Journal articles on the topic 'Gardiner report'

In 1969 Barton & Whithead described the Gaslight Phenomenon. In this condition a presentation of mental illness is found, on further enquiry, to a hospital. Previous reports have highlighted the malicious intent of the exploiter (Barton & Whitehead, 1969; Smith & Sinanan, 1972; Tyndal, 1973; Lund & Gardiner, 1977).

It has been suggested that the use of different memory systems can be identified by asking subjects whether they remember or know a recognized stimulus (e g, Gardiner & Java, 1990, Tulving, 1985) In this view, remember responses indicate the use of episodic memory, and know responses the use of implicit memory (e g, Gardiner & Java, in press) or semantic memory (Tulving, 1993) We criticize this position on both conceptual and empirical grounds We argue that the concept of knowing and the instructions of the studies confound declarative knowledge (knowledge by description) and familiarity-based knowledge (knowledge by acquaintance) The two types of knowledge, however, seem to be associated with different psychological processes To test this notion, we conducted two recognition experiments in which the response criteria were either explicitly or implicitly manipulated The results clearly suggest that know responses are more likely than remember responses to be influenced by judgmental strategies that do not require a memorial presentation of the known stimulus Self-reports appear to be useful indicators of underlying mechanisms only to the extent that it is sufficiently understood how such reports are generated

8023 Background: Immunochemotherapy is standard of care for patients (pts) with previously untreated advanced stage follicular lymphoma (FL). Four-year data from the Phase III GALLIUM study (NCT01332968) have previously demonstrated an improvement in the primary endpoint of investigator-assessed progression-free survival (PFS) for obinutuzumab (GA101, G) plus chemotherapy (G-chemo) versus rituximab plus chemotherapy (R-chemo) (Townsend et al. ASH 2018). Here, we report efficacy and safety results from an updated analysis. Methods: Eligibility criteria: ≥18 years; advanced stage, previously untreated grade 1–3a FL; requiring treatment according to Groupe d’Etude des Lymphomes Folliculaires criteria. Pts were randomized 1:1 to receive G 1000mg IV (day [D] 1, 8 and 15 of Cycle 1; D1 of each subsequent cycle) or R 375mg/m2 IV (D1 of each cycle) with CHOP, CVP, or bendamustine for 6 or 8 cycles. Responders received maintenance therapy with the same monoclonal antibody every 2 months for 2 years. Results: 1202 pts (median age 59 years) were enrolled (n = 601 per treatment arm). Median duration of follow-up was 76.5 months. Pts receiving G- vs R-chemo demonstrated improved PFS (5-year PFS: hazard ratio [HR] 0.76; 95% CI: 0.62–0.92; p = 0.0043; 70.5% [95% CI: 66.4–74.1] vs 63.2% [95% CI: 59.0–67.1]). There was no notable difference in 5-year overall survival (OS), with few events in either arm (HR 0.87; 95% CI: 0.62–1.22; p = 0.41; G-chemo: 90.2% [95% CI: 87.5–92.4]; R-chemo: 89.4% [95% CI: 86.6–91.6]). Time-to-next-treatment (TTNT) was greater in the G- vs R-chemo arm (5-year TTNT rate: HR 0.72; 95% CI: 0.57–0.90; p = 0.0039; 79.7% [95% CI: 76.1–82.7] vs 72.9% [95% CI: 69.1–76.4]). Incidence of grade 3–5 adverse events was 79.3% in the G-chemo arm and 71.2% in the R-chemo arm, and consistent with those reported in the primary analysis (Marcus et al. N Engl J Med 2017). Conclusions: These data further demonstrate the clinically meaningful and durable benefit of treatment with G-chemo relative to R-chemo in previously untreated FL pts. Acknowledgement: GALLIUM was sponsored by F. Hoffmann-La Roche Ltd. Third-party medical writing assistance, under the direction of William Townsend, was provided by Louise Profit and Stephanie Lacey of Gardiner-Caldwell Communications, and was funded by F. Hoffmann-La Roche Ltd. Clinical trial information: NCT01332968 .

The spider genus Desis Walckenaer, 1837 is the type genus of the spider family Desidae Pocock, 1895. Desis spiders hide in silk sacs between rocks or shells during high tide and forage during low tide (Baehr et al. 2017). Four Desis species have been recorded from Asia: Desis gardineri Pocock, 1904 (India), Desis inermis Gravely, 1927 (India), Desis japonica Yaginuma, 1956 (Japan) and Desis martensi L. Koch, 1872 (Malaysia) (World Spider Catalog 2020). Until now, only one species of the family Desidae, Badumna tangae Zhu, Zhang & Yang, 2006, has been reported from China (Zhu et al. 2006). Here, we describe a new species of Desis and report the genus from China for the first time.

It has been suggested by Pettibone (1953) and Lwebuga-Musaka (1970) that the elytra of scaleworms may function in respiration, not as the sites of gaseous exchange, but rather the means by which respiratory water currents were created over the dorsum. A role in sensory perception was also postulated (Pettibone, 1953). However, no detailed morphological study accompanied this work. To date the scales of only a few polychaete species have been examined ultrastructurally, and these studies have focused mostly on cuticular features (Anton-Erxleben, 1977, 1981a, b). Considerable attention has been focused on the bioluminescent properties of the elytra of the scaleworm, Harmothoe lunulata (Delle Chiaje) (see Bassot, 1979; Nicholas et al. 1981, 1982). Other morphological features of Pholoe minuta studied at the ultrastructural level include gametogenic (Heffernan & Keegan, 1988a) and larval (Heffernan & Keegan, 1988b) stages as well as the digestive tract (Heffernan, 1988). There are several reports on the ultrastructure of polychaete gills (Storch & Welsch, 1972; Spies, 1973; Storch & Alberti, 1978; Menendez et al., 1984; Storch & Gaill, 1986). These works have recently been reviewed by Gardiner (1988). This study describes the fine structure of the scales of Pholoe minuta and the features illustrated here are in agreement with a role in respiration and sensory perception.

Specific Event Identifiersa. Event type: Outdoor music festival.b. Event onset date: December 3, 2016.c. Location of event: Regatta Point, Commonwealth Park.d. Geographical coordinates: Canberra, Australian Capital Territory (ACT), Australia (-35.289002, 149.131957, 600m).e. Dates and times of observation in latitude, longitude, and elevation: December 3, 2016, 11:00-23:00.f. Response type: Event medical support.AbstractIntroductionYoung adult patrons are vulnerable to risk-taking behavior, including drug taking, at outdoor music festivals. Therefore, the aim of this field report is to discuss the on-site medical response during a music festival, and subsequently highlight observed strategies aimed at minimizing substance abuse harm.MethodThe observed outdoor music festival was held in Canberra (Australian Capital Territory [ACT], Australia) during the early summer of 2016, with an attendance of 23,008 patrons. First aid and on-site medical treatment data were gained from the relevant treatment area and service.ResultsThe integrated first aid service provided support to 292 patients. Final analysis consisted of 286 patients’ records, with 119 (41.6%) males and 167 (58.4%) females. Results from this report indicated that drug intoxication was an observed event issue, with 15 (5.1%) treated on site and 13 emergency department (ED) presentations, primarily related to trauma or medical conditions requiring further diagnostics.ConclusionThis report details an important public health need, which could be met by providing a coordinated approach, including a robust on-site medical service, accepting intrinsic risk-taking behavior. This may include on-site drug-checking, providing reliable information on drug content with associated education.LutherM, GardinerF, LensonS, CaldicottD, HarrisR, SabetR, MalloyM, PerkinsJ. An effective risk minimization strategy applied to an outdoor music festival: a multi-agency approach. Prehosp Disaster Med. 2018;33(2):220–224.

Introduction: The 2017 US FDA approval of a subcutaneous (SC) injection form of rituximab made available an alternative means of administering rituximab for patients with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and chronic lymphocytic leukemia (CLL). Although patients have reported a preference for SC rituximab injection (R-SC) over intravenous rituximab infusion (R-IV), nurse provider preferences for R-SC versus R-IV in the real-world setting have not been studied. Here, we report the findings of a survey designed to assess nurse treatment preferences for R-SC versus R-IV. Methods: A descriptive, cross-sectional survey of 208 oncology nurse providers was conducted via a web-based questionnaire between June 6, 2019 and July 10, 2019. Nurses who administered at least one R-IV and at least one R-SC treatment between July 1, 2017 and April 30, 2019 in US Oncology Network (USON) clinics were eligible to participate. The survey comprised 21 items, and evaluated nurses' experience with R-SC versus R-IV, preference for SC or IV administration, convenience, and overall experience. Results: Of the 208 nurse providers invited to participate in the survey, 43 completed the survey (20.7% response rate). Almost all nurses who completed the survey were familiar with administering R-IV, with 70% of the respondents administering >20 infusions in the past year. Nurses were also familiar with administering R-SC, with 56% of respondents administering 1-10 injections in the past year and 44% administering >10 injections in the past year. Fifty-three percent of respondents preferred administering R-SC over R-IV, with time saving, convenience, and patient preference chosen as the most common reasons. Most respondents (58%) had a positive/very positive experience with R-SC over R-IV, as a result of patient time saved, clinic/staff time saved, and quality time with patients. In total, 19% of respondents had a neutral experience with R-SC compared with R-IV. Of those reporting a neutral experience with R-SC, a comparable ease of administration was the most common reason. Twenty-three percent of respondents reported a negative/very negative experience with R-SC, with discomfort with the R-SC route of administration (i.e. physical effort) chosen as the most common reason for the negative experience. Eighty-four percent of respondents reported spending 1.5 to over 2 hours of nursing time monitoring and administering R-IV for each patient. The majority of respondents (98%) agreed that chair time could be saved with each administration of R-SC compared with R-IV. Respondents reported that the time saved could be used to see more patients (50%), complete nursing procedures (36%), and complete administrative work (14%). Forty-four percent of respondents reported that 1.5 to 2 hours could be saved with each administration of R-SC as compared with R-IV, with 67% of respondents agreeing that the quality of patient care was not impacted by the shorter administration time of R-SC. In terms of convenience, 63% of respondents reported R-SC is more convenient than R-IV, and 49% reported their overall impression of injecting R-SC as easy. Moreover, 49% reported that they agreed or strongly agreed that they would recommend R-SC to their medical colleagues, and 63% agreed or strongly agreed that they believe patients would prefer R-SC over R-IV. Conclusions: Based on an online survey of nurse providers with experience administering R-IV and R-SC, a majority of nurse providers preferred administering R-SC over R-IV. Time saved, convenience, and patient preference contributed to the positive experience with R-SC. Acknowledgements: This study was sponsored by Genentech, Inc. Third party editorial assistance, under the direction of Mitul Gandhi and Sheila Shapouri, was provided by Katie Buxton of Gardiner-Caldwell Communications and was funded by F. Hoffmann-La Roche Ltd. Disclosures Gandhi: Seattle Genetics: Other: Education ; Pharmacyclics: Other: Food and beverage ; AbbVie: Other: Food and beverage ; Pfizer: Other: Education ; GSK: Other: Food and beverage ; Genentech, Inc.: Other: Food and beverage ; Acerta Pharma: Research Funding. Shapouri:Genentech, Inc.: Employment; Roche: Equity Ownership. Ravelo:Genentech: Employment, Equity Ownership. Sudharshan:McKesson: Consultancy, Employment. Clark:McKesson: Consultancy, Employment, Equity Ownership. Dawson:Genentech: Employment; Roche/Genentech: Equity Ownership.

The logicist program, which was initiated in the 1970s by J.C. Gardin, aims to clarify the reasoning processes in the field of archaeology and to explore new forms of publication, in order to overcome the growing imbalance between the flood of publications and our capacities of assimilation. The logicist program brings out the cognitive structure of archaeological constructs, which establishes a bridge between empirical facts or descriptive propositions, at one end of the argumentation, and interpretative propositions at the other. This alternative form of publication is designed to highlight the chain of inference and the evidence on which it stands. In the case of the logicist publication of the archaeological excavation in Rigny (Indre-et-Loire, France), our workflow can provide different levels of access to the content, allowing both speed-reading and in-depth consultation. Both the chains of inference and the ArSol database containing the field records that provide evidence for the initial propositions are visualized in a diagram structure. We rely on the International Committee for Documentation Conceptual Reference Model (CIDOC CRM) entities for ensuring the semantic interoperability of such publications within the Linked Open Data. Inference chains are mapped to CRMinf and ArSol records are mapped to CRM, CRMSci and CRMArcheo. Moreover, as part of the work carried out by the French Huma-Num MASA Consortium, a project is underway to allow the building of logicist publications starting from a graphical interface for describing the structure and content of propositions.

