisation patterns in the final life year to assess palliative care potential.MethodsRetrospective cluster analyses (k-means) of anonymised healthcare expenditure (HCE) trajectories, derived from health insurance claims of a representative sample of Swiss decedents who died between 2008 and 2010 (2 age classes: 4818 <66 years, 22 691 elderly).Results3 (<66 years) and 5 (elderly) trajectory groups were identified, whose shapes were dominated by HCE from inpatient care in hospitals and at nursing homes. In each age class, the most expensive group (average cumulative HCE for <66 years: SFr 84 295; elderly: SFr 84 941) also had the largest abundance of cancers (<66 years: 55%; elderly: 32%) and showed signs of continued treatment intensification until shortly before death. Although sizes of these high-cost groups were comparatively small (26% in younger; 6% in elderly), they contributed substantially to the end-of-life HCE in each age class (62% and 18%, respectively).As age increased, these potential target groups for palliative care gained in share among <66-year olds (from 9% in children to 28% in 60–65-year olds), but decreased from 17% (66–70-year olds) to 1% (>90-year olds) among elderly.ConclusionsCost trajectory clustering is well suited for first-pass population screenings of groups that warrant closer inspection to improve end-of-life healthcare allocation. The Swiss data suggest that many decedents undergo intensive medical treatment until shortly before death. Investigations into the clinical circumstances and motives of patients and physicians may help to guide palliative care.

<p class="abstract"><strong>Background:</strong> Squamosal COM is a condition caused by various etiological factors which are likely to affect the other side too. If diagnosed and intervened in time, the progression of the disease from simple negative middle ear pressure to cholesteatoma formation can be prevented and ear can be protected from hearing loss. Therefore it is important to assess and evaluate the contralateral ear appropriately.</p><p class="abstract"><strong>Methods:</strong> This prospective study included patients above six years of age suffering from unilateral squamosal chronic otitis media. Their contralateral ears were examined and assessed for any ear disease. </p><p class="abstract"><strong>Results:</strong> We found various conditions in contralateral ears ranging from normal tympanic membrane to various types and grades of retractions of pars tensa as well as pars flaccida and some infectious conditions too. The commonest finding was secretory otitis media (23%) and the least common was otomycosis (3%).</p><p class="abstract"><strong>Conclusions:</strong> Most common status in contralateral ear was found to be secretory otitis media in adult and paediatric age groups (23%). In our study, 84% of the patients showed pathology in the contralateral ear and 16% were normal, so the study proves that in patients with unilateral squamosal otitis media, with no complaints or previous history of discharge in contralateral ear shows pathology to quite a good extent¸ so the contralateral ear should always be evaluated comprehensively to efficiently diagnose any alterations and provide timely therapeutic intervention to prevent further progression of the disease and hearing loss.</p>

BackgroundThe negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control.DesignA parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted.ParticipantsEligibility criteria: age 18–65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of ≥ 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient. Exclusion criteria: inability to participate in the groups and insufficient command of English.SettingsParticipants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces.InterventionsControl intervention: a 10-week, 90-minute, 20-session group beginners’ Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist.OutcomesThe primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up.ResultsA total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in means of the PANSS negative subscale at the end of treatment was 0.03 [95% confidence interval (CI) –1.11 to 1.17], showing no advantage of the intervention. In the secondary outcomes, the mean difference in the Clinical Assessment Interview for negative symptoms expression subscale at the end of treatment was 0.62 (95% CI –1.23 to 0.00), and in extrapyramidal movement disorder symptoms –0.65 (95% CI –1.13 to –0.16) at the end of treatment and –0.58 (95% CI –1.07 to –0.09) at 6 months’ follow-up, showing a small significant advantage of body psychotherapy. No serious adverse events related to the interventions were reported. The total costs of the intervention were comparable with the control, with no clear evidence of cost-effectiveness for either condition.LimitationsOwing to the absence of a treatment-as-usual arm, it is difficult to determine whether or not both arms are an improvement over routine care.ConclusionsIn comparison with an active control, group body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia. These findings conflict with the review that led to the current National Institute for Health and Care Excellence guidelines suggesting that arts therapies may be an effective treatment for negative symptoms.Future workDetermining whether or not this lack of effectiveness extends to all types of art therapies would be informative.Trial registrationCurrent Controlled Trials ISRCTN842165587.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 11. See the NIHR Journals Library website for further project information.

Background: Novel Psychoactive Substances (NPS) are a heterogeneous class of synthetic molecules including synthetic cannabinoid receptor agonists (SCRAs). Psychosis is associated with SCRAs use. There is limited knowledge regarding the structured assessment and psychometric evaluation of clinical presentations, analytical toxicology and clinical management plans of patients presenting with psychosis and SCRAs misuse. Methods: We gathered information regarding the clinical presentations, toxicology and care plans of patients with psychosis and SCRAs misuse admitted to inpatients services. Clinical presentations were assessed using the PANSS scale. Vital signs data were collected using the National Early Warning Signs tool. Analytic chemistry data were collected using urine drug screening tests for traditional psychoactive substances and NPS. Results: We described the clinical presentation and management plan of four patients with psychosis and misuse of SCRAs. Conclusion: The formulation of an informed clinical management plan requires a structured assessment, identification of the index NPS, pharmacological interventions, increases in nursing observations, changes to leave status and monitoring of the vital signs. The objective from using these interventions is to maintain stable physical health whilst rapidly improving the altered mental state.

Abstract Objective: Semi-invasive foramen ovale electrodes (FOEs) are used as an alternative to invasive recording techniques in the presurgical evaluation of patients with temporal lobe epilepsy. To maximize patient safety and interventional success, frameless stereotactic FOE placement by use of a variation of an upper jaw fixation device with an external fiducial frame, in combination with an aiming device and standard navigation software, was evaluated by the Innsbruck Epilepsy Surgery Program. Methods: Patients were immobilized noninvasively with the Vogele-Bale-Hohner headholder (Medical Intelligence GmbH, Schwabmünchen, Germany) to plan computed tomography and surgery. Frameless stereotactic cannulation of the foramen and intracranial electrode placement were achieved with the help of an aiming device mounted to the base plate of the headholder. Ease of applicability, safety, and results obtained with foramen ovale recording were investigated. Results: Twenty-six FOEs were placed in 13 patients under general anesthesia. The foramen ovale was successfully cannulated in all patients. One patient reported transient painful mastication after the procedure as a complication attributable to use of the Vogele-Bale-Hohner mouthpiece. In one patient, a persistent slight buccal hypesthesia was present 3 months after the procedure. To pass the foramen, slight adjustments in the needle position had to be made in 10 sides (38.4%). To place the intracranial electrodes, adjustments were necessary six times (23.7%). An entirely new path had to be planned once (3.8%). Seizure recording provided conclusive information in all patients (100%). Outcome in operated patients was Engel Class Ia in six patients, Class IId in one patient, Class IIb in one patient, and Class IVa in one patient (minimum follow-up, 6 mo). Conclusion: The Vogele-Bale-Hohner headholder combined with an external registration frame eliminates the need for invasive head clamp fixation. FOE placement can be planned “offline” and performed under general anesthesia later. This can be valuable in patients with distorted anatomy and/or small foramina or in patients not able to undergo the procedure under sedation. Results are satisfactory with regard to patient safety, patient comfort, predictability, and reproducibility. FOEs supported further treatment decisions in all patients.

Background. In psychosis, the prime indicator of outcome has been relapse, but hospital readmission can no longer be used for this purpose. Researchers now require methods for assessing relapse that are objective, blind, reliable and valid. We describe the reliability and validity of such a technique using case-notes.Method. Information from routine clinical notes of participants in the Lambeth Early Onset (LEO) study (less all references that would unblind the assessor) were recorded on a form divided into 1-month sections. Operational definitions of remission and relapse enabled clinicians to identify remissions and relapses blindly from the summary information. We calculated reliability regarding both the fact and the timing of remission and relapse. PANSS ratings at 6 and 18 months provided a measure of validity.Results. The kappa value for the identification of remission by individuals ranged from 0·64 to 0·82, while that for consensus between paired raters was 0·56. The corresponding values for relapse were 0·57–0·59 and 0·71. Intra-class correlations for time to remission and to relapse were very high. Raters guessed correctly whether the participants came from the intervention or control group on 60–75% of occasions. Independent PANSS ratings were strongly related to the remission/relapse status of participants.Conclusions. The reliability of the technique described here was moderate to good, its validity was good, and it provides a useful and timely addition to methods of evaluating remission and relapse in psychosis. On the basis of our experience, we recommend consensus rather than individual ratings.

Background: Menstruation still a taboo subject to whisper and so, more difficult to discuss the hygiene, practices, perception and myth associated with it. The very ancient socio -cultural restrictions still play a major role in plenty of reproductive tract infections left undiagnosed. Thus resulting in the potential loss of economy in terms of GDP, medical costs, and status of health. The objectives of the study were to assess the awareness, source of information and problems regarding menstrual hygiene at pre-questionnaire stage and to compare the assessment of awareness at post questionnaire stage after educational intervention provided among the study group; to find out the mean age of menarche among the study group; to find out the knowledge regarding symptoms of reproductive tract infections among the study group; to inculcate safe hygienic practices during menstruation so as to percolate the same during reproductive episodes e.g. termination of pregnancy or uterine bleeding etc. Methods: Convenient sampling with Semi-structured questionnaire method. A girls’ government school chosen for the study with 197 girls including class standard 9th, 10th, 11th and 12th. After the session of pre questionnaire, all girls were included in the study who were present on the day. Results: On statistical analysis, mean age of menarche among girls is 13.5 years. Data regarding awareness level found statistically significant after the completion of study. Conclusions: Satisfactory improvement in hygiene level found post intervention. It could be implied on massive level in all the schools in country. In conformity with, Indian government also came up with the programme of provision of free sanitary pads in government schools.

The so-called Arab spring of 2011 did not pass by Yemen. As it became clear later on, it triggered a chain of events leading up to cardinal changes in the country’s destiny. It would be wrong, however, to call the 2011 turmoil a revolution since it failed to bring about a fundamental social and political transformation. This was achieved later, in 2014-2015, when a vigorous social protest was accompanied by an outburst of tribalism as the Shiite Houthi movement dared to challenge the long-standing domination of powerful traditional clans that used to be represented by President Salih who lost his position but kept trying to ensure a comeback. In a completely new and surprising configuration of forces Salih made an alliance with the Houthites who succeeded in quickly overrunning most of the country. These events, unlike the 2011 events, can be branded a genuine revolution. The situation was aggravated by the increased activity of “Al-Qaeda in the Arabian peninsula” and the separatist movement in the South. As the Houthites appeared to be winning, Saudi Arabia began a large scale military intervention aimed at preventing Yemen from becoming a Shia-dominated state and possibly an Iranian stooge. As a result of the Saudi air bombardment, contours of a serious international conflict have been shaping up. Acknowledgements. Research has been implemented in the framework of NRU HSE Program of Fundamental Studies in 2015 with support of Russian Scientifi c Foundation, Project № 14-18-03615.

ABSTRACTObjective: to identify the use and acceptance of condoms among students; executing educational interventions on HIV/AIDS. Method: quantitative approach intervention study among students between the ages of 10 and 15 years, in a public school in Recife-PE, Brazil. The sample consisted of 30 students divided into two rooms, with 16 students in 7th and 8th grade 14 in the 8th and 9th grade. For the sample selection, inclusion and exclusion criteria were taken into consideration. Data collection was performed with the use of a questionnaire and the analysis by the Epi-Info version 3.5, software. Then educational interventions were carried out through lectures. All this after the approval of the research project by the Research Ethics Committee of the Center for Health Sciences, Federal University of Pernambuco/CCS/UFPE, under protocol No. 191/10, with the signing of the free and informed consent by parents/guardians. Results: among the main results, it was noted that 66.7% of the students agreed that the use of condoms reduces the risk of contracting HIV/AIDS; 63.3% agreed that to reduce the risks of contracting HIV/AIDS is to use condoms, regardless of the number of partners; 56.7% of young people gave their opinions that they disagree about performing sexual activity without a condom; 36.7% use condoms with all sexual partners. Conclusion: There was a satisfactory index of acceptance for the use of condoms. Descriptors: teenager; condoms; students. RESUMOObjetivos: identificar o uso e aceitação dos preservativos entre estudantes; realizar intervenções educativas sobre o HIV/aids. Método: estudo de intervenção, de abordagem quantitativa entre os estudantes na faixa etária entre 10 e 15 anos, em uma escola pública do Recife-PE. A amostra foi de 30 alunos, distribuídos em duas salas, sendo 16 alunos da 7º série do 8º ano e 14 do 8º série do 9º ano. Para a seleção da amostra foram levados em consideração critérios de inclusão e exclusão. A coleta de dados foi realizada com o uso de questionário e análise pelo Epi-Info versão 3.5. Em seguida, foram realizadas intervenções educativas por meio de palestras. Tudo isso após a aprovação do projeto de pesquisa pelo Comitê de Ética em Pesquisas do Centro de Ciências da Saúde, da Universidade Federal de Pernambuco/CCS/UFPE, sob n° 191/10, com a assinatura do Termo de Consentimento Livre e Esclarecido pelos pais/responsáveis. Resultados: dentre os principais resultados, observou-se que 66,7% dos estudantes concordaram que o uso de preservativos reduz o risco de contrair HIV/AIDS; 63,3% concordaram que para reduzir os riscos de contrair o HIV/AIDS é usar preservativos, independente do número de parceiros; 56,7% dos jovens opinaram que discordam em realizar atividade sexual sem preservativo; 36,7% usarão preservativos com todos os parceiros sexuais. Conclusão: houve índice satisfatório de aceitação no uso de preservativos. Descritores: adolescente; preservativos; estudantes.RESUMENObjetivos: identificar el uso y aceptación de los preservativos entre estudiantes; realizar intervenciones educativas sobre el VIH/SIDA. Método: estudio de intervención, de abordaje cuantitativo entre los estudiantes de entre diez y quince años, en una escuela pública de Recife (PE, Brasil). El universo fue de 30 alumnos, distribuidos en dos clases, dieciséis alumnos del 7ºcurso y catorce del 8º curso de educación primaria. Para la selección del muestreo se tuvieron en cuenta criterios de inclusión y exclusión. La recogida de datos se realizó mediante empleo de cuestionario y análisis por la versión Epi-Info. Seguidamente se realizaron intervenciones educativas por medio de conferencias. Todo ello tras la aprobación del proyecto de investigación por el Comité de Ética en Investigaciones del Centro de Ciencias de la Sanidad de la Universidad Federal de Pernambuco/CCS/UFPE. bajo nº 191/10, con la firma del Término de Libre y Espontánea Voluntad por parte de los padres/tutores. Resultados: entre los principales resultados, se observó que el 66,7% de los estudiantes estuvieron de acuerdo con que el empleo de preservativos reduce el riesgo de contraer VIH/SIDA; el 63,3% aceptaron que para reducir el riesgo de adquirir el VIH/SIDA hay que usar preservativos, independientemente del número de compañeros sexuales; 56,7% de los jóvenes opinaron que no aceptan realizar actividades sexuales sin preservativo; el 36,7% utilizarán preservativos con todos sus compañeros sexuales. Conclusión: hubo un índice satisfactorio de aceptación del uso del preservativo. Descriptores: adolescente; preservativos; estudiantes.

