Journal articles on the topic 'Commune health stations'

The primary health care system in Vietnam has been playing an important role in prevention and control of diseases. This study aimed to describe the capacity of commune health stations in Chi Linh district, Hai Duong province for prevention and control of noncommunicable diseases (NCDs). A mixed-methods (quantitative and qualitative approaches) approach was applied to collect data in 20 commune health stations. The participants, including health workers, stakeholders, and patients with NCDs, were selected for the study. The findings reported that the main activities of prevention and control of NCDs at commune health stations (CHSs) still focused on information-education-community (IECs), unqualified for providing screening, diagnosis, and treatments of NCDs. The capacity for prevention and control of NCDs in CHSs was inadequate to provide health care services related to prevention and control of NCDs and unmet with the community’s demands. In order to ensure the role and implementation of primary care level, there is an urgent need to improve the capacity of CHSs for prevention and control of NCDs, particularly a national budget for NCDs prevention and control, the essential equipment and medicines recommended by the World Health Organization should be provided and available at the CHSs.

Background: The incidence of breast cancer has increased consistently in Vietnam over the past two decades. Data from 2012 indicates an increase from an age-standardized rate of 16.2 per 100,000 in 2002, to 23.0 per 100,000 in 2012. Despite this, and consistent studies indicating late diagnosis, there has been a lack of empirical studies on what breast cancer services exist and how they function across different levels of the Vietnamese health system. Aim: Our project sought to examine the accessibility, affordability, and appropriateness of breast cancer services in Vietnam with the objective of making recommendations to strengthen service delivery. Methods: The project used a mixed-methods approach, collecting data through self-administered questionnaires (n=69) and in-depth interviews (n=23) with health professionals working at facilities across all four levels of the Vietnamese health system (national, provincial, district, & commune). We completed in-depth interviews with women (n=12) diagnosed with breast cancer, focusing on their experiences of accessing and using services. Our study was located across three provinces, representing the northern, central, and southern regions of the country. Results: Our results show that screening activities for breast cancer in the community are not systematically organized or provided. There are no stand-alone screening campaigns for breast cancer and facility-based opportunistic screening is limited. There is scope for strengthening the primary and secondary levels of the Vietnamese health system to detect, diagnose and treat breast cancer. Increased autonomy and support for commune-level health stations to conduct screening activities, the systematic incorporation of opportunistic screening, and the extension of breast cancer-specific training for commune and district level health care staff are potential areas for strengthening. Conclusion: Our study suggests that there should be concerted efforts to implement the Ministry of Health's strategic objectives to decentralise and strengthen commune and district levels of the health system in relation to detection, diagnosis and treatment of breast cancer. No studies have been conducted that pilot interventions to provide systematic and comprehensive breast cancer services at the lower levels of the health system. Specific attention should be given to increasing autonomy and support for commune level health stations to conduct screening activities; for the systematic incorporation of opportunistic screening; and the extension of breast cancer-specific training for commune and district level health care staff.

ObjectivesThe study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups.Design/settingSecondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted.ParticipantsA total of 4900 individuals who reported using healthcare services are analysed.Outcomes measureNumbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year.ResultsThe result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics.ConclusionOur findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level.

A cross-sectional study using DASS21 was performed in June 2019 on staff working at the commune health stations (CHSs), regional general clinics and district general clinics in Soc Son district, Hanoi to assess the mental disorders of the health care workers are working here. Among the 355 health care workers (HCWs) who participated, women accounted for 75.5%. People aged under 30 accounting for 33.5% of HCWs. Physicians, nurses take up 54.4%, and HCWs in the Soc Son district have worked in the health sector for more than ten years, accounting for 45.1%. The study shows that the rates of stress, anxiety, and depression were 13.8%, 25.4% and 16.6%, respectively. 31% of HCWs have at least one mental disorder, 8.2% of study subjects have all three manifestations of mental disorders, 8.4% of study subjects have two symptoms and 14.4% of the study subjects had only one manifestation. The rates of stress, anxiety, and depression were initially screened from the research results. The development of research directions for defnitive diagnosis and support for improving health care workers’ mental health should be integrated.

Introduction: Healthcare workers (HCWs) are at the frontline of COVID-19 control and prevention but also are high-risk groups for COVID-19 infection. The low level of knowledge and negative attitudes toward COVID-19 among HCWs can lead to inappropriate responding, wrong diagnoses, and poor practices for prevention. This research aims to examine the knowledge, attitudes, and practices regarding COVID-19 prevention and factors influencing the practices among HCWs in Daklak province, Vietnam. Method: A cross-sectional study was conducted among 963 HCWs working at district health centers and commune health stations through an online survey. Results: Overall, HCWs have good knowledge (91.3%), a positive attitude (71.5%), and appropriate practice (83.1%) regarding COVID-19 prevention. There was 89.6% of HCWs facing difficulties in practicing preventive measures such as felt difficult to change their habits (56.4%), insufficient personal protective equipment (PPE) (40.0%), and inconvenience to practice preventive measures (14.4%). The factors associated with implementing good practices are age group, residence, and knowledge about COVID-19. Recommendation: The Daklak Department of Health should provide additional training programs and guidelines about COVID-19 prevention and PPE for HCWs. More studies on risk and protective factors, and assessment about KAP regarding COVID-19 prevention at the post of the pandemic are needed.

Background: Hand, foot and mouth disease (HFMD) is a public health problem in Viet Nam, and studies have reported seasonal fluctuation in the occurrence of HFMD. This study sought to describe the occurrence of HFMD and its associated meteorological factors in Dak Lak province, Viet Nam. Methods: Monthly data on HFMD cases were collected from all commune health stations in Dak Lak province from 2012 through 2013. An HFMD case was defined as a brief febrile illness accompanied by a typical skin rash with or without mouth ulcers. Average temperature, maximum temperature, minimum temperature, humidity, rainfall, evaporation, sunshine duration and wind speed were recorded monthly at five local meteorological stations throughout Dak Lak. Data were aggregated at the district level, and the association between these meteorological factors and HFMD cases were examined by Poisson regression. Results: In 2012 through 2013, there were 7128 HFMD patients in Dak Lak. The number of HFMD cases increased during the rainy season. An increased risk of HFMD was associated with higher average temperature (risk ratio and 95% confidence interval: 1.06; 1.03–1.08 per 1 °C increase), higher rainfall (1.19; 1.14–1.24 per 200 mm increase) and longer sunshine duration (1.14; 1.07–1.22 per 60 hours increase). The risk of HFMD was inversely associated with wind speed (0.77; 0.73–0.81 per 1 m/s increase). Conclusion: This study suggests that there is a significant association between HFMD occurrence and climate. Temperature, rainfall, wind speed and sunshine duration could be used as meteorological predictors of HFMD occurrence in Viet Nam’s Central Highlands region. Intensified surveillance for HFMD during the rainy season is recommended.

Background: Liver cancer has been leading cancer mortality nationwide in Viet Nam. Aim: The aim was to examine time trends of liver cancer mortality by performing population-based mortality registration in Nghe An province, 2005-2014. Methods: We yearly collected data from all 480 Commune Health Stations from 2005 to 2014 using the designed form of “Mortality Registration” with a guideline of underlying-, immediate, - and contribute cause of death. Five variables were included name, age, sex, date of death and cause of death. Average residents of each commune were also yearly reported. All cases were coded ICD-10, then liver cancer (C22) was derived. Age-standardized rate (ASR) was estimated. Trend of liver cancer was observed by estimated mortality rates ratio and 95% confident interval (MRR) for 5-period of 2005-2006 (reference), 2007-2008, 2009-2010, 2011-2012, 2013-2014, adjusted for total mortality rate and proportion of cases with unknown causes of death, for total, subgroup of ages 40 or older, and ages less than 40. Results: Among registered 7,667 cases of liver cancer, there were 855 cases aged less than 40. Mortality rates per 100,000 (ASR) were increased from 37.4 to 52.8 in men and 9.2 to 12.6 in women, from 2005 to 2014, respectively. The increased trends were significantly seen for the subpopulation ages 40 or older only, MRR=1.56, 95% CI: 1.38-1.76 in men and MRR=1.67, 95% CI: 1.36-2.04 in women, all P trend < 0.05. In contrast, the decreased trends were significantly observed for the subpopulation ages less than 40, MRR=0.72, 95% CI: 0.54-0.97 in men and MRR=0.47, 95% CI: 0.22-0.99 in women, all P trend < 0.05. Conclusion: The significant decline risks of death from liver cancer for the subpopulation ages less than 40 during 2005-2014 might be explained by HBV vaccine nationwide from 1998 to date and reduction of environmental factors induced this cancer sites in improving healthy environments after the war ended in 1975. Key-words: Liver-cancer, population-based mortality registration, Viet Nam, HBV-vaccine.

Abstract In Vietnam, the overall prevalence of hypertension (HTN) was 21%, with lower estimates for the prevalence of HTN awareness and treatment. The health systems, like other low- and middle-income countries, were designed to provide acute care for episodic conditions, rather than a chronic condition where patients need long-term care across time and disciplines. This article describes the delivery and organization of HTN care at primary healthcare (PHC) settings in both urban and rural areas at Hue Province of Central Vietnam in comparison with Thai Nguyen province in Northern Vietnam based on the infrastructure capacity and patients’ and providers’ perspectives and experiences We used mixed-methods design that included in-depth semi-structured interviews with patients and healthcare providers at purposively selected PHC facilities in two districts of each province and a modified version of the service availability and readiness assessment inventory at all PHC facilities. We found that HTN patients in both provinces can access healthcare services to diagnose, treat and control their HTN condition at the PHC level with a focus on district facilities. Health services in Hue have allowed commune health stations (CHSs) to provide routine monitoring and prescription refills for HTN patients while maintaining periodical visits to a higher level of care to monitor the stability of the disease. Such provision of care at CHSs remained restricted in Thai Nguyen. Further improvements are necessary for referral procedures, information system to allow for longitudinal follow-up across levels of care and defining a basic health insurance or benefits package, which meets patients’ preferences with a monthly timespan for prescription refills.

This study explores factors associated with people’s willingness-to-pay (WTP) for family-based health insurance covering the whole family in central Vietnam. The amount of WTP was elicited by using a contingent value method in 2014 and the mean WTP was 2.27 percent of GDP per capita. Firstly, our study reveals that even the poor are willing to pay towards obtaining health insurance. Secondly, our regression analysis shows that the health insurance status of the household head, in addition to education, wealth level, and family size, is associated with WTP. Furthermore, our estimation results with restricted sample households whose designated health facility is the commune health station (CHS) confirm that healthcare service quality measures designed based on patients’ past experiences at the CHS are significant predictors of WTP as they can affect people’s valuation of the benefit of the health insurance.

The long-distance commute to school caused by urban sprawl and the car-oriented urban construction model are key factors leading to primary/middle school students being picked up by their parents in cars. Encouraging those students to take rail transit can reduce their dependence on cars. This paper uses a stepwise regression based on rail-transit swipe data to explore the influence of the built environment on rail-transit commuting characteristics in Wuhan, and uses a geographically weighted regression (GWR) model to analyze the spatial heterogeneity of significant influencing variables. The study found that: (1) 60% of students are one-way commuters; (2) 88.6% of students travel less than 10 km; (3) the floor area ratio, bus station density and whether the station is a transfer station have an obvious positive effect on the flow of commuters; (4) whether the station is a departure station has a positive effect on the commuting distance, but the mixed degree of land use and road density have a negative effect on the commuting distance. This research can assist cities in formulating built environment optimization measures and related policies to improve school-age children’s use of rail transit. This is important in the development of child-friendly cities.

A study of 600 rural under-five mothers’ knowledge, attitude, and practice (KAP) in child care was performed in 4 southern provinces of Vietnam. The mothers were randomly selected and interviewed about sociodemographic factors, health seeking behaviour, and practice of home care of children and neonates. 93.2% of the mothers were literate and well-educated, which has been shown to be important for child health care. 98.5% were married suggesting a stable family, which is also of importance for child health. Only 17.3% had more than 2 children in their family. The mother was the main caretaker in 77.7% of the families. Only 1% would use quacks as their first health contact, but 25.2% would use a private clinic, which therefore eases the burden on the government system. Nearly 69% had given birth in a hospital, 27% in a commune health station, and only 2.7% at home without qualified assistance. 89% were giving exclusive breast feeding at 6 months, much more frequent than in the cities. The majority of the mothers could follow IMCI guideline for home care, although 25.2% did not deal correctly with cough and 38.7% did not deal correctly with diarrhoea. Standard information about Integrated Management of Childhood Illnesses (IMCI) based home care is still needed.

BackgroundThe Pacific Arts Festival is a mass-gathering event occurring every four years in Oceania. The 10th festival in American Samoa, July 20 to August 2, 2008, brought 2200 performers and 2500 tourists (a 15% population increase) from 27 Pacific nations to the island. Anticipated healthcare concerns included hospital surge (175% in 2004), HIV/STI transmission, imported/communicable diseases, food/water/sanitation-borne illness, interpersonal violence, and healthcare resource utilization.ObjectiveTo describe the preparedness and response efforts for this mass gathering event by emergency medical services, the hospital, and the department of health.MethodsA retrospective review of after-action reports, public health and emergency department surveillance records, and key-informant interviews was conducted. Descriptive statistics were used to evaluate data.ResultsA Unified Command structure was utilized for pre-/post-event response. Patient surveillance data was collected daily. During the festival 217 participants (42% female, 58% male, Average age 36) sought medical care. Acute illness (n = 166), injury (n = 39), other (n = 15), routine follow up (n = 9), chronic conditions (n = 6), mental health (n = 1), OB/GYN (n = 1) were complaints addressed. Predominant acute illnesses included headache (n = 49, 23%), respiratory illness (n = 30, 14%), musculoskeletal pain (n = 26, 12%), and gastroenteritis (n = 17, 8%). One fatality occurred among delegates. No public health outbreaks were reported. Visits per healthcare venue demonstrated a decentralization of patient surge from the hospital setting (37.4% venue aid stations, 28.1% delegation medical staff, 24% DOH clinic, 10.6% hospital).ConclusionA unified health command structure was effective in responding to this mass gathering event. Surveillance data was rapidly gathered and utilized to direct healthcare resources. Efforts to decentralize healthcare from the hospital were successful. Public health emergencies were avoided.

Statins, inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, are the largest selling class of drugs prescribed for the pharmacological treatment of hypercholesterolemia and dyslipidaemia. Statins also possess other therapeutic effects, called pleiotropic, because the blockade of the conversion of HMG-CoA to (R)-mevalonate produces a concomitant inhibition of the biosynthesis of numerous isoprenoid metabolites (e.g., geranylgeranyl pyrophosphate (GGPP) or farnesyl pyrophosphate (FPP)). Thus, the prenylation of several cell signalling proteins (small GTPase family members: Ras, Rac, and Rho) is hampered, so that these molecular switches, controlling multiple pathways and cell functions (maintenance of cell shape, motility, factor secretion, differentiation, and proliferation) are regulated, leading to beneficial effects in cardiovascular health, regulation of the immune system, anti-inflammatory and immunosuppressive properties, prevention and treatment of sepsis, treatment of autoimmune diseases, osteoporosis, kidney and neurological disorders, or even in cancer therapy. Thus, there is a growing interest in developing more sustainable protocols for preparation of statins, and the introduction of biocatalyzed steps into the synthetic pathways is highly advantageous—synthetic routes are conducted under mild reaction conditions, at ambient temperature, and can use water as a reaction medium in many cases. Furthermore, their high selectivity avoids the need for functional group activation and protection/deprotection steps usually required in traditional organic synthesis. Therefore, biocatalysis provides shorter processes, produces less waste, and reduces manufacturing costs and environmental impact. In this review, we will comment on the pleiotropic effects of statins and will illustrate some biotransformations nowadays implemented for statin synthesis.