Abstract Introduction: Maintenance and/or improvements in health-related quality of life (HRQoL) are important in patients with chronic lymphocytic leukemia (CLL). GIBB (NCT02320487) is an ongoing, open-label, single-arm Phase II study of the combination of obinutuzumab (GA101; G) and bendamustine (B) (BG) in patients with previously untreated CLL. A previous report from the GIBB study demonstrated an investigator-assessed objective response rate of 89.2%, a complete response rate of 49.0%, and no unexpected safety signals with BG (Sharman et al. ASCO 2017). Here, we present the HRQoL data from GIBB. Methods: In the GIBB trial, patients received BG by intravenous infusion over six 28-day cycles: obinutuzumab 100mg on Day (D)1, 900mg on D2, and 1000mg on D8 and D15 of Cycle 1, then 1000mg on D1 of Cycles 2-6; B 90mg/m2 on D2-3 of Cycle 1, and on D1-2 of Cycles 2-6. The European Organisation for Research and Treatment of Cancer Quality of Life - Core (EORTC QLQ-C30) questionnaire includes a global health status measure, 5 functional scales (physical, emotional, cognitive, social, and role functioning), 8 symptom scales/items (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, and diarrhea), and an item on financial difficulties (Aaronson et al. J Natl Cancer Inst 1993). The EORTC Quality of Life Questionnaire-Chronic Lymphocytic Leukemia 16 (QLQ-CLL16) is a 16-item module, specific to CLL, containing 4 multi-item scales (fatigue, treatment side effects, disease symptoms, and infection) and 2 single items (social activities and future health worries; EORTC website, accessed July 25, 2017). Both questionnaires were completed by patients on D1 of Cycles 1 (baseline), 3, and 6, at the end of induction treatment (defined as +28 days from D1 of Cycle 6 or early treatment termination visit), at the response visit (defined as 2-3 months after the end of induction treatment, for all patients who received study treatment and had not experienced disease progression), and every 3 months thereafter at follow-up visits. HRQoL scores were linear transformed to a 0-100 point scale. Mean baseline scores and mean score changes at each visit were evaluated. A threshold of ≥10-point change in score represents a clinically meaningful difference. Results: Of 102 patients enrolled in the trial, 98 completed a questionnaire at baseline and at least one other questionnaire during a follow-up visit. Questionnaire completion rates were 86.7%, 77.6%, 80.6%, and 86.7% at Cycles 3, 6, at the end of induction treatment, and at the response visit, respectively. Median age was 61 years and 68.4% of patients were male. According to the EORTC QLQ-C30 (Figure 1), clinically meaningful improvements were observed for global health status at the response visit, and for role functioning at the end of induction treatment and at the response visit. A trend was observed for improvement in emotional functioning. The greatest improvement in HRQoL score was observed for fatigue (mean baseline score: 37.64), with mean changes from baseline of −4.01, −5.48, −11.67, and −16.34 at Cycles 3, 6, at the end of induction treatment, and at the response visit, respectively. Improvements were also observed for insomnia (mean baseline score: 33.33), with mean changes from baseline of −6.59, −9.09, −9.7, and −10.98, respectively. There was no worsening in other patient-reported symptoms or functional status over time. Similarly, with the EORTC QLQ-CLL16 (Figure 2), clinically meaningful improvements in symptoms were observed for fatigue, disease symptoms, and future health worries during treatment, at the end of induction treatment and/or at the response visit. The greatest change at the response visit was observed for fatigue (−21.23) and future health worries (−20.24). A positive trend was also observed for improvements in the social activities scale. Conclusions: We previously reported that BG is an effective regimen for first-line treatment of CLL with no unexpected safety signals. In addition, the HRQoL data from the GIBB trial suggest that BG treatment improves patient HRQoL. Several clinically meaningful improvements were observed in HRQoL, including global health status, functioning, symptoms, and future health worries at the time of the response visit. Disclosures Sharman: Acerta: Consultancy, Research Funding; TG Therapeutics: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Gilead: Consultancy, Research Funding; Genentech: Consultancy, Honoraria, Other: GIBB is sponsored by Genentech Inc. Third-party editorial support, under the direction of Anthony Masaquel, was provided by Lynda McEvoy of Gardiner-Caldwell Communications, and was funded by F. Hoffmann-La Roche Ltd, Research Funding; Celgene: Consultancy, Honoraria, Research Funding. Yimer: Juno pharma: Equity Ownership; Bellucum Pharma: Equity Ownership. Babu: Alexion: Speakers Bureau; Abbvie: Consultancy. Li: Genentech: Employment, Equity Ownership. Mun: Genentech: Employment, Equity Ownership. Trask: Genentech: Employment, Other: stock. Masaquel: Genentech Inc.: Employment, Other: I Receive Roche stock options. Reyes: Genentech Inc.: Employment, Equity Ownership.

Background: The incidence of thyroid cancer is increasing worldwide at an alarming rate. BRAFV600E mutation is described to be associated with a worse prognostic of thyroid carcinomas, as well as extrathyroidal invasion and increased mortality. Objective: To our knowledge, there are no reported studies neither from Morocco nor from other Maghreb countries re- garding the prevalence of BRAFV600E mutation in thyroid carcinomas. Here we aim to evaluate the frequency of BRAFV600E oncogene in Moroccan thyroid carcinomas. Methods: In this Single-Institution retrospective study realized in the Anatomic Pathology and Histology Service in the Mil- itary Hospital of Instruction Mohammed V ‘HMIMV’ in Rabat, we report, using direct genomic sequencing, the assessment of BRAFV600E in 37 thyroid tumors. Results: We detected BRAFV600E mutation exclusively in Papillary Thyroid Carcinomas ‘PTC’ with a prevalence of 28% (8 PTC out 29 PTC). Like international trends, Papillary Thyroid Carcinomas ’PTC’ is more frequent than Follicular Thyroid Carcinomas ‘FTC’ and Anaplastic Thyroid Carcinomas ‘ATC’ (29 PTC, 7 FTC and 1 ATC). Conclusion: Our finding gives to the international community the first estimated incidence of this oncogene in Morocco showing that this prevalence falls within the range of international trends (30% to 90%) reported in distinct worldwide ge- ographic regions. Keywords: Biomarker; BRAFV600E; Thyroid cancer; Morocco.

The gray wolf (Canis lupus) was extirpated from Yellowstone National Park by U.S. Government personnel during 1914-1926. Since then, occasional reports of wolves in Yellowstone National Park have been recorded (Weaver 1978), but no recent records exist of wolves breeding in the park. In recent years, public attitudes towards predators have changed such that predators are more commonly viewed as an integral component of natural ecosystems (see e.g., Mech 1970, Despain et al. 1986, Dunlap 1988). An increasing proportion of the American public desires that wolves be reestablished in Yellowstone National Park (McNaught 1987, Bath 1991). ln 1987, the U.S. Fish and Wildlife Service approved a Recovery Plan for the Northern Rocky Mountain wolf (U.S. Fish & Wildlife Service 1987). Before proceeding with wolf recovery, however, Congress appropriated funds in 1988 and 1989 and directed that studies be conducted by the U.S. Fish and Wildlife Service and the National Park Service to determine the effects of wolf recovery on ungulate populations. Boyce (1990) developed a predator-prey model for ungulate populations in Yellowstone National Park as a part of this Congressional charge to determine the probable outcome of wolf recovery. Our purpose is to expand upon the simulation model of Boyce (1990) to predict the probable consequences of wolf reintroduction in Yellowstone National Park to ungulate populations in Jackson Hole and along the North Fork of the Shoshone River. As in the previous model, this model allows the user to choose among several likely management scenarios. By manipulating alternatives, the user of the model can explore the consequences of management actions. In particular, it is essential to be able to anticipate if wolves will be culled if they leave the parks, if poaching can be controlled within the park, and if hunting for bison and elk will continue in the Yellowstone River valley north of Gardiner, Montana. Any such model must incorporate the natural variability in the environment, because the vagaries of climate can have enormous effects on ecological processes. Therefore, the model is a stochastic one, i.e., it contains random variation in climatic variables. Such stochastic model structure is important because it helps to educate the user that it is impossible to predict precisely the consequences of wolf recovery. It is not the purpose of this effort to offer recommendations for whether wolf recovery should take place, but rather to provide resource managers with an additional tool which will assist them in making that decision.

Abstract Background: Epigenetic manipulation and immunomodulation are therapeutic strategies in hematologic malignancies. In our previous study, the combination of romidepsin and lenalidomide showed a 51% overall response rate (ORR), 23% complete response (CR) rate in patients with relapsed/ refractory B-cell (BCL) and T-cell (TCL) lymphoma. Given the potential synergy of proteasome inhibitors with histone deacetylase inhibitors and lenalidomide, we conducted a phase Ib/IIa study evaluating the safety and toxicity of romidepsin and lenalidomide with carfilzomib in patients with relapsed/refractory lymphoma. Here we report the completed phase II results. Methods: Romidepsin and carfilzomib were given IV on days 1, 8 and lenalidomide was given orally on days 1-14 of a 21-day cycle. A standard 3+3 dose escalation was followed: The starting dose was romidepsin 8 mg/m2,lenalidomide 15 mg, carfilzomib 36mg/m2. Tumor response was based on disease-specific criteria.Patients could be treated until progression, intolerance, or response adequate to allow allogeneic transplantation. Results: 24 of the 27 patients treated as part of the study were evaluable for determination of the maximum tolerated dose. Additionally, one was evaluable for efficacy and 2 were evaluable for toxicity only. 16 patients were treated for TCL: PTCL-NOS-7, AITL-5, MF-2, transformed MF-1, extra-nodal NK/T-cell lymphoma-1. 11 patients were treated for BCL: DLBCL (7) mantle cell lymphoma (MCL) (2), follicular lymphoma (FL) (2). Of note, one of the aforementioned AITL patients had concurrent DLBCL and was evaluated for efficacy in both B-cell and T-cell cohorts. Dose level 2 (romidepsin 8 mg/m2,lenalidomide 15 mg, carfilzomib 45mg/m2) exceeded the MTD with 2/6 DLTs: 1 grade 3 thrombocytopenia resulting in treatment delay and 1 grade 4 thrombocytopenia. There were no DLTs among 6 patients treated in dose level 1 (romidepsin 8 mg/m2,lenalidomide 15 mg, carfilzomib 36mg/m2) and dose level 1 was deemed the MTD. Overall, grade 3-4 toxicities in >10% patients included neutropenia and thrombocytopenia. 16 treatment related serious adverse events were seen in 9 patients and included: anemia-1, vomiting/diarrhea-1, dyspenea-1, edema-1, febrile neutropenia-1, fever-2, generalized weakness-1, heart failure-1, hypotension-1, infection-2, gastrointestinal bleed-1, and DVT-1. Of the 11 TCL evaluable for response at the MTD, ORR was 45.5% (5/11, 95% CI: 23.4 to 83.3%). The complete response (CR) rate was 36.4% (4/11, 95% CI: 10.9 to 69.2%) and the partial response (PR) rate was 9% (1/11, 95% CI: 2.3 to 51.8%). The median event free survival (EFS) for patients with TCL was 13.6 w (95% CI: 5.7-74.6). Among all patients with TCL (N=16), the ORR was 50% (8/16). CRs were seen in 4/5 AITL and 1/7 PTCL-NOS; PRs were seen in PTCL-NOS-1, AITL-1, and transformed MF-1. Of the 8 BCL evaluable for response at MTD, the ORR was 50% (4/8, 95% CI: 0-41%) with 3 PRs and 1 CR. The median EFS for patients with BCL was 19.8 w (95% CI: 5.4-NR). Among all patients with BCL evaluable for response (n=10), PRs were seen in 4 patients with DLBCL and 1 patient with MCL. One patient with concurrent DLBCL and AITL achieved a CR. The median EFS for all patients treated at the MTD was 14.5 w (95% CI: 5.7 to NR). The median time to best response was 5.7 w. The median duration of response was 38.7 w (95% CI: 9.7 to NR). 3 patients with TCL and 1 with MCL underwent allogeneic transplantation following response to this therapy and were censored at time of transplant. Sustained complete responses were seen in 2 additional patients with TCL: one remained in CR for 11.7 months and another remains on treatment at 17 months. The median duration of follow up was 56.0 w (range 2.4 to 102.1 w). Conclusions: The MTD dose for phase 2 study was identified as romidepsin 8mg/m2, lenalidomide 15mg and carfilzomib 36mg/m2. No unexpected toxicities have emerged. At this dose, the overall response rate for BCL and TCL was 50%. Responses were seen across various BCL and TCL histologies. In particular, in AITL, the regimen has shown responses in all 5 patients. Given the promising overall and complete response rates, the regimen warrants further study. Disclosures Mehta-Shah: Celgene: Research Funding; Verastem: Research Funding; Bristol Myers-Squibb: Research Funding. Moskowitz: Bristol Myers-Squibb: Consultancy, Research Funding; Seattle Genetics: Honoraria, Research Funding; Takeda: Honoraria; ADC Therapeutics: Research Funding; Incyte: Research Funding. Lunning: Onyx: Consultancy; Pharmacyclics: Consultancy; Spectrum: Consultancy; Celgene: Consultancy; TG Therapeutics: Consultancy; Juno: Consultancy; Genentech: Consultancy; Gilead: Consultancy; BMS: Consultancy; AbbVie: Consultancy; Epizyme: Consultancy. Kumar: Celgene: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Research Funding. Gerecitano: Genentech: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Aratana: Consultancy, Membership on an entity's Board of Directors or advisory committees; Mass Medical International: Honoraria, Membership on an entity's Board of Directors or advisory committees; Orexo: Honoraria, Membership on an entity's Board of Directors or advisory committees; Samus Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Honoraria, Membership on an entity's Board of Directors or advisory committees; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees; Royal Bank of Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bayer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Arcus Medica: Consultancy, Membership on an entity's Board of Directors or advisory committees. Zelenetz: Amgen: Consultancy; Celgene: Consultancy. Hamlin: Gilead: Consultancy, Honoraria; Portola: Consultancy, Honoraria, Other: research support; Incyte: Other: research support; Celgene: Consultancy, Honoraria; Seattle Geneitcs: Other: research support; Novartis: Other: research support. Noy: Pharmacyclics LLC, an AbbVie Company: Honoraria, Other: Travel, Accommodation, Expenses, Research Funding, Speakers Bureau. Younes: Bristol-Myers Squibb: Honoraria; Celgene: Honoraria; Bayer: Honoraria; Johnson & Johnson: Research Funding; Novartis: Research Funding; Incyte: Honoraria; Roche: Consultancy, Honoraria, Other: Third-party medical writing assistance, under the direction of Anas Younes, was provided by Scott Malkin of Gardiner-Caldwell Communications, and was funded by F. Hoffmann-La Roche Ltd.; Curis: Research Funding; Takeda Millenium: Honoraria; Seattle Genetics: Honoraria; Sanofi: Honoraria; Merck: Honoraria; Janssen: Honoraria. Dogan: Roche Pharmaceuticals: Consultancy; Peer Review Institute: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy; Seattle Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees. Horwitz: Mundipharma: Consultancy; Aileron Therapeutics: Research Funding; BMS: Consultancy; HUYA: Consultancy; Infinity/Verastem: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Kyowa-Hakka-Kirin: Consultancy, Research Funding; Millenium/Takeda: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; ADCT Therapeutics: Research Funding; Forty-Seven: Consultancy, Research Funding.