The purpose of this study was to analyze the effect of a unit of basketball based on Teaching Games for Understanding model combined with a program of unstructured practice based on small-sided games (experimental group), in comparison to the only application of the unit (control group), on the decision-making and execution in Physical Education students. Participants were 31 students with ages between 12 and 14. The intervention was conducted over four weeks, developing eight PE lessons and eight school recess to unstructured practice. The decision-making and the execution of the pass action were measured by systematic observation, using the Game Performance Evaluation Tool instrument. Results showed in the experimental group, significantly higher values in post-test with respect to pre-test, in both variables (decison-making, p = .001; execution, p = .024). Regarding to the control group, these differences were found only in the decision-making (p = .021). Findings demonstrated that the joined application of a unit with unstructured practise is more effective to improve decision-making and skill execution that if students are expose only in the Physical Education lessons. Therefore, we recommend teachers promote opportunities to students to have experiences in school recess. Resumen: El propósito de este estudio fue analizar el efecto de una Unidad Didáctica de baloncesto basada en el modelo Enseñanza de los Juegos a través de la Comprensión, combinada con un programa de práctica no estructurada basado en juegos modificados (grupo experimental), en comparación con la aplicación únicamente de la Unidad Didáctica (grupo control), en la toma de decisiones y la ejecución en alumnos de Educación Física. Participaron 31 alumnos con edades entre 12 y 14 años. La intervención se realizó durante cuatro semanas, desarrollándose ocho clases de Educación Física y ocho recreos para la práctica no estructurada. La toma de decisiones y la ejecución fueron medidas a través de observación sistemática, usando el Instrumento de Evaluación del Rendimiento en el Juego. Los resultados mostraron en el grupo experimental, valores significativamente más altos en la evaluación final con respecto a la inicial, en ambas variables (toma de decisiones, p = .001; ejecución, p = .024).. Con respecto al grupo control, estas diferencias se encontraron solo en la toma de decisiones (p = .021). Los resultados demostraron que la aplicación conjunta de una Unidad Didáctica con práctica no estructurada es más efectiva para mejorar tanto la toma de decisiones como la ejecución de las habilidades, en vez de exponer a los alumnos solo a las clases de Educación Física. Por tanto, se recomienda que los profesores promuevan oportunidades de práctica en los recreos para los alumnos.

Objectives: To verify the usability of social media like WhatsApp in delivering knowledge to 4th year and Final year MBBS students and to compare the improvement of knowledge gain through e-learning and didactic lecture. Concurrently, perception of students about e-learning via WhatsApp will also be gathered. Study Design: Prospective Analytical Interventional study. Setting: Department of Medical Education of Sahiwal Medical College Sahiwal. Period: 01.01.2020 to 31.03.2020. Material & Methods: On 4th year and Final year MBBS students two Whatsapp group were made, one for each class. Then the students were taught different topics by WhatsApp. Assessment of knowledge of e-learning through WhatsApp was done by feedback form. Results: The results revealed that technical, educational and instructional advantages of teaching learning activity via WhatsApp out pars disadvantages. Increase in interaction with peers and getting a fair chance to participate in group discussion were top two educational benefits of learning through WhatsApp with 64.10% and 62.80% students agreeing to it. A majority of the students (89.8%) agreed to the facts that the availability of smart phones was not an issue for them and they are very comfortable in using Whatsapp as e learning tool (61.6%). on the other hand 29.5 % of the students were disagreed with the fact that they are getting more chances in clearing their concepts on Whatsapp. Conclusion: Increase in interaction with the peers and getting more chance to discuss a particular topic with group has made WhatsApp a new and convenient tool for teaching/learning activity. Students also found Whatsapp as less time consuming as compared to conventional lectures. A few disadvantages, like lesser chance of clearing the concepts on Whatsapp can be overruled by making small groups and using mobiles with bigger screen.

Abstract Introduction: Idelalisib is a first-in-class PI3Kδ-inhibitor. In clinical studies idelalisib demonstrated significant efficacy in patients with CLL, including patients with TP53 aberrations (del17p and/or TP53m). On this basis national and international guidelines in Europe recommend idelalisib as one treatment option in this high-risk CLL patient population. However, it is unclear how efficacy reported in clinical studies translates into real world experience. Considering the importance of such data, we initiated a real world study soon after market authorization of idelalisib in the European Union prospectively investigating efficacy and safety of idelalisib in routine clinical practice. Concomitant PJP prophylaxis is a risk minimization measure that was introduced after market authorization of idelalisib. Nevertheless, the impact on patient outcomes in routine clinical practice has not been studied in detail. We therefore also analyzed the impact of PJP prophylaxis on overall survival (OS) within this real world cohort. Methods: A prospective, two-cohort, multicenter, non-interventional post-authorization safety study (PASS) reporting real world safety and efficacy data on the use of idelalisib in Germany. Inclusion of patients was based on the physician's decision to initiate treatment with idelalisib in accordance with the European Summary of Product Characteristics. Descriptive statistics were used for data analysis. Results: This analysis included 84 CLL patients with a median age of 74 years. 88% of patients were older than 65 years, 70% were male and 86% presented with one or more co-morbidities. Binet stage A, B, C was reported in 25%, 33% and 37% of patients, respectively. The median time from diagnosis to start of idelalisib therapy was 89.5 months and patients received a median number of two prior lines of therapy, including treatment with the BTK inhibitor ibrutinib in 11 patients (13%). With a median observation time of 11.5 months the median overall survival (OS) for the entire CLL patient population was not reached. Our CLL cohort included 24 patients (29%) that did not receive PJP prophylaxis for idelalisib therapy. We therefore compared OS in patients with and without concomitant PJP prophylaxis. In patients receiving PJP prophylaxis survival rates were higher in the first 6-12 months of therapy, with 6-month and 12-month survival rates in patients with vs without PJP prophylaxis of 98% vs 76% and 84% vs 76%, respectively (Figure 1). 19% of CLL patients (n=16) had documented TP53 aberrations, including five patients that received idelalisib as first-line treatment. In patients with TP53 aberrations the overall response rate (ORR) was 77% compared to 67% in patients without TP53 aberrations. Importantly, the 12-month survival rates for patients with and without TP53 aberrations were similar with 81% and 83%, respectively. Median OS was not reached for either patient population (Figure 2). Conclusion: This prospective real world study started collecting data on the efficacy and safety of idelalisib in routine clinical practice soon after market authorization of idelalisib in Europe. Results demonstrate similar efficacy of idelalisib irrespective of the patients' TP53 status confirming the efficacy previously reported in pivotal clinical studies. Additionally, our results provide evidence that PJP prophylaxis is an effective risk minimization measure impacting on survival. Disclosures Hoechstetter: Hexal: Other: Travel Grants; Abbvie: Other: Travel Grants; Gilead Sciences: Consultancy, Other: Travel Grants. Eissmann:Gilead Sciences: Employment. Hucke:Gilead Sciences: Employment. van Troostenburg:Gilead Sciences: Employment. Ramroth:Gilead Sciences: Employment. Knauf:Celgene: Consultancy, Honoraria; Gilead Sciences: Consultancy; Janssen: Consultancy; Mundipharma: Consultancy; Roche: Consultancy; Amgen: Consultancy, Honoraria; AbbVie: Consultancy.

Abstract Abstract 4329 Chronic thromboembolic pulmonary hypertension (CTEPH) results from obstruction of the major pulmonary arteries by incompletely resolved or organized pulmonary emboli which have become incorporated into the pulmonary artery wall, eventually causing an increase in pulmonary vascular resistances. CTEPH is a condition that is recognised in an increased percentage of patients. Pulmonary endarterectomy (PEA) is recognized as being the only curative option for a subgroup of those patients, but anaesthesiologists and intensivists face many challenges in how they manage these patients perioperatively. Ultimately, it is the combination of skills in a multidisciplinary team that leads to a successful procedure and dramatically improves patient's quality of life and life expectancy. Careful pre- and post-operative management is therefore essential for such a successful outcome following PEA. In 1994 in Pavia was started a program in which members of a multidisciplinary team work in close interaction with the aim of increase experience in the challenging problems these patients present in the evaluative, surgical, and post-operative phases of their care. Pregnancy in women with pulmonary hypertension (PH) is reported to carry a maternal mortality rate of 30–56%. No report is available on the management of pregnancy and delivery in patients with CTPH. We report our experience of the management of a pregnancy in a patient previously submitted to PEA in whom pressures decreased significantly but remained higher than normal due to partial intervention. EFS, 29 yrs, had first hemoptysis in 2001. Since then, she suffered effort dyspnea. A second hemoptysis occurred in 2004. She was admitted to hospital as having “Multiple foci pneumonia, with pulmonary hypertension of unclear origin”. In 2005 patient was admitted to a different hospital. A CT scan showed: “Congenital right pulmonary artery agenesia associated with bilateral multiple artero-venous malformations. NYHA Class III”. Patients was transferred to our hospital. Thrombophilic workout resulted negative. PaO2: 79.9 mmHg, pulmonary artery pressures (PAP): 130/60/13 mmHg, pulmonary vascular resistances (PVR): 1.083 dynes/sec/min−5. CT angio-scan: Severe dilation of the common pulmonary artery (34 mm). Right pulmonary artery visible only at proximal level. Bronchial artery dilation, bilaterally. V/Q scan: Absent visualization of the right pulmonary artery. Perfusion absent. Arteriography: Clearcut thrombosis of the right pulmonary artery (initial tract). Multiple typical CTPH lesions of the left pulmonary artery. Lower limb compression ultrasound (CUS): No sign of deep or superficial vein thrombosis. On 11 april, 2005 PEA was performed on the left side, with an attempt on the right side. No agenesia of the right pulmonary artery was found. Probable occlusion in early age, with evolution in fibrosis. Post surgery, PaO2: 94.3 mmHg, PAP: 53/32/15 mmHg, PVR: 453 dynes/sec/min−5. On September 16, 2005 she was pregnant, seventh week. After careful multidisciplinary counseling, patient decided to continue pregnancy. Anticoagulant treatment was switched from warfarin to low molecular weight heparin (LMWH), therapeutic dosage. Two days before elective delivery, LMWH was reduced to prophylactic dosages. On march 2, 2006 after an uncomplicated Caesarean section under general anesthesia, she delivered a healthy baby girl. During the following months, PAPs and functional parameters normalized. Patient is today in relatively good health. Is under oral vitamin K antagonists treatment. In 2007, being pregnant again, opted for therapeutic abortion. Maternal mortality in parturients with PAH or CTPH remains prohibitively high, despite lower death rates than previous decades. Early advice on pregnancy risks, including contraception, remains paramount. Women with PAH or CTPH who become pregnant warrant a multidisciplinary approach with consideration of appropriate therapies. Disclosures: No relevant conflicts of interest to declare.

Abstract:: Substantial affirmation suggested that oxidative stress remains an impelling target, contributing to initiate and exacerbate the multiple neurological complications in age-related neurodegeneration (ARN). Factors including gene and environmental toxins now becoming the most threatening cause of oxidative stress. It leads to mitochondrial dysfunction of the neurons that ultimately causes permanent loss of its functionality. Clinical trials on antioxidants are still in the pipeline to access it as a potential therapeutic class. But this raised the generosity for not only to investigate the module of the antioxidant mechanism but also to justify the drug delivery and doses regimen. Biological barriers predominantly Blood-brain barrier (BBB) and rapid first-pass metabolism are some of the potential obstacles for the effective targeting of the therapeutic agent. Bioactive drugs with antioxidant capacity, loaded with lipid-based Nano career system has revealed to be a novel therapeutic intervention for ARN. The review will deal with the comprehensive state-of-art methodology for the delivery of bioactive loaded lipid Nanocarriers to treat neurodegeneration. A systematic analysis of published reports will help the researchers to understand the role of natural compound loaded Nanoengineered system in the field of ARN as a potential Nano therapeutic intervention.

Stilbenoids constitute a major class of plant-derived secondary metabolites occurring in abundance across several families and are well-known for their nutritional and health-promoting benefits. Several investigations have established their therapeutic potential in the management of different types of cancer, neuroinflammation, arthritis, disorders in lipid metabolism, microbial infection etc. Studies on resveratrol monomer, oxyresveratrol, their synthetic analogs, piceatannol, pterostilbene can be found in the literature. But a collective and comprehensive review on chemistry, pharmacological effects, structure-activity relationship and pharmacokinetics of plant-derived oligostilbenes and stilbene glycosides is missing. These phytochemicals are generally characterised by poor oral bioavailability due to extensive first-pass metabolism and conjugation. The present chapter aims to fill up these lacunae and also focuses on further studies that can be performed in the future to translate these immensely potential secondary metabolites into human clinical setting from cell culture and animal studies at the preclinical level for effective therapeutic intervention of various pathological conditions.

<p class="MsoNormal" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-size: 10pt; mso-bidi-font-style: italic; mso-bidi-font-size: 12.0pt;"><span style="font-family: Times New Roman;">The idea of inflation targeting in emerging countries is not a new one. There have been papers that favor or reject the idea of implementing such a system in these countries for mainly institutional reasons. This paper does not deal with these normative arguments. Emerging countries are implementing IT regimes and therefore it is necessary to understand how it should be done and what problems can arise. Therefore this paper focuses on exchange rate issues for inflation targeting. These issues have their root in the basic relation that exists in emerging countries between inflation and the exchange rate, a relation known as the &ldquo;pass through effect&rdquo;. The simple setup used in this paper shows how the monetary authorities implementing an IT regime must intervene in the exchange rate market in order to comply with the inflation target. The central bank intervenes in order to avoid exchange rate movements that would affect the overall inflation rate through the pass-through effect. These results mean that the dirty floating or fear of floating hypothesis should be modified when applied to countries implementing IT, since their intervention (or dirty floating activities) may be justified.</span></span></p>

Background and objective: The medical students should be trained in BLS/ACLS/PALS in order to attain the skills for emergency patient management. The objective of the study is to compare the knowledge, attitude and practice about BLS/ACLS/PALS among the interventional and non-interventional groups both before intervention and after intervention. Methods: This interventional study was done among final year medical students and house surgeons in six Medical colleges of Northern Kerala.The study subjects were categorized into two groups,Category 1 received an orientation class on BLS/ACLS/PALS and students belonging to category 2 did not receive the orientation class. A pre-validated pretested questionnaire to assess the Knowledge, Attitude and Practice of medical students regarding BLS/ACLS/PALS was distributed after the orientation class.The control group (category 2) who did not receive the orientation class also were given the questionnaire same as that of other group. Results: Total of 608 students participated in this study.Out of which 325 received an orientation class. Unpaired t-test done in pretest among interventional and non-interventional group showed p value>0.01 which implied that both groups were comparable. The mean scores of Knowledge, attitude and practice in the post test increased to 8.111±1.507, 2.328±.743, 2.065±.297 among house surgeons and an increment to 6.260±1.087, 2.277±.474, 1.659±.659 among final years in the interventional group as when compared with the scores of the non-interventional group. Paired t test also showed significant difference among interventional group while there was no change in the non-interventional group.(p>0.05). Conclusion: BLS/ACLS/PALS training among undergraduates can improve the Knowledge, Attitude and Practice of medical students thereby increasing the resuscitation as well as the survival of patients in emergency care. Keywords: BLS, ACLS , PALS, Resuscitation