Examining the WBGT (Wet Bulb Globe Temperature) profiles in the two study locations was intended to show temperature differences during the week of the study. Information obtained from the weather stations that provide contextual long-term information on heat and humidity also showed temperature differences. The average measured temperature and humidity in the past year from each of these weather stations show an average heat index of 22 °C in Bogor and an average heat index of 32 °C in Karawang. Interpretation of the chronic kidney disease (CKD) and chronic kidney disease of unknown etiology (CKDu) findings was more complicated because we also found that farmers in our two locations reported differences in the use of mechanization in their farming, presumably impacting their workloads.

AbstractObjectiveAlternative food sources (AFS) such as local markets in disadvantaged areas are promising strategies for preventing chronic disease and reducing health inequalities. The present study assessed how sociodemographic characteristics, physical access and fruit and vegetable (F&V) consumption are associated with market use in a newly opened F&V market next to a subway station in a disadvantaged neighbourhood.DesignTwo cross-sectional surveys were conducted among adults: (i) on-site, among shoppers who had just bought F&V and (ii) a telephone-based population survey among residents living within 1 km distance from the market.SettingOne neighbourhood in Montreal (Canada) with previously limited F&V offerings.SubjectsRespectively, 218 shoppers and 335 residents completed the on-site and telephone-based population surveys.ResultsAmong shoppers, 23 % were low-income, 56 % did not consume enough F&V and 54 % did not have access to a car. Among all participants living 1 km from the market (n472), market usage was associated (OR; 95 % CI) with adequate F&V consumption (1·86; 1·10, 3·16), living closer to the market (for distance: 0·86; 0·76, 0·97), having the market on the commute route (2·77; 1·61, 4·75) and not having access to a car (2·96; 1·67, 5·26).ConclusionsWhen implemented in strategic locations such as transport hubs, AFS like F&V markets offer a promising strategy to improve F&V access among populations that may be constrained in their food acquisition practices, including low-income populations and those relying on public transportation.

The Communications Interface Board (CIB) is an improved communications architecture that was demonstrated on the International Space Station (ISS). ISS communication interfaces allowing for real-time telemetry and health monitoring require a significant amount of development. The CIB simplifies the communications interface to the ISS for real-time health monitoring, telemetry, and control of resident sensors or experiments. With a simpler interface available to the telemetry bus, more sensors or experiments may be flown. The CIB accomplishes this by acting as a bridge between the ISS MIL-STD-1553 low-rate telemetry (LRT) bus and the sensors allowing for two-way command and telemetry data transfer. The CIB was designed to be highly reliable and radiation hard for an extended flight in low Earth orbit (LEO) and has been proven with over 40 months of flight operation on the outside of ISS supporting two sets of flight experiments. Since the CIB is currently operating in flight on the ISS, recent results of operations will be provided. Additionally, as a vehicle health monitoring enabling technology, an overview and results from two experiments enabled by the CIB will be provided. Future applications for vehicle health monitoring utilizing the CIB architecture will also be discussed.

Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation’s whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City’s (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city’s overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital’s opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.

AbstractNairobi’s urban slums are ill equipped to prevent spread of the novel coronavirus disease (COVID-19) due to high population density, multigenerational families in poorly ventilated informal housing, and poor sanitation. Physical distancing policies, curfews, and a citywide lockdown were implemented in March and April 2020 resulting in sharp decreases in movement across the city. However, most people cannot afford to stay home completely (e.g., leaving daily to fetch water). If still employed, they may need to travel longer distances for work, potentially exposing them COVID-19 or contributing to its spread. We conducted a household survey across five urban slums to describe factors associated with mobility in the previous 24 h. A total of 1695 adults were interviewed, 63% female. Of these, most reported neighborhood mobility within their informal settlement (54%), 19% stayed home completely, and 27% reported long-distance mobility outside their informal settlement, mainly for work. In adjusted multinomial regression models, women were 58% more likely than men to stay home (relative risk ratio (RRR): 1.58, 95% confidence interval (CI): 1.16, 2.14) and women were 60% less likely than men to report citywide mobility (RRR: 0.40; 95% CI 0.31, 0.52). Individuals in the wealthiest quintile, particularly younger women, were most likely to not leave home at all. Those who reported citywide travel were less likely to have lost employment (RRR: 0.49; 95% CI 0.38, 0.65) and were less likely to avoid public transportation (RRR: 0.30; 95% CI 0.23, 0.39). Employment and job hunting were the main reasons for traveling outside of the slum; less than 20% report other reasons. Our findings suggest that slum residents who retain their employment are traveling larger distances across Nairobi, using public transportation, and are more likely to be male; this travel may put them at higher risk of COVID-19 infection but is necessary to maintain income. Steps to protect workers from COVID-19 both in the workplace and while in transit (including masks, hand sanitizer stations, and reduced capacity on public transportation) are critical as economic insecurity in the city increases due to COVID-19 mitigation measures. Workers must be able to commute and maintain employment to not be driven further into poverty. Additionally, to protect the majority of individuals who are only travelling locally within their settlement, mitigation measures such as making masks and handwashing stations accessible within informal settlements must also be implemented, with special attention to the burden placed on women.

Background: While language barriers between healthcare providers and minority-language-speaking patients often lead to miscommunication and jeopardize patient safety, language audits of the former have received little attention.Goal: Based on the context in Southern Taiwan, where the elderly population mainly speaks the local dialect Taiwanese, this study examines nurses' perceptions of their proficiency in and need for medical Taiwanese (‘MED-TW'), and attitudes toward it.
 Method: A questionnaire survey was conducted among 859 nurses from three levels of healthcare units: primary care stations (H1), a regional hospital (H2) and a medical center (H3).
 Results: Nurses from the rural-based H1 unit displayed significantly stronger needs for Taiwanese (TW) than those from urban-based H2 and H3. Specifically, H1 nurses reported encounters with the largest proportion of TW-speaking clients (p<0.001) and the highest frequency of using TW with clients (p<0.001). However, H1 nurses' self-evaluation of their TW proficiency revealed a lower score than those of the H2 and H3 nurses, especially with regard to medical TW proficiency (p<0.05). Finally, while nurses with a high command of TW felt it helped their work, those with a low level did not feel this impacted their performance.
 Conclusion: Nurses working in locations where the use of the minority language is prevalent would benefit more from learning this language.

AbstractConcerned to assert sovereignty over northern territories, Canada in 1922 began an annual patrol to the eastern Arctic to establish and maintain police posts. The experienced Captain Bernier and the Arctic made four trips; then from 1926 to 1931 the government chartered Beothic, a larger sealing ship. The patrol was led by a civil servant and transported doctors, scientists, court officials and representatives of the Royal Canadian Mounted Police. As part of depression economies in the 1930s, space was rented on the Hudson's Bay Company's Nascopie under Capt Smellie and many more Inuit were visited, but fur trading interests took precedence. Major McKeand, the patrol leader, had many roles and useful research continued, but Nascopie sank in July 1947. With postwar concern for a heightened government presence in the Arctic, and after some interim arrangements, the patrol was resumed in 1950 in CD. Howe. The new expedition was especially designed for an expanded medical team eager to test all Inuit for tuberculosis, as a result of which many were evacuated to southern hospitals. In 1959 Northern Affairs turned over command of the slow-moving patrol to the senior doctor, and in 1968 National Health and Welfare belatedly decided that the movement of Inuit into settlements with nursing stations and airstrips made the C. D. Howe service redundant, so the patrol was discontinued.

ABSTRACT Initial DoD support of Federal Emergency Management Agency (FEMA) operations for New York City (NYC) coronavirus disease 2019 (COVID-19) relief included the deployment of military medics to the Javits New York Medical Station and USNS Comfort. When Air Force (AF) Reservists arrived in NYC, 64th Air Expeditionary Group leaders worked with FEMA, Task Force New York/New Jersey, and NYC chains of command to send Airmen to NYC hospitals, including Lincoln Medical Center (LMC). Within 72 hours of arrival, 60 AF Reservists, including 30 registered nurses and 3 medical technicians, integrated into LMC to provide support during April and May 2020. This assistance began during the peak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Air Force nurses provided over 6,000 hours of care to over 800 patients in the emergency department and ad hoc intensive care and medical-surgical units. As infections declined, AF nurses shifted to providing care in established units. In these units, AF nurses provided patient care and worked directly with LMC nurses to provide directed teaching experiences to improve their comfort and competency with caring for acutely ill COVID-19 patients. The deployment of AF Reservists into civilian facilities was a success and bolstered the capability of three facilities struggling to care for SARS-CoV-2 patients. This effort was recognized by military and civilian healthcare leaders and resulted in over 600 military medical personnel being sent to support 11 NYC public hospitals.

Background: The majority (70%) of cardiac arrests in Sweden are experienced in the patient’s home. In these situations, the ambulance nurses may encounter several ethical dilemmas. Aim: The aim was to investigate Swedish specialist ambulance nurses’ experiences of ethical dilemmas associated with cardiac arrest situations in adult patients’ homes. Methods: Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. Ethical considerations: Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process. Findings: Two main themes with six sub-themes were identified: The scene – creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients’ integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being’s dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. Conclusion: The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient’s dignity and to serve life and health.

Type 1 and type 2 diabetes are increasing in prevalence and diabetes complications are common. Diabetes complications are rarely studied in youth, despite the potential onset in childhood. Microvascular complications of diabetes include retinopathy, diabetic kidney disease or nephropathy, and neuropathy that may be somatic or autonomic. Macrovascular disease is the leading cause of death in patients with type 1 diabetes. Strict glycaemic control will reduce microvascular and macrovascular complications; however, they may still manifest in youth. This article discusses the diagnosis and treatment of complications that arise from type 1 and type 2 diabetes mellitus in youth. Screening for complications is paramount as early intervention improves outcome. Screening should commence from 11 years of age depending on the duration of type 1 diabetes or at diagnosis for patients with type 2 diabetes. Diabetic retinopathy may require invasive treatment such as laser therapy or intravitreal antivascular endothelial growth factor therapy to prevent future blindness. Hypertension and albuminuria may herald diabetic nephropathy and require management with angiotensin converting enzyme (ACE) inhibition. In addition to hypertension, dyslipidaemia must be treated to reduce macrovascular complications. Interventional trials aimed at examining the treatment of diabetes complications in youth are few. Statins, ACE inhibitors and metformin have been successfully trialled in adolescents with type 1 diabetes with positive effects on lipid profile, microalbuminuria and measures of vascular health. Although relatively rare, complications do occur in youth and further research into effective treatment for diabetes complications, particularly therapeutics in children in addition to prevention strategies is required.

Background. With the continuous improvement of the modernization of the Chinese military and the major adjustments made by the state to the recruitment policy, the newly recruited military undergone multiple pressures such as targeted high-intensity military training and environmental changes. The mental health of military has become a crucial factor of improving the fighting capacity effectiveness of the troops. Objectives. To explore occupational stress of young recruits in the Xinjiang plateau environment during their basic military training period and analyze the relationship between occupational stress and secretory immunoglobulin A (sIgA) levels. Methods. Using multistage stratified cluster random sampling, 625 recruits stationed at Xinjiang plateau command in 2014 were enrolled as subjects. Occupational stress was assessed by the Occupational Stress Inventory Revised Edition (OSI-R). sIgA in saliva was quantified by enzyme-linked immunosorbent assay. The resulting data were analyzed using descriptive statistics, nonparametric tests, and correlation analysis. Results. Based on demographic characteristics, occupational stress was higher in the urban group than the rural group, coping ability for stress was greater in individuals who were students before joining the army than nonstudents, occupational stress was higher in smokers than nonsmokers, and coping ability for stress was higher in nonsmokers than in smokers (all P<0.05). Being an only child, educational level and age were not significantly related to occupational stress scores (P>0.05). Salivary sIgA level was higher in the high occupational stress group than in the low stress group (P<0.01). Salivary sIgA was positively correlated with scores on the occupational role and personal strain questionnaires (rs=0.229, rs=0.268, P<0.01). Conclusion. Demographic characteristics influenced occupational stress among young recruits in cold and high-altitude area. Further, there were some relationships between occupational stress and salivary sIgA in young military recruits.

The article is devoted to the systems for forecasting accidents with the release of toxic and explosion and fire hazardous substances into the atmosphere in real time. The presence of forecasting systems at the production facility allows dispatcher services and other interested parties to provide the required information for making decisions on minimizing the consequences of an accident, formed taking in to account current weather conditions, current data on the technological process and gas pollution detectors readings. The TOXI+Prognosis software developed by CJSC «Scientific and technical center of industrial safety problems research» is considered as an example of such a fore casting system. The main capabilities of this software, as well as the experience of its implementation in the dispatcher service of a hazardous production facility of URALCHEM, JSC engaged in the production of ammonia and carbamide are presented. In the process of impl ementation, a terrain map was entered into TOXI+Prognosis software parameters and location of hazardous equipment, as well as gas pollution detectors, places of presence of people were specified, the list of possible accident scenarios was determined, conditions for automatic start-up of accident scenarios based on the readings of gas pollution detectors were developed, receipt and accounting for these readings, as well as data on weather conditions from the meteorological station of the enterprise were organized. In the process of operation, TOXI+Prognosis software analyzes the readings of the pollution detectors and checks the conditions for starting the accid ent forecast. If these conditions are met, then the calculation is carried out: the exposure areas are determined and visualized on the terrain plan taking into account the current weather conditions based on the parameters of the exposed areas, the locations and the number of people (taking into account the current number) entering these zones are identified and sent to the dispatcher. The specified information is stored in the program and can be provided to the interested parties, including in automatic mode. The calculation can also be performed by the command of the dispatcher.