We consider the potential of the Russian landowners’ estates patrimonial records management as a historical source for the features characteristic of the landlord economy development after the serfdom abolition. We study the fate of patrimonial archives of Russia in the comparative aspect with the history of other countries, mechanisms of values nationalization from the largest Tambov estates, its consequences for documentary collections. An important element of the work was the consideration of historiographical aspects of the work with the private estates document circulation. Consideration of the positions of A.M. Anfimov, L.P. Kovalenko, L.P. Minarik re-garding authentic qualities of patrimonial records management allows to identify the advantages and disadvantages of using patrimonial documents in historical research. Specific characteristics of landlords’ records management are considered on the material of a separate Fund of the Novo-Pokrovsky estate in the Tambov Governorate (State archive of the Tambov Region). The Fund combines 1309 units, reflecting the history of the estate from the time of its purchase in 1895 until the liquidation of the estate in 1918. A variety of records management documentation shows the development and complexity of administrative control of a certain manor. The structure of the archive includes orders, circulars and instructions of the Main office to the manager, administrative orders of the chief manager to the heads of individual districts, cases of purchase by count A.V. Orlov-Davydov of other estates in the Tambov Governorate, books of summary budgets of savings, annual reports, abstracts of incoming papers, summary production statistics on individual holdings, credit data. These materials are reliable sources for studying the economic consequences of modernization of large landlords’ economy.

Abstract Introduction Despite recent efforts to standardize the definition of 'new bleeds' in hemophilia A clinical trials, most notably by Blanchette et al. (J Thromb Haemost 2014), cross-study comparisons of these endpoints are still compromised by different bleed definitions, analysis methodologies and data collection approaches. The emicizumab clinical development program included an observational, non-interventional study (NIS; NCT02476942), in which a bleed and medication questionnaire (BMQ) was used to prospectively collect data on treatment with standard-of-care with factor VIII (FVIII) or bypassing agents (BPA) in adult and adolescent people with hemophilia A (PwHA) with and without inhibitors to FVIII. The study design allowed for an examination of the differences between treated and untreated bleeds, as well as any differences in their incidence between the inhibitor and non-inhibitor populations. Participation in the study was not expected to affect the number of treated and untreated bleeds. Methods The NIS was a global prospective study designed to collect real-world data on PwHA with or without inhibitors treated with current standard-of-care therapy according to routine clinical practice. Eligible participants from the NIS subsequently could enroll in a Phase III trial of emicizumab. Adult and adolescent participants (aged ≥12 years) were prompted to complete the BMQ daily. The BMQ was developed by the sponsor to enable data collection directly by patients. In addition to treatments administered, the BMQ allowed the patient to enter all the bleeds the patient experienced, irrespective of whether they were treated or not. For the purpose of the analysis of primary and secondary endpoints, a bleed was derived from the data using the definitions outlined by Blanchette et al. (J Thromb Haemost 2014) and Oldenburg et al. (N Engl J Med 2017). The efficacy endpoints included treated bleeds, all bleeds, spontaneous bleeds, joint bleeds and target joint bleeds. Results In the inhibitor and non-inhibitor cohorts, 103 and 94 patients were enrolled, with a median efficacy period of 25.4 and 27.7 weeks, respectively. NIS data for treated and untreated bleeds, including bleed types and bleed causes, are displayed in Table 1. Of all bleeds reported in the study, 625 (40.0%) were untreated in patients with inhibitors, and 160 (13.5%) were untreated in patients without inhibitors. Conclusions The NIS was the first study to report large numbers of untreated bleeds in PwHA, particularly in those with inhibitors, where approximately 40% of all bleeds were untreated (Mahlangu et al. ASH 2016; Kruse-Jarres et al. EAHAD 2018). The design of the BMQ allowed participants to capture bleeds and bleed treatment independently and enabled granular information on untreated and treated bleeds to be derived, as opposed to only bleeds where a treatment was administered, as had previously been captured in the majority of clinical studies (Keipert et al. ISTH 2018; Clausen et al. Haemophilia 2014). The reason for the large difference in the proportion of untreated bleeds in the inhibitor population versus the non-inhibitor population is unknown and warrants further investigation, but may be at least partially due to higher confidence in the efficacy of FVIII, less treatment burden, and better drug availability compared with BPAs; this may therefore influence the patient's decision on whether or not to treat. The NIS showed that further efforts to harmonize bleed definitions, analyses methodology and data collection in hemophilia A clinical trials are warranted in order to provide transparency on treated and untreated bleeds, as the latter might have been under-reported in clinical studies to date. Capturing untreated bleeds in future trials could provide useful insights to physicians as, while the long-term sequelae of untreated bleeds are as yet unknown, they are expected to be, at the very least, distressing for patients. Acknowledgments: Editorial assistance under the direction of the authors was provided by Maria Alfaradhi, PhD, of Gardiner-Caldwell Communications, and was funded by F. Hoffmann-La Roche Ltd. Disclosures Callaghan: Sancilio Pharmaceuticals Company: Employment; Hema Pharmaceuticals: Honoraria; Alnylam Pharmaceuticals: Equity Ownership; Amgen: Employment; Roche/Genentech: Employment, Honoraria, Membership on an entity's Board of Directors or advisory committees; Global Blood Therepeutics: Employment; Novo Nordisk: Employment, Membership on an entity's Board of Directors or advisory committees; Pfizer: Employment, Honoraria, Research Funding; Bioverativ: Honoraria; Octapharma: Honoraria; Shire: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Grifols: Honoraria; Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees. Asikanius:Roche: Employment, Equity Ownership. Lehle:F. Hoffmann-La Roche: Employment. Oldenburg:Biotest: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Biogen Idec: Honoraria, Membership on an entity's Board of Directors or advisory committees; Chugai: Honoraria, Membership on an entity's Board of Directors or advisory committees; Grifols: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Swedish Orphan Biovitrum: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; CSL Behring: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Octapharma: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Shire: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Mahlangu:Novo Nordisk: Honoraria, Research Funding; Pfizer: Research Funding; Spark: Honoraria; Bayer: Research Funding; Roche: Honoraria, Research Funding; Chugai: Honoraria; CSL Berhing: Honoraria; Alnylam: Research Funding; Shire: Honoraria; CLS: Research Funding. Uguen:F.Hoffmann-LaRoche: Employment. Chebon:F. Hoffmann-La Roche: Employment. Kruse-Jarres:Roche/Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; CSL Behring: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Grifols: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Consultancy, Membership on an entity's Board of Directors or advisory committees. Jimenez-Yuste:Grifols: Consultancy, Research Funding; Octapharma: Consultancy, Research Funding; NovoNordisk: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Sobi: Consultancy, Research Funding; Shire: Consultancy, Research Funding; Roche: Consultancy, Research Funding; Bayer: Consultancy, Research Funding; CSL Behring: Consultancy. Shima:F. Hoffmann-La Roche Ltd: Membership on an entity's Board of Directors or advisory committees; Chugai Pharmaceutical Co., Ltd: Consultancy, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties: Anti-FIXa/X bispecific antibodies , Research Funding, Speakers Bureau. Trask:Roche: Employment, Equity Ownership. Kessler:Genentech: Research Funding; Sangamo: Research Funding; Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Biomarin: Research Funding; Dimension Advisory boards: Membership on an entity's Board of Directors or advisory committees; Octapharma: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Honoraria, Research Funding; DSMB: Membership on an entity's Board of Directors or advisory committees. Levy:Roche: Employment, Equity Ownership. Santagostino:Shire: Membership on an entity's Board of Directors or advisory committees; Octapharma: Membership on an entity's Board of Directors or advisory committees; Grifols: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Kedrion: Membership on an entity's Board of Directors or advisory committees; Sobi: Membership on an entity's Board of Directors or advisory committees; Bioverativ: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees.