Each community’s title deed carries the indelible blood stains of our ancestors. (Watson, "Howard’s End" 2)IntroductionAccording to the Oxford English Dictionary, the term coalition comes from the Latin coalescere or ‘coalesce’, meaning “come or bring together to form one mass or whole”. Coalesce refers to the unity affirmed as something grows: co – “together”, alesce – “to grow up”. While coalition is commonly associated with formalised alliances and political strategy in the name of self-interest and common goals, this paper will draw as well on the broader etymological understanding of coalition as “growing together” in order to discuss the Australian government’s recent changes to land rights legislation, the 2007 Emergency Intervention into the Northern Territory, and its decision to use Indigenous land in the Northern Territory as a dumping ground for nuclear waste. What unites these distinct cases is the role of the Australian nation-state in asserting its sovereign right to decide, something Giorgio Agamben notes is the primary indicator of sovereign right and power (Agamben). As Fiona McAllan has argued in relation to the Northern Territory Intervention: “Various forces that had been coalescing and captivating the moral, imaginary centre were now contributing to a spectacular enactment of a sovereign rescue mission” (par. 18). Different visions of “growing together”, and different coalitional strategies, are played out in public debate and policy formation. This paper will argue that each of these cases represents an alliance between successive, oppositional governments - and the nourishment of neoliberal imperatives - over and against the interests of some of the Indigenous communities, especially with relation to land rights. A critical stance is taken in relation to the alterations to land rights laws over the past five years and with the Northern Territory Emergency Intervention, hereinafter referred to as the Intervention, firstly by the Howard Liberal Coalition Government and later continued, in what Anthony Lambert has usefully termed a “postcoalitional” fashion, by the Rudd Labor Government. By this, Lambert refers to the manner in which dominant relations of power continue despite the apparent collapse of old political coalitions and even in the face of seemingly progressive symbolic and material change. It is not the intention of this paper to locate Indigenous people in opposition to models of economic development aligned with neoliberalism. There are examples of productive relations between Indigenous communities and mining companies, in which Indigenous people retain control over decision-making and utilise Land Council’s to negotiate effectively. Major mining company Rio Tinto, for example, initiated an Aboriginal and Torres Strait Islanders Policy platform in the mid-1990s (Rio Tinto). Moreover, there are diverse perspectives within the Indigenous community regarding social and economic reform governed by neoliberal agendas as well as government initiatives such as the Intervention, motivated by a concern for the abuse of children, as outlined in The Little Children Are Sacred Report (Wild & Anderson; hereinafter Little Children). Indeed, there is no agreement on whether or not the Intervention had anything to do with land rights. On the one hand, Noel Pearson has strongly opposed this assertion: “I've got as much objections as anybody to the ideological prejudices of the Howard Government in relation to land, but this question is not about a 'land grab'. The Anderson Wild Report tells us about the scale of Aboriginal children's neglect and abuse" (ABC). Marcia Langton has agreed with this stating that “There's a cynical view afoot that the emergency intervention was a political ploy - a Trojan Horse - to sneak through land grabs and some gratuitous black head-kicking disguised as concern for children. These conspiracy theories abound, and they are mostly ridiculous” (Langton). Patrick Dodson on the other hand, has argued that yes, of course, the children remain the highest priority, but that this “is undermined by the Government's heavy-handed authoritarian intervention and its ideological and deceptive land reform agenda” (Dodson). WhitenessOne way to frame this issue is to look at it through the lens of critical race and whiteness theory. Is it possible that the interests of whiteness are at play in the coalitions of corporate/private enterprise and political interests in the Northern Territory, in the coupling of social conservatism and economic rationalism? Using this framework allows us to identify the partial interests at play and the implications of this for discussions in Australia around sovereignty and self-determination, as well as providing a discursive framework through which to understand how these coalitional interests represent a specific understanding of progress, growth and development. Whiteness theory takes an empirically informed stance in order to critique the operation of unequal power relations and discriminatory practices imbued in racialised structures. Whiteness and critical race theory take the twin interests of racial privileging and racial discrimination and discuss their historical and on-going relevance for law, philosophy, representation, media, politics and policy. Foregrounding contemporary analysis in whiteness studies is the central role of race in the development of the Australian nation, most evident in the dispossession and destruction of Indigenous lands, cultures and lives, which occurred initially prior to Federation, as well as following. Cheryl Harris’s landmark paper “Whiteness as Property” argues, in the context of the US, that “the origins of property rights ... are rooted in racial domination” and that the “interaction between conceptions of race and property ... played a critical role in establishing and maintaining racial and economic subordination” (Harris 1716).Reiterating the logic of racial inferiority and the assumption of a lack of rationality and civility, Indigenous people were named in the Australian Constitution as “flora and fauna” – which was not overturned until a national referendum in 1967. This, coupled with the logic of terra nullius represents the racist foundational logic of Australian statehood. As is well known, terra nullius declared that the land belonged to no-one, denying Indigenous people property rights over land. Whiteness, Moreton-Robinson contends, “is constitutive of the epistemology of the West; it is an invisible regime of power that secures hegemony through discourse and has material effects in everyday life” (Whiteness 75).In addition to analysing racial power structures, critical race theory has presented studies into the link between race, whiteness and neoliberalism. Roberts and Mahtami argue that it is not just that neoliberalism has racialised effects, rather that neoliberalism and its underlying philosophy is “fundamentally raced and produces racialized bodies” (248; also see Goldberg Threat). The effect of the free market on state sovereignty has been hotly debated too. Aihwa Ong contends that neoliberalism produces particular relationships between the state and non-state corporations, as well as determining the role of individuals within the body-politic. Ong specifies:Market-driven logic induces the co-ordination of political policies with the corporate interests, so that developmental discussions favour the fragmentation of the national space into various contiguous zones, and promote the differential regulation of the populations who can be connected to or disconnected from global circuits of capital. (Ong, Neoliberalism 77)So how is whiteness relevant to a discussion of land reform, and to the changes to land rights passed along with Intervention legislation in 2007? Irene Watson cites the former Minister for Indigenous Affairs, Mal Brough, who opposed the progressive individual with what he termed the “failed collective.” Watson asserts that in the debates around land leasing and the Intervention, “Aboriginal law and traditional roles and responsibilities for caring and belonging to country are transformed into the cause for community violence” (Sovereign Spaces 34). The effects of this, I will argue, are twofold and move beyond a moral or social agenda in the strictest sense of the terms: firstly to promote, and make more accessible, the possibility of private and government coalitions in relation to Indigenous lands, and secondly, to reinforce the sovereignty of the state, recognised in the capacity to make decisions. It is here that the explicit reiteration of what Aileen Moreton-Robinson calls “white possession” is clearly evidenced (The Possessive Logic). Sovereign Interventions In the Northern Territory 50% of land is owned by Indigenous people under the Aboriginal Land Rights Act 1976 (ALRA) (NT). This law gives Indigenous people control, mediated via land councils, over their lands. It is the contention of this paper that the rights enabled through this law have been eroded in recent times in the coalescing interests of government and private enterprise via, broadly, land rights reform measures. In August 2007 the government passed a number of laws that overturned aspects of the Racial Discrimination Act 197 5(RDA), including the Northern Territory National Emergency Response Bill 2007 and the Aboriginal Land Rights (Northern Territory) Amendment (Township Leasing) Bill 2007. Ostensibly these laws were a response to evidence of alarming levels of child abuse in remote Indigenous communities, which has been compiled in the special report Little Children, co-chaired by Rex Wild QC and Patricia Anderson. This report argued that urgent but culturally appropriate strategies were required in order to assist the local communities in tackling the issues. The recommendations of the report did not include military intervention, and instead prioritised the need to support and work in dialogue with local Indigenous people and organisations who were already attempting, with extremely limited resources, to challenge the problem. Specifically it stated that:The thrust of our recommendations, which are designed to advise the NT government on how it can help support communities to effectively prevent and tackle child sexual abuse, is for there to be consultation with, and ownership by the local communities, of these solutions. (Wild & Anderson 23) Instead, the Federal Coalition government, with support from the opposition Labor Party, initiated a large scale intervention, which included the deployment of the military, to install order and assist medical personnel to carry out compulsory health checks on minors. The intervention affected 73 communities with populations of over 200 Aboriginal men, women and children (Altman, Neo-Paternalism 8). The reality of high levels of domestic and sexual abuse in Indigenous communities requires urgent and diligent attention, but it is not the space of this paper to unpack the media spectacle or the politically determined response to these serious issues, or the considered and careful reports such as the one cited above. While the report specifies the need for local solutions and local control of the process and decision-making, the Federal Liberal Coalition government’s intervention, and the current Labor government’s faithfulness to these, has been centralised and external, imposed upon communities. Rebecca Stringer argues that the Trojan horse thesis indicates what is at stake in this Intervention, while also pinpointing its main weakness. That is, the counter-intuitive links its architects make between addressing child sexual abuse and re-litigating Indigenous land tenure and governance arrangements in a manner that undermines Aboriginal sovereignty and further opens Aboriginal lands to private interests among the mining, nuclear power, tourism, property development and labour brokerage industries. (par. 8)Alongside welfare quarantining for all Indigenous people, was a decision by parliament to overturn the “permit system”, a legal protocol provided by the ALRA and in place so as to enable Indigenous peoples the right to refuse and grant entry to strangers wanting to access their lands. To place this in a broader context of land rights reform, the Aboriginal Land Rights (Northern Territory) Act 2006, created the possibility of 99 year individual leases, at the expense of communal ownership. The legislation operates as a way of individualising the land arrangements in remote Indigenous communities by opening communal land up as private plots able to be bought by Aboriginal people or any other interested party. Indeed, according to Leon Terrill, land reform in Australia over the past 10 years reflects an attempt to return control of decision-making to government bureaucracy, even as governments have downplayed this aspect. Terrill argues that Township Leasing (enabled via the 2006 legislation), takes “wholesale decision-making about land use” away from Traditional Owners and instead places it in the hands of a government entity called the Executive Director of Township Leasing (3). With the passage of legislation around the Intervention, five year leases were created to enable the Commonwealth “administrative control” over the communities affected (Terrill 3). Finally, under the current changes it is unlikely that more than a small percentage of Aboriginal people will be able to access individual land leasing. Moreover, the argument has been presented that these reforms reflect a broader project aimed at replacing communal land ownership arrangements. This agenda has been justified at a rhetorical level via the demonization of communal land ownership arrangements. Helen Hughes and Jenness Warin, researchers at the rightwing think-tank, the Centre for Independent Studies (CIS), released a report entitled A New Deal for Aborigines and Torres Strait Islanders in Remote Communities, in which they argue that there is a direct casual link between communal ownership and economic underdevelopment: “Communal ownership of land, royalties and other resources is the principle cause of the lack of economic development in remote areas” (in Norberry & Gardiner-Garden 8). In 2005, then Prime Minister, John Howard, publicly introduced the government’s ambition to alter the structure of Indigenous land arrangements, couching his agenda in the language of “equal opportunity”. I believe there’s a case for reviewing the whole issue of Aboriginal land title in the sense of looking more towards private recognition …, I’m talking about giving them the same opportunities as the rest of their fellow Australians. (Watson, "Howard’s End" 1)Scholars of critical race theory have argued that the language of equality, usually tied to liberalism (though not always) masks racial inequality and even results in “camouflaged racism” (Davis 61). David Theo Goldberg notes that, “the racial status-quo - racial exclusions and privileges favouring for the most part middle - and upper class whites - is maintained by formalising equality through states of legal and administrative science” (Racial State 222). While Howard and his coalition of supporters have associated communal title with disadvantage and called for the equality to be found in individual leases (Dodson), Altman has argued that there is no logical link between forms of communal land ownership and incidences of sexual abuse, and indeed, the government’s use of sexual abuse disingenuously disguises it’s imperative to alter the land ownership arrangements: “Given the proposed changes to the ALRA are in no way associated with child sexual abuse in Aboriginal communities […] there is therefore no pressing urgency to pass the amendments.” (Altman National Emergency, 3) In the case of the Intervention, land rights reforms have affected the continued dispossession of Indigenous people in the interests of “commercial development” (Altman Neo-Paternalism 8). In light of this it can be argued that what is occurring conforms to what Aileen Moreton-Robinson has highlighted as the “possessive logic of patriarchal white sovereignty” (Possessive Logic). White sovereignty, under the banner of benevolent paternalism overturns the authority it has conceded to local Indigenous communities. This is realised via township leases, five year leases, housing leases and other measures, stripping them of the right to refuse the government and private enterprise entry into their lands (effectively the right of control and decision-making), and opening them up to, as Stringer argues, a range of commercial and government interests. Future Concerns and Concluding NotesThe etymological root of coalition is coalesce, inferring the broad ambition to “grow together”. In the issues outlined above, growing together is dominated by neoliberal interests, or what Stringer has termed “assimilatory neoliberation”. The issue extends beyond a social and economic assimilationism project and into a political and legal “land grab”, because, as Ong notes, the neoliberal agenda aligns itself with the nation-state. This coalitional arrangement of neoliberal and governmental interests reiterates “white possession” (Moreton-Robinson, The Possessive Logic). This is evidenced in the position of the current Labor government decision to uphold the nomination of Muckaty as a radioactive waste repository site in Australia (Stokes). In 2007, the Northern Land Council (NLC) nominated Muckaty Station to be the site for waste disposal. This decision cannot be read outside the context of Maralinga, in the South Australian desert, a site where experiments involving nuclear technology were conducted in the 1960s. As John Keane recounts, the Australian government permitted the British government to conduct tests, dispossessing the local Aboriginal group, the Tjarutja, and employing a single patrol officer “the job of monitoring the movements of the Aborigines and quarantining them in settlements” (Keane). Situated within this historical colonial context, in 2006, under a John Howard led Liberal Coalition, the government passed the Commonwealth Radioactive Waste Management Act (CRWMA), a law which effectively overrode the rulings of the Northern Territory government in relation decisions regarding nuclear waste disposal, as well as overriding the rights of traditional Aboriginal owners and the validity of sacred sites. The Australian Labor government has sought to alter the CRWMA in order to reinstate the importance of following due process in the nomination process of land. However, it left the proposed site of Muckaty as confirmed, and the new bill, titled National Radioactive Waste Management retains many of the same characteristics of the Howard government legislation. In 2010, 57 traditional owners from Muckaty and surrounding areas signed a petition stating their opposition to the disposal site (the case is currently in the Federal Court). At a time when nuclear power has come back onto the radar as a possible solution to the energy crisis and climate change, questions concerning the investments of government and its loyalties should be asked. As Malcolm Knox has written “the nuclear industry has become evangelical about the dangers of global warming” (Knox). While nuclear is a “cleaner” energy than coal, until better methods are designed for processing its waste, larger amounts of it will be produced, requiring lands that can hold it for the desired timeframes. For Australia, this demands attention to the politics and ethics of waste disposal. Such an issue is already being played out, before nuclear has even been signed off as a solution to climate change, with the need to find a disposal site to accommodate already existing uranium exported to Europe and destined to return as waste to Australia in 2014. The decision to go ahead with Muckaty against the wishes of the voices of local Indigenous people may open the way for the co-opting of a discourse of environmentalism by political and business groups to promote the development and expansion of nuclear power as an alternative to coal and oil for energy production; dumping waste on Indigenous lands becomes part of the solution to climate change. During the 2010 Australian election, Greens Leader Bob Brown played upon the word coalition to suggest that the Liberal National Party were in COALition with the mining industry over the proposed Mining Tax – the Liberal Coalition opposed any mining tax (Brown). Here Brown highlights the alliance of political agendas and business or corporate interests quite succinctly. Like Brown’s COALition, will government (of either major party) form a coalition with the nuclear power stakeholders?This paper has attempted to bring to light what Dodson has identified as “an alliance of established conservative forces...with more recent and strident ideological thinking associated with free market economics and notions of individual responsibility” and the implications of this alliance for land rights (Dodson). It is important to ask critical questions about the vision of “growing together” being promoted via the coalition of conservative, neoliberal, private and government interests.Acknowledgements Many thanks to the reviewers of this article for their useful suggestions. 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Langton, Marcia. “It’s Time to Stop Playing Politics with Vulnerable Lives.” Opinion. Sydney Morning Herald, 30 Nov. 2007: 2. McAllan, Fiona. “Customary Appropriations.” borderlands ejournal 6.3 (2007). 22 Nov. 2010 ‹http://www.borderlands.net.au/vol6no3_2007/mcallan_appropriations.htm>. Moreton-Robinson, Aileen. “The Possessive Logic of Patriarchal White Sovereignty: The High Court and the Yorta Yorta Decision.” borderlands e-journal 3.2 (2004). 1 Aug. 2007 ‹http://www.borderlands.net.au/vol3no2_2004/moreton_possessive.htm>. ———. “Whiteness, Epistemology and Indigenous Representation.” Whitening Race. Ed. Aileen Moreton-Robinson. Canberra: Aboriginal Studies Press, 75-89. Norberry, J., and J. Gardiner-Garden. Aboriginal Land Rights (Northern Territory) Amendment Bill 2006. Australian Parliamentary Library Bills Digest 158 (19 June 2006). Ong, Aihwa. Neoliberalism as Exception: Mutations in Citizenship and Sovereignty. Durham: Duke University Press, 2006. 75-97.Oxford English Dictionary. 3rd. ed. Oxford: Oxford UP, 2005. Rio Tinto. "Rio Tinto Aboriginal Policy and Programme Briefing Note." June 2007. 22 Nov. 2010 ‹http://www.aboriginalfund.riotinto.com/common/pdf/Aboriginal%20Policy%20and%20Programs%20-%20June%202007.pdf>. Roberts, David J., and Mielle Mahtami. “Neoliberalising Race, Racing Neoliberalism: Placing 'Race' in Neoliberal Discourses.” Antipode 42.2 (2010): 248-257. Stringer, Rebecca. “A Nightmare of the Neocolonial Kind: Politics of Suffering in Howard's Northern Territory Intervention.” borderlands ejournal 6.2 (2007). 22 Nov. 2010 ‹http://www.borderlands.net.au/vol6no2_2007/stringer_intervention.htm>.Stokes, Dianne. "Muckaty." n.d. 1 Aug. 2010 ‹http://www.timbonham.com/slideshows/Muckaty/>. Terrill, Leon. “Indigenous Land Reform: What Is the Real Aim of Land Reform?” Edited version of a presentation provided at the 2010 National Native Title Conference, 2010. 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Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVR) has emerged as an effective treatment modality for high surgical risk patients with severe functional mitral regurgitation (FMR). Novel echocardiographic parameters, such as deformation imaging and their predictive significance have not been analyzed in this group of patients. Purpose The purpose of this study is to identify echocardiographic predictors of response in patients with FMR undergoing PMVR. Methods We retrospectively analyzed 44 consecutive patients with ischemic or dilated cardiomyopathy, reduced ejection fraction and severe functional MR (FMR), aged 71±9 years, 71% males, LVEF 30.9±8.7%, mitral valve effective regurgitant orifice area (EROA)>20mm2, regurgitant volume (RV) >30ml and logistic EuroSCORE 22±14.7%. At baseline and 1-year after PMVR we assessed echocardiographic parameters such as LV longitudinal strain (LVGLS) and peak left atrial longitudinal strain (PALS) using speckle tracking echocardiography, LV end-systolic and end-diastolic volumes (LVESV, LVEDV), LA volume, MR severity by Doppler echocardiography along with BNP levels, NYHA class and 6 minute walking distance. Results One year after edge-to-edge repair there was a significant reduction of MR (74.2% had mild to moderate MR, 22.6% moderate-to-severe MR and 3.2% severe MR) and BNP levels (933±943pg/ml to 669±824pg/ml), improvement of NYHA class (3.11±0.55 to 2.0±0.6, P<0.05) and increase of the 6 minute walking distance (251±141 to 296±148m, P<0.05). LA volume was reduced (132.5±62.1ml to 115.2±57.7ml) and PALS was improved (6.89±3.47 to 7.94±5.27) (P<0.05 for all comparisons). Baseline LVGLS did not change significantly post intervention (−8.8±4.1 vs. −8.8±3.9, P=0.7) but the baseline value predicted the percentage difference in LVEDV (r=−0.61, P<0.01), LVESV (r=−0.47, P=0.03), BNP (r=0.45, P=0.04) and NYHA class (r=0.63, P<0.01). The best reverse LV remodeling was found in patients with GLS better than −10% and the trend was that the better the GLS the greater the LVEDV and LVESV reduction post-intervention. Additionally, patients with GLS between −10% and −5% had the largest improvement in BNP (P<0.05) and NYHA class (P=0.005). Conclusions Edge-to-edge repair is effective in reducing MR in patients with severe functional MR and has a positive impact in patients' clinical status at one year follow up. A preserved LVGLS seems to be a good predictor of reverse modeling and clinical improvement post intervention.