Abstract Introduction Occupational stress can have a direct influence on worker safety and health. Navy medical professionals are known to neglect self-care, putting them at risk for deteriorations in psychological health that can lead to adverse patient outcomes. To support medical professionals, a peer-to-peer intervention called Buddy Care, embedded in Navy Medicine’s Caregiver Occupational Stress Control (CgOSC) program, was evaluated. Strategies to prevent and better manage occupational stress are vital to improve the health care providers’ abilities to cope with day-to-day stressors, which is crucial to maintaining mission readiness. The overarching aim of this quality improvement pilot project was to implement and evaluate Buddy Care and to provide context as an evidenced-based peer intervention and leadership tool at a military hospital in Guam. This project is the first to implement and evaluate Buddy Care intervention for an active duty U.S. Navy population stationed overseas. Materials and Methods A convenience sample of 40 Navy active duty assigned to three inpatient units were offered Buddy Care intervention, which was introduced by conducting a Unit Assessment. A pre-test and 3- and 6-month post-test intervention design used a self-administered, 79-item CgOSC Staff Wellness Questionnaire which included five validated measures to assess the independent variable: (1) Response to Stressful Experience Scale, (2) Perception of Safety, (3) Horizontal Cohesion, (4) Perceived Stress Scale, and (5) Burnout Measure, short version. This project was determined as exempt by the Department of Navy Human Research Protection Program and did not require further review by the Institutional Review Board. Results Of the 40 questionnaires collected, 39 were partially completed. Paired sample t-tests were conducted between designated time-points to maximize the sample size and retain the repeated measures nature of the outcome variables. The small sample size allowed for statistical comparisons; however no statistically significant differences were found across the time-points. There was a large effect size for Perceptions of Safety and a medium effect size for Burnout Measure from baseline to 3 months, with both lowered at the 6 months. Although the sample size was too small to achieve statistical significance, the effect size analysis suggested that significance might be obtained with a larger sample. Conclusion The small number of participants and missing data significantly limited the ability to identify reliable changes across time-points. Despite the lack of statistically significant findings, there was an unintended positive result. The Unit Assessment piqued the interest of other departments, and during the project period, 11 departments requested a Unit Assessment. Although there were no requests for Buddy Care intervention from the targeted sample, it was occurring an average of 40 times per month throughout the command. Replication of this project in a similar setting is encouraged so that Buddy Care can be further evaluated. Understanding the effectiveness of well-mental health programs that promote early intervention and prevention efforts may contribute to a psychologically tougher medically ready force. Shortly after project completion, a CgOSC Instruction was approved by the Navy Surgeon General, highlighting the importance of CgOSC and Buddy Care on the operational readiness of Navy Medicine.

<p><strong>Abstract.</strong> The development of the sharing economy has provided an important realization path for urban’s green and healthy development, and has also accelerated the speed of urban development. With the constant capital pouring into the public transport field, dock-less shared bicycle is a relatively new form of transport in urban areas, and it provides a bikesharing service to fulfil urban short trips. Dock-less shared bicycle, with a characteristic of riding and stopping anywhere, has successfully solved the last mile travel problem. Recently, studies focus on the on the temporal spatial characteristics of public bicycle based on public bicycle operation data. However, there are few studies on the identification of riding patterns based on the characteristics of temporal and spatial behavior of residents. In addition, researches have been conducted on public bicycles administered by the government, and the dock-less shared bicycle have different characteristics from public bicycles in terms of scale of use and mode of use. This paper aims to analyze the temporal and spatial characteristics of residents using shared bicycles, and attempts to explore the characteristics of the riding modes of the dock-less shared bicycles.</p><p>Mobike sharing bicycle dataset of Beijing city were obtained for the research and this dataset contains a wealth of attributes with cover of 396600 shared bicycle users and 485500 riding records from May 10 to May 25 in 2017. Additionally, 19 types of POI (Point of Interest) data were also obtained through the API of Baidu Maps. To examine the patterns of shared bicycle trips, these POI data are categorized into five types including residential, commercial, institution, recreation and transport. Spatiotemporal analysis method, correlation analysis methods and kernel density methods were used to analyse the temporal and spatial characteristics of shared bicycle trips, revealing the time curve and spatial hotspot distribution area of shared bikes. Furthermore, a new matrix of riding pattern based on POI was proposed to identify the riding patterns during massive sharing bicycle dataset.</p><p>This paper aims to explore the riding behaviour of shared bicycles, and the research results are as follows:</p><p>(1) Temporal characteristics of riding behaviour</p><p>The use of the Mobike bicycles is significantly different on weekdays and weekends (Figure1). Figure 2 clearly shows a morning peak (7–9 h) and evening peak (17–19 h), corresponding with typical commute time. At noon, some users' dining activities triggered a certain close-distance riding behavior, which formed a noon peak. Different from the riding characteristics of the working days, there are many recreational and leisure riding behaviors on the weekends. The distribution of riding time is more balanced, and there is no obvious morning and evening peak phenomenon.</p><p>(2) Spatial characteristics of riding behavior</p><p> The spatial distribution of riding behaviour varies with different roads (Figure 2) and people prefer to choose trunk roads for cycling trips. Spatial hotpot detecting method based on the kernel density is applied to identify the active degree of bike sharing trip during a whole weekday (Figure 3). The red colour represents a high active degree and the green and blue colour means the low degree. Note that almost no riding occurred in the early hours of the morning and late at night. The characteristics of three riding peaks are obvious in the figure. A large number of travels occurred in Second Ring to Fourth Ring Road, and some travel activities were concentrated near traffic sites.</p><p>(3) Patterns of riding behavior</p><p> Different riding patterns happens in different space and change over the time at two scales of day and hour. During morning peak and evening peak on weekdays, more than 60 percent of riding trips are corresponding with typical commuting activities. The observed commuting pattern of morning peak (Figure 4(a) and (b)) implies that the majority of shared bicycle trips might relate to home, transports, commercial area and some institution. For example, students choose shared bicycles to do some school activities, people prefer to use shared bicycles as a connection tool to bus station and metro stops and people handle daily affairs in some government agencies. However, a large part of the shared bicycle trips on weekends shows the characteristics of non-commuting riding pattern, which means more leisure activities take place at weekends (Figure 4(c) and (d)). Non-commuting pattern of riding behavior mainly occurs among residential areas, metro stops, bus stations and recreational facilities, such as parks, playgrounds, etc.</p>

Tuổi thọ tăng là một trong những thành tựu to lớn về phát triển kinh tế - xã hội nói chung và chămsóc sức khỏe nói riêng. Tuy nhiên, già hóa dân số diễn ra với tốc độ nhanh đặt ra thách thức lớn hệthống chăm sóc sức khỏe (CSSK) người cao tuổi (NCT), đặc biệt tuyến y tế cơ sở như các Trạm Ytế. Nghiên cứu này nhằm mô tả sự sẵn sàng cung cấp dịch vụ chăm sóc sức khoẻ người cao tuổi tạitrạm y tế.Nghiên cứu kết hợp giữa định lượng và định tính tại 15 trạm y tế và Trung tâm y tế huyện Cần Đước,tỉnh Long An, Việt Nam.Kết quả nghiên cứu cho thấy các trạm y tế chưa sẵn sàng cung cấp dịch vụ CSSK người cao tuổi dothiếu nhân lực y tế; chưa đảm bảo về thuốc, trang thiết bị (TTB) để khám sàng lọc, chẩn đoán và điềutrị các bệnh bệnh mạn tính thường gặp ở người cao tuổi (NCT) như: Tăng huyết áp (THA), Đái tháođường (ĐTĐ), Hen phế quả/Phổi tắc nghẽn mãn tính (HPQ/COPD) và ung thư.

Background: Patient satisfaction is generally considered as an indicator to improve the quality of health services. Most studies on patients satisfaction in Vietnam were carried out in hospital settings while limited studies conducted in primary care settings. This study aimed to evaluate the clients’ satisfaction towards medical services of some commune health centers in Thua Thien Hue Province, Vietnam. Method: A cross-sectional study was conducted on a random sample of 300 participants recruited from the list of patients using medical services in four commune health centers. The questionnaire covers five dimensions of patient satisfaction with a standardized Likert scale of 1-5 points; the higher the score, the higher the satisfaction with the service offered. Results: A high percentage of participants (92.7%) were satisfied with medical service. The overall mean satisfaction with medical service was 3.62 out of 5 points. There were significant differences in scores of accessibility; communication skills, behaviors and attitudes of medical staffs; the results of medical service provided and the general satisfaction when comparing the rural (n=150) and the urban (n=150) areas. Conclusions: The findings showed a high proportion of participants satisfied with medical services at commune health centers in Thua Thien Hue province while suggested several points to improve the medical services and increase the patient satisfaction. Key words: patient satisfaction, primary health care, medical service, commune health stations

This study—using multinomial logistic regressions—analyzed a national sample of 2977 older adults to examine factors associated with their health services utilization in 4 types of health providers—namely, commune health stations (CHSs), private clinics, private hospitals, and public hospitals in Vietnam. Older Vietnamese favored using public hospitals for their health consultancies, even for regular health checkups. For nonsevere illness, the relative risk ratio of choosing private clinics was 3 times (95% CI: 2.2-4.1) that of CHSs. Possession of public health insurance was a key enabling factor that influenced the older adults’ choice of CHSs over private clinics. Older adults of ethnic minority and living in rural areas were more likely to use CHSs than other health facilities. This study suggests a substantial quality improvement of services at CHSs, an innovative reform toward a diversified structure of private and public clinics to address diverse needs and to strengthen primary care for older adults.

Abstract Background Poor access to healthcare facilities and consequently nutrition counseling services hinders the uptake of recommended infant and young child feeding (IYCF) practices. To address these barriers and improve IYCF practices, Alive & Thrive (A&T) initiated community support groups in remote villages across nine provinces in Vietnam. Objective This study examines the effectiveness of the support group model and related project costs for reaching underserved areas to improve IYCF practices. Methods To evaluate the model’s implementation and project costs, we reviewed implementation guidelines, expenditure and coverage reports, monitoring data, and budgets for the nine provinces. To evaluate the model’s effectiveness, we used a 3-stage sampling method to conduct a cross-sectional survey from April to May 2014 in three provinces entailing interviewing mothers of children aged 0–23 months in communes with (intervention; n = 551) and without support groups (comparison; n = 559). Findings Coverage: From November 2011 to November 2014, in partnership with the government, A&T supported training for 1513 facilitators and the establishing 801 IYCF support groups in 267 villages across nine provinces. During this period, facilitators provided ~ 166,000 meeting/support contacts with ~ 33,000 pregnant women and mothers with children aged 0–23 months in intervention villages. Costs: The average project costs for supporting the meetings, compensating village collaborators, and providing supportive supervision through staff in commune health stations were USD 5 per client and USD 1 per contact. After adding expenditures for training, supportive supervision, and additional administrative costs at central and provincial levels, the average project cost was USD 15 per client and USD 3 per contact. Effectiveness: Survey participants in intervention and comparison communes had similar maternal, child, and household characteristics. Multiple logistic regression models showed that living in intervention communes was associated with higher odds of early initiation of breastfeeding (OR: 1.7; 95% CI: 1.1, 2.7), exclusive breastfeeding from 0 to 5 months (OR: 12.5; 95% CI: 6.7, 23.4), no bottle feeding (OR: 2.69; 95% CI: 1.82, 3.99), and minimum acceptable diet (OR: 1.51; 95% CI: 0.98, 2.33) compared to those living in comparison communes. Conclusion The IYCF support group model was effective in reaching populations residing in remote areas and likely contributed to improved IYCF practices. The study suggests that the model could be scaled up to promote equity in breastfeeding support.

Objective: Describe the practice of health communication and education about diabetes among village health workers in Vu Thu district, Thai Binh province in 2020. Subjects: Village Health Worker and Head of Commune Health Station in the communes of Vu Thu district, Thai Binh province. Method: the epidemiological method described through the cross-sectional investigation, combine quantitative research and qualitative research. Results: 69.5% of village health workers had carried out communication and health education for villagers about diabetes in the past year; Over 80% of village health workers had a plan and over 60% cooperate in communicating and educating about diabetes about diabetes; 15/15 opinion of the head of the station said that the communication and education about diabetes in the commune was small, not continuous, mainly indirect communication; 13/15 comments that the biggest difficulty in health communication and education was that the village health workers were still limited in knowledge and skills.

Abstract Background A key step to advancing the goal of malaria elimination in Viet Nam by 2030 is focusing limited resources for treatment and prevention to groups most at risk for malaria transmission. Methods To better understand risk factors for malaria transmission in central Viet Nam, a survey of 1000 malaria positive cases and 1000 malaria negative controls was conducted. Cases and controls were matched for age and gender and self-presented at commune health stations (CHS) in Binh Phuoc, Dak Nong and Dak Lak Provinces. Diagnoses were confirmed with microscopy, rapid diagnostic test and PCR. Participants were interviewed about 50 potential risk factors for malaria, which included information about occupation, forest visitation, travel, healthcare-seeking behaviour and prior use of anti-malaria interventions. Participants were enrolled by trained government health workers and the samples were analysed in Vietnamese government laboratories. Data were analysed by univariable, block-wise and multivariable logistic regression. Results Among cases, 61.8% had Plasmodium falciparum, 35.2% Plasmodium vivax and 3% mixed species infections. Median (IQR) age was 27 (21–36) years and 91.2% were male. Twenty-five risk factors were associated with being a case and eleven with being a control. Multivariable analysis found that malaria cases correlated with forest workers, recent forest visitation, longer duration of illness, having a recorded fever, number of malaria infections in the past year, having had prior malaria treatment and having previously visited a clinic. Conclusions This study demonstrates the benefits of increased statistical power from matched controls in malaria surveillance studies, which allows identification of additional independent risk factors. It also illustrates an example of research partnership between academia and government to collect high quality data relevant to planning malaria elimination activities. Modifiable risk factors and implications of the findings for malaria elimination strategy are presented.

Objective: Identify training needs on health communication and education about diabetes among village health workers in Vu Thu district, Thai Binh province in 2020.Subjects: Village Health Worker and Head of Commune Health Station in the communes of Vu Thu district, Thai Binh province.Method: the epidemiological method described through the cross-sectional investigation, combine quantitative research and qualitative research.Results: 70.2% of village health workers had participated in training courses on communication skills - health education; The highest proportion of respondents saying that the training period was enough (76.8%), 95.6% of the respondents think that the content of each training course was appropriate for them, and 62.3% evaluated organizational form of the training class to attract students; 50.4% ofvillage health workers needed to be trained in health communication skills, 49.5% of village health workers needed to be trained in health counseling skills, 26.2% hoped to train communication skillsthrough loudspeakers, radio; The most difficulty of village health workers when participating in training / training was due to a matter of time (41.1%).

ABSTRACT Emergency medical services (EMS) provides a critical role in the rapid treatment, stabilization, and transfer of patients in the prehospital setting. The national EMS provider for Israel has developed a robust and unique organization of volunteers with advanced telecommunication strategies to activate and direct them in order to improve these processes. The volunteers include local high school students, international college students, emergency medical technicians, on-call volunteers, motorcyclists, and Life Guardian first responders. The telecommunication strategies include pagers, push-to-talk over cellular, and sophisticated smartphone-based software applications. These are monitored and directed via a central command and control station. Such processes, both on an organizational as well as technical level, can be adapted to improve prehospital emergency care.