Introduction: For patients (pts) with relapsed indolent non-Hodgkin lymphoma (iNHL) who develop resistance to rituximab, treatment options are limited and the prognosis is poor. The open-label, randomized, Phase III GADOLIN (NCT01059630) study compared the efficacy and safety of obinutuzumab (GA101; G) plus bendamustine (B) induction, followed by G maintenance (G-B arm), with B induction (B arm; standard of care) in rituximab-refractory iNHL. The primary analysis in 396 pts (data cutoff: September 1, 2014; median observation time, 21.0 months) showed that Independent Review Committee (IRC)-assessed progression-free survival (PFS; primary endpoint) was significantly longer with G-B (median not reached [NR]) vs B (14.9 months), corresponding to a 45% reduction in risk of progression or death (hazard ratio [HR], 0.55; 95% confidence interval [CI]: 0.40, 0.74; p=0.0001; Sehn et al. Lancet Oncol 2016). The safety profile of G-B was manageable. Here, we report the final analysis of efficacy and safety for GADOLIN (when safety follow-up for all pts had been completed [2 years' safety follow-up from last dose]; data cutoff: November 30, 2018). Methods: Enrolled pts were aged ≥18 years with documented rituximab-refractory iNHL and an ECOG performance status of 0-2. Pts received either G 1000mg intravenously (i.v.) (Days [D] 1, 8, and 15 of Cycle [C] 1, and D1 of C2-6) plus B 90mg/m2/day i.v. (D1 and 2 of C1-6) or B monotherapy (120mg/m2/day i.v., D1 and 2 of C1-6) in 28-day cycles. Following induction, pts in the G-B arm without evidence of progression received G maintenance (1000mg i.v. every 2 months for 2 years or until disease progression). Final analysis endpoints included investigator (INV)-assessed PFS, overall survival (OS), time to new anti-lymphoma treatment (TTNT), and safety. The safety population included pts who received ≥1 dose of study treatment, excluding two pts crossing over to G-B during maintenance. Results: Of 413 iNHL pts in the ITT population (G-B, 204; B, 209), 335 (G-B, 164; B, 171) had follicular lymphoma (FL). Median (range) observation time was 57.5 (0.4-97.6) months for the G-B arm and 47.9 (0-100.9) months for the B arm (i.e. 27.6 and 35.6 months additional follow-up since the primary analysis). Median INV-assessed PFS was 25.8 months for the G-B arm vs 14.1 months for the B arm (HR, 0.57; 95% CI: 0.45, 0.73; p<0.0001) in all iNHL pts (Figure 1A). Overall, fewer iNHL pts died in the G-B (84/204; 41.2%) than in the B (100/203; 49.3%) arm; median OS was 88.3 vs 65.6 months (HR, 0.77; 95% CI: 0.57, 1.03; p=0.0810; 23% risk reduction [Figure 1A]). Median TTNT was also longer with G-B vs B (38.2 vs 18.9 months, respectively [HR, 0.60; 95% CI: 0.47, 0.76]). Results for FL pts were as follows: median PFS, 24.1 vs 13.7 months (HR, 0.51; 95% CI: 0.39, 0.67; p<0.0001 [Figure 1B]); median OS, NR vs 60.3 months (HR, 0.71; 95% CI: 0.51, 0.98; p=0.0343); median TTNT, 33.6 vs 18.0 months (HR, 0.56; 95% CI: 0.43, 0.73). In the safety population (N=407; G-B, 204; B, 203), 149/204 (73.0%) of pts in the G-B arm and 134/203 (66.0%) in the B arm experienced grade ≥3 adverse events (AEs). Compared with B, grade ≥3 neutropenia (37.3% vs 30.0%) and grade ≥3 infusion-related reactions (11.3% vs 5.4%) were more frequent with G-B, and grade ≥3 thrombocytopenia (10.8% vs 15.8%) and anemia (7.4% vs 10.8%) were less frequent. The incidences of grade ≥3 infections (22.5% vs 19.2%) and grade ≥3 second malignancies (7.8% vs 5.9%) were similar between arms. The proportion of pts with serious AEs was 91/204 (44.6%) in the G-B arm and 76/203 (37.4%) in the B arm; fatal AEs were reported in 20/204 (9.8%) and 15/203 (7.4%) of pts, respectively. The most frequent AEs leading to death in the G-B vs B arms were infections (six vs seven pts, respectively) and second malignancies (eight vs four pts, respectively). Safety results in FL pts were comparable with all iNHL pts. Conclusions: Final analysis of the GADOLIN study showed that G-B was associated with a 43% reduction in the risk of progression or death compared with B in pts with rituximab-refractory iNHL and a 49% reduction in pts with FL, with a sustained and clinically relevant OS benefit in pts with FL. There were no new safety signals with longer follow-up. Acknowledgments: The GADOLIN study was sponsored by F. Hoffmann-La Roche Ltd. Third party medical writing assistance, under the direction of Laurie Sehn, was provided by Louise Profit of Gardiner-Caldwell Communications and was funded by F. Hoffmann-La Roche Ltd. Disclosures Sehn: TEVA Pharmaceuticals Industries: Consultancy, Honoraria; Lundbeck: Consultancy, Honoraria; Astra Zeneca: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Lundbeck: Consultancy, Honoraria; TEVA Pharmaceuticals Industries: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Apobiologix: Consultancy, Honoraria; F. Hoffmann-La Roche/Genentech: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy, Honoraria; Acerta: Consultancy, Honoraria; Verastem: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria; Acerta: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Kite Pharma: Consultancy, Honoraria; Janssen-Ortho: Consultancy, Honoraria; Janssen-Ortho: Honoraria; Celgene: Consultancy, Honoraria; Karyopharm: Consultancy, Honoraria; TG Therapeutics: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Merck: Consultancy, Honoraria; TG Therapeutics: Consultancy, Honoraria; F. Hoffmann-La Roche/Genentech: Consultancy, Honoraria, Research Funding; Astra Zeneca: Consultancy, Honoraria; Kite Pharma: Consultancy, Honoraria; Merck: Consultancy, Honoraria. Trněný:Takeda: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria; Celgene: Consultancy; Gilead Sciences: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; MorphoSys: Consultancy, Honoraria; Incyte: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; F. Hoffmann-La Roche: Consultancy, Honoraria. Bouabdallah:Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Dueck:Amgen: Consultancy; Celgene: Consultancy; Janssen: Consultancy; Roche: Research Funding. Gribben:Abbvie: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Acerta/Astra Zeneca: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding. Lugtenburg:Celgene: Honoraria; Janssen-Cilag: Honoraria; Servier: Honoraria, Research Funding; Takeda: Honoraria, Research Funding; Roche: Honoraria, Research Funding, Speakers Bureau; Genmab: Honoraria. Salles:Epizyme: Consultancy, Honoraria; BMS: Honoraria; Roche, Janssen, Gilead, Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis, Servier, AbbVie, Karyopharm, Kite, MorphoSys: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Autolus: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Other: Educational events; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events. Knapp:F. Hoffmann-La Roche Ltd: Employment. Nielsen:F. Hoffmann-La Roche Ltd: Employment, Equity Ownership. Liu:Roche Pharma Development, Shanghai, China: Employment. Cheson:Seattle Genetics: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Trillium: Research Funding; TG Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Symbios: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol Myers Squibb: Research Funding; Portola: Research Funding; Kite: Research Funding; Gilead: Research Funding; Epizyme: Research Funding; Morphosys: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; Acerta: Consultancy, Research Funding.

Abstract We have recently reported the superiority of prolonged ambulatory versus short intensive post-remission therapy in 416 patients with AML aged 65 years or more (median age, 72 years) selected to be treated intensively in the ALFA-9803 trial (C. Gardin et al. Blood 2007). We report here on the prognostic value of cytogenetic abnormalities in 339 of these patients with available karyotype (27 not done, 50 failures). When classical endpoints (CR rate, DFS, OS) were used, we were only able to identify one very unfavorable subgroup of 14% patients (N=49 with −7, abnormalities of both chromosomes 5 and 7, 3q abnormality, or complex karyotype with 5 abnormalities or more; CR rate, 30%). No significant differences in outcome were found between patients with any other abnormality and the 171 patients with a normal karyotype/−Y (overall CR rate, 62%). When cumulative incidences of AML-related events (primary refractory AML, relapses) were used as endpoints with induction deaths and deaths in first CR as competing events, three distinct subsets were more easily identified: 14% very unfavorable-risk patients, as detailed above; 59% standard-risk patients (N=200 with t(8;21), inv(16), normal karyotype/−Y, or isolated +8; CR rate, 65%); and 27% unfavorable-risk patients (N=90 with other abnormalities, including notably 5q− and 7q−; CR rate, 58%). Median failure-free interval (Fig 1; P<.001, by the Gray test) and relapse-free interval (Fig 2; P<.001, by the Gray test) were 2.3, 12.4, and 8.1 months and 4.2, 15.0, and 10.5 months in these three subsets, respectively. Interestingly, prolonged ambulatory post-remission therapy was associated with longer DFS and OS in the standard-risk subset only. The results demonstrate that despite their poor general outcome, older patients with AML may be subdivided in three meaningful cytogenetic subgroups. This 3-subgroup classification should help to optimize disease management decisions such as intensive versus non-intensive or investigational therapies for induction or consolidation. 1. Failure-free interval 1. Failure-free interval 2. Relapse-free interval 2. Relapse-free interval

Background:There are several reports that cytomegalovirus (CMV) reactivation resulted in more co-infections affecting survival in rheumatic disease, and CMV reactivation can lead to infections in granulomatosis with polyangiitis patients by inducing CD4+CD28- T cell and depressing naïve T cell populations.1-4Despite this evidence, the prognostic value of CMV reactivation for severe infections in patients with connective tissue disease are still unknown.Objectives:The aim of this study was to examine prognostic factors for severe infection during the early phase of treatment, especially in CMV reactivation, in patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) who received initial high dose corticosteroid therapy (prednisolone > 0.8mg/kg/day).Methods:We analyzed the data of 88 consecutive hospitalized patients newly diagnosed with AAV at our hospital from January 2006 to March 2019 in this retrospective cohort study. There were 32 patients with CMV reactivation during remission induction therapy compared to 56 patients without CMV reactivation. CMV reactivation was defined by the detection of CMV pp65 antigen in blood samples, and CMV positive cells ≥ 5 per 3.0 × 105polymorphonuclear neutrophils (PMNs). The variable for severe infections within 180 days with apvalue < 0.1 in univariate analysis were selected for multivariate analysis using the Cox regression model. The positive predictive value (PPV) and positive likelihood ratio (PLR) of CMV reactivation for subsequent severe infections were also analyzed.Results:Patients with CMV reactivation, compared to those without, had a higher prevalence of MPO-ANCA, renal manifestation and renal impairment at diagnosis, received hemodialysis (HD), higher revised five factor score (FFS), older age, higher Birmingham Vasculitis Activity Score at diagnosis, and higher initial doses of corticosteroids (CS) at baseline. Revised FFS ≥ 2, renal involvement, high initial serum creatinine (≥ 1.5 mg/dl) at diagnosis, received HD, and CMV reactivation were associated with severe infections in the univariate analysis, although receiving cyclophosphamide or rituximab was not. Among these variables, CMV reactivation (Hazard ratio [HR] 3.50; 95% confidence interval [CI]: 1.22-10.10;p= 0.02) and high initial serum creatinine at diagnosis (HR 8.09; 95%CI: 2.00-32.73;p< 0.01) were independent risk factors for severe infections within 180 days. (Table 1) The PPV and PLR of CMV reactivation for subsequent severe infections were 35% and 1.91. When including higher initial serum creatinine, PPV and PLR for subsequent severe infections was 67% and 7.26.Table 1.Cox regression analysis for severe infections within 180 days.Univariate analysisMultivariate analysisPotential prognostic factorsHR (95% CI)P valueHR (95% CI)P valueAge ≥ 651.36 (0.48-3.71)0.580Male1.23 (0.50-3.04)0.648Past history of lung disease0.39 (0.11-1.36)0.140Past history of diabetes mellitus0.64 (0.15-2.77)0.550Lung involvement1.76 (0.67-4.62)0.254Renal involvement†3.68 (1.22-11.10)0.021Serum Cr ≥ 1.5 at diagnosis9.50 (3.40-26.49)< 0.0018.09 (2.00-32.73)0.003Hemodialysis4.85 (1.73-13.54)0.0030.96 (0.31-2.97)0.950BVAS ≥ 201.50 (0.59-3.81)0.393Revised FFS ≥ 24.40 (1.28-15.13)0.0180.83 (0.16-4.27)0.818MPSL pulse therapy1.16 (0.47-2.86)0.746Received CYC or RTX1.54 (0.55-4.27)0.409CMV reactivation5.10 (1.93-13.48)0.0013.50 (1.22-10.06)0.020† “Renal involvement” was excluded in the multivariate analysis to avoid multicollinearity.Conclusion:Our study shows that there should be focus on subsequent severe infections when CMV reactivation is detected during early phase of treatment, especially in renal-impaired patients with ANCA-associated vasculitis.References:[1]Gardiner BJ et al. Rheumatol Int. 2019;39:1229-40[2]Hung M et al. J Microbiol Immunol Infect. 2019;52:114-21.[3]Hanaoka R et al. Mod Rheumatol. 2012;22:438-45.[4]Morgan MD et al. Arthritis Rheum. 2011;63:2127-37.Disclosure of Interests:Daisuke Waki Speakers bureau: Mitsubishi Tanabe Pharma, AbbVie Inc, eisai Co,. Ltd, ONO PHARMACEUTICAL CO., LTD,, Keisuke Nishimura Speakers bureau: Mitsubishi Tanabe Pharma Corporation. Pfizer Inc. Kyowa Kirin Co., Ltd. Chugai Pharmaceutical Co., Ltd. ONO PHARMACEUTICAL CO., LTD. Japan Blood Products Organization. Kissei Pharmaceutical Co., Ltd. Astellas Pharma Inc. AYUMI Pharmaceutical Corporation. Eisai Co., Ltd. DAIICHI SANKYO COMPANY. Norvartis AG. Bayer AG. Sanofi K.K., Tomohiro Yoshida: None declared, Keiichiro Kadoba: None declared, Nozomi Tanaka: None declared, Hiroyuki Murabe: None declared, Toshihiko Yokota: None declared