Background: Low-income and Latino neighborhoods are at high risk for having low provision of bystander CPR for victims of out-of-hospital cardiac arrest (OHCA). Novel community-based intervention is needed in these neighborhoods to increase awareness of CPR techniques and, ultimately, to decrease mortality from OHCA. Objective: To determine the feasibility of a train-the-trainer hands-only CPR program as a required assignment in a middle school. Methods: Design: Prospective survey-based interventional study. Setting: Public charter school in the Denver, CO metropolitan area. Population: Cohort of 118 subjects was recruited out of 134 eligible seventh grade students. Observations: Participants completed a 6-question test to assess baseline knowledge of CPR. Subjects then completed a group hands-only CPR training lasting 1 hour using the CPR Anytime kit, which included both an educational DVD and hands-on practical skills training with an inflatable mannequin. Participants were then asked to use these kits to train other community members over a 2-week period. At the end of the study, students were asked to complete the same 6-question survey to assess their retention of knowledge. Two-sample t-tests were conducted to assess for differences in hands-only CPR knowledge pre- and post-CPR training. Results: Demographics are given for the entire seventh grade class ( Table 1 ). Students were mostly white (71.6%), and 11 (8.2%) participated in the Free & Reduced Lunch program. Of 134 seventh graders attending the school, 118 (88%) completed a pre-intervention survey and 74 (55%) completed a post-intervention survey. Between the surveys, the mean number of questions answered correctly increased ( Table 2 ), as did performance on the question asking where to place AED pads on the chest (p < .001). Students performed poorest in both pre- and post-testing on identifying the appropriate situation for performing hands-only CPR. Conclusion: Implementation of a school-based train-the-trainee CPR education program is a feasible endeavor. Students demonstrated increased knowledge of CPR techniques two weeks after training compared to baseline. Future studies will need to be conducted to assess the people who are then trained by these students using the CPR Anytime Kits.

In this summary we present the reports and reflections of teachers who participate in an on-going research project named Mapping the effects of media images on the imaginary of working teachers: treading the personal knowledge of a Symbolic Pedagogy. The teachers, who work with children aged between 7 and 11 years, in Brazilian state schools, have reflected upon the influences of television shows as potential sources of diverse readings. In class, they have carried out distinct interventions and have played the role of human media (Penteado, 2002, and Porto, 2005), meaning that these teachers have acted as bridges, screens or mirrors for communications in which individual and cultural contents of a certain culture are exchanged. According to Michel Maffesoli (2001:9), there is a quotidian sociology whose main particularity is to offer a reading of the social life considering the sphere of the quotidian as a place that, in its banality and receptivity, and accompanied by the corresponding imaginary, allows investigators and other social observers to find important elements for the understanding of a social weave and its complexity. Therefore, what we have intended was related to television as a possible source of teaching: by signifying and re-signifying contents and, above all, through the intervention of teachers, by enabling different dynamics and organizations of collective actions in a school environment. In such a manner, televised communication becomes a space for socialization and apprehension of other contents. It can be the means to organize, unite, and conquer spaces and desires of a determined group or community. We are, of course, entering a domain that will be the place of the universal human collective tendencies, that are transported or mediumizated by the media, through the identification with a character of and image. En este resumen apuntamos los relatos y reflexiones de profesoras que imparten clases junto a los niños, entre 7 y 11 años, en escuelas publicas, en Brasil, resultantes de una pesquisa, aún en curso: Mapeando los efectos de las imágenes mediáticas no imaginario de profesoras en clase: Trillando los saberes personales de una Pedagogía Simbólica. Ellas han reflexionado sobre las influencias de los programas de televisión como potenciales generadores de otras lecturas. Desde la clase, han hecho intervenciones distintas. Además, han asumido el papel de una mídia humana (Penteado, 2002 e Porto, 2005), desde aquí entendido que las profesoras son como puentes, pantallas o espejamientos de comunicaciones donde están en cambio los contenidos individuales y culturales de una cultura determinada. Según Michel Maffesoli (2001:9) hay aquí una sociología de lo cotidiano en que su mayor particularidad es ofrecer una lectura de la vida social considerando la esfera de lo cotidiano como un lugar de los que, en su banalidad y receptividad, y acompañados del imaginario que les corresponden, permiten a los investigadores u otros observadores sociales encontrar elementos importantes para la comprensión de una trama social y su complejidad. Entonces lo que desde aquí intentaremos, dice respecto a la televisión como una posibilidad de enseñanza: significación y re-significación de contenidos Sobre todo, a través de la intervención de las profesoras, posibilitando dinámicas y organizaciones de acciones colectivas, en un ambiente escolar. Así la comunicación televisiva pasa a ser un espacio de socialización y aprehensión de otros contenidos. Por lo tanto ella puede ser un modo de organizar, unir y conquistar espacios y deseos en un determinado grupo o comunidad. Por supuesto nos estamos adentrando en un espacio que habrá de ser el lugar de las tendencias colectivas humanas universales, que son transportadas o mediunizados por los medios a través de la identificación con un personaje o una imagen.

Learning a creativity-based skill like programming requires practice and dedication. In “traditional” programming courses, instructors spend most of their time lecturing to large groups of students, with little class time to spend on active exercises or personal interaction. Students are not in control of the content delivery or its pacing, nor is it effectively communicated that practice is needed to master programming. Moreover, most practice is individual and graded strictly, meaning students suffer heavy penalties for minor slips while learning or collaborating. This past year we experimented with a self-paced version of introductory programming, where students spend class time working on problems in small groups at their own pace. Learning is intentional because students take responsibility for their learning, rather than waiting for the instructor. Our pass rates in the course improved by 25% with these modifications. This design could be adapted to other disciplines. We propose to demonstrate our innovations by leading the audience in a simulation of our self-paced, active learning, class by teaching the 'students' to solve a simple puzzle. Members of our instructional team will play the role of teaching assistants, who offer peer learning opportunities in our classrooms. Like students, the audience will have varying levels of previous exposure to these puzzles, so they will move through the exercises at their own pace. We will demonstrate how faculty can use immediate automated feedback, asynchronous online content, individual assessments with the ability to test up to five times, interventions, peer-learning, and mini-lectures to allow students to learn new skills at their own pace. Suggestions for adapting this to other disciplines will also be discussed.

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVR) is a safe treatment option for high surgical risk patients with severe functional mitral regurgitation (FMR). Recent trials have proven this method’s efficiency but novel echocardiographic markers such as deformation imaging have never been analyzed in this subgroup of patients. Purpose The purpose of this study is to analyze novel echocardiographic parameters in patients treated for FMR and identify predictors of response in patients undergoing PMVR. Methods We retrospectively analyzed 79 consecutive high surgical risk patients (logistic EuroSCORE 21.8 ± 15.2%), with ischemic or dilated cardiomyopathy, reduced EF (31.0 ± 8.5%) and severe functional MR (FMR). Effective regurgitant orifice area (EROA) was measured at 28.8 ± 15.1mm2 and regurgitant volume (RV) at 41.7 ± 18.3ml. At baseline and 1-year after PMVR or optimal medical treatment (OMT) we assessed echocardiographic parameters such as LV global longitudinal strain (LVGLS) and peak left atrial longitudinal strain (PALS), LV end-systolic and end-diastolic volumes (LVESV, LVEDV), LA volume, MR severity along with BNP levels, NYHA class and 6 minute walking distance (6MWT). Results One year after PMVR there was a significant reduction of MR (3.7 ± 0.4 vs 1.7 ± 0.8) and BNP levels (980 ± 1027pg/ml vs 420 ± 338pg/ml, p = 0.005), improvement of NYHA class (3.20 ± 0.55 to 2.0 ± 0.6, P &lt; 0.05) and increase of 6MWD (240 ± 137 to 298 ± 139m, P &lt; 0.01). LA volume and LVEDV were reduced (141 ± 79ml to 114 ± 74ml and 221 ± 74 to 193 ± 62ml respectively) (P &lt; 0.01 for all comparisons). On the other hand, patients treated with OMT didn’t have any change of their MR (3.4 ± 0.5 vs 3.4 ± 0.9), BNP levels (601 ± 652 vs 610 ± 748) or NYHA class status (2.6 ± 0.6 vs 2.4 ± 0.6). Additionally, LA and LV volumes were approximately the same (134 ± 69 vs 141 ± 61ml and 222 ± 64 vs 222 ± 56ml respectively) (p &lt; 0.05 for all comparisons). Baseline LVGLS slightly increased post intervention (-8.5 ± 4.1% vs -9.1 ± 3.7%, r = 0.76, P &lt; 0.01), and was associated with the absolute (r=-0.46, p = 0.01) and percentage difference in LVEDV (r= -0.61, P &lt; 0.01). ROC curve analysis identified a cut-off value for GLS of -7.45% (AUC 0.815, 95% CI: 0.647-0.983; p = 0.007) associated with more than 15% LV reverse remodeling, with a sensitivity and specificity of 71% and 75% respectively. Conclusions Edge-to-edge repair is a safe and effective method for treating patients with functional MR and has a positive clinical impact in patients at one year follow up. A preserved LVGLS seems to be a good predictor of LV reverse modeling post intervention.