Abstract Introduction With more than 370,000 military and civilian personnel stationed across Pacific Command (PACOM), medical evacuation in this largest command presents unique challenges. The authors describe medical evacuations analyzed from the U.S. Air Force Transportation Command Regulating and Command & Control Evacuation System (TRAC2ES) in PACOM. Materials and Methods We performed a retrospective review of all TRAC2ES medical records for medical evacuations of adult patients from the PACOM theater of operations conducted between January 1, 2008 and December 31, 2018. We abstracted free text data entry in TRAC2ES to characterize the diagnoses requiring patient movement. Data are presented using descriptive statistics. Results During this 11-year period, 3,328 PACOM TRAC2ES encounters met inclusion criteria. Of these evacuations, 65.8% were male and were comprised mostly of active duty military (1,600, 48.1%) and U.S. civilians (1,706, 51.3%). Most transports originated in Japan (1,210 transports, 36.4%) or Guam (924 transports, 27.8%) with Hawaii (1,278 transports, 38.4%) as the most frequent destination. The majority of evacuations were routine (72.5%) with only 4.9% urgent evacuations. Medical conditions (2,905 transports, 87%) accounted for the largest proportion of transports, surpassing injuries (442 transports, 13%). The most common reasons for medical transports were behavioral health (671 transports, 20.2%) and cardiovascular disease (505 transports, 15.1%). Conclusions The majority of medical evacuations in PACOM were because of medical illness with routine precedence category, mirroring the largely noncombat operations occurring across this large area.

Abstract: The Community Engagement Model was developed as a tool for the production of health communication videos for broadcast on local television stations. The model, a hybrid of participatory video design and social marketing techniques, uses iterative design principles for both production and evaluation. This article reports on the use of this model for the design and production of a series of videos aimed at promoting awareness of the BC NurseLine (a 24-hour telephone health service) among Farsi speakers in the Greater Vancouver area. Statistical analysis of project-related data suggests that the use of an extensive, culturally engaged process to produce and evaluate the videos was integral to its success. The steps taken in this campaign are described to show how the Community Engagement Model can be used to produce effective, culturally sensitive, participatory media targeted at specific communities.
 
 Résumé: Le « Community Engagement Model » (modèle d’engagement communautaire) a été développé afin de produire des courtes vidéos de communication pour la santé, diffusées sur des postes de télévision locales. Le modèle, un hybride entre les techniques de vidéo participative et de marketing social, se sert des principes de design itératif pour la production ainsi que l’évaluation. Le présent document décrit l’utilisation de ce modèle dans la conception et la production d’une série de vidéos ayant pour but de mieux faire connaître le BC NurseLine (service d’info-santé 24-h de la Colombie Britannique) auprès de la communauté farsi dans la région métropolitaine de Vancouver. Une analyse statistique suggère que l’intégration d’un processus extensif et engagé au niveau culturel, tant dans la production que dans l’évaluation de ces vidéos, a été un facteur clé dans leur succès. Le processus suivi lors de cette campagne est décrit pour montrer comment le modèle d’engagement communautaire puisse être employé pour produire des médias participatifs, à la fois efficaces et adaptés aux spécificités culturelles, ciblant des communautés spécifiques.

ABSTRACT Background: In March 2020, the Louisiana Department of Health activated the Medical Monitoring Station (MMS) in downtown New Orleans. This alternative care site is designed to decompress hospitals and nursing homes overwhelmed by the coronavirus disease 2019 (COVID-19) pandemic. Given the city’s historic vulnerability to hurricanes, planning for possible tropical weather events has been a priority for MMS leadership. Methods: The planning process incorporated input from all sectors/agencies working at the facility, to ensure consistency and cohesion. The MMS Shelter-in-Place Plan (MSIPP) was created, and a comprehensive tabletop exercise was conducted. Results: Six planning topics emerged as a result of the planning process and were used to create a comprehensive plan for sheltering-in-place. These topics address hurricane preparedness for patient care, interfacility coordination, wrap-around services, medical logistics, essential staffing, and incident command during a shelter-in-place scenario. Conclusions: The MSIPP created by the MMS helped to maximize patient safety and continuity of operations during a real-world event. Select pieces of the plan were activated to meet the needs and threat level of Tropical Storm Cristobal. This experience reinforced the need for originality, scalability, and flexibility in building emergency operations plans in the midst of an unprecedented pandemic.

ABSTRACT Introduction The coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has led to one of the world’s largest infectious disease outbreaks. COVID-19 first emerged in Wuhan, Hubei, China, in December 2019, and the emergence was especially concerning to the U.S. Forces Korea (USFK) stationed in the Republic of Korea (ROK, South Korea), which remains vital to peace and security of the East Asian region. The first wave of cases emerged in South Korea from China before a globally established response, which forced USFK into a challenging position to combat a novel virus with countless unknowns regarding effective control and portended impact. Materials and Methods As cases began to emerge in South Korea, USFK in early February began to proactively formulate peninsula-wide preventative health measures to protect the force. Eventually, USFK spearheaded a uniquely proactive Operation Kill the Virus that targeted COVID-19 as an enemy that must be rigorously defended against. Through the operation, USFK systematically employed eight key principles to successfully combat the pandemic, which are documented in this article. Results The operation’s eight principles focused on (1) Treat it like a combat operation, (2) Protect the force to protect the mission, (3) Stay one step ahead of the curve by exercising an abundance of caution, (4) Use predictive analysis, (5) Maintain open and transparent dialog with the community every day, (6) Be empathetic but prepare the community for lifestyle and culture changes, (7) Follow and enforce rules, and finally (8) Keep your foot on the gas and fight complacency. By closely collaborating with the ROK government, especially the Korean Centers for Disease Control and Prevention, USFK effectively limited the number of locally acquired cases, including service members, families, and civilians, to 24 by April 2020. Vital to that success was ensuring a sufficient capability and capacity to test, trace, treat, and logistically support with personal protective equipment and sufficient infrastructure for quarantine and isolation. As the pandemic shifted to the USA and Europe, new cases in the ROK shifted from locally acquired to imported from international travelers. Fundamental to USFK’s sustained preservation of readiness and training included aggressive quarantine and testing of all arrivals from the United States of America (USA), identification of hotspots in all installations, and perpetual fine-tuning of the operation’s principles in collaboration with the ROK’s aggressive approach to eradicate COVID-19 from the peninsula. Conclusions In successfully executing the operation, USFK imparts three main lessons for future outbreaks. First, a military command should execute a health response similar to how it executes combat operations against a battlefield enemy. Second, the command should maintain flexibility to new changes or risks that alter courses of action. And finally, engagement with the local community, host nation, and international partners should not be compromised when formulating strategies. The USFK’s immediate recognition of the public health threat by all levels of leadership and medical personnel enabled a unique and highly effective Operation Kill the Virus that engaged all members of the community, both local and international.

ABSTRACT Introduction Cognitive processes such as perception and reasoning are preceded and dependent on attention. Because of the close overlap between neural circuits of attention and eye movement, attention may be objectively quantified with recording of eye movements during an attention-dependent task. Our previous work demonstrated that performance scores on a circular visual tracking task that requires dynamic synchronization of the gaze with the target motion can be impacted by concussion, sleep deprivation, and attention deficit/hyperactivity disorder. The current study examined the characteristics of performance on a standardized predictive visual tracking task in a large sample from a U.S. Military population to provide military normative data. Materials and Methods The sample consisted of 1,594 active duty military service members of either sex aged 18-29 years old who were stationed at Fort Hood Army Base. The protocol was reviewed and approved by the U.S. Army Medical Research and Materiel Command Institutional Review Board. Demographic, medical, and military history data were collected using questionnaires, and performance-based data were collected using a circular visual tracking test and Trail Making Test. Differences in visual tracking performance by demographic characteristics were examined with a multivariate analysis of variance, as well as a Kolmogorov-Smirnov test and a rank-sum test. Associations with other measures were examined with a rank-sum test or Spearman correlations. Results Robust sex differences in visual tracking performance were found across the various statistical models, as well as age differences in several isolated comparisons. Accordingly, norms of performance scores, described in terms of percentile standings, were developed adjusting for age and sex. The effects of other measures on visual tracking performance were small or statistically non-significant. An examination of the score distributions of various metrics suggested that strategies preferred by men and women may optimize different aspects of visual tracking performance. Conclusion This large-scale quantification of attention, using dynamic visuomotor synchronization performance, provides rigorously characterized age- and sex-based military population norms. This study establishes analytics for assessing normal and impaired attention and detecting changes within individuals over time. Practical applications for combat readiness and surveillance of attention impairment from sleep insufficiency, concussion, medication, or attention disorders will be enhanced with portable, easily accessible, fast, and reliable dynamic eye-tracking technologies.