Abstract Introduction: The phase 2 CheckMate 205 study (NCT02181738) of nivolumab (nivo) has demonstrated high objective response rates, durable efficacy, and acceptable safety profiles in patients (pts) with relapsed/refractory classical Hodgkin lymphoma (R/R cHL) after failure of autologous hematopoietic cell transplantation (auto-HCT) regardless of prior brentuximab vedotin (BV) treatment (Younes A et al. Lancet Oncol 2016; Fanale M et al. ICML 2017 [Oral 125]). Recently proposed new response criteria aim to account for atypical patterns of response with checkpoint inhibitors which may not be fully captured by conventional response criteria (Cheson BD et al. Blood 2016; Younes A et al, Ann Oncol 2017). Studies in solid tumors have shown that pts may continue to derive clinical benefits from nivo beyond disease progression as defined by conventional criteria (George S et al, JAMA Oncol 2016; Long GV et al, JAMA Oncol 2017). Here we report outcomes among pts with R/R cHL treated beyond progression (TBP) in CheckMate 205. Methods: This single-arm, multicenter study enrolled pts (age ≥18 y) with R/R cHL after failure of auto-HCT into 3 independent cohorts (A: BV naïve, B: BV after auto-HCT, C: BV before and/or after auto-HCT). Nivo 3 mg/kg IV every 2 wk was given until disease progression or unacceptable toxicity. Response was assessed by 2007 International Working Group criteria. Best overall response (BOR) was assessed per investigator. A protocol amendment in July 2014 allowed pts to be TBP (investigator-assessed) if they met prespecified criteria, including deriving clinical benefit, stable performance status, and non-rapid progression. Pts TBP were required to discontinue in the event of further progression (≥10% increase in tumor burden). Tumor burden after initial progression was assessed in a prespecified analysis. Exploratory analyses assessed overall survival (OS) and time to next therapy (TTNT) in pts TBP. Results: In total, 70/243 (29%) pts were TBP: 19 in Cohort A, 23 in B, and 28 in C. Demographics were similar to the overall study population: 57% had stage IV disease at study entry, median (range) age was 37 (18-72) y, and median number of prior therapies was 3 (2-5). BOR prior to progression was complete remission (CR) in 5 (7%) pts, partial remission (PR) in 31 (44%), stable disease (SD) in 20 (29%), and progressive disease in 13 (19%) (BOR was non-evaluable in 1 pt). Among pts TBP, the initial cause of progression was a ≥50% increase in total tumor burden in 13 (19%) pts, non-target lesion progression in 17 (24%), and new lesions in 47 (67%) (pts could have multiple findings as reasons for progression). The median time to initial progression in pts TBP was 6 mo; 11 mo in pts with initial BOR of CR and 7 mo in pts with initial PR or SD. At December 2016 database lock, median (range) doses of nivo beyond progression were 8 (1-43), and median duration of treatment beyond progression was 5 (0-19) mo. Overall, 21 (30%) pts TBP remained on treatment; the most common reason for discontinuation was further disease progression (80%). The majority of pts TBP demonstrated stable reductions in tumor burden with continued treatment. Median (95% CI) TTNT from first study dose of nivo was 17 (14, not estimable) mo (Figure). Median OS from date of initial progression was not reached in pts TBP and OS was 84% (95% CI 70, 92) at 1 y. Treatment-related adverse events (TRAEs) occurred in 46% of pts (13% grade [G] 3-4) after progression, vs 64% (9% G3-4) prior to progression. Serious TRAEs after progression were aspartate aminotransferase increase (n=1) and hypercalcemia (n=1), both G3-4. Ten deaths occurred in pts TBP; 7 were due to disease progression and none were considered related to study drug. Conclusions: In total, 29% of pts from CheckMate 205 Cohort A/B/C were TBP. New lesions were the most common reason for initial progression in pts TBP. Stable reductions in tumor burden were seen with continued treatment in pts TBP, and median TTNT and OS remained high. Proposed updates to response criteria may help to better assess the long-term efficacy of checkpoint inhibitors. These data suggest that pts considered to show stable performance status, non-rapid progression, and clinical benefits despite progression according to conventional response criteria may derive long-term benefits from continued nivo treatment. Study funding: BMS. Writing support: Simon Wigfield, Caudex, funded by BMS. Disclosures Cohen: Bioinvent: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takada: Research Funding; Bristol Myers Squibb: Research Funding; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Infinity: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; LAM Therapeutics, Inc: Research Funding. Engert: Amgen: Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Affimed: Consultancy, Honoraria, Research Funding. Ansell: Merck: Research Funding; Celldex: Research Funding; Seattle Genetics: Research Funding; Bristol-Myers Squibb: Research Funding; Affimed: Research Funding. Younes: Roche: Consultancy, Honoraria, Other: Third-party medical writing assistance, under the direction of Anas Younes, was provided by Scott Malkin of Gardiner-Caldwell Communications, and was funded by F. Hoffmann-La Roche Ltd.; Bayer: Honoraria; Bristol-Myers Squibb: Honoraria; Novartis: Research Funding; Janssen: Honoraria; Merck: Honoraria; Curis: Research Funding; Sanofi: Honoraria; Takeda Millenium: Honoraria; Johnson & Johnson: Research Funding; Seattle Genetics: Honoraria; Incyte: Honoraria; Celgene: Honoraria. Trneny: Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Savage: Roche: Research Funding; Seattle Genetics: Consultancy, Honoraria; Bristol-Myers Squibb: Honoraria; Merck: Honoraria; Celgene: Consultancy. Ramchandren: Seattle Genetics: Consultancy; Janssen: Research Funding; Merck: Research Funding; Pharmacyclics: Research Funding. Collins: ADC Therapeutics: Research Funding; Roche: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria; Celgene: Research Funding; Celleron: Consultancy; MSD: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Bristol-Myers Squibb: Research Funding; Amgen: Research Funding. Fanale: AMGEN: Membership on an entity's Board of Directors or advisory committees; CELGENE: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; TAKEDA: Honoraria, Research Funding; ONYX: Research Funding; SEATTLE GENETICS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; MOLECULAR TEMPLATES: Research Funding; MERCK: Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GENENTECH: Research Funding; ADC THERAPEUTICS: Research Funding. Armand: Bristol-Myers Squibb: Consultancy, Other: research funding (institutional); Merck: Consultancy, Other: research funding (institutional); Infinity: Consultancy; Pfizer: Consultancy, Other: research funding (institutional); Affimed: Other: research funding (institutional); Otsuka: Other: research funding (institutional); Sequenta: Other: research funding (institutional); Sigma Tau: Other: research funding (institutional); Roche: Other: research funding (institutional); Tensha: Other: research funding (institutional). Zinzani: Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Johnson & Johnson: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharm Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Verastem: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees. De Boer: Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; MSD: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees, Other: Non-restricted grant for research in head and neck cancer; Eisai: Membership on an entity's Board of Directors or advisory committees; Astellas: Other: member of Independent Data Monitoring Committee. Shipp: Cell Signaling: Honoraria; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Research Funding; Takeda: Other: Scientific Advisory Board; Merck: Other: Scientific Advisory Board; Gilead: Other: Scientific Advisory Board; AstraZeneca: Honoraria. Santoro: Merck: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees. Timmerman: Seattle Genetics: Consultancy; Celgene: Consultancy; Bristol-Myers Squibb: Consultancy, Honoraria, Other: Travel expenses, Research Funding; Genmab: Consultancy, Equity Ownership; Kite Pharma: Research Funding; ImmuneGene: Research Funding. Sacchi: Bristol-Myers Squibb: Employment. Sy: Bristol-Myers Squibb: Employment. Kuruvilla: BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Honoraria; Janssen: Consultancy; Hoffman LaRoche: Consultancy; Seattle Genetics: Consultancy, Honoraria; Amgen: Honoraria; Roche: Honoraria; Janssen: Honoraria; Lundbeck: Honoraria; Merck: Honoraria; Karyopharm: Research Funding; Roche: Research Funding; Celgene: Honoraria, Research Funding.

Background: Results of the phase III QUAZAR trial suggest that post-remission treatment with an oral form (CC-486) of azacitidine (AZA) can prolong CR duration and overall survival(OS) in AML patients reaching at least PR with intensive chemotherapy (IC) (Wei et al, ASH 2019). Maintenance treatment with subcutaneous (SC) AZA was recently shown to improve DFS in elderly AML (Huls et al, Blood 2019, a study that also included 10% MDS). We report very long term results of a study evaluating SC AZA as post-remission treatment in patients with AML post-MDS or high-risk MDS (HR-MDS) who achieved at least PR after IC, a population known to have short responses with IC. Methods: Inclusion criteria were (1) HR-MDS according to IPSS, or AML after a documented phase of MDS(2) who entered CR, CRi or PR after IC with anthracycline and AraC within 28 days of inclusion (3) ECOG &lt;= 2, absence of infection or organ toxicity from IC (4) no identified donor for allo SCT at inclusion. Dosing of SC AZA was 60mg/m2/d for 5 days every 28 days, with adjustments according to tolerance, and until relapse or toxicity. Results: From July 2006 to June 2009, 51 pts (M:31/F:20) were included. The 46 evaluable pts had achieved CR (n=28), CRi (n=11), and PR (n=7) before study entry. Median age was 66y (range 55-78). Diagnosis at IC onset was MDS (n=13) and AML (n=33), IPSS cytogenetics was normal (n= 28), intermediate (n=10), high (n= 6), and failed (n=2). Median time from diagnosis of MDS to IC was 8 months (range 0.5-101). Median number of AZA maintenance cycles was 7.5 (1-76) in CR pts (&gt;23 cycles in 5 of them) and 4.5 (1-24) in CRi or PR pts (&gt; 23 cycles in 1). Two patients were allografted and censored at allo SCT. Median follow-up was 16.5 months As of May 2020 (cut off date of analysis) median DFS and OS from response were 6.9 m and 16.9 m, respectively (figure). In CR patients, median and 18 months OS were 18.9 months and 58%, versus 12.8 months and 50% in CRi-PR patients (p=0.33) All non allografted patients eventually relapsed. 7 had a response duration &gt;18 months (6 CR patients: 22, 23, 25, 36, 40, and 84 months; 1 CRi patient: 24 months) OS from inclusion was &gt;3 years in 7 patients (CR pts: 150, 126,74, 51, 50,40 months; CRi pt:58 months), in addition to the 2 allografted pts who remained alive in CR at 156+ and 159+ months No baseline factor including cytogenetics, diagnosis at IC onset (MDS vs AML), % bone marrow blasts, age or time from MDS diagnosis to treatment, significantly predicted DFS or OS. AZA dosing in CR patients was escalated in 9 pts to 75mg/m2/d due to good tolerance but had to be reduced in 6 pts, due to GI toxicity (n=1) and cytopenias (n=5). During SC AZA maintenance, 2/28 CR pts developed febrile neutropenia, compared to 4/18 pts in CRi or PR (including 1 fatal case). In the 22 AML post MDS pts who reached CR, DFS and OS were similar to those observed in 46 AML post AML pts included in a previous ALFA study where pts in CR after IC received DNR/IDA-AraC post-remission therapy (Gardin, Blood 2007). Conclusion: In the very long term analysis of this trial in AML post MDS and HR-MDS treated with induction intensive chemotherapy, post-remission therapy with SC AZA alone was associated with a median DFS and OS of 6.9 and 16.9 months, respectively, with some prolonged response. Results appeared similar to those we had reported with intensive consolidation chemotherapy, but using an ambulatory treatment with limited myelosuppression. Figure Disclosures Braun: Daiichy-Sankyo: Honoraria; Servier: Research Funding. Bouabdallah:Takeda: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Gilead Sciences: Consultancy, Honoraria. Ades:Celgene/BMS: Research Funding; novartis: Research Funding; takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; jazz: Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Research Funding. Fenaux:Abbvie: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; BMS: Honoraria, Research Funding; Jazz: Honoraria, Research Funding.

Abstract Background Inhibitory Killer Immunoglobulin-like Receptors (KIR) negatively regulate Natural Killer (NK) cell-mediated killing of HLA class I-expressing tumors. Lack of KIR-HLA class I interactions has been associated with antitumor efficacy and increased survival in patients (pts) with AML in CR after haploidentical stem cell transplantation from KIR-mismatched donors(Ruggeri, Blood 2007). IPH2101, a fully human mAb designed to enhance antitumor effects of NK cells by blocking the major inhibitory HLA-C-specific KIR can be safely administered in elderly pts with AML (Vey, Blood 2012). Lirilumab is a 2nd generation anti-KIR mAb currently evaluated in multiple indications and combinations with encouraging preliminary results in combination with nivolumab in pts with squamous cell carcinoma of the head and neck (Leidner, SITC 2016). Here we report the results of a phase 2 trial with lirilumab as single agent in the maintenance therapy of elderly pts with AML in first CR. The objectives of this randomized phase 2 study were to determine if lirilumab could improve leukemia free survival (LFS) and to assess two dose schedules predicted from the phase 1 dose-escalation trial (Vey, ASCO 2015) to be associated with either continuous (CONT) or intermittent (INT) full KIR occupancy. Methods EFFIKIR was a randomized double-blind 3-arm placebo controlled trial (NCT01687387). Eligible pts were: aged 60 to 80 yrs, diagnosed with non-APL AML, in CR1 following standard induction (1 to 2 cycles) and consolidation (1 to 2 cycles) and had: ECOG performance status of 0-1, adequate hematologic, liver and renal function. Pts were randomly allocated to receive placebo or lirilumab given at either 0.1 mg/kg q 12 weeks (INT) or 1mg/kg q 4 weeks (CONT) according to a minimization algorithm adjusting for center, primary vs. secondary AML, number of consolidation cycles (1 vs. 2) and cytogenetics. Pts were to receive up to 2 yrs of therapy. The primary endpoint was LFS by independent central review. Results Between November 2012 and July 2014, 153 pts were randomized and 152 pts were treated; Pts characteristics are depicted in Table 1. All had received 7+3 induction therapy. Most pts (81%) received 2 cycles of consolidation prior to inclusion. Consolidation chemotherapy consisted of intermediate-dose single agent cytarabine (IDAC) in 53%, and 5+1 in 47% of the pts, according to the recommendations of the ALFA and FILO cooperative groups, respectively. Median time since diagnosis was 4.9 months (mo) [2.8-15.5]. Median time between CR or the last consolidation and randomization were 3.3 [1.1-5.9] and 1.5 mo [0.3-3.5], respectively. The 3 arms were well balanced apart from a slight trend in favor of the placebo arm for lower age, better ECOG, and use of IDAC as consolidation. In March 2015, based upon DSMB recommendation, treatment of pts in CONT was discontinued in light of an excess of early relapses. Mean number of treatment cycles administered was 14.7, 8.8 and 13.8 in the INT, CONT and placebo arms respectively and only 6 pts had one cycle postponed in the lirilumab arms. Major reasons for study discontinuation were relapse (63%) and adverse events (AE) (10%). AE rate was analyzed by taking into account the exposure across pts in each arm. Slightly more AE rate of G1-G2 asthenia, diarrhea and pruritus was observed in CONT arm. Occurrence of hematological disorders did not differ between the 3 arms. 17 pts (11%) experienced second primary malignancies across the 3 arms. PK/PD results were in line with the model predictions: transient full KIR occupancy lasting 7-28 days for the majority of the INT arm pts and permanent full occupancy in the CONT arm. Lirilumab is not significantly immunogenic and does not induce major modifications in peripheral blood NK and T cell subsets. With a median follow-up of 36.6 mo [33.4; 38.2], 108 pts experienced relapses and 2 pts died before relapse. LFS results are presented in Table 2. Conclusions Single agent lirilumab administered for up to 24 cycles was well tolerated. Lirilumab did not result in a statistically significant improvement of LFS in the challenging setting of maintenance in AML in elderly pts. Immune-pharmacological studies will be presented. Potential hypotheses relevant for AML and lirilumab monotherapy (e.g. dosage/schedule optimization, partial desensitization by continuous KIR blockade leading to an impaired immunosurveillance by NK cells) for the non-significant trends will be discussed. Disclosures Recher: Novartis, Celgene, Jazz, Sunesis, Amgen: Consultancy; Celgene, Sunesis, Amgen, Novartis: Research Funding. Pautas: Pfizer: Honoraria. Rousselot: Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sunesis: Honoraria; Incyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; BMS: Research Funding. Castaigne: Pfizer: Honoraria, Research Funding. Jourdan: NOVARTIS: Consultancy, Honoraria. Gardin: Sunesis: Honoraria; AbbVie: Honoraria; Celgene: Honoraria. Delannoy: Innate Pharma: Honoraria. Beautier: Innate Pharma: Employment, Equity Ownership. Paturel: Innate Pharma: Employment, Equity Ownership. Andre: Innate Pharma: Employment, Equity Ownership. Zerbib: Innate Pharma: Employment, Equity Ownership. Dulphy: Celgene: Research Funding; Innate Pharma: Research Funding; Celyad: Consultancy, Membership on an entity's Board of Directors or advisory committees. Olive: Imcheck Therapeutics: Other: Cofunder; GSK: Research Funding; Innate Pharma: Research Funding. Pigneux: Pfizer: Membership on an entity's Board of Directors or advisory committees; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy; MSD: Consultancy, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Sunesis: Membership on an entity's Board of Directors or advisory committees; Jazz: Consultancy, Membership on an entity's Board of Directors or advisory committees; Biogaran: Consultancy, Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees. Dombret: Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travels, Accommodations, Research Funding, Speakers Bureau; Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travels, Accommodations, Research Funding, Speakers Bureau; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz Pharma.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kite Pharma.: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees; Daiichi Sankyo: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sunesis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Cellectis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Menarini: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Chugai/Roche: Consultancy.