Active participation of the girl child in development is hampered by Menstrual Hygiene Management (MHM) challenges. MHM is an important gender issue and a critical component in holistic human development. It affects about 25% of the global population aged between 15 and 49 years. Water, sanitation and hygiene (WASH) interventions in schools have not prioritised MHM, thus exposing girls and the entire school community to health related hazards. The study explored knowledge, attitudes and community practices, and investigated the impact of religious and cultural beliefs on MHM and how they impact on the girl child in Masvingo district. The survey was largely qualitative and employed methodologies of document analysis, Focus Group Discussions (FGD) and structured interviews. Participants included four churches, 13 NGOs, eight government departments and 40 women. Findings revealed deeply embedded power relations, a culture of silence around MHM, noninvolvement of men in MHM issues, limited availability in terms of information, and a girl unfriendly infrastructure, and limited access to menstrual hygiene products due to poverty and poor management and disposal practices. Resultant effects ranged from poor class participation, lack of concentration and constrained interactions with peers and teachers, low self-esteem, anxiety and the general feeling of being discriminated against. Results confirmed the need for increased awareness initiatives on MHM in a bid to tackle inherent religious and cultural beliefs that are a barrier to effective holistic implementation of WASH interventions that empower women and girls. Lobbying government to provide an appropriate policy framework, education and training, construction of girl friendly sanitary facilities, exploring and capitalisation of local production of Reusable Menstrual Pads (RUMPS), more research targeting children living with disabilities, those living in refugee and makeshift camps and Orphans and Vulnerable Children (OVC), are some of the recommendations coming out of the study

Objective Ultra-low Temperature Whole-Body Cryotherapy can relieve pain, inhibit inflammation, improve sleep quality, promote immune regulation, reduce excessive muscle tone, and improve damaged joints and muscle function. Currently, it is widely used in competitive sports. There have been few studies on the effects of Ultra-low Temperature Whole-Body Cryotherapy on some endocrine indexes such as testosterone. In the previous study, it was found that the 25-year-old soldier had a good effect on the changes of hormones and other indicators after the cold treatment the next morning and after a week of cold treatment. However, the impact of Ultra-low Temperature Whole-Body Cryotherapy on large age groups with a marked decline in testosterone secretion has not yet begun. Therefore, this study intends to pass a rigorous controlled experiment, taking ordinary healthy men aged 20 and 40 as research subjects, to observe the changes of testosterone and other endocrine indicators before and two hours after cryotherapy for 2 different age groups. Investigate deeply of the changes in testosterone and other endocrine indicators after ultra-low cryotherapy in the general population of different ages, to provide more reference for the application of ultra-low temperature cold therapy in a wider population. Methods Eight male students with age of 22.0±0.8 yrs in the physical fitness class of Beijing sport university as group A. Eight healthy men with age of 42.2±4.5yrs as group B. The cold therapy parameters used in the experiment were -130 ° C ,for 150 s. The blood samples collected in group A were from 8:00 to 9:00 in the morning，immediately after cold therapy，30 minutes after cold therapy,，and 2 hours after cold therapy. In group B were collected before cold treatment and 2 hours after cold treatment. In order to avoid the influence of the time rhythm of testosterone secretion, the time points of blood sample collection during cold therapy and non-cold therapy were strictly consistent. Group A and group B were compared before and after cold treatment at the same time at room temperature. No statistical comparison was made between groups A and B. The test indicators were testosterone (T), follicular stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2). The data obtained from the experiment were expressed by mean and standard deviation, and the relevant indicators collected were statistically analyzed. Results (1) Compared with the test value of before cryotherapy, Testosterone(T) in group A had a decrease of -7.8%, -13.4%, and -3.6% at the point of the cryotherapy finished immediately, 30 minutes after cryotherapy, and 2 hours after cryotherapy, respectively. There has been a continuous decline in the Control group with a decrease of -5.7%, -11.3%, and -12.0%, respectively. Compared with the test value of before cryotherapy, there was a significant difference at each time between the cryotherapy group and the control group; there was also a significant difference between the two groups at 2 hours after the cryotherapy. (2) Compared with the test value of before cryotherapy, FSH in group A increased 8.6% after cryotherapy immediately, increased 2.3% at the time of 2 hours after cryotherapy, However, the control group showed different degrees of decline, with a decrease of -4.09%, -6.9%, and -6.4%, respectively. And there were significant differences in FSH between the time point of after cryotherapy immediately and 30 minutes after cryotherapy compared with before cryotherapy. (3) Compared with the test value of before cryotherapy, group A had an increase of 7.9% in LH immediately after Cryotherapy and 1.0% in 2 hours after cryotherapy, while the control group showed different degrees of decline, with a decrease of -13.4%， -13.5% and -8.0%.（4）Compared with the test value of before Cryotherapy, group A showed different degrees of decline in E2 as immediately after cryotherapy, 30 minutes after cryotherapy and 2 hours after cryotherapy with the decrease ranges of -8.6%, -21.9% and -35.2% respectively. The changes of the control group were 8.7%, -18.7% and -22.6%, respectively. There were significant differences between the cryotherapy group and the control group at 30 minutes and 2 hours after the cryotherapy compared with before the intervention.(5) Before cryotherapy and 2 hours after cryotherapy, FSH and LH in group B decreased in cryotherapy and control, but the decrease in cryotherapy group was higher than control group; The change of T was different from FSH and LH. After the cryotherapy, the cryotherapy group showed a significant increase, which was 27% higher than before the cryotherapy, while the control group decreased by -7.5%,and there was a significant difference in T between the cryotherapy group and the control group before and after cryotherapy. Conclusions (1)Ultra-low Temperature Whole-Body Cryotherapy has a certain degree of influence on the hypothalamic-pituitary-gonadal (H-P-G) axis. Testosterone will increase 2 hours after cryotherapy, and Ultra-low Temperature Whole-Body Cryotherapy can promote testosterone secretion.(2) Ultra-low Temperature Whole-Body Cryotherapy can reduce the decomposition of testosterone and improve serum testosterone to some extent. (3) Ultra-low Temperature Whole-Body Cryotherapy is more effective in promoting testosterone secretion in people with relatively high age and testosterone secretion relative to the downhill stage (35-40 years old and older).

How to inculcate virtue in the citizens of Magnesia by means of the dance component of choreia constitutes one of the principal concerns in the Laws (= Leg.), revealing Plato's evolving ideas about the expediency of music and paideia for the construction of his ideal city since the Republic. Indeed, a steady stream of monographs and articles on the Laws has enriched our understanding of how Plato theorizes the body as a site of intervention and choral dance as instrumental in solidifying social relations and in conditioning the ethical and political self. As one scholar has aptly put it: ‘a city and its sociopolitical character [are] effectively danced into existence.’ Drawing on this recent work, I focus on an enigmatic passage in Laws Book 7 that merits more attention than it has received, in which Plato curiously singles out Bacchic dances from those that are ‘without controversy’ (815b7–d4): τὴν τοίνυν ἀμφισβητουμένην ὄρχησιν δεῖ πρῶτον χωρὶς τῆς ἀναμφισβητήτου διατεμεῖν. τίς οὖν αὕτη, καὶ πῇ δεῖ χωρὶς τέμνειν ἑκατέραν; ὅση μὲν βακχεία τ᾽ ἐστὶν καὶ τῶν ταύταις ἑπομένων, ἃς Νύμφας τε καὶ Πᾶνας καὶ Σειληνοὺς καὶ Σατύρους ἐπονομάζοντες, ὥς φασιν, μιμοῦνται κατῳνωμένους, περὶ καθαρμούς τε καὶ τελετάς τινας ἀποτελούντων, σύμπαν τοῦτο τῆς ὀρχήσεως τὸ γένος οὔθ᾽ ὡς εἰρηνικὸν οὔθ᾽ ὡς πολεμικὸν οὔθ᾽ ὅτι ποτὲ βούλεται ῥᾴδιον ἀφορίσασθαι: διορίσασθαι μήν μοι ταύτῃ δοκεῖ σχεδὸν ὀρθότατον αὐτὸ εἶναι, χωρὶς μὲν πολεμικοῦ, χωρὶς δὲ εἰρηνικοῦ θέντας, εἰπεῖν ὡς οὐκ ἔστι πολιτικὸν τοῦτο τῆς ὀρχήσεως τὸ γένος, ἐνταῦθα δὲ κείμενον ἐάσαντας κεῖσθαι, νῦν ἐπὶ τὸ πολεμικὸν ἅμα καὶ εἰρηνικὸν ὡς ἀναμφισβητήτως ἡμέτερον ὂν ἐπανιέναι. So, first of all, we should separate questionable dancing far from dancing that is without controversy. Which is the controversial kind, and how are the two to be distinguished? All the dancing that is of a Bacchic kind and cultivated by those who indulge in intoxicated imitations of Nymphs, Pans, Sileni and Satyrs (as they name them), when performing certain rites of expiation and initiation—this entire class of dancing cannot easily be marked off either as pacific or as warlike, nor as of any one particular kind. The most correct way of defining it appears to me to be this—to place it away from both pacific and warlike dancing, and to pronounce that this type of dancing is οὐ πολιτικόν; having thus set aside and dismissed it, we will now return to the warlike and pacific types, which without controversy belong to us.

ABSTRACT ObjectivesThe gap between a population’s actual and ideal health can be quantified by Disability-Adjusted Life Years (DALY). This metric combines the Years Lived with Disability (YLD) and Years of Life Lost (YLL). When supplemented by a Comparative Risk Assessment (CRA) it can depict the magnitude of disease burden and the effect that modifiable exposures contribute. We aim to utilise routine healthcare records to quantify the burden and potential reduction in DALY caused by stroke. ApproachHospital stays involving a stroke diagnosis (ICD-9: 430-431, 433-34, 436; ICD-10: I60-61, I63-64) were identified through secondary care primary diagnoses from 1981-2013 and used to derive the incidence of acute stroke and the point-prevalence of chronic stroke. Disability weights for each health state of stroke sequelae were sourced from the Global Burden of Disease 2013 study and used to derive YLD. YLL for each death was calculated using Scotland-specific life tables for deaths where stroke was the underlying cause. Eight waves of the Scottish Health Survey (SHES) from 1995-2012 were linked to secondary care and mortality records. Risk factors were identified from SHES then mapped to levels in the Dahlgren and Whitehead model and Population Attributable Fractions (PAFs) were calculated for each risk factor that was a significant casual risk of stroke from a Cox-proportional hazard regression model. ResultsStroke was responsible for 47,836 DALY in Scotland during 2013 which was a reduction of 33.3% from 2000. The proportion of YLD contributing to DALY was 7.6% in 2000 rising to 14.4% in 2013. The main reasons for the changing profile of DALY are due to the large reduction in mortality and influence of the rising prevalence of chronic stroke. Stroke mortality reduced 34.3% during the period 2000-2013 from 7,013 deaths in 2000 to 4,610 in 2013, whilst chronic prevalence increased from 46,184 in 2000 to 59,367 in 2013. Between 23.5 to 38.8% of excess first stroke incidence can be explained by education, social class and area deprivation, which were all significant predictors of stroke after adjusting for confounding. Altering the exposure distribution for each independent risk factor to its theoretical minimum risk exposure level could potentially reduce the DALY by between 9,615 to 15,882 in 2013. ConclusionThis study highlights the benefit of using linked administrative health records to quantify the burden of stroke on the population and how public health interventions to tackle inequalities would be a method of reducing strokes in Scotland.