IntroductionI have been studying the creation of Metro style train travel in Sydney for over a decade. My focus has been on the impact that media has had on the process (see Richardson, “Curatorial”; “Upheaval”; “Making”). Through extensive expert, public, and media research, I have investigated the coalitions and alliances that have formed (and disintegrated) between political, bureaucratic, news media, and public actors and the influences at work within these actor-networks. As part of this project, I visited an underground Métro turning fifty in Montreal, Canada. After many years studying the development of a train that wasn’t yet tangible, I wanted to ask a functional train the simple ethnomethodological/Latourian style question, “what do you do for a city and its people?” (de Vries). Therefore, in addition to research conducted in Montreal, I spent ten days wandering through many of the entrances, tunnels, staircases, escalators, mezzanines, platforms, doorways, and carriages of which the Métro system consists. The purpose was to observe the train in situ in order to broaden potential conceptualisations of what a train does for a city such as Montreal, with a view of improving the ideas and messages that would be used to “sell” future rapid rail projects in other cities such as Sydney. This article outlines a selection of the pathways wandered, not only to illustrate the power of social research based on physical wandering, but also the potential power the metaphorical and conceptual wandering an Actor-Network Theory (ANT) assemblage affords social research for media communications.Context, Purpose, and ApproachANT is a hybrid theory/method for studying an arena of the social, such as the significance of a train to a city like Montreal. This type of study is undertaken by following the actors (Latour, Reassembling 12). In ANT, actors do something, as the term suggests. These actions have affects and effects. These might be contrived and deliberate influences or completely circumstantial and accidental impacts. Actors can be people as we are most commonly used to understanding them, and they can also be texts, technological devices, software programs, natural phenomena, or random occurrences. Most significantly though, actors are their “relations” (Harman 17). This means that they are only present if they are relating to others. These relations and the resulting influences and impacts are called networks. A network in the ANT sense is not as simple as the lines that connect train stations on a rail map. Without actions, relations, influences, and impacts, there are no actors. Hence the hyphen in actor-network; the actor and the network are symbiotic. The network, rendered visible through actor associations, consists of the tenuous connections that “shuttle back and forth” between actors even in spite of the fact their areas of knowledge and reality may be completely separate (Latour Modern 3). ANT, therefore, may be considered an empirical practice of tracing the actors and the network of influences and impacts that they both help to shape and are themselves shaped by. To do this, central ANT theorist Bruno Latour employs a simple research question: “what do you do?” This is because in the process of doing, somebody or something is observed to be affecting other people or things and an actor-network becomes identifiable. Latour later learned that his approach shared many parallels with ethnomethodology. This was a discovery that more concretely set the trajectory of his work away from a social science that sought explanations “about why something happens, to ontological ones, that is, questions about what is going on” (de Vries). So, in order to make sense of people’s actions and relations, the focus of research became asking the deceptively simple question while refraining as much as possible “from offering descriptions and explanations of actions in terms of schemes taught in social theory classes” (14).In answering this central ANT question, studies typically wander in a metaphorical sense through an array or assemblage (Law) of research methods such as formal and informal interviews, ethnographic style observation, as well as the content analysis of primary and secondary texts (see Latour, Aramis). These were the methods adopted for my Montreal research—in addition to fifteen in-depth expert and public interviews conducted in October 2017, ten days were spent physically wandering and observing the train in action. I hoped that in understanding what the train does for the city and its people, the actor-network within which the train is situated would be revealed. Of course, “what do you do?” is a very broad question. It requires context. In following the influence of news media in the circuitous development of rapid rail transit in Sydney, I have been struck by the limited tropes through which the potential for rapid rail is discussed. These tropes focus on technological, functional, and/or operational aspects (see Budd; Faruqi; Hasham), costs, funding and return on investment (see Martin and O’Sullivan; Saulwick), and the potential to alleviate peak hour congestion (see Clennell; West). As an expert respondent in my Sydney research, a leading Australian architect and planner, states, “How boring and unexciting […] I mean in Singapore it is the most exciting […] the trains are fantastic […] that wasn’t sold to the [Sydney] public.” So, the purpose of the Montreal research is to expand conceptualisations of the potential for rapid rail infrastructure to influence a city and improve communications used to sell projects in the future, as well as to test the role of both physical and metaphorical ANT style wanderings in doing so. Montreal was chosen for three reasons. First, the Métro had recently turned fifty, which made the comparison between the fledgling and mature systems topical. Second, the Métro was preceded by decades of media discussion (Gilbert and Poitras), which parallels the development of rapid transit in Sydney. Finally, a different architect designed each station and most stations feature art installations (Magder). Therefore, the Métro appeared to have transcended the aforementioned functional and numerically focused tropes used to justify the Sydney system. Could such a train be considered a long-term success?Wandering and PathwaysIn ten days I rode the Montreal Métro from end to end. I stopped at all the stations. I wandered around. I treated wandering not just as a physical research activity, but also as an illustrative metaphor for an assemblage of research practices. This assemblage culminates in testimony, anecdotes, stories, and descriptions through which an actor-network may be glimpsed. Of course, it is incomplete—what I have outlined below represents only a few pathways. However, to think that an actor-network can ever be traversed in its entirety is to miss the point. Completion is a fallacy. Wandering doesn’t end at a finish line. There are always pathways left untrodden. I have attempted not to overanalyse. I have left contradictions unresolved. I have avoided the temptation to link paths through tenuous byways. Some might consider that I have meandered, but an actor-network is never linear. I can only hope that my wanderings, as curtailed as they may be, prove nuanced, colourful, and rich—if not compelling. ANT encourages us to rethink social research (Latour, Reassembling). Central to this is acknowledging (and becoming comfortable with) our own role as researcher in the illumination of the actor-network itself.Here are some of the Montreal pathways wandered:First Impressions I arrive at Montreal airport late afternoon. The apartment I have rented is conveniently located between two Métro stations—Mont Royal and Sherbrooke. I use my phone and seek directions by public transport. To my surprise, the only option is the bus. Too tired to work out connections, I decide instead to follow the signs to the taxi rank. Here, I queue. We are underway twenty minutes later. Travelling around peak traffic, we move from one traffic jam to the next. The trip is slow. Finally ensconced in the apartment, I reflect on how different the trip into Montreal had been, from what I had envisaged. The Métro I had travelled to visit was conspicuous in its total absence.FloatingIt is a feeling of floating that first strikes me when riding the Métro. It runs on rubber tyres. The explanation for the choice of this technology differs. There are reports that it was the brainchild of strong-willed mayor, Jean Drapeau, who believed the new technology would showcase Montreal as a modern world-scale metropolis (Gilbert and Poitras). However, John Martins-Manteiga provides a less romantic account, stating that the decision was made because tyres were cheaper (47). I assume the rubber tyres create the floating sensation. Add to this the famous warmth of the system (Magder; Hazan, Hot) and it has a thoroughly calming, even lulling, effect.Originally, I am planning to spend two whole days riding the Métro in its entirety. I make handwritten notes. On the first day, at mid-morning, nausea develops. I am suffering motion sickness. This is a surprise. I have always been fine to read and write on trains, unlike in a car or bus. It causes a moment of realisation. I am effectively riding a bus. This is an unexpected side-effect. My research program changes—I ride for a maximum of two hours at a time and my note taking becomes more circumspect. The train as actor is influencing the research program and the data being recorded in unexpected ways. ArtThe stained-glass collage at Berri-Uquam, by Pierre Gaboriau and Pierre Osterrath, is grand in scale, intricately detailed and beautiful. It sits above the tunnel from which the trains enter and leave the platform. It somehow seems wholly connected to the train as a result—it frames and announces arrivals and departures. Other striking pieces include the colourful, tiled circles from the mezzanine above the platform at station Peel and the beautiful stained-glass panels on the escalator at station Charlevoix. As a public respondent visiting from Chicago contends, “I just got a sense of exploration—that I wanted to have a look around”.Urban FormAn urban planner asserts that the Métro is responsible for the identity and diversity of urban culture that Montreal is famous for. As everyone cannot live right above a Métro station, there are streets around stations where people walk to the train. As there is less need for cars, these streets are made friendlier for walkers, precipitating a cycle. Furthermore, pedestrian-friendly streets promote local village style commerce such as shops, cafes, bars, and restaurants. So, there is not only more access on foot, but also more incentive to access. The walking that the Métro induces improves the dynamism and social aspects of neighbourhoods, a by-product of which is a distinct urban form and culture for different pockets of the city. The actor-network broadens. In following the actors, I now have to wander beyond the physical limits of the system itself. The streets I walk around station Mont Royal are shopping and restaurant strips, rich with foot traffic at all times of day; it is a vibrant and enticing place to wander.Find DiningThe popular MTL blog published a map of the best restaurants the Métro provides access to (Hazan, Restaurant).ArchitectureStation De La Savane resembles a retro medieval dungeon. It evokes thoughts of the television series Game of Thrones. Art and architecture work in perfect harmony. The sculpture in the foyer by Maurice Lemieux resembles a deconstructed metal mace hanging on a brutalist concrete wall. It towers above a grand staircase and abuts a fence that might ring a medieval keep. Up close I realise it is polished, precisely cut cylindrical steel. A modern fence referencing another time and place. Descending to the platform, craggy concrete walls are pitted with holes. I get the sense of peering through these into the hidden chambers of a crypt. Overlaying all of this is a strikingly modern series of regular and irregular, bold vertical striations cut deeply into the concrete. They run from floor to ceiling to add to a cathedral-like sense of scale. It’s warming to think that such a whimsical train station exists anywhere in the world. Time WarpA public respondent describes the Métro:It’s a little bit like a time machine. It’s a piece of the past and piece of history […] still alive now. I think that it brings art or form or beauty into everyday life. […] You’re going from one place to the next, but because of the history and the story of it you could stop and breathe and take it in a little bit more.Hold ups and HostagesA frustrated General Manager of a transport advocacy group states in an interview:Two minutes of stopping in the Métro is like Armageddon in Montreal—you see it on every media, on every smartphone [...] We are so captive in the Métro [there is a] loss of control.Further, a transport modelling expert asserts:You’re a hostage when you’re in transportation. If the Métro goes out, then you really are stuck. Unfortunately, it does go out often enough. If you lose faith in a mode of transportation, it’s going to be very hard to get you back.CommutingIt took me a good week before I started to notice how tired some of the Métro stations had grown. I felt my enthusiasm dip when I saw the estimated arrival time lengthen on the electronic noticeboard. Anger rose as a young man pushed past me from behind to get out of a train before I had a chance to exit. These tendrils of the actor-network were not evident to me in the first few days. Most interview respondents state that after a period of time passengers take less notice of the interesting and artistic aspects of the Métro. They become commuters. Timeliness and consistency become the most important aspects of the system.FinaleI deliberately visit station Champ-de-Mars last. Photos convince me that I am going to end my Métro exploration with an experience to savour. The station entry and gallery is iconic. Martins-Manteiga writes, “The stained-glass artwork by Marcelle Ferron is almost a religious experience; it floods in and splashes down below” (306). My timing is off though. On this day, the soaring stained-glass windows are mostly hidden behind protective wadding. The station is undergoing restoration. Travelling for the last time back towards station Mont Royal, my mood lightens. Although I had been anticipating this station for some time, in many respects this is a revealing conclusion to my Métro wanderings.What Do You Do?When asked what the train does, many respondents took a while to answer or began with common tropes around moving people. As a transport project manager asserts, “in the world of public transport, the perfect trip is the one you don’t notice”. A journalist gives the most considered and interesting answer. He contends:I think it would say, “I hold the city together culturally, economically, physically, logistically—that’s what I do […] I’m the connective tissue of this city”. […] How else do you describe infrastructure that connects poor neighbourhoods to rich neighbourhoods, downtown to outlying areas, that supports all sorts of businesses both inside it and immediately adjacent to it and has created these axes around the city that pull in almost everybody [...] And of course, everyone takes it for granted […] We get pissed off when it’s late.ConclusionNo matter how real a transportation system may be, it can always be made a little less real. Today, for example, the Paris metro is on strike for the third week in a row. Millions of Parisians are learning to get along without it, by taking their cars or walking […] You see? These enormous hundred-year-old technological monsters are no more real than the four-year-old Aramis is unreal: They all need allies, friends […] There’s no inertia, no irreversibility; there’s no autonomy to keep them alive. (Latour, Aramis 86)Through ANT-based physical and metaphorical wanderings, we find many pathways that illuminate what a train does. We learn from various actors in the actor-network through which the train exists. We seek out its “allies” and “friends”. We wander, piecing together as much of the network as we can. The Métro does lots of things. It has many influences and it influences many. It is undeniably an actor in an actor-network. Transport planners would like it to appear seamless—commuters entering and leaving without really noticing the in-between. And sometimes it appears this way. However, when the commuter is delayed, this appearance is shattered. If a signal fails or an engine falters, the Métro, through a process mediated by word of mouth and/or social and mainstream media, is suddenly rendered tired and obsolete. Or is it historic and quaint? Is the train a technical problem for the city of Montreal or is it characterful and integral to the city’s identity? It is all these things and many more. The actor-network is illusive and elusive. Pathways are extensive. The train floats. The train is late. The train makes us walk. The train has seeded many unique villages, much loved. The train is broken. The train is healthy for its age. The train is all that is right with Montreal. The train is all that is wrong with Montreal. The artwork and architecture mean nothing. The artwork and architecture mean everything. Is the train overly limited by the tyres that keep it underground? Of course, it is. Of course, it isn’t. Does 50 years of history matter? Of course, it does. Of course, it doesn’t. It thrives. It’s tired. It connects. It divides. It’s functional. It’s dirty. It’s beautiful. It’s something to be proud of. It’s embarrassing. A train offers many complex and fascinating pathways. It is never simply an object; it lives and breathes in the network because we live and breathe around it. It stops being effective. It starts becoming affective. Sydney must learn from this. My wanderings demonstrate that the Métro cannot be extricated from what Montreal has become over the last half century. In May 2019, Sydney finally opened its first Metro rail link. And yet, this link and other ongoing metro projects continue to be discussed through statistics and practicalities (Sydney Metro). This offers no affective sense of the pathways that are, and will one day be, created. By selecting and appropriating relevant pathways from cities such as Montreal, and through our own wanderings and imaginings, we can make projections of what a train will do for a city like Sydney. We can project a rich and vibrant actor-network through the media in more emotive and powerful ways. Or, can we not at least supplement the economic, functional, or technocratic accounts with other wanderings? Of course, we can’t. Of course, we can. 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Managing the Changing Nature of Policymaking Subject to Mediatisation” M/C Journal 18.4 (2015). 7 Aug. 2019 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/998>.———. “‘Making it Happen’: Deciphering Government Branding in Light of the Sydney Building Boom.” M/C Journal 20.2 (2017). 7 Aug. 2019 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/1221>.Saulwick, Jacob. “Plenty of Sums in Rail Plans But Not Everything Adds Up.” Sydney Morning Herald 7 Nov. 2011. 17 Apr. 2012 <http://www.smh.com.au/opinion/politics/plenty-of-sums-in-rail-plans-but-not-everything-adds-up-20111106-1n1wn.html>.Sydney Metro. 16 July 2019. <https://www.sydneymetro.info/>.West, Andrew. “Second Harbour Crossing – or Chaos.” Sydney Morning Herald 31 May 2010. 17 Jan. 2018 <http://www.smh.com.au/nsw/second-harbour-crossing--or-chaos-20100530-wnik.html>.