Abstract One of the most evidential behavioral results for two memory processes comes from Gardiner and Java (Memory & Cognition, 18, 23–30 1990). Participants provided more “remember” than “know” responses for old words but more know than remember responses for old nonwords. Moreover, there was no effect of word/nonword status for new items. The combination of a crossover interaction for old items with an invariance for new items provides strong evidence for two distinct processes while ruling out criteria or bias explanations. Here, we report a modern replication of this study. In three experiments, (Experiments 1, 2, and 4) with larger numbers of items and participants, we were unable to replicate the crossover. Instead, our data are more consistent with a single-process account. In a fourth experiment (Experiment 3), we were able to replicate Gardiner and Java’s baseline results with a sure–unsure paradigm supporting a single-process explanation. It seems that Gardiner and Java’s remarkable crossover result is not replicable.

The year 1991 continued to be a time of change for those in the early childhood sector. This was no surprise, because 1990 had ended with two significant announcements. The first was that the Minister of Education had promulgated revised guidelines for the recently introduced charters. The second announcement was that all educational services were again to be subjected to a series of reviews – four of which would be in the early childhood sector. These announcements followed hard on the heels of the promulgation in September 1990 of the Education (Early Childhood Centres) Regulations 1990. Changes in early childhood qualifications and training were also being implemented and teething problems were becoming evident. Meanwhile, debate about the proposed introduction of the “Parents as First Teachers” (PAFT) project continued. Overall, at the end of 1990, the early childhood education sector was still undergoing great change and was described as in need of some stability and consolidation (e.g., Dalli, 1990a). Stability and consolidation were indeed what most early childhood organisations and their users had been hoping for in 1991. However, the general desire that 1991 would give the early childhood sector time to concentrate on growth and development of quality had to be quickly pushed aside (Wells, 1991). The first half of 1991 was spent writing submissions to the review teams dealing with early childhood issues, digesting the new regulations and waiting nervously for the Budget. Anxiety mounted when the first convenor of the funding review team resigned (presumably in protest) and an independent member, Crispin Gardiner, filed a minority report (Dominion, May 3 1991). Subsequently, officials’ activity on early childhood funding shifted from the Ministry of Education to the States Services Commission. The Budget announcements included first-phase realisation of the “Parents as First Teachers” policy and news that many had feared about reductions in funding ($18 million less for under 2 year olds) and in quality requirements for charters. As well, bulk funding of kindergarten teachers’ salaries was announced. A complete surprise was the reduction of funding for advisory support and in-service training, and the tendering out of a sizeable proportion of the work of the Early Childhood Development Unit. In this paper, we propose to comment on the revised guidelines for charters for early childhood services (the Statement of Desirable Objectives and Practices), and on some aspects of the reviews and the Budget announcements made following those reviews. We particularly consider early childhood qualifications and training developments, and comment on the new policy “Parents as First Teachers” (PAFT)...