We (I, Robert Lawrence and, in a rare display of unity, all my online avatars and agents)hereby render and proclaim thisMANIFESTO OF PIECES AND BITS IN SERVICE OF CONTRADICTIONAL AESTHETICSWe start with the simple premise that art has the job of telling us who we are, and that through the modern age doing this job while KEEPING UP with accelerating cultural change has necessitated the invention of something we might call the avant-garde. Along the way there has been an on-again-off-again affair between said avant-garde and technology. We are now in a new phase of the new and the technology under consideration is the Internet.The recent hyperventilating about the term postInternet reflects the artworld’s overdue recognition of the effect of the Internet on the culture at large, and on art as a cultural practice, a market, and a historical process.I propose that we cannot fully understand what the Internet is doing to us through a consideration of what happens on the screen, nor by considering what happens in the physical space we occupy either before or behind the screen. Rather we must critically and creatively fathom the flow of cultural practice between and across these realms. This requires Hybrid art combining both physical and Internet forms.I do not mean to imply that single discipline-based art cannot communicate complexity, but I believe that Internet culture introduces complexities that can only be approached through hybrid practices. And this is especially critical for an art that, in doing the job of “telling us who we are”, wants to address the contradictory ways we now form and promote, or conceal and revise, our multiple identities through online social media profiles inconsistent with our fleshly selves.We need a different way of talking about identity. A history of identity:In the ancient world, individual identity as we understand it did not exist.The renaissance invented the individual.Modernism prioritized and alienated him (sic).Post-Modernism fragmented him/her.The Internet hyper-circulates and amplifies all these modalities, exploding the possibilities of identity.While reducing us to demographic market targets, the Web facilitates mass indulgence in perversely individual interests. The now common act of creating an “online profile” is a regular reiteration of the simple fact that identity is an open-ended hypothesis. We can now live double, or extravagantly multiple, virtual lives. The “me meme” is a ceaseless morph. This is a profound change in how identity was understood just a decade ago. Other historical transformations of identity happened over centuries. This latest and most radical change has occurred in the click of a mouse. Selfhood is now imbued with new complexity, fluidity and amplified contradictions.To fully understand what is actually happening to us, we need an art that engages the variant contracts of the physical and the virtual. We need a Hybrid art that addresses variant temporal and spatial modes of the physical and virtual. We need an art that offers articulations through the ubiquitous web in concert with the distinct perspectives that a physical gallery experience uniquely offers: engagement and removal, reflection and transference. Art that tells us who we are today calls for an aesthetics of contradiction. — Ro Lawrence (and all avatars) 2011, revised 2013, 2015, 2018. The manifesto above grew from an artistic practice beginning in 1998 as I started producing a website for every project that I made in traditional media. The Internet work does not just document or promote the project, nor is it “Netart” in the common sense of creative work restricted to a browser window. All of my efforts with the Internet are directly linked to my projects in traditional media and the web components offer parallel aesthetic voices that augment or overtly contradict the reading suggested by the traditional visual components of each project.This hybrid work grew out of a previous decade of transmedia work in video installation and sculpture, where I would create physical contexts for silent video as a way to remove the video image from the seamless flow of broadcast culture. A video image can signify very differently in a physical context that separates it from the flow of mass media and rather reconnects it to lived physical culture. A significant part of the aesthetic pleasure of this kind of work comes from nuances of dissonance arising from contradictory ways viewers had learned to read the object world and the ways we were then still learning to read the electronic image world. This video installation work was about “relocating” the electronic image, but I was also “locating” the electronic image in another sense, within the boundaries of geographic and cultural location. Linking all my projects to specific geographic locations set up contrasts with the spatial ubiquity of electronic media. In 1998 I amplified this contrast with my addition of extensive Internet components with each installation I made.The Way Things Grow (1998) began as an installation of sculptures combining video with segments of birch trees. Each piece in the gallery was linked to a specific geographic location within driving distance of the gallery exhibiting the work. In the years just before this piece I had moved from a practice of text-augmented video installations to the point where I had reduced the text to small printed handouts that featured absurd Scripts for Performance. These text handouts that viewers could take with them suggested that the work was to be completed by the viewer later outside the gallery. This to-be-continued dynamic was the genesis of a serial form in work going forward from then on. Thematic and narrative elements in the work were serialized via possible actions viewers would perform after leaving the gallery. In the installation for The Way Things Grow, there was no text in the gallery at all to suggest interpretations of this series of video sculptures. Even the titles offered no direct textual help. Rather than telling the viewers something about the work before them in the gallery, the title of each piece led the viewer away from the gallery toward serial actions in the specific geographic locations the works referred to. Each piece was titled with an Internet address.Figure 1: Lawrence, Robert, The Way Things Grow, video Installation with web components at http://www.h-e-r-e.com/grow.html, 1998.When people went to the web site for each piece they found only a black page referencing a physical horizon with a long line of text that they could scroll to right for meters. Unlike the determinedly embodied work in the gallery, the web components were disembodied texts floating in a black void, but texts about very specific physical locations.Figure 2: Lawrence, Robert, The Way Things Grow, partial view of webpage at http://www.h-e-r-e.com/growth_variant4.html, 1998.The texts began with the exact longitude and latitude of a geographical site in some way related to birch trees. ... A particularly old or large tree... a factory that turned birch trees into popsicle sticks and medical tongue depressors... etc. The website texts included directions to the site, and absurd scripts for performance. In this way the Internet component transformed the suite of sculptures in the gallery to a series of virtual, and possibly actual, events beyond the gallery. These potential narratives that viewers were invited into comprised an open-ended serial structure. The gallery work was formal, minimal, essentialist. On the web it was social, locative, deconstructive. In both locations, it was located. Here follows an excerpt from the website. GROWTH VARIANT #25: North 44:57:58 by West 93:15:56. On the south side of the Hennepin County Government Center is a park with 9 birch trees. These are urban birches, and they display random scratchings, as well as proclamations of affection expressed with pairs of initials and a “+” –both with and without encircling heart symbols. RECOMMENDED PERFORMANCE: Visit these urban birches once each month. Photograph all changes in their bark made by humans. After 20 years compile a document entitled, "Human Mark Making on Urban Birches, a Visual Study of Specific Universalities". Bring it into the Hennepin County Government Center and ask that it be placed in the archives.An Acre of Art (2000) was a collaborative project with sculptor Mark Knierim. Like The Way Things Grow, this new work, commissioned by the Minneapolis Art Institute, played out in the gallery, in a specific geographic location, and online. In the Art Institute was a gallery installation combining sculptures with absurd combinations of physical rural culture fitting contradictorily into an urban "high art" context. One of the pieces, entitled Landscape (2000), was an 18’ chicken coop faced with a gold picture frame. Inside were two bard rock hens and an iMac. The computer was programmed to stream to the Internet live video from the coop, the world’s first video chicken cam. As a work unfolding across a long stretch of time, the web cam video was a serial narrative without determined division into episodes. The gallery works also referenced a specific acre of agricultural land an hour from the Institute. Here we planted a row of dwarf corn at a diagonal to the mid-western American rural geometric grid of farmland. Visitors to the rural site could sit on “rural art furniture,” contemplate the corn growing, and occasionally witness absurd performances. The third stream of the piece was an extensive website, which playfully theorized the rural/urban/art trialectic. Each of the three locations of the work was exploited to provide a richer transmedia interpretation of the project’s themes than any one venue or medium could. Location Sequence is a serial installation begun in 1999. Each installation has completely different physical elements. The only consistent physical element is 72 segments of a 72” collapsible carpenter's ruler evenly spaced to wrap around the gallery walls. Each of the 72 segments of the ruler displays an Internet web address. Reversing the notion of the Internet as a place of rapid change compared to a more enduring physical world, in this case the Internet components do not change with each new episode of the work, while the physical components transform with each new installation. Thematically, all aspects of the work deal with various shades of meaning of the term "location." Beginning/Middle/End is a 30-year conceptual serial begun in 2002, presenting a series of site-specific actions, objects, or interventions combined with corresponding web pages that collectively negotiate concepts related to time, location, and narrative. Realizing a 30-year project via the web in this manner is a self-conscious contradiction of the culture of the instantaneous that the Internet manifests and propagates.The installation documented here was completed for a one-night event in 2002 with Szilage Gallery in St Petersburg, Florida. Bricks moulded with the URLs for three web sites were placed in a historic brick road with the intention that they would remain there through a historical time frame. The URLs were also projected in light on a creek parallel to the brick road and seen only for several hours. The corresponding web site components speculate on temporal/narrative structures crossing with geographic features, natural and manufactured.Figure 3: Lawrence, Robert, Beginning/Middle/End, site-specific installation with website in conjunction with 30-year series, http://www.h-e-r-e.com/beginning.html, 2002-32.The most recent instalment was done as part of Conflux Festival in 2014 in collaboration with painter Ld Lawrence. White shapes appeared in various public spaces in downtown Manhattan. Upon closer inspection people realized that they were not painted tags or stickers, but magnetic sheets that could be moved or removed. An optical scan tag hidden on the back of each shape directed to a website which encouraged people to move the objects to other locations and send a geo-located photo to the web site to trace the shape's motion through the world. The work online could trace the serial narrative of the physical installation components following the installation during Conflux Festival. Figure 4: Lawrence, Robert w/Lawrence, Ld, Gravity Ace on the Move, site-specific installation with geo-tracking website at http://www.h-e-r-e.com/gravityace/. Completed for Conflux Festival NYC, 2014, as part of Beginning/Middle/End.Dad's Boots (2003) was a multi-sited sculpture/performance. Three different physical manifestations of the work were installed at the same time in three locations: Shirakawa-go Art Festival in Japan; the Phipps Art Center in Hudson, Wisconsin; and at the Tampa Museum of Art in Florida. Physical components of the work included silent video projection, digital photography, computer key caps, and my father's boots. Each of these three different installations referred back to one web site. Because all these shows were up at the same time, the work was a distributed synchronous serial. In each installation space the title of the work was displayed as an Internet address. At the website was a series of popup texts suggesting performances focused, however absurdly, on reassessing paternal relationships.Figure 5: Lawrence, Robert, Dad’s Boots, simultaneous gallery installation in Florida, Wisconsin and Japan, with website, 2003. Coincidently, beginning the same time as my transmedia physical/Internet art practice, since 1998 I have had a secret other-life as a tango dancer. I came to this practice drawn by the music and the attraction of an after-dark subculture that ran by different rules than the rest of life. While my life as a tanguero was most certainly an escape strategy, I quickly began to see that although tango was different from the rest of the world, it was indeed a part of this world. It had a place and a time and a history. Further, it was a fascinating history about the interplays of power, class, wealth, race, and desire. Figure 6: Lawrence, Robert, Tango Intervention, site-specific dance interventions with extensive web components, 2007-12.As Marta Savigliano points out in Tango and the Political Economy of Passion, “Tango is a practice already ready for struggle. It knows about taking sides, positions, risks. It has the experience of domination/resistance from within. …Tango is a language of decolonization. So pick and choose. Improvise... let your feet do the thinking. Be comfortable in your restlessness. Tango” (17). The realization that tango, my sensual escape from critical thought, was actually political came just about the time I was beginning to understand the essential dynamic of contradiction between the physical and Internet streams of my work. Tango Intervention began in 2007. I have now, as of 2018, done tango interventions in over 40 cities. Overall, the project can be seen as a serial performance of contradictions. In each case the physical dance interventions are manifestations of sensual fantasy in public space, and the Internet components recontextualize the public actions as site-specific performances with a political edge, revealing a hidden history or current social situation related to the political economy of tango. These themes are further developed in a series of related digital prints and videos shown here in various formats and contexts.In Tango Panopticon (2009), a “spin off” from the Tango Intervention series, the hidden social issue was the growing video surveillance of public space. The first Tango Panopticon production was Mayday 2009 with people dancing tango under public video surveillance in 15 cities. Mayday 2010 was Tango Panopticon 2.0, with tangointervention.org streaming live cell phone video from 16 simultaneous dance interventions on 4 continents. The public encountered the interventions as a sensual reclaiming of public space. Contradictorily, on the web Tango Panopticon 2.0 became a distributed worldwide action against the growing spectre of video surveillance and the increasing control of public commons. Each intervention team was automatically located on an online map when they started streaming video. Visitors to the website could choose an action from the list of cities or click on the map pins to choose which live video to load into the grid of 6 streaming signals. Visitors to the physical intervention sites could download our free open source software and stream their own videos to tangointervention.org.Figure 7: Lawrence, Robert, Tango Panopticon 2.0, worldwide synchronous dance intervention with live streaming video and extensive web components, 2010.Tango Panopticon also has a life as a serial installation, initially installed as part of the annual conference of “Digital Resources for Humanities and the Arts” at Brunel University, London. All shots in the grid of videos are swish pans from close-ups of surveillance cameras to tango interveners dancing under their gaze. Each ongoing installation in the series physically adapts to the site, and with each installation more lines of video frames are added until the images become too small to read.Figure 8: Lawrence, Robert, Tango Panopticon 2.0 (For Osvaldo), video installation based on worldwide dance intervention series with live streaming video, 2011.My new work Equivalence (in development) is quite didactic in its contradictions between the online and gallery components. A series of square prints of clouds in a gallery are titled with web addresses that open with other cloud images and then fade into randomly loading excerpts from the CIA torture manual used at Guantanamo Bay Detention Center.Figure 9: Lawrence, Robert, Eauivalence, digital prints, excerpts from CIA Guantanamo Detention Center torture manual, work-in-progress.The gallery images recall Stieglitz’s Equivalents photographs from the early 20th century. Made in the 1920s to 30s, the Equivalents comprise a pivotal change in photographic history, from the early pictorial movement in which photography tried to imitate painting, and a new artistic approach that embraced features distinct to the photographic medium. Stieglitz’s Equivalents merged photographic realism with abstraction and symbolist undertones of transcendent spirituality. Many of the 20th century masters of photography, from Ansel Adams to Minor White, acknowledged the profound influence these photographs had on them. Several images from the Equivalents series were the first photographic art to be acquired by a major art museum in the US, the Boston Museum of Fine Arts.My series Equivalence serves as the latest episode in a serial art history narrative. Since the “Pictures Generation” movement in the 1970s, photography has cannibalized its history, but perhaps no photographic body of work has been as quoted as Stieglitz’s Equivalents. A partial list includes: John Baldessari’s series Blowing Cigar Smoke to Match Clouds That Are the Same(1973), William Eggleston’s series Wedgwood Blue (1979), John Pfahl’s smoke stack series (1982-89), George Legrady’s Equivalents II(1993), Vik Muniz’sEquivalents(1997), Lisa Oppenheim (2012), and most recently, Berndnaut Smilde’s Nimbus Series, begun in 2012. Over the course of more than four decades each of these series has presented a unique vision, but all rest on Stieglitz’s shoulders. From that position they make choices about how to operate relative the original Equivalents, ranging from Baldessari and Muniz’s phenomenological playfulness to Eggleston and Smilde’s neo-essentialist approach.My series Equivalence follows along in this serial modernist image franchise. What distinguishes it is that it does not take a single position relative to other Equivalents tribute works. Rather, it exploits its gallery/Internet transmediality to simultaneously assume two contradictory positions. The dissonance of this positioning is one of my main points with the work, and it is in some ways resonant with the contradictions concerning photographic abstraction and representation that Stieglitz engaged in the original Equivalents series almost a century ago.While hanging on the walls of a gallery, Equivalence suggests the same metaphysical intentions as Stieglitz’s Equivalents. Simultaneously, in its manifestation on the Internet, my Equivalence series transcends its implied transcendence and claims a very specific time and place –a small brutal encampment on the island of Cuba where the United States abandoned any remaining claim to moral authority. In this illegal prison, forgotten lives drag on invisibly, outside of time, like untold serial narratives without resolution and without justice.Partially to balance the political insistence of Equivalence, I am also working on another series that operates with very different modalities. Following up on the live streaming technology that I developed for my Tango Panopticon public intervention series, I have started Horizon (In Development).Figure 10: Lawrence, Robert, Horizon, worldwide synchronous horizon interventions with live streaming video to Internet, work-in-progress.In Horizon I again use live cell phone video, this time streamed to an infinitely wide web page from live actions around the world done in direct engagement with the horizon line. The performances will begin and automatically come online live at noon in their respective time zone, each added to the growing horizontal line of moving images. As the actions complete, the streamed footage will begin endlessly looping. The project will also stream live during the event to galleries, and then HD footage from the events will be edited and incorporated into video installations. Leading up to this major event day, I will have a series of smaller instalments of the piece, with either live or recorded video. The first of these preliminary versions was completed during the Live Performers Workshop in Rome. Horizon continues to develop, leading to the worldwide synchronous event in 2020.Certainly, artists have always worked in series. However, exploiting the unique temporal dimensions of the Internet, a series of works can develop episodically as a serial work. If that work unfolds with contradictory thematics in its embodied and online forms, it reaches further toward an understanding of the complexities of postInternet culture and identity. ReferencesSaviligliano, Marta. Tango and the Political Economy of Passion. Boulder: Westview Press, 1995.