In the contemporary urban environment of mass transit, it falls to a small group of public officers to keep large number of travellers safe. The small size of their force and the often limited powers they exert mean that these public safety ‘transit officers’ must project more authority and control than they really have. It is this ambience of authority and control which, in most situations they encounter and seek to influence, is enough to keep the public safe. This paper examines the ambience of a group of transit officers working on the railway lines of an Australian capital city. We seek to show how transit officers are both influenced by, and seek to influence, the ambience of their workplace and the public spaces they inhabit whilst on duty, and here we take ambience to apply to the surrounding atmosphere, the aura, and the emotional environment of a place or situation: the setting, tone, or mood. For these transit officers to keep the public safe, they must themselves remain safe. A transit officer who is disabled in a confrontation with a violent offender is unable to provide protection to his or her passengers. Thus, in the culture of the transit officers, their own workplace safety takes on a higher significance. It affects not just themselves. The ambience exuded by transit officers, and how transit officers see their relationship with the travelling public, their management and other organisational work groups, is an important determinant of their work group’s safety culture. Researching the Working Lives of Transit Officers in Perth Our discussion draws on an ethnographic study of the working lives and communication cultures of transit officers (TOs) employed by the Public Transport Authority (PTA) of Western Australia (WA). Transit officers have argued that to understand fully the challenges of their work it is necessary to spend time with them as they undertake their daily duties: roster in, roster out. To this end, the research team and the employer organisation secured an ARC Linkage Grant in partnership with the PTA to fund doctoral candidate and ethnographer Christine Teague to research the workers’ point of view, and the workers’ experiences within the organisation. The two-hundred TOs are unique in the PTA. Neither of the other groups who ride with them on the trains, the drivers and revenue protection staff (whose sole job is to sell and check tickets), experiences the combination of intense contact with passengers, danger of physical injury or group morale. The TOs of the PTA in Perth operate from a central location at the main train station and the end stations on each line. Here there are change lockers where they can lock up their uniforms and equipment such as handcuffs and batons when not on duty, an equipment room where they sign out their radios, and ticket-checking machines. At the main train station there is also a gym, a canteen and holding cells for offenders they detain. From these end stations and central location, the TOs fan out across the network to all suburbs where they either operate from stations or onboard the trains. The TOs also do ‘delta van’ duty providing rapid, mobile back-up support for their colleagues on stations or trains, and providing transport for arrested persons to the holding cell or police lock up. TOs are on duty whenever the trains are running–but the evenings and nights are when they are mainly rostered on. This is when trouble mostly occurs. The TOs’ work ends only after the final train has completed its run and all offenders who may require detaining and charging have been transferred into police custody. While the public perceive that security is the TOs’ most frequent role, much of the work involves non-confrontational activity such as assisting passengers, checking tickets and providing a reassuring presence. One way to deal with an ambiguous role is to claim an ambience of power and authority regardless. Various aspects of the TO role permit and hinder this, and the paper goes on to consider aspects of ambience in terms of fear and force, order and safety, and role confusion. An Ambience of Fear and Force The TOs are responsible for front-line security in WA’s urban railway network. Their role is to offer a feeling of security for passengers using the rail network after the bustle of the work day finishes, and is replaced by the mainly recreational travels of the after hours public. This is the time when some passengers find the prospect of evening travel on the public transport rail network unsettling–so unsettling that it was a 2001 WA government election promise (WA Legislative Council) that every train leaving the city centre after 7pm would have two TOs riding on it. Interestingly, recruitment levels have never been high enough for this promise to be fully kept. The working conditions of the TOs reflect the perception, and to an extent, the reality that some late night travel on public transport involves negotiating an edgy ambience with an element of risk, rubbing shoulders with people who may be loud, rowdy, travelling in a group, and or drug and alcohol affected. As Fred (all TO names are pseudonyms) comments: You’re not dealing with rational people, you’re not dealing with ‘people’: most of the people you’re dealing with are either drunk or under the influence of drugs, so they’re not rational, they don’t hear you, they don’t understand what you’re saying, they just have no sense of what’s right or wrong, you know? Especially being under the influence, so I mean, you can talk till you’re blue in the face with somebody who’s drunk or on drugs, I mean, all you have to say is one thing. ‘Oh, can I see your ticket please’, ‘oh, why do I need a fucking ticket’, you know? They just don’t get simple everyday messages. Dealing with violence and making arrest is a normal part of this job. Jo described an early experience in her working life as a TO:Within the first week of coming out of course I got smacked on the side of the head, but this lady had actually been certified, like, she was nuts. She was completely mental and we were just standing on the train talking and I’ve turned around to say something to my partner and she was fine, she was as calm as, and I turned around and talked to my partner and the next thing I know I ended up with her fist to the side of my head. And I went ‘what the hell was that’? And she went off, she went absolutely ballistic. I ended up arresting her because it was assault on an officer whether she was mental or not so I ended up arresting her.Although Jo here is describing how she experienced an unprovoked assault in the early days of her career as a TO, one of the most frequent precursors to a TO injury occurs when the TO is required to make an arrest. The injury may occur when the passenger to be arrested resists or flees, and the TO gives chase in dark or treacherous circumstances such as railway reserves and tunnels, or when other passengers, maybe friends or family of the original person of concern, involve themselves in an affray around the precipitating action of the arrest. In circumstances where capsicum spray is the primary way of enforcing compliance, with batons used as a defence tool, group members may feel that they can take on the two TOs with impunity, certainly in the first instance. Even though there are security cameras on trains and in stations, and these can be cued to cover the threatening or difficult situations confronting TOs, the conflict is located in the here-and-now of the exchanges between TOs and the travelling public. This means the longer term consequence of trouble in the future may hold less sway with unruly travellers than the temptation to try to escape from trouble in the present. In discussing the impact of remote communications, Rubert Murdoch commented that these technologies are “a powerful influence for civilised behaviour. If you are arranging a massacre, it will be useless to shoot the cameraman who has so inconveniently appeared on the scene. His picture will already be safe in the studio five thousand miles away and his final image may hang you” (Shawcross 242). Unfortunately, whether public aggression in these circumstances is useless or not, the daily experience of TOs is that the presence of closed circuit television (CCTV) does not prevent attacks upon them: nor is it a guarantee of ‘civilised behaviour’. This is possibly because many of the more argumentative and angry members of the public are dis-inhibited by alcohol or other drugs. Police officers can employ the threat or actual application of stun guns to control situations in which they are outnumbered, but in the case of TOs they can remain outnumbered and vulnerable until reinforcements arrive. Such reinforcements are available, but the situation has to be managed through the communication of authority until the point where the train arrives at a ‘manned’ station, or the staff on the delta vehicle are able to support their colleagues. An Ambience of Order and Safety Some public transport organisations take this responsibility to sustain an ambience of order more seriously than others. The TO ethnographer, Christine Teague, visited public transport organisations in the UK, USA and Canada which are recognised as setting world-class standards for injury rates of their staff. In the USA particularly, there is a commitment to what is called ‘the broken windows’ theory, where a train is withdrawn from service promptly if it is damaged or defaced (Kelling and Coles; Maple and Mitchell). According to Henry (117): The ‘Broken Windows’ theory suggests that there is both a high correlation and a causal link between community disorder and more serious crime: when community disorder is permitted to flourish or when disorderly conditions or problems are left untended, they actually cause more serious crime. ‘Broken windows’ are a metaphor for community disorder which, as Wilson and Kelling (1982) use the term, includes the violation of informal social norms for public behaviour as well as quality of life offenses such as littering, graffiti, playing loud radios, aggressive panhandling, and vandalism.This theory implies that the physical ambience of the train, and by extension the station, may be highly influential in terms of creating a safe working environment. In this case of ‘no broken window’ organisations, the TO role is to maintain a high ‘quality of life’ rather than being a role predominantly about restraining and bringing to justice those whose behaviour is offensive, dangerous or illegal. The TOs in Perth achieve this through personal means such as taking pride in their uniforms, presenting a good-natured demeanour to passengers and assisting in maintaining the high standard of train interiors. Such a priority, and its link to reduced workforce injury, suggests that a perception of order impacts upon safety. It has long been argued that the safety culture of an organisation affects the safety performance of that organisation (Pidgeon; Leplat); but it has been more recently established that different cultural groupings in an organisation conceive and construct their safety culture differently (Leith). The research on ‘safety culture’ raises a problematic which is rarely addressed in practice. That problematic is this: managers frequently engage with safety at the level of instituting systems, while workers engage with safety in terms of behaviour. When Glendon and Litherland comment that, contrary to expectations, they could find no relationship between safety culture and safety performance, they were drawing attention to the fact that much managerial safety culture is premised upon systems involving tick boxes and the filling in of report forms. The broken window approach combines the managerial tick box with managerial behaviour: a dis-ordered train is removed from service. To some extent a general lack of fit between safety culture and safety performance endorses Everett’s view that it is conceptually inadequate to conceive organisations as cultures: “the conceptual inadequacy stems from the failure to distinguish between culture and behavioural features of organizational life” (238). The general focus upon safety culture as a way of promoting improvements in safety performance assumes that compliance with a range of safety systems will guarantee a safe workplace. Such an assumption, however, risks positioning the injured worker as responsible for his or her own predicament and sets up an environment in which some management officials are wont to seek ways in which that injured worker’s behaviour failed to conform with safety rules or safety processes. Yet there are roles which place workers in harm’s way, including military duties, law enforcement and some emergency services. Here, the work becomes dangerous as it becomes disorderly. An Ambience of Roles and Confusion As the research reported here progressed, it became clear that the ambience around the presentation of the self in the role of a TO (Goffman) was an important part of how ‘safety’ was promoted and enacted in their work upon the PTA (WA) trains, face to face with the travelling public. Goffman’s view of all people, not specifically TOs, is that: Regardless of the particular objective which the individual has in mind and of his motive for having this objective, it will be in his interests to control the conduct of the others, especially their responsive treatment of him. This will largely be through influencing the perception and definition that others will come to formulate of him. He will influence them by expressing himself in such a way that the kind of impression given off will lead them to act voluntarily in accordance with his own plan. (3)This ‘influencing of perception’ is an important element of performing the role of a TO. This task of the TOs is made all the more difficult because of confusions about their role in relation to two other officers: police (who have more power to act in situations of public safety) and revenue project officers (who have less), as we now discuss. The aura of the TO role borrows somewhat from those quintessential law and order officers: the police. TOs work in pairs, like many police, to support each other. They have a range of legal powers including the power of arrest, and they carry handcuffs, a baton and capsicum spray as a means of helping ensure their safety and effectiveness in circumstances where they might be outnumbered. The tools of their trade are accessibly displayed on heavy leather belts around their waists and their uniforms have similarities with police uniforms. However, in some ways these similarities are problematic, because TOs are not afforded the same respect as police. This situation underlines of the ambiguities negotiated within the ambience of what it is to be a TO, and how it is to conduct oneself in that role. Notwithstanding the TOs’ law and order responsibilities, public perceptions of the role and some of the public’s responses to the officers can position these workers as “plastic cops” (Teague and Leith). The penultimate deterrent of police officers, the stun gun (Taser), is not available to TOs who are expected to control all incidents arising on duty through the fact that they operate in pairs, with capsicum spray available and, as a last resort, are authorised to use their batons in self defence. Furthermore, although TOs are the key security and enforcement staff in the PTA workforce, and are managed separately from related staff roles, they believe that the clarity of this distinction is compromised because of similarities in the look of Revenue Protection Officers (RPOs). RPOs work on the trains to check that passengers have tickets and have paid the correct fares, and obtain names and addresses to issue infringement notices when required. They are not PTA employees, but contracted staff from an outside company. They also work in pairs. Significantly, the RPO uniform is in many respects identical to that of the TO, and this appears to be a deliberate management choice to make the number of TOs seem greater than it is: extending the TO ambience through to the activities of the RPOs. However, in the event of a disturbance, TOs are required and trained to act, while RPOs are instructed not to get involved; even though the RPOs appear to the travelling public to be operating in the role of a law-and-order-keeper, RPOs are specifically instructed not to get involved in breaches of the peace or disruptive passenger behaviour. From the point of view of the travelling public, who observe the RPO waiting for TOs to arrive, it may seems as if a TO is passively standing by while a chaotic situation unravels. As Angus commented: I’ve spoken to quite a few members of public and received complaints from them about transit officers and talking more about the incident have found out that it was actually [RPOs] that are dealing with it. So it’s creating a bad image for us …. It’s Transits that are copping all the flak for it … It is dangerous for us and it’s a lot of bad publicity for us. It’s hard enough, the job that we do and the lack of respect that we do get from people, we don’t need other people adding to it and making it harder. Indeed, it is not only the travelling public who can mistake the two uniforms. Mike tells of an “incident where an officer [TO] has called for backup on a train and the guys have got off [the train at the next station] and just stood there, and he didn’t realise that they are actually [revenue protection] officers, so he effectively had no backup. He thought he did, but he didn’t.” The RPO uniform may confer an ambience of power borrowed from TOs and communicated visually, but the impact is to compromise the authority of the TO role. Unfortunately, what could be a complementary role to the TOs becomes one which, in the minds of the TO workforce, serves to undermine their presence. This effect of this role confusion is to dilute the aura of authority of the TOs. At one end of a power continuum the TO role is minimised by those who see it as a second-rate ‘Wannabe cop’ (Teague and Leith 2008), while its impact is diluted at the other end by an apparently deliberate confusion between the TO broader ‘law and order’ role, and the more limited RPO revenue collection activities. Postlude To the passengers of the PTA in Perth, the presence and actions of transit officers appear as unremarkable as the daily commute. In this ethnographic study of their workplace culture, however, the transit officers have revealed ways in which they influence the ambience of the workplace and the public spaces they inhabit whilst on duty, and how they are influenced by it. While this ambient inter-relationship is not documented in the organisation’s occupational safety and health management system, the TOs are aware that it is a factor in their level at safety at work, both positively and negatively. Clearly, an ethnography study is conducted at a certain point in time and place, and culture is a living and changing expression of human interaction. The Public Transport Authority of Western Australia is committed to continuous improvement in safety and to the investigation of all ways and means in which to support TOs in their daily activities. This is evident not only in their support of the research and their welcoming of the ethnographer into the workforce and onto the tracks, but also in their robust commitment to change as the findings of the research have progressed. In particular, changes in the ambient TO culture and in the training and daily practices of TOs have already resulted from this research or are under active consideration. Nonetheless, this project is a cogent indicator of the fact that a safety culture is critically dependent upon intangible but nonetheless important factors such as the ambience of the workplace and the way in which officers are able to communicate their authority to others. References Everett, James. “Organizational Culture and Ethnoecology in Public Relations Theory and Practice.” Public Relations Research Annual. Vol. 2. Eds. Larissa Grunig and James Grunig. Hillsdale, NJ, 1990. 235-251. Glendon, Ian, and Debbie Litherland. “Safety Climate Factors, Group Differences and Safety Behaviour in Road Construction.” Safety Science 39.3 (2001): 157-188. Goffman, Erving. The Presentation of the Self in Everyday Life. London: Penguin, 1959. Henry, Vincent. The Comstat Paradigm: Management Accountability in Policing, Business and the Public Sector. New York: Looseleaf Law Publications, 2003. Kelling, George, and Catherine Coles. Fixing Broken Windows: Restoring Order and Reducing Crime in Our Communities. New York: Touchstone, 1996. Leith, David. Workplace Culture and Accidents: How Management Can Communicate to Prevent Injuries. Saarbrücken: VDM Verlag, 2008. Leplat, Jacques. “About Implementation of Safety Rules.” Safety Science 29.3 (1998): 189-204. Maple, Jack, and Chris Mitchell. The Crime Fighter: How You Can Make Your Community Crime-Free. New York: Broadway Books, 1999. Pidgeon, Nick. “Safety Culture and Risk Management in Organizations.” Journal of Cross-Cultural Psychology 22.1 (1991): 129-140. Shawcross, William. Rupert Murdoch. London: Chatto & Windus, 1992. Teague, Christine, and David Leith. “Men of Steel or Plastic Cops? The Use of Ethnography as a Transformative Agent.” Transforming Information and Learning Conference Transformers: People, Technologies and Spaces, Edith Cowan University, Perth, WA, 2008. ‹http://conferences.scis.ecu.edu.au/TILC2008/documents/2008/teague_and_leith-men_of_steel_or_plastic_cops.pdf›. Wilson, James, and George Kelling. “Broken Windows.” The Atlantic Monthly (Mar. 1982): 29-38. WA Legislative Council. “Metropolitan Railway – Transit Guards 273 [Hon Ed Dermer to Minister of Transport Hon. Simon O’Brien].” Hansard 19 Mar. 2009: 2145b.


 
 