Each community’s title deed carries the indelible blood stains of our ancestors. (Watson, "Howard’s End" 2)IntroductionAccording to the Oxford English Dictionary, the term coalition comes from the Latin coalescere or ‘coalesce’, meaning “come or bring together to form one mass or whole”. Coalesce refers to the unity affirmed as something grows: co – “together”, alesce – “to grow up”. While coalition is commonly associated with formalised alliances and political strategy in the name of self-interest and common goals, this paper will draw as well on the broader etymological understanding of coalition as “growing together” in order to discuss the Australian government’s recent changes to land rights legislation, the 2007 Emergency Intervention into the Northern Territory, and its decision to use Indigenous land in the Northern Territory as a dumping ground for nuclear waste. What unites these distinct cases is the role of the Australian nation-state in asserting its sovereign right to decide, something Giorgio Agamben notes is the primary indicator of sovereign right and power (Agamben). As Fiona McAllan has argued in relation to the Northern Territory Intervention: “Various forces that had been coalescing and captivating the moral, imaginary centre were now contributing to a spectacular enactment of a sovereign rescue mission” (par. 18). Different visions of “growing together”, and different coalitional strategies, are played out in public debate and policy formation. This paper will argue that each of these cases represents an alliance between successive, oppositional governments - and the nourishment of neoliberal imperatives - over and against the interests of some of the Indigenous communities, especially with relation to land rights. A critical stance is taken in relation to the alterations to land rights laws over the past five years and with the Northern Territory Emergency Intervention, hereinafter referred to as the Intervention, firstly by the Howard Liberal Coalition Government and later continued, in what Anthony Lambert has usefully termed a “postcoalitional” fashion, by the Rudd Labor Government. By this, Lambert refers to the manner in which dominant relations of power continue despite the apparent collapse of old political coalitions and even in the face of seemingly progressive symbolic and material change. It is not the intention of this paper to locate Indigenous people in opposition to models of economic development aligned with neoliberalism. There are examples of productive relations between Indigenous communities and mining companies, in which Indigenous people retain control over decision-making and utilise Land Council’s to negotiate effectively. Major mining company Rio Tinto, for example, initiated an Aboriginal and Torres Strait Islanders Policy platform in the mid-1990s (Rio Tinto). Moreover, there are diverse perspectives within the Indigenous community regarding social and economic reform governed by neoliberal agendas as well as government initiatives such as the Intervention, motivated by a concern for the abuse of children, as outlined in The Little Children Are Sacred Report (Wild & Anderson; hereinafter Little Children). Indeed, there is no agreement on whether or not the Intervention had anything to do with land rights. On the one hand, Noel Pearson has strongly opposed this assertion: “I've got as much objections as anybody to the ideological prejudices of the Howard Government in relation to land, but this question is not about a 'land grab'. The Anderson Wild Report tells us about the scale of Aboriginal children's neglect and abuse" (ABC). Marcia Langton has agreed with this stating that “There's a cynical view afoot that the emergency intervention was a political ploy - a Trojan Horse - to sneak through land grabs and some gratuitous black head-kicking disguised as concern for children. These conspiracy theories abound, and they are mostly ridiculous” (Langton). Patrick Dodson on the other hand, has argued that yes, of course, the children remain the highest priority, but that this “is undermined by the Government's heavy-handed authoritarian intervention and its ideological and deceptive land reform agenda” (Dodson). WhitenessOne way to frame this issue is to look at it through the lens of critical race and whiteness theory. Is it possible that the interests of whiteness are at play in the coalitions of corporate/private enterprise and political interests in the Northern Territory, in the coupling of social conservatism and economic rationalism? Using this framework allows us to identify the partial interests at play and the implications of this for discussions in Australia around sovereignty and self-determination, as well as providing a discursive framework through which to understand how these coalitional interests represent a specific understanding of progress, growth and development. Whiteness theory takes an empirically informed stance in order to critique the operation of unequal power relations and discriminatory practices imbued in racialised structures. Whiteness and critical race theory take the twin interests of racial privileging and racial discrimination and discuss their historical and on-going relevance for law, philosophy, representation, media, politics and policy. Foregrounding contemporary analysis in whiteness studies is the central role of race in the development of the Australian nation, most evident in the dispossession and destruction of Indigenous lands, cultures and lives, which occurred initially prior to Federation, as well as following. Cheryl Harris’s landmark paper “Whiteness as Property” argues, in the context of the US, that “the origins of property rights ... are rooted in racial domination” and that the “interaction between conceptions of race and property ... played a critical role in establishing and maintaining racial and economic subordination” (Harris 1716).Reiterating the logic of racial inferiority and the assumption of a lack of rationality and civility, Indigenous people were named in the Australian Constitution as “flora and fauna” – which was not overturned until a national referendum in 1967. This, coupled with the logic of terra nullius represents the racist foundational logic of Australian statehood. As is well known, terra nullius declared that the land belonged to no-one, denying Indigenous people property rights over land. Whiteness, Moreton-Robinson contends, “is constitutive of the epistemology of the West; it is an invisible regime of power that secures hegemony through discourse and has material effects in everyday life” (Whiteness 75).In addition to analysing racial power structures, critical race theory has presented studies into the link between race, whiteness and neoliberalism. Roberts and Mahtami argue that it is not just that neoliberalism has racialised effects, rather that neoliberalism and its underlying philosophy is “fundamentally raced and produces racialized bodies” (248; also see Goldberg Threat). The effect of the free market on state sovereignty has been hotly debated too. Aihwa Ong contends that neoliberalism produces particular relationships between the state and non-state corporations, as well as determining the role of individuals within the body-politic. Ong specifies:Market-driven logic induces the co-ordination of political policies with the corporate interests, so that developmental discussions favour the fragmentation of the national space into various contiguous zones, and promote the differential regulation of the populations who can be connected to or disconnected from global circuits of capital. (Ong, Neoliberalism 77)So how is whiteness relevant to a discussion of land reform, and to the changes to land rights passed along with Intervention legislation in 2007? Irene Watson cites the former Minister for Indigenous Affairs, Mal Brough, who opposed the progressive individual with what he termed the “failed collective.” Watson asserts that in the debates around land leasing and the Intervention, “Aboriginal law and traditional roles and responsibilities for caring and belonging to country are transformed into the cause for community violence” (Sovereign Spaces 34). The effects of this, I will argue, are twofold and move beyond a moral or social agenda in the strictest sense of the terms: firstly to promote, and make more accessible, the possibility of private and government coalitions in relation to Indigenous lands, and secondly, to reinforce the sovereignty of the state, recognised in the capacity to make decisions. It is here that the explicit reiteration of what Aileen Moreton-Robinson calls “white possession” is clearly evidenced (The Possessive Logic). Sovereign Interventions In the Northern Territory 50% of land is owned by Indigenous people under the Aboriginal Land Rights Act 1976 (ALRA) (NT). This law gives Indigenous people control, mediated via land councils, over their lands. It is the contention of this paper that the rights enabled through this law have been eroded in recent times in the coalescing interests of government and private enterprise via, broadly, land rights reform measures. In August 2007 the government passed a number of laws that overturned aspects of the Racial Discrimination Act 197 5(RDA), including the Northern Territory National Emergency Response Bill 2007 and the Aboriginal Land Rights (Northern Territory) Amendment (Township Leasing) Bill 2007. Ostensibly these laws were a response to evidence of alarming levels of child abuse in remote Indigenous communities, which has been compiled in the special report Little Children, co-chaired by Rex Wild QC and Patricia Anderson. This report argued that urgent but culturally appropriate strategies were required in order to assist the local communities in tackling the issues. The recommendations of the report did not include military intervention, and instead prioritised the need to support and work in dialogue with local Indigenous people and organisations who were already attempting, with extremely limited resources, to challenge the problem. Specifically it stated that:The thrust of our recommendations, which are designed to advise the NT government on how it can help support communities to effectively prevent and tackle child sexual abuse, is for there to be consultation with, and ownership by the local communities, of these solutions. (Wild & Anderson 23) Instead, the Federal Coalition government, with support from the opposition Labor Party, initiated a large scale intervention, which included the deployment of the military, to install order and assist medical personnel to carry out compulsory health checks on minors. The intervention affected 73 communities with populations of over 200 Aboriginal men, women and children (Altman, Neo-Paternalism 8). The reality of high levels of domestic and sexual abuse in Indigenous communities requires urgent and diligent attention, but it is not the space of this paper to unpack the media spectacle or the politically determined response to these serious issues, or the considered and careful reports such as the one cited above. While the report specifies the need for local solutions and local control of the process and decision-making, the Federal Liberal Coalition government’s intervention, and the current Labor government’s faithfulness to these, has been centralised and external, imposed upon communities. Rebecca Stringer argues that the Trojan horse thesis indicates what is at stake in this Intervention, while also pinpointing its main weakness. That is, the counter-intuitive links its architects make between addressing child sexual abuse and re-litigating Indigenous land tenure and governance arrangements in a manner that undermines Aboriginal sovereignty and further opens Aboriginal lands to private interests among the mining, nuclear power, tourism, property development and labour brokerage industries. (par. 8)Alongside welfare quarantining for all Indigenous people, was a decision by parliament to overturn the “permit system”, a legal protocol provided by the ALRA and in place so as to enable Indigenous peoples the right to refuse and grant entry to strangers wanting to access their lands. To place this in a broader context of land rights reform, the Aboriginal Land Rights (Northern Territory) Act 2006, created the possibility of 99 year individual leases, at the expense of communal ownership. The legislation operates as a way of individualising the land arrangements in remote Indigenous communities by opening communal land up as private plots able to be bought by Aboriginal people or any other interested party. Indeed, according to Leon Terrill, land reform in Australia over the past 10 years reflects an attempt to return control of decision-making to government bureaucracy, even as governments have downplayed this aspect. Terrill argues that Township Leasing (enabled via the 2006 legislation), takes “wholesale decision-making about land use” away from Traditional Owners and instead places it in the hands of a government entity called the Executive Director of Township Leasing (3). With the passage of legislation around the Intervention, five year leases were created to enable the Commonwealth “administrative control” over the communities affected (Terrill 3). Finally, under the current changes it is unlikely that more than a small percentage of Aboriginal people will be able to access individual land leasing. Moreover, the argument has been presented that these reforms reflect a broader project aimed at replacing communal land ownership arrangements. This agenda has been justified at a rhetorical level via the demonization of communal land ownership arrangements. Helen Hughes and Jenness Warin, researchers at the rightwing think-tank, the Centre for Independent Studies (CIS), released a report entitled A New Deal for Aborigines and Torres Strait Islanders in Remote Communities, in which they argue that there is a direct casual link between communal ownership and economic underdevelopment: “Communal ownership of land, royalties and other resources is the principle cause of the lack of economic development in remote areas” (in Norberry & Gardiner-Garden 8). In 2005, then Prime Minister, John Howard, publicly introduced the government’s ambition to alter the structure of Indigenous land arrangements, couching his agenda in the language of “equal opportunity”. I believe there’s a case for reviewing the whole issue of Aboriginal land title in the sense of looking more towards private recognition …, I’m talking about giving them the same opportunities as the rest of their fellow Australians. (Watson, "Howard’s End" 1)Scholars of critical race theory have argued that the language of equality, usually tied to liberalism (though not always) masks racial inequality and even results in “camouflaged racism” (Davis 61). David Theo Goldberg notes that, “the racial status-quo - racial exclusions and privileges favouring for the most part middle - and upper class whites - is maintained by formalising equality through states of legal and administrative science” (Racial State 222). While Howard and his coalition of supporters have associated communal title with disadvantage and called for the equality to be found in individual leases (Dodson), Altman has argued that there is no logical link between forms of communal land ownership and incidences of sexual abuse, and indeed, the government’s use of sexual abuse disingenuously disguises it’s imperative to alter the land ownership arrangements: “Given the proposed changes to the ALRA are in no way associated with child sexual abuse in Aboriginal communities […] there is therefore no pressing urgency to pass the amendments.” (Altman National Emergency, 3) In the case of the Intervention, land rights reforms have affected the continued dispossession of Indigenous people in the interests of “commercial development” (Altman Neo-Paternalism 8). In light of this it can be argued that what is occurring conforms to what Aileen Moreton-Robinson has highlighted as the “possessive logic of patriarchal white sovereignty” (Possessive Logic). White sovereignty, under the banner of benevolent paternalism overturns the authority it has conceded to local Indigenous communities. This is realised via township leases, five year leases, housing leases and other measures, stripping them of the right to refuse the government and private enterprise entry into their lands (effectively the right of control and decision-making), and opening them up to, as Stringer argues, a range of commercial and government interests. Future Concerns and Concluding NotesThe etymological root of coalition is coalesce, inferring the broad ambition to “grow together”. In the issues outlined above, growing together is dominated by neoliberal interests, or what Stringer has termed “assimilatory neoliberation”. The issue extends beyond a social and economic assimilationism project and into a political and legal “land grab”, because, as Ong notes, the neoliberal agenda aligns itself with the nation-state. This coalitional arrangement of neoliberal and governmental interests reiterates “white possession” (Moreton-Robinson, The Possessive Logic). This is evidenced in the position of the current Labor government decision to uphold the nomination of Muckaty as a radioactive waste repository site in Australia (Stokes). In 2007, the Northern Land Council (NLC) nominated Muckaty Station to be the site for waste disposal. This decision cannot be read outside the context of Maralinga, in the South Australian desert, a site where experiments involving nuclear technology were conducted in the 1960s. As John Keane recounts, the Australian government permitted the British government to conduct tests, dispossessing the local Aboriginal group, the Tjarutja, and employing a single patrol officer “the job of monitoring the movements of the Aborigines and quarantining them in settlements” (Keane). Situated within this historical colonial context, in 2006, under a John Howard led Liberal Coalition, the government passed the Commonwealth Radioactive Waste Management Act (CRWMA), a law which effectively overrode the rulings of the Northern Territory government in relation decisions regarding nuclear waste disposal, as well as overriding the rights of traditional Aboriginal owners and the validity of sacred sites. The Australian Labor government has sought to alter the CRWMA in order to reinstate the importance of following due process in the nomination process of land. However, it left the proposed site of Muckaty as confirmed, and the new bill, titled National Radioactive Waste Management retains many of the same characteristics of the Howard government legislation. In 2010, 57 traditional owners from Muckaty and surrounding areas signed a petition stating their opposition to the disposal site (the case is currently in the Federal Court). At a time when nuclear power has come back onto the radar as a possible solution to the energy crisis and climate change, questions concerning the investments of government and its loyalties should be asked. As Malcolm Knox has written “the nuclear industry has become evangelical about the dangers of global warming” (Knox). While nuclear is a “cleaner” energy than coal, until better methods are designed for processing its waste, larger amounts of it will be produced, requiring lands that can hold it for the desired timeframes. For Australia, this demands attention to the politics and ethics of waste disposal. Such an issue is already being played out, before nuclear has even been signed off as a solution to climate change, with the need to find a disposal site to accommodate already existing uranium exported to Europe and destined to return as waste to Australia in 2014. The decision to go ahead with Muckaty against the wishes of the voices of local Indigenous people may open the way for the co-opting of a discourse of environmentalism by political and business groups to promote the development and expansion of nuclear power as an alternative to coal and oil for energy production; dumping waste on Indigenous lands becomes part of the solution to climate change. During the 2010 Australian election, Greens Leader Bob Brown played upon the word coalition to suggest that the Liberal National Party were in COALition with the mining industry over the proposed Mining Tax – the Liberal Coalition opposed any mining tax (Brown). Here Brown highlights the alliance of political agendas and business or corporate interests quite succinctly. Like Brown’s COALition, will government (of either major party) form a coalition with the nuclear power stakeholders?This paper has attempted to bring to light what Dodson has identified as “an alliance of established conservative forces...with more recent and strident ideological thinking associated with free market economics and notions of individual responsibility” and the implications of this alliance for land rights (Dodson). It is important to ask critical questions about the vision of “growing together” being promoted via the coalition of conservative, neoliberal, private and government interests.Acknowledgements Many thanks to the reviewers of this article for their useful suggestions. ReferencesAustralian Broadcasting Authority. “Noel Pearson Discusses the Issues Faced by Indigenous Communities.” Lateline 26 June 2007. 22 Nov. 2010 ‹http://www.abc.net.au/lateline/content/2007/s1962844.htm>. Agamben, Giorgio. Homo Sacer. Stanford, California: Stanford University Press, 1998. Altman, Jon. “The ‘National Emergency’ and Land Rights Reform: Separating Fact from Fiction.” A Briefing Paper for Oxfam Australia, 2007. 1 Aug. 2010 ‹http://www.oxfam.org.au/resources/filestore/originals/OAus-EmergencyLandRights-0807.pdf>. Altman, Jon. “The Howard Government’s Northern Territory Intervention: Are Neo-Paternalism and Indigenous Development Compatible?” Centre for Aboriginal Economic Policy Research Topical Issue 16 (2007). 1 Aug. 2010 ‹http://caepr.anu.edu.au/system/files/Publications/topical/Altman_AIATSIS.pdf>. Brown, Bob. “Senator Bob Brown National Pre-Election Press Club Address.” 2010. 18 Aug. 2010 ‹http://greens.org.au/content/senator-bob-brown-pre-election-national-press-club-address>. Davis, Angela. The Angela Davis Reader. Ed. J. James, Oxford: Blackwell, 1998. Dodson, Patrick. “An Entire Culture Is at Stake.” Opinion. The Age, 14 July 2007: 4. Goldberg, David Theo. The Racial State. Massachusetts: Blackwell, 2002.———. The Threat of Race: Reflections on Neoliberalism. Massachusetts: Blackwell, 2008. Harris, Cheryl. “Whiteness as Property.” Harvard Law Review 106.8 (1993): 1709-1795. Keane, John. “Maralinga’s Afterlife.” Feature Article. The Age, 11 May 2003. 24 Nov. 2010 ‹http://www.theage.com.au/articles/2003/05/11/1052280486255.html>. Knox, Malcolm. “Nuclear Dawn.” The Monthly 56 (May 2010). Lambert, Anthony. “Rainbow Blindness: Same-Sex Partnerships in Post-Coalitional Australia.” M/C Journal 13.6 (2010). Langton, Marcia. “It’s Time to Stop Playing Politics with Vulnerable Lives.” Opinion. Sydney Morning Herald, 30 Nov. 2007: 2. McAllan, Fiona. “Customary Appropriations.” borderlands ejournal 6.3 (2007). 22 Nov. 2010 ‹http://www.borderlands.net.au/vol6no3_2007/mcallan_appropriations.htm>. Moreton-Robinson, Aileen. “The Possessive Logic of Patriarchal White Sovereignty: The High Court and the Yorta Yorta Decision.” borderlands e-journal 3.2 (2004). 1 Aug. 2007 ‹http://www.borderlands.net.au/vol3no2_2004/moreton_possessive.htm>. ———. “Whiteness, Epistemology and Indigenous Representation.” Whitening Race. Ed. Aileen Moreton-Robinson. Canberra: Aboriginal Studies Press, 75-89. Norberry, J., and J. Gardiner-Garden. Aboriginal Land Rights (Northern Territory) Amendment Bill 2006. Australian Parliamentary Library Bills Digest 158 (19 June 2006). Ong, Aihwa. Neoliberalism as Exception: Mutations in Citizenship and Sovereignty. Durham: Duke University Press, 2006. 75-97.Oxford English Dictionary. 3rd. ed. Oxford: Oxford UP, 2005. Rio Tinto. "Rio Tinto Aboriginal Policy and Programme Briefing Note." June 2007. 22 Nov. 2010 ‹http://www.aboriginalfund.riotinto.com/common/pdf/Aboriginal%20Policy%20and%20Programs%20-%20June%202007.pdf>. Roberts, David J., and Mielle Mahtami. “Neoliberalising Race, Racing Neoliberalism: Placing 'Race' in Neoliberal Discourses.” Antipode 42.2 (2010): 248-257. Stringer, Rebecca. “A Nightmare of the Neocolonial Kind: Politics of Suffering in Howard's Northern Territory Intervention.” borderlands ejournal 6.2 (2007). 22 Nov. 2010 ‹http://www.borderlands.net.au/vol6no2_2007/stringer_intervention.htm>.Stokes, Dianne. "Muckaty." n.d. 1 Aug. 2010 ‹http://www.timbonham.com/slideshows/Muckaty/>. Terrill, Leon. “Indigenous Land Reform: What Is the Real Aim of Land Reform?” Edited version of a presentation provided at the 2010 National Native Title Conference, 2010. Watson, Irene. “Sovereign Spaces, Caring for Country and the Homeless Position of Aboriginal Peoples.” South Atlantic Quarterly 108.1 (2009): 27-51. Watson, Nicole. “Howard’s End: The Real Agenda behind the Proposed Review of Indigenous Land Titles.” Australian Indigenous Law Reporter 9.4 (2005). ‹http://www.austlii.edu.au/au/journals/AILR/2005/64.html>.Wild, R., and P. Anderson. Ampe Akelyernemane Meke Mekarie: The Little Children Are Sacred. Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse. Northern Territory: Northern Territory Government, 2007.