The advent of the #MeToo movement and the scale of participation in 85 countries (Gill and Orgad; see Google Trends) has greatly expanded debate about the revival of feminism (Winch Littler and Keeler) and the contribution of digital media to a “reconfiguration” of feminism (Jouet). Insofar as these campaigns are concerned with sexual harassment and related forms of sexual abuse, the longer history of sexual harassment in which this practice was named by women’s movement activists in the 1970s has gone largely unremarked except in the broad sense of the recharging or “techno-echo[es]” (Jouet) of earlier “waves” of feminism. However, #MeToo and its companion movement #TimesUp, and its fighting fund timesupnow.org, stemmed directly from the allegations in 2017 against the media mogul Harvey Weinstein by Hollywood professionals and celebrities. The naming of prominent, powerful men as harassers and the celebrity sphere of activism have become features of #MeToo that warrant comparison with the naming of sexual harassment in the earlier era of feminism.While the practices it named were not new, the term “sexual harassment” was new, and it became a defining issue in second wave feminism that was conceptualised within the continuum of sexual violence. I outline this history, and how it transformed the private, individual experiences of many women into a shared public consciousness about sexual coercion in the workplace, and some of the debate that this generated within the women’s movement at the time. It offers scope to compare the threshold politics of naming names in the 21st century, and its celebrity vanguard which has led to some ambivalence about the lasting impact. For Kathy Davis (in Zarkov and Davis), for instance, it is atypical of the collective goals of second wave feminism.In comparing the two eras, Anita Hill’s claims against Clarence Thomas in the early 1990s is a bridging incident. It dates from closer to the time in which sexual harassment was named, and Hill’s testimony is now recognised as a prototype of the kinds of claims made against powerful men in the #MeToo era. Lauren Berlant’s account of “Diva Citizenship”, formulated in response to Hill’s testimony to the US Senate, now seems prescient of the unfolding spectacle of feminist subjectivities in the digital public sphere and speaks directly to the relation between individual and collective action in making lasting change. The possibility of change, however, descends from the intervention of the women’s movement in naming sexual harassment.The Name Is AllI found my boss in a room ... . He was alone ... . He greeted me ... touched my hair and ... said ... “Come, Ruth, sit down here.” He motioned to his knee. I felt my face flush. I backed away towards the door ... . Then he rose ... and ... put his hand into his pocket, took out a roll of bills, counted off three dollars, and brought it over to me at the door. “Tell your father,” he said, “to find you a new shop for tomorrow morning.” (Cohen 129)Sexual coercion in the workplace, such as referred to in this workplace novel published in 1918, was spoken about among women in subcultures and gossip long before it was named as sexual harassment. But it had no place in public discourse. Women’s knowledge of sexual harassment coalesced in an act of naming that is reputed to have occurred in a consciousness raising group in New York at the height of the second wave women’s movement. Lin Farley lays claim to it in her book, Sexual Shakedown, first published in 1978, in describing the coinage of the term from a workshop on women and work in 1974 at Cornell University. The group of participants was made up, she says, of near equal numbers of black and white women with “economic backgrounds ranging from very affluent to poor” (11). She describes how, “when we had finished, there was an unmistakable pattern to our employment ... . Each one of us had already quit or been fired from a job at least once because we had been made too uncomfortable by the behaviour of men” (11–12). She claims to have later devised the term “sexual harassment” in collaboration with others from this group (12).The naming of sexual harassment has been described as a kind of “discovery” (Leeds TUCRIC 1) and possibly “the only concept of sexual violence to be labelled by women themselves” (Hearn et al. 20). Not everyone agrees that Farley’s group first coined the term (see Herbert 1989) and there is some evidence that it was in use from the early 1970s. Catherine Mackinnon accredits its first use to the Working Women United Institute in New York in connection with the case of Carmita Wood in 1975 (25). Yet Farley’s account gained authority and is cited in several other contemporary radical feminist works (for instance, see Storrie and Dykstra 26; Wise and Stanley 48), and Sexual Shakedown can now be listed among the iconic feminist manifestoes of the second wave era.The key insight of Farley’s book was that sexual coercion in the workplace was more than aberrant behaviour by individual men but was systemic and organised. She suggests how the phrase sexual harassment “is the first verbal description of women’s feelings about this behaviour and it unstintingly conveys a negative perception of male aggression in the workplace” (32). Others followed in seeing it as organised expression of male power that functions “to keep women out of non-traditional occupations and to reinforce their secondary status in the workplace” (Pringle 93), a wisdom that is now widely accepted but seemed radical at the time.A theoretical literature on sexual harassment grew rapidly from the 1970s in which the definition of sexual harassment was a key element. In Sexual Shakedown, Farley defines it with specific connection to the workplace and a woman’s “function as worker” (33). Some definitions attempted to cover a range of practices that “might threaten a woman’s job security or create a stressful or intimidating working environment” ranging from touching to rape (Sedley and Benn 6). In the wider radical feminist discussion, sexual harassment was located within the “continuum of sexual violence”, a paradigm that highlighted the links between “every day abuses” and “less common experiences labelled as crimes” (Kelly 59). Accordingly, it was seen as a diminished category of rape, termed “little rape” (Bularzik 26), or a means whereby women are “reminded” of the “ever present threat of rape” (Rubinstein 165).The upsurge of research and writing served to document the prevalence and history of sexual harassment. Radical feminist accounts situated the origins in the long-standing patriarchal assumption that economic responsibility for women is ultimately held by men, and how “women forced to earn their own living in the past were believed to be defenceless and possibly immoral” (Rubinstein 166). Various accounts highlighted the intersecting effects of racism and sexism in the experience of black women, and women of colour, in a way that would be now termed intersectional. Jo Dixon discussed black women’s “least advantaged position in the economy coupled with the legacy of slavery” (164), while, in Australia, Linda Rubinstein describes the “sexual exploitation of aboriginal women employed as domestic servants on outback stations” which was “as common as the better documented abuse of slaves in the American South” (166).In The Sexual Harassment of Working Women, Catherine Mackinnon provided a pioneering legal argument that sexual harassment was a form of sex discrimination. She defined two types: the quid pro quo, when “sexual compliance is exchanged, or proposed to be exchanged, for an employment opportunity” (32); and sexual harassment as a “persistent condition of work” that “simply makes the work environment unbearable” (40). Thus the feminist histories of sexual harassment became detailed and strategic. The naming of sexual harassment was a moment of relinquishing women’s experience to the gaze of feminism and the bureaucratic gaze of the state, and, in the legal interventions that followed, it ceased to be exclusively a feminist issue.In Australia, a period of bureaucratisation and state intervention commenced in the late 1970s that corresponded with similar legislative responses abroad. The federal Sex Discrimination Act was amended in 1984 to include a definition of sexual harassment, and State and Territory jurisdictions also framed legislation pertaining to sexual harassment (see Law Council of Australia). The regimes of redress were linked with Equal Opportunity and Affirmative Action frameworks and were of a civil order. Under the law, there was potential for employers to be found vicariously liable for sexual harassment.In the women’s movement, legislative strategies were deemed reformist. Radical and socialist feminists perceived the de-gendering effects of these policies in the workplace that risked collusion with the state. Some argued that naming and defining sexual harassment denies that women constantly deal with a range of harassment anywhere, not only in the workplace (Wise and Stanley 10); while others argued that reformist approaches effectively legitimate other forms of sex discrimination not covered by legislation (Game and Pringle 290). However, in feminism and in the policy realm, the debate concerned sexual harassment in the general workplace. In contrast to #MeToo, it was not led by celebrity voices, nor galvanised by incidents in the sphere of entertainment, nor, by and large, among figures of public office, except for a couple of notable exceptions, including Anita Hill.The “Spectacle of Subjectivity” in the “Scene of Public Life”Through the early 1990s as an MA candidate at the University of Queensland, I studied media coverage of sexual harassment cases, clipping newspapers and noting electronic media reports on a daily basis. These mainly concerned incidents in government sector workplaces or small commercial enterprises. While the public prominence of the parties involved was not generally a factor in reportage, occasionally, prominent individuals were affected, such as the harassment of the athlete Michelle Baumgartner at the Commonwealth Games in 1990 which received extensive coverage but the offenders were never publicly named or disciplined. Two other incidents stand out: the Ormond College case at the University of Melbourne, about which much has been written; and Anita Hill’s claims against Clarence Thomas during his nomination to the US Supreme Court in 1991.The spectacle of Hill’s testimony to the US Senate is now an archetype of claims against powerful men, although, at the time, her credibility was attacked and her dignified presentation was criticised as “too composed. Too cool. Too censorious” (Legge 31). Hill was also seen to counterpose the struggles of race and gender, and Thomas himself famously described it as “a hi-tech lynching of an uppity black” (qtd in Stephens 1). By “hi-tech”, Thomas alluded to the occasion of the first-ever live national broadcast of the United States Senate hearings in which Hill’s claims were aired directly to the national public, and re-broadcast internationally in news coverage. Thus, it was not only the claims but the scale and medium of delivery to a global audience that set it apart from other sexual harassment stories.Recent events have since prompted revisiting of the inequity of Hill’s treatment at the Senate hearings. But well before this, in an epic and polemical study of American public culture, Berlant reflected at length on the heroism of Hill’s “witnessing” as paradigmatic of citizenship in post-Reaganite America’s “shrinking” public sphere. It forms part of her much wider thesis regarding the “intimate public sphere” and the form of citizenship “produced by personal acts and values” (5) in the absence of a context that “makes ordinary citizens feel they have a common public culture, or influence on a state” (3), and in which the fundamental inequality of minority cultures is assumed. For Berlant, Hill’s testimony becomes the model of “Diva Citizenship”; the “strange intimacy” in which the Citizen Diva, “the subordinated person”, believes in the capacity of the privileged ones “to learn and to change” and “trust[s] ... their innocence of ... their obliviousness” of the system that has supported her subjugation (222–223). While Berlant’s thesis pertains to profound social inequalities, there is no mistaking the comparison to the digital feminist in the #MeToo era in the call to identify with her suffering and courage.Of Hill’s testimony, Berlant describes how: “a member of a stigmatised population testifies reluctantly to a hostile public the muted and anxious history of her imperiled citizenship” (222). It is an “act of heroic pedagogy” (223) which occurs when “a person stages a dramatic coup in a public sphere in which she does not have privilege” (223). In such settings, “acts of language can feel like explosives” and put “the dominant story into suspended animation” (223). The Diva Citizen cannot “change the world” but “challenges her audience” to identify with her “suffering” and the “courage she has had to produce” in “calling on people to change the practices of citizenship into which they currently consent” (223). But Berlant cautions that the strongest of Divas cannot alone achieve change because “remaking the scene of public life into a spectacle of subjectivity” can lead to “a confusion of ... memorable rhetorical performance with sustained social change itself” (223). Instead, she argues that the Diva’s act is a call; the political obligation for the action of change lies with the collective, the greater body politic.The EchoIf Acts of Diva Citizenship abound in the #MeToo movement, relations between the individual and the collective are in question in a number of ways. This suggests a basis of comparison between past and present feminisms which have come full circle in the renewed recognition of sexual harassment in the continuum of sexual violence. Compared with the past, the voices of #MeToo are arguably empowered by a genuine, if gradual, change in the symbolic status of women, and a corresponding destabilization of the images of male power since the second wave era of feminism. The one who names an abuser on Twitter symbolises a power of individual courage, backed by a responding collective voice of supporters. Yet there are concerns about who can “speak out” without access to social media or with the constraint that “the sanctions would be too great” (Zarkov and Davis). Conversely, the “spreadability” — as Jenkins, Ford and Green term the travelling properties of digital media — and the apparent relative ease of online activism might belie the challenge and courage of those who make the claims and those who respond.The collective voice is also allied with other grassroots movements like SlutWalk (Jouet), the women’s marches in the US against the Trump presidency, and the several national campaigns — in India and Egypt, for instance (Zarkov and Davis) — that contest sexual violence and gender inequality. The “sheer numbers” of participation in #MeToo testify to “the collectivity of it all” and the diversity of the movement (Gill and Orgad). If the #MeToo hashtag gained traction with the “experiences of white heterosexual women in the US”, it “quickly expanded” due to “broad and inclusive appeal” with stories of queer women and men and people of colour well beyond the Global North. Even so, Tarana Burke, who founded the #MeToo hashtag in 2006 in her campaign of social justice for working class women and girls of colour, and endorsed its adoption by Hollywood, highlights the many “untold stories”.More strikingly, #MeToo participants name the names of the alleged harassers. The naming of names, famous names, is threshold-crossing and as much the public-startling power of the disclosures as the allegations and stimulates newsworthiness in conventional media. The resonance is amplified in the context of the American crisis over the Trump presidency in the sense that the powerful men called out become echoes or avatars of Trump’s monstrous manhood and the urgency of denouncing it. In the case of Harvey Weinstein, the name is all. A figure of immense power who symbolised an industry, naming Weinstein blew away the defensive old Hollywood myths of “casting couches” and promised, perhaps idealistically, the possibility for changing a culture and an industrial system.The Hollywood setting for activism is the most striking comparison with second wave feminism. A sense of contradiction emerges in this new “visibility” of sexual harassment in a culture that remains predominantly “voyeuristic” and “sexist” (Karkov and Davis), and not least in the realm of Hollywood where the sexualisation of women workers has long been a notorious open secret. A barrage of Hollywood feminism has accompanied #MeToo and #TimesUp in the campaign for diversity at the Oscars, and the stream of film remakes of formerly all-male narrative films that star all-female casts (Ghostbusters; Oceans 11; Dirty, Rotten Scoundrels). Cynically, this trend to make popular cinema a public sphere for gender equality in the film industry seems more glorifying than subversive of Hollywood masculinities. Uneasily, it does not overcome those lingering questions about why these conditions were uncontested openly for so long, and why it took so long for someone to go public, as Rose McGowan did, with claims about Harvey Weinstein.However, a reading of She Said, by Jodie Kantor and Megan Tuohey, the journalists who broke the Weinstein story in the New York Times — following their three year efforts to produce a legally water-tight report — makes clear that it was not for want of stories, but firm evidence and, more importantly, on-the-record testimony. If not for their (and others’) fastidious journalism and trust-building and the Citizen Divas prepared to disclose their experiences publicly, Weinstein might not be convicted today. Yet without the naming of the problem of sexual harassment in the women’s movement all those years ago, none of this may have come to pass. Lin Farley can now be found on YouTube retelling the story (see “New Mexico in Focus”).It places the debate about digital activism and Hollywood feminism in some perspective and, like the work of journalists, it is testament to the symbiosis of individual and collective effort in the action of change. The tweeting activism of #MeToo supplements the plenum of knowledge and action about sexual harassment across time: the workplace novels, the consciousness raising, the legislation and the poster campaigns. In different ways, in both eras, this literature demonstrates that names matter in calling for change on sexual harassment. But, if #MeToo is to become the last long take on sexual harassment, then, as Berlant advocates, the responsibility lies with the body politic who must act collectively for change in ways that will last well beyond the courage of the Citizen Divas who so bravely call it on.ReferencesBerlant, Lauren. The Queen of America Goes to Washington City: Essays on Sex and Citizenship. 1997. Durham: Duke UP, 2002.Bularzik, Mary. “Sexual Harassment at the Workplace: Historical Notes.” Radical America 12.4 (1978): 25-43.Cohen, Rose. Out of the Shadow. NY: Doran, 1918.Dixon, Jo. “Feminist Reforms of Sexual Coercion Laws.” Sexual Coercion: A Sourcebook on Its Nature, Causes and Prevention. Eds. Elizabeth Grauerholz and Mary A. Karlewski. Massachusetts: Lexington, 1991. 161-171.Farley, Lin. Sexual Shakedown: The Sexual Harassment of Women in the Working World. London: Melbourne House, 1978.Game, Ann, and Rosemary Pringle. “Beyond Gender at Work: Secretaries.” Australian Women: New Feminist Perspectives. Melbourne: Oxford UP, 1986. 273–91.Gill, Rosalind, and Shani Orgad. “The Shifting Terrain of Sex and Power: From the ‘Sexualisation of Culture’ to #MeToo.” Sexualities 21.8 (2018): 1313–1324. <https://doi-org.elibrary.jcu.edu.au/10.1177/1363460718794647>.Google Trends. “Me Too Rising: A Visualisation of the Movement from Google Trends.” 2017–2020. <https://metoorising.withgoogle.com>.Hearn, Jeff, Deborah Shepherd, Peter Sherrif, and Gibson Burrell. The Sexuality of Organization. London: Sage, 1989.Herbert, Carrie. Talking of Silence: The Sexual Harassment of Schoolgirls. London: Falmer, 1989.Jenkins, Henry, Sam Ford, and Joshua Green. Spreadable Media: Creating Value and Meaning in a Networked Culture. New York: New York UP, 2013.Jouet, Josiane. “Digital Feminism: Questioning the Renewal of Activism.” Journal of Research in Gender Studies 8.1 (2018). 1 Jan. 2018. <http://dx.doi.org.elibrary.jcu.edu.au/10.22381/JRGS8120187>.Kantor, Jodi, and Megan Twohey. She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement. London: Bloomsbury, 2019.Kelly, Liz. “The Continuum of Sexual Violence.” Women, Violence, and Social Control. Eds. Jalna Hanmer and Mary Maynard. London: MacMillan, 1989. 46–60.Legge, Kate. “The Harassment of America.” Weekend Australian 19–20 Oct. 1991: 31.Mackinnon, Catherine. The Sexual Harassment of Working Women. New Haven: Yale UP, 1979.New Mexico in Focus, a Production of NMPBS. 26 Jan. 2018. <https://www.youtube.com/watch?v=LlO5PiwZk8U>.Pringle, Rosemary. Secretaries Talk. Sydney: Allen and Unwin, 1988.Rubinstein, Linda. “Dominance Eroticized: Sexual Harassment of Working Women.” Worth Her Salt. Eds. Margaret Bevege, Margaret James, and Carmel Shute. Sydney: Hale and Iremonger, 1982. 163–74.Sedley, Ann, and Melissa Benn. Sexual Harassment at Work. London: NCCL Rights for Women Unit, 1986.Stephens, Peter. “America’s Sick and Awful Farce.” Sydney Morning Herald 14 Oct. 1991: 1.Storrie, Kathleen, and Pearl Dykstra. “Bibliography on Sexual Harassment.” Resources for Feminist Research/Documentation 10.4 (1981–1982): 25–32.Wise, Sue, and Liz Stanley. Georgie Porgie: Sexual Harassment in Every Day Life. London: Pandora, 1987.Winch, Alison, Jo Littler, and Jessalyn Keller. “Why ‘Intergenerational Feminist Media Studies’?” Feminist Media Studies 16.4 (2016): 557–572. <https://doi.org/10.1080/14680777.2016.1193285>.Zarkov, Dubravka, and Kathy Davis. “Ambiguities and Dilemmas around #MeToo: #ForHowLong and #WhereTo?” European Journal of Women's Studies 25.1 (2018): 3–9. <https://doi.org/10.1177/1350506817749436>.