 Introduction In a period marked by the pervasiveness of new mobile technologies saturating urban areas of the Asia-Pacific region, it can be easy to forget the realities of life in the rural areas. In a location such as Australia, in which 80% of the population lives in urban areas, one must be reminded of the sociotechnological realities of rural existence where often-newer mobile communication devices cease to function. This paper focuses on these black spots – and often forgotten areas – where examples of older, mediated technologies such as UHF Citizen Band (CB) radios can be found as integral to practices of everyday rural life. As Anderson notes, constructs of the nation are formed through contested notions of what individuals and communities imagine and project as a sense of place. In Australia, one of the dominant contested imageries can be found in the urban and rural divide, a divide that is not just social and cultural but technological; it is marked by a digital divide. This divide neatly corresponds to the images of Australia experienced by Australians (predominantly living in urban areas) and exported tourist images of the rugged vast rural landscapes. The remote Australia Outback is a popular destination for domestic tourists. Its sparsely populated and rough terrain attracts tourists seeking a quintessentially Australian experience. Roads are often unmade and in poor condition. Fuel and food supplies and health services are widely separated and there is almost no permanent accommodation. Apart from a small number of regional centres there is no access to mobile phones or radio broadcasts. As a consequence tourists must be largely self sufficient. While the primary roads carry significant road traffic it is possible to drive all day on secondary roads without seeing another person. Isolation and self-sufficiency are both an attraction and a challenge. Travelling in campervans, towing caravans or camper trailers and staying in caravan parks, national parks, roadside stops or alone in the bush, tourists spend extended times in areas where there are few other tourists. Many tourists deal with this isolation by equipping their vehicles with CB radios. Depending on the terrain, they are able to listen to, and participate in conversations with other CB users within a 10-20 kilometre range. In some areas where there are repeater stations, the range of radio transmissions can be extended. This paper examines the role of these CB radios in the daily life of tourists in the Australian Outback. Theoretical Issues The links between travel, the new communications technologies and the diminished spatial-time divide have been explored by John Urry. According to Urry, mobile electronic devices make it possible for people “to leave traces of their selves in informational space” (266). Using these informational traces, mobile communication technologies ‘track’ the movements of travellers, enabling them to communicate synchronously. People become ’nodes in multiple networks of communication and mobility’ (266). Another consequence of readily available communication independent of location is for the meaning of social connections. Social encounters provide tourists with the opportunity to develop and affirm understandings of their shared common occupation of unfamiliar social and cultural landscapes (Harrison). Both transitory and enduring relationships provide information, companionship and resources that allow tourists to create, share and give meaning to their experiences (Stokowski). Communication technology also enables individuals to enter and remain part of social networks while physically absent and distant from them (Johnsen; Makimoto and Manners, Urry). The result is a “nomadic intimacy” in an everyday social and physical environment characterised by extended spaces and individual freedom to move around in these spaces (Fortunati). For travellers in the Australian Outback, this “nomadic intimacy” is both literal and metaphorical. Research has shown that travellers use mobile communications services and a range of other communication strategies to maintain a “symbolic proximity” with family, friends and colleagues (Wurtzel and Turner) and to promote a sense of “presence while absent”, or ‘co-presence’ (Gergen; Lury; Short, Williams and Christie; White and White, “Keeping Connected”; White and White, “Home and Away”). Central to the original notion of co-presence was that it was contingent on those involved in a given communication both being and feeling close enough to perceive each other and to be perceived in the course of their activities (Goffman). That is, the notion of co-presence initially referred to physical presence in face-to-face contact and interactions. However, increasing use of mobile phones in particular has meant that this sense of connection can be affirmed at a distance. But what happens when travellers do not have access to mobile phones and the Internet, and as a consequence, do not have access to their networks of family, friends and colleagues? How do they deal with travel and isolation in a harsh environment? These issues are the starting point for the present paper, which examines travellers’ experience of CB radio in the remote Australian Outback. This exploration of how the CB radio has been incorporated into the daily lives of these travellers can be seen as a contribution to an understanding of the domestication of mobile communications (Haddon). Methodology People were included in the study if they used CB radios while travelling in remote parts of Western Australian and the Northern Territory. The participants were approached in caravan parks, camping grounds and at roadside stops. Most were travelling in caravans while others were using camper trailers and campervans. Twenty-four travellers were interviewed, twelve men and twelve women. All were travelling with partners or spouses, and one group of two couples was travelling together. They ranged in age from twenty five to seventy years, and all were Australian residents. The duration of their travels varied from six weeks to eleven months. Participants were interviewed using a semi-structured interview schedule. The interviews were transcribed and then thematically coded with respect to regularly articulated points of view. Where points of view were distinctive, they were noted during the coding process as contrasting instances. While the relatively small sample size limits generalizability, the issues raised by the respondents provide insights into the meaning of CB radio use in the daily life of travellers in the Australian Outback. Findings Staying Safe The primary reason given for travelling with a CB radio was personal safety. The tourists interviewed were aware of the risks associated with travelling in the Outback. Health emergencies, car accidents and problems with tyres in a harsh and hot environment without ready access to water were often mentioned. ‘If you call a May Day someone will come out and answer…” (Female, 55). Another interviewee reported that: Last year we helped some folk who were bogged in the sand right at the end of the road in the middle of nowhere. The wife just started calling the various channels explaining that they were bogged and asking whether there was anyone out there….We went and towed them out. …. It would have been a long walk for them to get help. (Female, 55) Even though most interviewees had not themselves experienced a personal emergency, many recounted stories about how CB radio had been used to come to the aid of someone in distress. Road conditions were another concern. Travellers were often rightly very concerned about hazards ahead. One traveller noted: You are always going to hear someone who gives you an insight as to what is happening up ahead on the road. If there’s an accident up ahead someone’s going to get on the radio and let people know. Or there could be road works or the road could be shitty. (Male, 50) Safety arose in another context. Tourists share the rough and often dusty roads with road trains towing up to three trailers. These vehicles can be 50 metres long. A road train creates wind turbulence when it passes a car and trailer or caravan and the dust it raises reduces visibility. Because of this car drivers and caravanners need to be extremely careful when they pass or are passed by one. Passing a road train at 100 km can take 2.5km. Interviewees reported that they communicated with road train drivers to negotiate a safe time and place to pass. One caravanner noted: Sometimes you see a road train coming up behind you. You call him up and say ” I’ll pull over for you mate and slow down and you go”. You use it a lot because it’s safer. We are not in a hurry. Road trains are working and they are in a hurry and he (sic.) is bigger, so he has the right of way. (Male, 50) As with the dominant rationale for installing and using a CB radio, Rice and Katz showed that concern about safety is the primary motive for women acquiring a mobile phone, and safety was also important for men. The social contact enabled by CB radio provided a means of tracking the movements of other travellers who were nearby. This tracking ability engendered a sense of comfort and enabled them to communicate and exchange information synchronously in a potentially dangerous environment. As a consequence, a ‘metaworld’ (Suvantola) of ‘informational traces’ (Urry) was created. Making Oneself Known All interactions entail conventions and signals that enable a conversation to commence. These conventions were also seen to apply to CB conversations. Driving in a car or truck involves being physically enclosed with the drivers and passengers being either invisible or only partially visible to other travellers. Caravanners deal with this lack of visibility in a number of ways. Many have their first names, the name of their caravan and the channel they use on the rear of their van. A typical sign was “Bill and Rose, Travelling Everywhere, Channel 18” or “Harry and Mary, Bugger Work, Gone Fishing”, Channel 18” clearly visible to anyone coming from behind. (The male partner’s name was invariably first.) A sign that identified the occupants was seen as an invitation to chat by other travellers. One traveller said that if he saw such a sign he would call up by saying: “Hello Harry and Mary”. From then on who knows where it goes. It depends on the people. If someone comes back really cheery and a bit cheeky I can be cheery and cheeky back. (Male, 50) The names of caravans were used in other more personal ways. One couple from South Africa had given their van a Zulu name and that was seen as a way of identifying their origins and encouraging a specific kind of conversation while they were on the road. This couple reported that People call us up and ask us what it means. We have lots of calls about that. We’ve had more conversations about that than anything else. (Male, 67) Another caravanner reported that he had seen a van with “Nanna and Poppa’ on the back. They used that as a cue to start a conversation about their grandchildren. But caravan names linked to their CB radio channel can have a deeper personal meaning. One couple had their first names and the number 58 on the rear of their van. (The number 58 is beyond the range of CB channels.) On further questioning the number 58 was revealed to be the football club number of a daughter who had died. The sign was an attempt to deal with their grief and its public display a way of entering into a conversation about grief and loss. It has probably backfired because it puts people back into their shell because they think “We don’t want to talk about death”. But because of the sign we’ve met people who’ve lost a child too. (Male, 50) As Featherstone notes, drivers develop competence in switching between a range of communicative modes while they are travelling. These range from body gestures to formal signalling devices on other cars. Signage on caravans designed to invite conversation was a specialised signalling device specific to the CB user. Talking Loneliness was another theme emerging from the interviews. One of the attractions of the Outback is its sparse population. As one interviewee noted ‘You can travel all day and not see another soul’ (Female, 35). But this loneliness can be a challenge. Some of these roads are pretty lonely, the radio lets you know that there’s somebody else out there. (Male, 54) Hearing other travellers talk was comforting. As with previous research showing that travellers use mobile communications services to maintain a “symbolic proximity” (Gergen; Lury; Short, Williams and Christie; White and White, “Keeping Connected”) the CB conversations enabled the travellers to feel this sense of connection. These interactions also offered them the possibility of converting mediated relationships into face-to-face encounters along the road. That is, some travellers reported that CB-based chats with people while they were driving would lead to a decision to stop along the road for a shared morning tea or lunch. Conventions governed the use of specific channels. Some of these are government regulated, while others are user generated. For instance, Channels 18 and 40, were seen as ‘working channels’. Some interviewees felt very strongly about people who ‘cluttered up’ these channels and moved to another unused channel when they wanted to have an extended conversation. One couple was unaware of the local convention and could not understand why no one was calling them up. They later discovered that they were on the ‘wrong channel’. Interviewees travelling in a convoy would use the standard channel for travellers and then agree to move to another channel of their choice. When we travelling in a convoy we go off Channel 18 and use another channel to talk. The girls love it to talk about their knitting and work out what they’ve done wrong. We sometimes tell jokes. Also we work out what we are going to do in the next town. (Male, 67) These extended conversations parallel the lengthy conversations between drivers equipped with CB radio in the United States during the 1970’s which Dannaher described as ‘as diverse as those found at a cocktail party’. They also provided a sense of the “nomadic intimacy” described by Fortunati. Eavesdropping While travellers used Channel 18 for conversations they set their radio to automatically scan all forty channels. When a conversation was located the radio would stop scanning and they could listen to what was being said. This meant that travellers would overhear conversations between strangers. We scan all the channels so you can hear anyone coming up behind, especially trucks and you can hear them say “that damn caravan” and you can say ’ that damn caravan will pull over at the first opportunity.” (Female, 44) But the act of listening in to other people’s conversations created moral dilemmas for some travellers. One interviewee described it as “voyeurism for the ears”. While she described listening to farm conversations as giving her an insight into daily life on huge cattle station she was tempted to butt into one conversation that she was listening to. On reflection she decided against entering the conversation. She said: I didn’t want them to know that we were eavesdropping on their conversation. I’d be embarrassed if a third-party knew that we were listening in. I guess that I’ve been taught that you shouldn’t listen in to other people’s conversations. It’s not good manners… (Female, 35) When travellers overheard conversations between road train or truck drivers they had mixed responses. These conversations were often sexually loaded and seen as coarse by the middle class travellers. Some were forgiving of the conversational excesses, distinguishing themselves from the rough and tumble world of the ‘truckies’. One traveller noted that the truck drivers use a lot of bad language, but you’ve got to go with that, because that’s the type of people they are. But you have to go with the flow. We know that we are ‘playing’ and the truckies are ‘working’ so you have to be considerate to them. (Female, 50) While the language of the truck drivers was often threatening to middle class travellers, overhearing their conversations was also seen as a comfort. One traveller remarked that sometimes you hear truckies talking about their families and they obviously know each other. It’s kind of nice to see how they think. (Female, 50) Travellers had similar feelings when they overheard conversations from cattle stations. Also, local cattle station workers and their families would use CB radios for their social and working communications. Travellers would often overhear these conversations. One traveller noted that when we are driving through a cattle station we work out which channel they are using, and we lock it on that one. And then we listen until they are out of range. We are city people and listening to the station chatter gives us a bit of an insight into what it must be like as a farmer working land out here. And then we talk about the farmers’ conversations. (Female, 35) Another traveller noted: If you are travelling and there’s nothing you can see you can listen to the farmer talking to his wife or the kids. It’s absolutely awesome to hear conversations on radio. (Female, 67) This empathic listening allows the travellers to imagine the lives of others in settings quite different from those with which they are familiar. Furthermore, hearing farmers talking about fixing the fence in the left paddock or rounding up strays makes ‘you feel that you’re not alone’. The networking of the travellers’ social life arising from listening in to others meant that they were able to learn about the environment in which they found themselves, as well as enabling them to feel that they continued to remain embedded or ‘co-present’ in social relationships in circumstances of considerable physical isolation. Conclusions The accounts provided by tourists illustrated the way communications technologies – in this case, CB radio – enabled people to become ’nodes in multiple networks of communication and mobility’ described by Urry and to maintain ‘co-presence’. The CB radio allowed tourists to remain part of social networks while being physically absent from them (Gergen). Their responses also demonstrated the significance of CB radio in giving meaning to the experience of travel. The CB radio was shown to be an important part of the travel experience in the remote Australian Outback. The use of CB made it possible for travellers in the Australian Outback to obtain information vital for the safe traverse of the huge distances and isolated roads. The technology enabled them to break down the atomism and frontier-like isolation of the highway. Drivers and their passengers could reach out to other travellers and avoid remaining unconnected strangers. Long hours on the road could be dealt with by listening in on others’ conversations, even though some ambivalence was expressed about this activity. Despite an awareness that they could be violating the personal boundaries of others and that their conversations could be overheard, the use of CB radio meant staying safe and enjoying guilty pleasures. Imagined or not. References Anderson, Benedict. Imagined Community. London: Verso, 1983 Dannefer, W. Dale. “The C.B. Phenomenon: A Sociological Appraisal.” Journal of Popular Culture 12 (1979): 611-19. Featherstone, Mike. “Automobilities: An Introduction.” Theory, Culture and Society 21.4/5 (2004): 1-24. Fortunati, Leopoldina. “The Mobile Phone: Towards New Categories and Social Relations.” Information, Communication and Society 5.2 (2002): 513-28. Gergen, Kenneth. “The Challenge of Absence Presence.” Perpetual Contact: Mobile Communications, Private Talk, Public Performance. Ed. James Katz. Cambridge: Cambridge UP, 2002. 227-54. Goffman, Erving. Behavior in Public Places: Notes on the Social Organization of Gatherings. New York: Free Press of Glencoe, 1963. Haddon, Leslie. “Domestication and Mobile Telephony.” Machines That Become Us: The Social Context of Personal Communication Technology. Ed. James E. Katz. New Brunswick, N.J.: Transaction Publishers, 2003. 43-55. Harrison, Julia. Being a Tourist: Finding Meaning in Pleasure Travel. Vancouver: U of British Columbia P, 2003. Johnsen, Truls Erik. “The Social Context of Mobile Use of Norwegian Teens.” Machines That Become Us: The Social Context of Personal Communication Technology. Ed. James Katz. London: Transaction Publishers, 2003. 161-69. Ling, Richard. “One Can Talk about Common Manners! The Use of Mobile Telephones in Inappropiate Situations.” Communications on the Move: The Experience of Mobile Telephony in the 1990s (Report of Cost 248: The Future European Telecommunications User Mobile Workgroup). Ed. Leslie Haddon. Farsta, Sweden: Telia AB, 1997. 97-120. Lury, Celia. “The Objects of Travel.” Touring Cultures: Transformations of Travel and Theory. Eds. Chris Rojek and John Urry. London: Routledge, 1997. 75-95. Rice, Ronald E., and James E. Katz. “Comparing Internet and Mobile Phone Usage: Digital Divides of Usage, Adoption and Dropouts.” Telecommunications Policy 27 (2003): 597-623. Short, J., E. Williams, and B. Christie. The Social Psychology of Telecommunications. New York: Wiley, 1976. Stokowski, Patricia. “Social Networks and Tourist Behavior.” American Behavioural Scientist 36.2 (1992): 212-21. Suvantola, Jaakko. Tourist’s Experience of Place. Aldershot: Ashgate, 2002. Urry, John. “Mobility and Proximity.” Sociology 36.2 (2002): 255-74. ———. “Social Networks, Travel and Talk.” British Journal of Sociology 54.2 (2003): 155-75. White, Naomi Rosh, and Peter B. White. “Home and Away: Tourists in a Connected World.” Annals of Tourism Research 34. 1 (2007): 88-104. White, Peter B., and Naomi Rosh White. “Keeping Connected: Travelling with the Telephone.” Convergence: The International Journal of Research into New Media Technologies 11.2 (2005): 102-18. Williams, Stephen, and Lynda Williams. “Space Invaders: The Negotiation of Teenage Boundaries through the Mobile Phone.” The Sociological Review 53.2 (2005): 314-31. Wurtzel, Alan H., and Colin Turner. “Latent Functions of the Telephone: What Missing the Extension Means.” The Social Impact of the Telephone. Ed. Ithiel de Sola Pool. Cambridge: MIT Press, 1977. 246-61. 
 
 
 