The Leichhardt Highway is a six hundred-kilometre stretch of sealed inland road that joins the Australian Queensland border town of Goondiwindi with the Capricorn Highway, just south of the Tropic of Capricorn. Named after the young Prussian naturalist Ludwig Leichhardt, part of this roadway follows the route his party took as they crossed northern Australia from Morton Bay (Brisbane) to Port Essington (near Darwin). Ignoring the usual colonial practice of honouring the powerful and aristocratic, Leichhardt named the noteworthy features along this route after his supporters and fellow expeditioners. Many of these names are still in use and a series of public monuments have also been erected in the intervening century and a half to commemorate this journey. Unlike Leichhardt, who survived his epic trip, some contemporary travellers who navigate the remote roadway named in his honour do not arrive at their final destinations. Memorials to these violently interrupted lives line the highway, many enigmatically located in places where there is no obvious explanation for the lethal violence that occurred there. This examination profiles the memorials along Leichhardt’s highway as Gothic practice, in order to illuminate some of the uncanny paradoxes around public memorials, as well as the loaded emotional terrain such commemorative practices may inhabit. All humans know that death awaits them (Morell). Yet, despite this, and the unprecedented torrent of images of death and dying saturating news, television, and social media (Duwe; Sumiala; Bisceglio), Gorer’s mid-century ideas about the denial of death and Becker’s 1973 Pulitzer prize-winning description of the purpose of human civilization as a defence against this knowledge remains current in the contemporary trope that individuals (at least in the West) deny their mortality. Contributing to this enigmatic situation is how many deny the realities of aging and bodily decay—the promise of the “life extension” industries (Hall)—and are shielded from death by hospitals, palliative care providers, and the multimillion dollar funeral industry (Kiernan). Drawing on Piatti-Farnell’s concept of popular culture artefacts as “haunted/haunting” texts, the below describes how memorials to the dead can powerfully reconnect those who experience them with death’s reality, by providing an “encrypted passageway through which the dead re-join the living in a responsive cycle of exchange and experience” (Piatti-Farnell). While certainly very different to the “sublime” iconic Gothic structure, the Gothic ruin that Summers argued could be seen as “a sacred relic, a memorial, a symbol of infinite sadness, of tenderest sensibility and regret” (407), these memorials do function in both this way as melancholy/regret-inducing relics as well as in Piatti-Farnell’s sense of bringing the dead into everyday consciousness. Such memorialising activity also evokes one of Spooner’s features of the Gothic, by acknowledging “the legacies of the past and its burdens on the present” (8).Ludwig Leichhardt and His HighwayWhen Leichhardt returned to Sydney in 1846 from his 18-month journey across northern Australia, he was greeted with surprise and then acclaim. Having mounted his expedition without any backing from influential figures in the colony, his party was presumed lost only weeks after its departure. Yet, once Leichhardt and almost all his expedition returned, he was hailed “Prince of Explorers” (Erdos). When awarding him a significant purse raised by public subscription, then Speaker of the Legislative Council voiced what he believed would be the explorer’s lasting memorial —the public memory of his achievement: “the undying glory of having your name enrolled amongst those of the great men whose genius and enterprise have impelled them to seek for fame in the prosecution of geographical science” (ctd. Leichhardt 539). Despite this acclaim, Leichhardt was a controversial figure in his day; his future prestige not enhanced by his Prussian/Germanic background or his disappearance two years later attempting to cross the continent. What troubled the colonial political class, however, was his transgressive act of naming features along his route after commoners rather than the colony’s aristocrats. Today, the Leichhardt Highway closely follows Leichhardt’s 1844-45 route for some 130 kilometres from Miles, north through Wandoan to Taroom. In the first weeks of his journey, Leichhardt named 16 features in this area: 6 of the more major of these after the men in his party—including the Aboriginal man ‘Charley’ and boy John Murphy—4 more after the tradesmen and other non-aristocratic sponsors of his venture, and the remainder either in memory of the journey’s quotidian events or natural features there found. What we now accept as traditional memorialising practice could in this case be termed as Gothic, in that it upset the rational, normal order of its day, and by honouring humble shopkeepers, blacksmiths and Indigenous individuals, revealed the “disturbance and ambivalence” (Botting 4) that underlay colonial class relations (Macintyre). On 1 December 1844, Leichhardt also memorialised his own past, referencing the Gothic in naming a watercourse The Creek of the Ruined Castles due to the “high sandstone rocks, fissured and broken like pillars and walls and the high gates of the ruined castles of Germany” (57). Leichhardt also disturbed and disfigured the nature he so admired, famously carving his initials deep into trees along his route—a number of which still exist, including the so-called Leichhardt Tree, a large coolibah in Taroom’s main street. Leichhardt also wrote his own memorial, keeping detailed records of his experiences—both good and more regretful—in the form of field books, notebooks and letters, with his major volume about this expedition published in London in 1847. Leichhardt’s journey has since been memorialised in various ways along the route. The Leichhardt Tree has been further defaced with numerous plaques nailed into its ancient bark, and the town’s federal government-funded Bicentennial project raised a formal memorial—a large sandstone slab laid with three bronze plaques—in the newly-named Ludwig Leichhardt Park. Leichhardt’s name also adorns many sites both along, and outside, the routes of his expeditions. While these fittingly include natural features such as the Leichhardt River in north-west Queensland (named in 1856 by Augustus Gregory who crossed it by searching for traces of the explorer’s ill-fated 1848 expedition), there are also many businesses across Queensland and the Northern Territory less appropriately carrying his name. More somber monuments to Leichhardt’s legacy also resulted from this journey. The first of these was the white settlement that followed his declaration that the countryside he moved through was well endowed with fertile soils. With squatters and settlers moving in and land taken up before Leichhardt had even arrived back in Sydney, the local Yeeman people were displaced, mistreated and completely eradicated within a decade (Elder). Mid-twentieth century, Patrick White’s literary reincarnation, Voss of the eponymous novel, and paintings by Sidney Nolan and Albert Tucker have enshrined in popular memory not only the difficult (and often described as Gothic) nature of the landscape through which Leichhardt travelled (Adams; Mollinson, and Bonham), but also the distinctive and contrary blend of intelligence, spiritual mysticism, recklessness, and stoicism Leichhardt brought to his task. Roadside Memorials Today, the Leichhardt Highway is also lined with a series of roadside shrines to those who have died much more recently. While, like centotaphs, tombstones, and cemeteries, these memorialise the dead, they differ in usually marking the exact location that death occurred. In 43 BC, Cicero articulated the idea of the dead living in memory, “The life of the dead consists in the recollection cherished of them by the living” (93), yet Nelson is one of very few contemporary writers to link roadside memorials to elements of Gothic sensibility. Such constructions can, however, be described as Gothic, in that they make the roadway unfamiliar by inscribing onto it the memory of corporeal trauma and, in the process, re-creating their locations as vivid sites of pain and suffering. These are also enigmatic sites. Traffic levels are generally low along the flat or gently undulating terrain and many of these memorials are located in locations where there is no obvious explanation for the violence that occurred there. They are loci of contradictions, in that they are both more private than other memorials, in being designed, and often made and erected, by family and friends of the deceased, and yet more public, visible to all who pass by (Campbell). Cemeteries are set apart from their surroundings; the roadside memorial is, in contrast, usually in open view along a thoroughfare. In further contrast to cemeteries, which contain many relatively standardised gravesites, individual roadside memorials encapsulate and express not only the vivid grief of family and friends but also—when they include vehicle wreckage or personal artefacts from the fatal incident—provide concrete evidence of the trauma that occurred. While the majority of individuals interned in cemeteries are long dead, roadside memorials mark relatively contemporary deaths, some so recent that there may still be tyre marks, debris and bloodstains marking the scene. In 2008, when I was regularly travelling this roadway, I documented, and researched, the six then extant memorial sites that marked the locations of ten fatalities from 1999 to 2006. (These were all still in place in mid-2014.) The fatal incidents are very diverse. While half involved trucks and/or road trains, at least three were single vehicle incidents, and the deceased ranged from 13 to 84 years of age. Excell argues that scholarship on roadside memorials should focus on “addressing the diversity of the material culture” (‘Contemporary Deathscapes’) and, in these terms, the Leichhardt Highway memorials vary from simple crosses to complex installations. All include crosses (mostly, but not exclusively, white), and almost all are inscribed with the name and birth/death dates of the deceased. Most include flowers or other plants (sometimes fresh but more often plastic), but sometimes also a range of relics from the crash and/or personal artefacts. These are, thus, unsettling sights, not least in the striking contrast they provide with the highway and surrounding road reserve. The specific location is a key component of their ability to re-sensitise viewers to the dangers of the route they are travelling. The first memorial travelling northwards, for instance, is situated at the very point at which the highway begins, some 18 kilometres from Goondiwindi. Two small white crosses decorated with plastic flowers are set poignantly close together. The inscriptions can also function as a means of mobilising connection with these dead strangers—a way of building Secomb’s “haunted community”, whereby community in the post-colonial age can only be built once past “murderous death” (131) is acknowledged. This memorial is inscribed with “Cec Hann 06 / A Good Bloke / A Good hoarseman [sic]” and “Pat Hann / A Good Woman” to tragically commemorate the deaths of an 84-year-old man and his 79-year-old wife from South Australia who died in the early afternoon of 5 June 2006 when their Ford Falcon, towing a caravan, pulled onto the highway and was hit by a prime mover pulling two trailers (Queensland Police, ‘Double Fatality’; Jones, and McColl). Further north along the highway are two memorials marking the most inexplicable of road deaths: the single vehicle fatality (Connolly, Cullen, and McTigue). Darren Ammenhauser, aged 29, is remembered with a single white cross with flowers and plaque attached to a post, inscribed hopefully, “Darren Ammenhauser 1971-2000 At Rest.” Further again, at Billa Billa Creek, a beautifully crafted metal cross attached to a fence is inscribed with the text, “Kenneth J. Forrester / RIP Jack / 21.10.25 – 27.4.05” marking the death of the 79-year-old driver whose vehicle veered off the highway to collide with a culvert on the creek. It was reported that the vehicle rolled over several times before coming to rest on its wheels and that Forrester was dead when the police arrived (Queensland Police, ‘Fatal Traffic Incident’). More complex memorials recollect both single and multiple deaths. One, set on both sides of the road, maps the physical trajectory of the fatal smash. This memorial comprises white crosses on both sides of road, attached to a tree on one side, and a number of ancillary sites including damaged tyres with crosses placed inside them on both sides of the road. Simple inscriptions relay the inability of such words to express real grief: “Gary (Gazza) Stevens / Sadly missed” and “Gary (Gazza) Stevens / Sadly missed / Forever in our hearts.” The oldest and most complex memorial on the route, commemorating the death of four individuals on 18 June 1999, is also situated on both sides of the road, marking the collision of two vehicles travelling in opposite directions. One memorial to a 62-year-old man comprises a cross with flowers, personal and automotive relics, and a plaque set inside a wooden fence and simply inscribed “John Henry Keenan / 23-11-1936–18-06-1999”. The second memorial contains three white crosses set side-by-side, together with flowers and relics, and reveals that members of three generations of the same family died at this location: “Raymond Campbell ‘Butch’ / 26-3-67–18-6-99” (32 years of age), “Lorraine Margaret Campbell ‘Lloydie’ / 29-11-46–18-6-99” (53 years), and “Raymond Jon Campbell RJ / 28-1-86–18-6-99” (13 years). The final memorial on this stretch of highway is dedicated to Jason John Zupp of Toowoomba who died two weeks before Christmas 2005. This consists of a white cross, decorated with flowers and inscribed: “Jason John Zupp / Loved & missed by all”—a phrase echoed in his newspaper obituary. The police media statement noted that, “at 11.24pm a prime mover carrying four empty trailers [stacked two high] has rolled on the Leichhardt Highway 17km north of Taroom” (Queensland Police, ‘Fatal Truck Accident’). The roadside memorial was placed alongside a ditch on a straight stretch of road where the body was found. The coroner’s report adds the following chilling information: “Mr Zupp was thrown out of the cabin and his body was found near the cabin. There is no evidence whatsoever that he had applied the brakes or in any way tried to prevent the crash … Jason was not wearing his seatbelt” (Cornack 5, 6). Cornack also remarked the truck was over length, the brakes had not been properly adjusted, and the trip that Zupp had undertaken could not been lawfully completed according to fatigue management regulations then in place (8). Although poignant and highly visible due to these memorials, these deaths form a small part of Australia’s road toll, and underscore our ambivalent relationship with the automobile, where road death is accepted as a necessary side-effect of the freedom of movement the technology offers (Ladd). These memorials thus animate highways as Gothic landscapes due to the “multifaceted” (Haider 56) nature of the fear, terror and horror their acknowledgement can bring. Since 1981, there have been, for instance, between some 1,600 and 3,300 road deaths each year in Australia and, while there is evidence of a long term downward trend, the number of deaths per annum has not changed markedly since 1991 (DITRDLG 1, 2), and has risen in some years since then. The U.S.A. marked its millionth road death in 1951 (Ladd) along the way to over 3,000,000 during the 20th century (Advocates). These deaths are far reaching, with U.K. research suggesting that each death there leaves an average of 6 people significantly affected, and that there are some 10 to 20 per cent of mourners who experience more complicated grief and longer term negative affects during this difficult time (‘Pathways Through Grief’). As the placing of roadside memorials has become a common occurrence the world over (Klaassens, Groote, and Vanclay; Grider; Cohen), these are now considered, in MacConville’s opinion, not only “an appropriate, but also an expected response to tragedy”. Hockey and Draper have explored the therapeutic value of the maintenance of “‘continuing bonds’ between the living and the dead” (3). This is, however, only one explanation for the reasons that individuals erect roadside memorials with research suggesting roadside memorials perform two main purposes in their linking of the past with the present—as not only sites of grieving and remembrance, but also of warning (Hartig, and Dunn; Everett; Excell, Roadside Memorials; MacConville). Clark adds that by “localis[ing] and personalis[ing] the road dead,” roadside memorials raise the profile of road trauma by connecting the emotionless statistics of road death directly to individual tragedy. They, thus, transform the highway into not only into a site of past horror, but one in which pain and terror could still happen, and happen at any moment. Despite their increasing commonality and their recognition as cultural artefacts, these memorials thus occupy “an uncomfortable place” both in terms of public policy and for some individuals (Lowe). While in some states of the U.S.A. and in Ireland the erection of such memorials is facilitated by local authorities as components of road safety campaigns, in the U.K. there appears to be “a growing official opposition to the erection of memorials” (MacConville). Criticism has focused on the dangers (of distraction and obstruction) these structures pose to passing traffic and pedestrians, while others protest their erection on aesthetic grounds and even claim memorials can lower property values (Everett). While many ascertain a sense of hope and purpose in the physical act of creating such shrines (see, for instance, Grider; Davies), they form an uncanny presence along the highway and can provide dangerous psychological territory for the viewer (Brien). Alongside the townships, tourist sites, motels, and petrol stations vying to attract customers, they stain the roadway with the unmistakable sign that a violent death has happened—bringing death, and the dead, to the fore as a component of these journeys, and destabilising prominent cultural narratives of technological progress and safety (Richter, Barach, Ben-Michael, and Berman).Conclusion This investigation has followed Goddu who proposes that a Gothic text “registers its culture’s contradictions” (3) and, in profiling these memorials as “intimately connected to the culture that produces them” (Goddu 3) has proposed memorials as Gothic artefacts that can both disturb and reveal. Roadside memorials are, indeed, so loaded with emotional content that their close contemplation can be traumatising (Brien), yet they are inescapable while navigating the roadway. Part of their power resides in their ability to re-animate those persons killed in these violent in the minds of those viewing these memorials. In this way, these individuals are reincarnated as ghostly presences along the highway, forming channels via which the traveller can not only make human contact with the dead, but also come to recognise and ponder their own sense of mortality. While roadside memorials are thus like civic war memorials in bringing untimely death to the forefront of public view, roadside memorials provide a much more raw expression of the chaotic, anarchic and traumatic moment that separates the world of the living from that of the dead. While traditional memorials—such as those dedicated by, and to, Leichhardt—moreover, pay homage to the vitality of the lives of those they commemorate, roadside memorials not only acknowledge the alarming circumstances of unexpected death but also stand testament to the power of the paradox of the incontrovertibility of sudden death versus our lack of ability to postpone it. In this way, further research into these and other examples of Gothic memorialising practice has much to offer various areas of cultural study in Australia.ReferencesAdams, Brian. Sidney Nolan: Such Is Life. Hawthorn, Vic.: Hutchinson, 1987. Advocates for Highway and Auto Safety. “Motor Vehicle Traffic Fatalities & Fatality Rate: 1899-2003.” 2004. Becker, Ernest. The Denial of Death. New York: Simon & Schuster, 1973. Bisceglio, Paul. “How Social Media Is Changing the Way We Approach Death.” The Atlantic 20 Aug. 2013. Botting, Fred. Gothic: The New Critical Idiom. 2nd edition. Abingdon, UK: Routledge, 2014. 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