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IntroductionUtopian and forward looking in tenor, official narratives of urban renewal and development implicitly promote normative ideals of progress and necessary civic improvement. Yet an underlying condition of such renewal is frequently the very opposite of building: the demolition of existing urban fabric. Taking as its starting point the large-scale demolition of buildings proposed for the NSW Government’s Sydney Metro rail project, this article interrogates the role of literary treatments of demolition in mediating complex, and often contradictory, responses to transformations of the built environment. Case studies are drawn from literary texts in which demolition and infrastructure development are key preoccupations, notably Louis Aragon’s 1926 Surrealist document of a threatened Parisian arcade, Paris Peasant, and the non-fiction accounts of the redevelopment of London’s East End by British writer Iain Sinclair. Sydney UnbuiltPresently, Australia’s biggest public transport project according to the NSW Government website, the Sydney Metro is set to revolutionise Sydney’s rail future with more than 30 metro stations and a fleet of fully-automated driverless trains. Its impetus extends at least as far back as the Liberal-National Coalition’s landslide win at the 2011 New South Wales state election when Barry O’Farrell, then party leader, declared “NSW has to be rebuilt” (qtd in Aston). Infrastructure upgrades became one of the Coalition’s key priorities upon forming government. Following a second Coalition win at the 2015 election, the state of NSW, or the city of Sydney more accurately, remains today deep amidst widespread building works with an unprecedented number of infrastructure, development and urban renewal projects simultaneously underway.From an historical perspective, Sydney is certainly no stranger to demolition. This was in evidence in Demolished Sydney, an exhibition at the Museum of Sydney that captured the zeitgeist of 2016 with its historical survey of Sydney’s demolished architecture. As the exhibition media release pointed out: “Since 1788 Sydney has been built, unbuilt and rebuilt as it has grown from Georgian town to Victorian city to the global urban centre it is today” (Museum of Sydney). What this evolutionist narrative glosses over, however, is the extent to which the impact of Sydney’s significant reinventions of itself through large-scale redevelopment are often not properly registered until well after such changes have taken place. With the imminent commencement of Sydney Metro Stage 2 CBD works, the city similarly stands to lose a number of buildings that embody the civic urban ideals of an earlier era, the effects of which are unlikely to be fully appreciated until the project’s post-demolition phase. The revelation, over the past year, of the full extent of demolition required to build Sydney Metro casts a spotlight on the project and raises questions about its likely impact in reconfiguring the character of Sydney’s inner city. An Environmental Impact Statement Summary (EISS) released by the NSW Government in May 2016 confirms that 79 buildings in the CBD and surrounding suburbs are slated for demolition as part of station development plans for the Stage 2 Chatswood to Sydenham line (Transport for NSW). Initial assurances were that the large majority of acquisitions would be commercial buildings. Yet, the mix also comprises some locally-heritage listed structures including, most notably, 7 Elizabeth Street Sydney (Image 1), a residential apartment tower of 54 studio flats located at the top end of the Sydney central business district.Image 1: 7 Elizabeth Street Sydney apartment towers (middle). Architect: Emil Sodersten. Image credit: Ella Mudie.As the sole surviving block of CBD flats constructed during the 1930s, 7 Elizabeth Street had been identified by the Australian Institute of Architects as an example of historically significant twentieth-century residential architecture. Furthermore, the modernist block is aesthetically significant as the work of prominent Art Deco architect Emil Sodersten (1899-1961) and interior designer Marion Hall Best (1905-1988). Disregarding recommendations that the building should be retained and conserved, Transport for NSW compulsorily acquired the block, evicting residents in late 2016 from one of the few remaining sources of affordable housing in the inner-city. Meanwhile, a few blocks down at 302 Pitt Street the more than century-old Druids House (Image 2) is also set to be demolished for the Metro development. Prior to purchase by Transport for NSW, the property had been slated for a state-of-the-art adaptive reuse as a boutique hotel which would have preserved the building’s façade and windows. In North Sydney, a locally heritage listed shopfront at 187 Miller Street, one of the few examples of the Victorian Italianate style remaining on the street, faces a similar fate. Image 2. Druids House, 302 Pitt Street Sydney. Image credit: Ella Mudie.Beyond the bureaucratic accounting of the numbers and locations of demolitions outlined in the NSW Government’s EISS, this survey of disappearing structures highlights to what extent, large-scale transport infrastructure projects like Sydney Metro, can reshape what the Situationists termed the “psychogeography” of a city; the critical manner in which places and environments affect our emotions and behaviour. With their tendency to erase traces of the city’s past and to smooth over its textures, those variegations in the urban fabric that emerge from the interrelationship of the built environment with the lived experience of a space, the changes wrought by infrastructure and development thus manifest a certain anguish of urban dynamism that is connected to broader anxieties over modernity’s “speed of change and the ever-changing horizons of time and space” (Huyssen 23). Indeed, just as startling as the disappearance of older and more idiosyncratic structures is the demolition of newer building stock which, in the case of Sydney Metro, includes the slated demolition of a well-maintained 22-storey commercial office tower at 39 Martin Place (Image 3). Completed in just 1972, the fact that the lifespan of this tower will amount to less than fifty years points to the rapid obsolescence, and sheer disposability, of commercial building stock in the twenty first-century. It is also indicative of the drive towards destruction that operates within the project of modernism itself. Pondering the relationship of modernist architecture to time, Guiliana Bruno asks: can we really speak of a modernist ruin? Unlike the porous, permeable stone of ancient building, the material of modernism does not ‘ruin.’ Concrete does not decay. It does not slowly erode and corrode, fade out or fade away. It cannot monumentally disintegrate. In some way, modernist architecture does not absorb the passing of time. Adverse to deterioration, it does not age easily, gracefully or elegantly. (80)In its resistance to organic ruination, Bruno’s comment thus implies it is demolition that will be the fate of the large majority of the urban building stock of the twentieth century and beyond. In this way, Sydney Metro is symptomatic of far broader cycles of replenishment and renewal at play in cities around the world, bringing to the fore timely questions about demolition and modernity, the conflict between economic development and the civic good, and social justice concerns over the public’s right to the city. Image 3: 39 Martin Place Sydney. Image credit: Ella Mudie.In the second part of this article, I turn to literary treatments of demolition in order to consider what role the writer might play in giving expression to some of the conflicts and tensions, as exemplified by Sydney Metro, that manifest in ‘unbuilding’ the city. How might literature, I ask, be uniquely placed to mobilise critique? And to what extent does the writer—as both a detached observer and engaged participant in the city—occupy an ambivalent stance especially sensitive to the inherent contradictions and paradoxes of the built environment’s relationship to modernity?Iain Sinclair: Calling Time on the Grand Projects For more than two decades, British author Iain Sinclair has been mapping the shifting terrain of London and its edgelands across a spectrum of experimental fiction and non-fiction works. In addition to the thematic attention paid to neoliberal capitalist processes of urban renewal and their tendency to implode established ties between place, memory and identity, Sinclair’s hybrid documentary-novels are especially pertinent to the analysis of “writing demolition” for their distinct writerly approach. Two recent texts, Ghost Milk: Calling Time on the Grand Project (2011) and London Overground: A Day’s Walk around the Ginger Line (2015), highlight an intensification of interest on Sinclair’s part in the growing influence exerted by global finance, hyper consumerism and security fears on the reterritorialisation of the English capital. Written in the lead up to the 2012 London Olympics, Ghost Milk is Sinclair’s scathing indictment of the corporate greed that fuelled the large-scale redevelopment of Stratford and its surrounds ahead of the Games. It is an angry and vocal response to urban transformation, a sustained polemic intensified by the author’s local perspective. A long-term resident of East London, in the 1970s Sinclair worked as a labourer at Chobham Farm and thus feels a personal assault in how Stratford “abdicated its fixed identity and willingly prostituted itself as a backdrop for experimental malls, rail hubs and computer generated Olympic parks” (28). For Sinclair, the bulldozing of the Stratford and Hackney boroughs was performed in the name of a so-called civic legacy beyond the Olympic spectacle that failed to culminate in anything more than a “long march towards a theme park without a theme” (11), a site emblematic of the bland shopping mall architecture of what Sinclair derisorily terms “the GP [Grand Project] era” (125).As a literary treatment of demolition Ghost Milk is particularly concerned with the compromised role of language in urban planning rhetoric. The redevelopment required for the Olympics is backed by a “fraudulent narrative” (99), says Sinclair, a conspiratorial co-optation of language made to bend in the service of urban gentrification. “In many ways,” he writes, “the essential literature of the GP era is the proposal, the bullet-point pitch, the perversion of natural language into weasel forms of not-saying” (125). This impoverishment and simplification of language, Sinclair argues, weakens the critical thinking required to recognise the propagandising tendencies underlying so many urban renewal programs.The author’s vocal admonishment of the London Olympics did not go unnoticed. In 2008 a reading from his forthcoming book Hackney, That Rose-Red Empire (2009), at a local library was cancelled out of fear of providing a public platform for his negative views. In Ghost Milk Sinclair reflects upon the treatment of his not yet published docu-novel as “found guilty, with no right of reply, of being political but somehow outside politics” (115). Confronted with the type of large-scale change that underpins such projects as the Olympic Games, or the Sydney Metro closer to home, Sinclair’s predicament points to the ambiguous position of influence occupied by writers. On the one hand, influence is limited in so far as authors play no formal part in the political process. Yet, when outspoken critique resonates words can become suddenly powerful, radically undermining the authority of slick environmental impact statements and sanctioned public consultation findings. In a more poetic sense, Sinclair’s texts are further influential for the way in which they offer a subjective mythologising of the city as a counterpoint to the banal narratives of bureaucratised urbanism. This is especially apparent in London Overground: A Day’s Walk around the Ginger Line (2015), in which Sinclair recounts a single-day street-level pedestrian exploration of the 35-mile and 33-station circuit of the new London Overground railway line. Surveying with disapproval the “new bridges, artisan bakeries, blue-bike racks and coffee shops” (20) that have sprung up along the route of the elevated railway, the initial gambit of the text appears to be to critique the London Overground as a “device for boosting property values” (23). Rail zone as “generator for investment” (31), and driver of the political emasculation of suburbs like Hackney and Shoreditch. Yet as the text develops the narrator appears increasingly drawn to the curious manner in which the Overground line performs an “accidental re-mapping of London” (24). He drifts, then, in search of: a site in which to confront one’s shadow. In a degraded form, this was the ambition behind our orbital tramp. To be attentive to the voices; to walk beside our shadow selves. To reverse the polarity of incomprehensible public schemes, the secret motors of capital defended and promoted by professionally mendacious politicians capable of justifying anything. (London Overground 127)Summoning the oneiric qualities of the railway and its inclination to dreaming and reverie, Sinclair reimagines it as divine oracle, a “ladder of initiation” (47) bisecting resonant zones animated by traces of the visionary artists and novelists whose sensitivity to place have shaped the perception of the London boroughs in the urban imaginary. It is in this manner that Sinclair’s walks generate “an oppositional perspective against the grand projects of centralized planning and management of space” (Weston 261). In a kind of poetic re-enchantment of urban space, texts like Ghost Milk and London Overground shatter the thin veneer of present-day capitalist urbanism challenging the reader to conceive of alternative visions of the city as heterogeneous and imbued with deep historical time.Louis Aragon: Demolition and ModernityWhile London Overground was composed after the construction of the new railway circuit, the pre-demolition phase of a project is, by comparison, a threshold moment. Literary responses to impending demolition are thus shaped in an unstable context as the landscape of a city becomes subject to unpredictable changes that can unfold at a very swift pace. Declan Tan suggests that the writing of Ghost Milk in the lead up to the London Olympics marks Sinclair’s disapproval as “futile, Ghost Milk is knowingly written as a documentary of near-history, an archival treatment of 2012 now, before it happens.” Yet, paradoxically it is the very futility of Sinclair’s project that intensifies the urgency to record, sharpening his polemic. This notion of writing a “documentary of near-history” also suggests a certain breach in time, which in the case of Louis Aragon’s Paris Peasant is mined for its revolutionary energies.First published in book form in 1926, Paris Peasant is an experimental Surrealist novel comprising four collage-like fragments including Aragon’s famous panegyric on the Passage de l’Opéra, a nineteenth-century Parisian arcade slated for demolition to make way for a new access road to the Boulevard Haussmann. Reading the text in the present era of Sydney Metro works, the predicament of the disappearing Opera Arcade resonates with the fate of the threatened Art Deco tower at 7 Elizabeth Street, soon to be razed to build a new metro station. Critical of the media’s overall neglect of the redevelopment, Aragon’s text pays sympathetic attention to the plight of the arcade’s business owners, railing against the injustices of their imminent eviction whilst mourning the disappearance of one of the last vestiges of the more organic configuration of the city that preceded the Haussmann renovation of Paris:the great American passion for city planning, imported into Paris by a prefect of police during the Second Empire and now being applied to the task of redrawing the map of our capital in straight lines, will soon spell the doom of these human aquariums. (Aragon 14)In light of these concerns it is tempting to cast Paris Peasant as a classic anti-development polemic. However, closer interrogation of the narrator’s ambivalent stance points to a more complicated attitude towards urban renewal. For, as he casts a forensic eye across the arcade’s shops it becomes apparent that these threatened sites hold a certain lure of attraction for the Surrealist author. The explanatory genre of the guide-book is subverted in a highly imaginative inventory of the arcade interiors. Touring its baths, brothels and hair salon, shoe shine parlour, run-down theatre, and the Café Certa—meeting place of the Surrealists—the narrator’s perambulation provides a launching point for intoxicated reveries and effervescent flights of fancy. Finally, the narrator concedes: “I would never have thought of myself as an observer. I like to let the winds and the rain blow through me: chance is my only experience, hazard my sole experiment” (88). Neither a journalist nor an historian, Paris Peasant’s narrator is not concerned merely to document the Opera Arcade for posterity. Rather, his interest in the site resides in its liminal state. On the cusp of being transformed into something else, the ontological instability of the arcade provides a dramatic illustration of the myth of architecture’s permanency. Aragon’s novel is concerned then, Abigail Susik notes, with the “insatiable momentum of progress,” and how it “renders all the more visible what could be called the radical remainders of modernity: the recently ruined, lately depleted, presently-passé entities that, for better and for worse, multiply and accumulate in the wake of accelerated production and consumption in industrial society” (34). Drawing comparison with Walter Benjamin’s sprawling Arcades Project, a kaleidoscopic critique of commodity culture, Paris Vaclav similarly characterises Paris Peasant as manifesting a distinct form of “political affect: one of melancholy for the destruction of the arcades yet also of a decidedly non-conservative devotion to aesthetic innovation” (24).Sensitive to the contradictory nature of progress under late capitalist modernity, Paris Peasant thus recognises destruction as an underlying condition of change and innovation as was typical of avant-garde texts of the early twentieth century. Yet Aragon resists fatalism in his simultaneous alertness to the radical potential of the marvellous in the everyday, searching for the fault lines in ordinary reality beneath which poetic re-enchantment challenges the status quo of modern life. In this way, Aragon’s experimental novel sketches the textures and psychogeographies of the city, tracing its detours and shifts in ambience, the relationship of architecture to dreams, memory and fantasy; those composite layers of a city that official documents and masterplans rarely ascribe value to and which literary authors are uniquely placed to capture in their writings on cities. ConclusionUnable to respond within the swift publication timeframes of journalistic articles, the novelist is admittedly not well-placed to halt the demolition of buildings. In this article, I have sought to argue that the power and agency of the literary response resides, rather, in its long view and the subjective perspective of the author. At the time of writing, Sydney Metro is poised to involve a scale of demolition that has not been seen in Sydney for several decades and which will transform the city in a manner that, to date, has largely passed uncritiqued. The works of Iain Sinclair and Louis Aragon’s Paris Peasant point to the capacity of literary texts to deconstruct those broader forces that increasingly reshape the city without proper consideration; exposing the seductive ideology of urban renewal and the false promises of grand projects that transform multifaceted cityscapes into homogenous non-places. The literary text thus makes visible what is easily missed in the experience of everyday life, forcing us to consider the losses that haunt every gain in the building and rebuilding of the city.ReferencesAragon, Louis. Paris Peasant. Trans. Simon Taylor Watson. Boston: Exact Change, 1994. Aston, Heath. “We’ll Govern for All.” Sydney Morning Herald 27 Mar. 2011. 23 Feb. 2017 <http://www.smh.com.au/nsw/state-election-2011/well-govern-for-all-20110326-1cbbf.html>. Bruno, Guiliana. “Modernist Ruins, Filmic Archaeologies.” Ruins. Ed. Brian Dillon. London: Whitechapel Gallery, 2011. 76-81.Huyssen, Andreas. Present Pasts: Urban Palimpsests and the Politics of Memory. Stanford: Stanford UP, 2003.Museum of Sydney. Demolished Sydney Media Release. Sydney: Sydney Living Museums 20 Oct. 2016. 25 Feb. 2017 <http://sydneylivingmuseums.com.au/2016/12/05/new-exhibition-demolished-sydney>.Paris, Vaclav. “Uncreative Influence: Louis Aragon’s Paysan de Paris and Walter Benjamin’s Passagen-Werk.” Journal of Modern Literature 37.1 (Autumn 2013): 21-39.Sinclair, Iain. Ghost Milk: Calling Time on the Grand Project. London: Penguin, 2012. ———. Hackney, That Rose Red Empire. London: Hamish Hamilton, 2009.———. London Overground: A Day’s Walk around the Ginger Line. 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