BASTARDYAll children born before matrimony, or so long after the death of the husband as to render it impossible that the child could be begotten by him, are bastards.– Cro. Jac. 451William Toone: The Magistrates Manual, 1817 (66)On 4 September 1832, the body of a newborn baby boy was found washed up on the shore at the port town of Fremantle, Western Australia. As the result of an inquest into the child’s suspicious death, a 20-year-old, unmarried woman named Mary Summerland was accused of concealing his birth. In October 2014, 25-year-old Irish backpacker Caroline Quinn faced court in Perth, Western Australia, over claims that she concealed the birth of her stillborn child after giving birth in the remote north west town of Halls Creek during May of the same year. Both women denied the existence of their children, both appear to have given birth to their “illegitimate” babies alone, and both women claimed that they did not know that they had ever been pregnant at all. In addition, both women hid the body of their dead child for several days while the people they lived with or were close to, did not appear to notice that the mother of the child had had a baby. In neither case did any person associated with either woman seek to look for the missing child after it had been born.Despite occurring 182 years apart, the striking similarities between these cases could lead to the assumption that it is almost as if there were a written script of behaviour that would explain the actions of both young women. Close examination of the laws surrounding child murder, infanticide and concealment of birth reveals evidence of similar behaviours being enacted by women as far back as the 1600s (and earlier), and all are shaped in response to the legal frameworks that prosecuted women who gave birth outside of marriage.This article traces the history of child murder law from its formation in England in the 1600s and explores how early moral assumptions concerning unmarried mothers echoed through the lived experiences of women who killed their illegitimate babies in colonial Western Australia, and continue to resonate in the treatment of, and legal response to, women accused of similar crimes in the present day. The Unlicensed ChildThe unlicensed child is a term coined by Swain and Howe to more accurately define the social matrix faced by single women and their children in Australia. The term seeks to emphasise the repressive and controlling religious, legal and social pressures that acted on Australian women who had children outside marriage until the mid-1970s (xxi, 1, 92, 94). For the purposes of this article, I extend Swain and Howe’s term the unlicensed child to coin the term the unlicensed mother. Following on from Swain and Howe’s definition, if the children of unmarried mothers did not have a license to be born, it is essential to acknowledge that their mothers did not have a license to give birth. Women who had children without social and legal sanction gave birth within a society that did not allocate them “permission” to be mothers, something that the corporeality of pregnancy made it impossible for them not to be. Their own bodies—and the bodies of the babies growing inside them—betrayed them. Unlicensed mothers were punished socially, religiously, legally and financially, and their children were considered sinful and inferior to children who had married parents simply because they had been born (Scheper-Hughes 410). This unspoken lack of authorisation to experience the unavoidably innate physicality of pregnancy, birth and motherhood, in turn implies that, until recently unmarried mothers did not have license to be mothers. Two MothersAll that remains of the “case” of Mary Summerland is a file archived at the State Records Office of Western Australia under the title CONS 3472, Item 10: Rex V Mary Summerland. Yet revealed within those sparse documents is a story echoed by the events surrounding Caroline Quinn nearly two hundred years later. In September 1832, Mary Summerland was an unmarried domestic servant living and working in Fremantle when the body of a baby was found lying on a beach very close to the settlement. Western Australia had only been colonized by the British in 1829. The discovery of the body of an infant in such a tiny village (colonial Fremantle had a population of only 436 women and girls out of 1341 non-Aboriginal emigrants) (Gardiner) set in motion an inquest that resulted in Mary Summerland being investigated over the suspicious death of the child.The records suggest that Mary may have given birth, apparently alone, over a week prior to the corpse of the baby being discovered, yet no one in Fremantle, including her employer and her family, appeared to have noticed that Mary might have been pregnant, or that she had given birth to a child. When Mary Summerland was eventually accused of giving birth to the baby, she strongly denied that she had ever been pregnant, and denied being the mother of the child. It is not known how her infant ended up being disposed of in the ocean. It is also not known if Mary was eventually charged with concealment or child murder, but in either scenario, the case against her was dismissed as “no true bill” when she faced her trial. The details publically available on the case of Caroline Quinn are also sparse. Even the sex of her child has not been revealed in any of the media coverage of the event. Yet examination of the limited details available on her charge of “concealment of birth” reveal similarities between her behaviours and those of Mary Summerland.In May 2014 Caroline Quinn had been “travelling with friends in the Kimberly region of Western Australia” (Lee), and, just as Mary did, Caroline claims she “did not realise that she was pregnant” when she went into labour (Independent.ie). She appears, like Mary Summerland, to have given birth alone, and also like Mary, when her child died due to unexplained circumstances she hid the corpse for several days. Also echoing Mary’s story, no person in the sparsely populated Hall’s Creek community (the town has a populace of 1,211) or any friends in Caroline’s circle of acquaintances appears to have noticed her pregnancy, nor did they realise that she had given birth to a baby until the body of the child was discovered hidden in a hotel room several days after her or his birth. The media records are unclear as to whether Caroline revealed her condition to her friends or whether they “discovered” the body without her assistance. The case was not brought to the attention of authorities until Caroline’s friends took her to receive medical attention at the local hospital and staff there notified the police.Media coverage of the death of Caroline Quinn’s baby suggests her child was stillborn or died soon after birth. As of 13 August 2014 Caroline was granted leave by the Chief Magistrate to return home to Ireland while she awaited her trial, as “without trivialising the matter, nothing more serious was alleged than the concealing of the birth” (Collins, "Irish Woman"). Caroline Quinn was not required to return to Australia to appear at her trial and when the case was presented at the Perth Magistrates Court on Thursday 2 October, all charges against her were dropped as the prosecutor felt “it was not in the public interest” to proceed with legal action (Collins, "Case").Statutory MarginalisationTo understand the similarities between the behaviours of, and legal and medical response to, Mary Summerland and Caroline Quinn, it is important to situate the deaths of their children within the wider context of child murder, concealment of birth and “bastardy” law. Tracing the development of these methods of law-making clarifies the parallels between much of the child murder, infanticide and concealment of birth narrative that has occurred in Western Australia since non-Aboriginal settlement.Despite the isolated nature of Western Australia, the nearly 400 years since the law was formed in England, and the extremely remote rural locations where both these women lived and worked, their stories are remarkably alike. It is almost as if there were a written script and each member of the cast knew what role to play: both Mary and Caroline knew to hide their pregnancies, to deny the overwhelmingly traumatic experience of giving birth alone, and to conceal the corpses of their babies. The fathers of their children appear to have cut off any connection to the women or their child. The family, friends, or employers of the parents of the dead babies knew to pretend that they did not know that the mother was pregnant or who the father was. The police and medical officers knew to charge these women and to collect evidence that could be used to simultaneously meet the needs of the both prosecution and the defence when the cases were brought to trial.In reference to Mary Summerland’s case, in colonial Western Australia when a woman gave birth to an infant who died under suspicious circumstances, she could be prosecuted with two charges: “child murder” and/or “concealment of birth”. It is suggestive that Mary may have been charged with both. The laws regarding these two offences were focused almost exclusively on the deaths of unlicensed children and were so deeply interconnected they are difficult to untangle. For Probyn, shame pierces the centre of who we think we are, “what makes it remarkable is that it reveals with precision our values, hopes and aspirations, beyond the generalities of good manners and cultured norms” (x). Dipping into the streams of legal and medical discourse that flow back to the seventeenth century highlights the pervasiveness of discourses marginalising single women and their children. This situates Mary Summerland and Caroline Quinn within a ‘burden on society’ narrative of guilt, blame and shame that has been in circulation for over 500 years, and continues to resonate in the present (Coull).An Act to Prevent the Destroying and Murthering of Bastard ChildrenIn England prior to the 17th century, penalties for extramarital sex, the birth and/or maintenance of unlicensed children or for committing child murder were expressed through church courts (Damme 2-6; Rapaport 548; Butler 61; Hoffer and Hull 3-4). Discussion of how the punishment of child murder left the religious sphere and came to be regulated by secular laws that were focused exclusively on the unlicensed mother points to two main arguments: firstly, the patriarchal response to unlicensed (particularly female) sexuality; and secondly, a moral panic regarding a perceived rise in unlicensed pregnancies in women of the lower classes, and the resulting financial burden placed on local parishes to support unwanted, unlicensed children (Rapaport 532, 48-52; McMahon XVII, 126-29; Osborne 49; Meyer 3-8 of 14). In many respects, as Meyer suggests, “the legal system subtly encouraged neonaticide through its nearly universally negative treatment of bastard children” (240).The first of these “personal control laws” (Hoffer and Hull 13) was the Old Poor Law created by Henry VIII in 1533, and put in place to regulate all members of English society who needed to rely on the financial assistance of the parish to survive. Prior to 1533, “by custom the children of the rich depended on their relations, while the ‘fatherless poor’ relied on the charity of the monastic institutions and the municipalities” (Teichman 60-61). Its implementation marks the historical point where the state began to take responsibility for maintenance of the poor away from the church by holding communities responsible for “the problem of destitution” (Teichman 60-61; Meyer 243).The establishment of the poor law system of relief created a hierarchy of poverty in which some poor people, such as those suffering from sickness or those who were old, were seen as worthy of receiving support, while others, who were destitute as a result of “debauchery” or other self-inflicted means were seen as undeserving and sent to a house of correction or common gaol. Underprivileged, unlicensed mothers and their children were seen to be part of the category of recipients unfit for help (Jackson 31). Burdens on SocietyIt was in response to the narrative of poor unlicensed women and their children being undeserving fiscal burdens on law abiding, financially stretched community members that in 1576 a law targeted specifically at holding genetic parents responsible for the financial maintenance of unlicensed children entered the secular courts for the first time. Called the Elizabethan Poor Law it was enacted in response to the concerns of local parishes who felt that, due to the expenses exacted by the poor laws, they were being burdened with the care of a greatly increased number of unlicensed children (Jackson 30; Meyer 5-6; Teichman 61). While the 1576 legislation prosecuted both parents of unlicensed children, McMahon interprets the law as being created in response to a blend of moral and economic forces, undergirded by a deep, collective fear of illegitimacy (McMahon 128). By the 1570s “unwed mothers were routinely whipped and sent to prison” (Meyer 242) and “guardians of the poor” could force unlicensed mothers to wear a “badge” (Teichman 63). Yet surprisingly, while parishes felt that numbers of unlicensed children were increasing, no concomitant rise was actually recorded (McMahon 128).The most damning evidence of the failure of this law, was the surging incidence of infanticide following its implementation (Rapaport 548-49; Hoffer and Hull 11-13). After 1576 the number of women prosecuted for infanticide increased by 225 percent. Convictions resulting in unlicensed mothers being executed also rose (Meyer 246; Hoffer and Hull 8, 18).Infanticide IncreasesBy 1624 the level of infanticide in local communities was deemed to be so great An Act to Prevent the Destroying and Murthering of Bastard Children was created. The Act made child murder a “sex-specific crime”, focused exclusively on the unlicensed mother, who if found guilty of the offence was punished by death. Probyn suggests that “shame is intimately social” (77) and indeed, the wording of An Act to Prevent highlights the remarkably similar behaviours enacted by single women desperate to avoid the shame and criminal implication linked to the social position of unlicensed mother: Whereas many lewd Women that have been delivered of Bastard Children, to avoyd their shame and to escape punishment [my italics], doe secretlie bury, or conceale the Death of their Children, and after if the child be found dead the said Women doe alleadge that the said Children were borne dead;…For the preventing therefore of this great Mischiefe…if any Woman…be delivered of any issue of the Body, Male or Female, which being born alive, should by the Lawes of this Realm be a bastard, and that she endeavour privatlie either by drowning or secret burying thereof, or any other way, either by herselfe of the procuring of others, soe to conceale the Death thereof, as that it may not come to light, whether it be borne alive or not, but be concealed, in every such Case the Mother so offending shall suffer Death… (Davies 214; O'Donovan 259; Law Reform Commission of Western Australia 104; Osborne 49; Rose 1-2; Rapaport 548). An Act to Prevent also “contained an extraordinary provision which was a reversion of the ordinary common law presumption of dead birth” (Davies 214), removing the burden of proof from the prosecution and placing it on the defence (Francus 133; McMahon 128; Meyer 2 of 14). The implication being that if the dead body of a newborn, unlicensed baby was found hidden, it was automatically assumed that the child had been murdered by their mother (Law Reform Commission of Western Australia 104; Osborne 49; Rapaport 549-50; Francus 133). This made the Act unusual in that “the offence involved was the concealment of death rather than the death itself” (O'Donovan 259). The only way an unlicensed mother charged with child murder was able to avoid capital punishment was to produce at least one witness to give evidence that the child was “borne dead” (Law Reform Commission of Western Australia 104; Meyer 238; McMahon 126-27).Remarkable SimilaritiesClearly, the objective of An Act to Prevent was not simply to preserve infant life. It is suggestive that it was enacted in response to women wishing to avoid the legal, social, corporal and religious punishment highlighted by the implementation of the poor law legislation enacted throughout earlier centuries. It is also suggestive that these pressures were so powerful that threat of death if found guilty of killing their neonate baby was not enough to deter women from concealing their unlicensed pregnancies and committing child murder. Strikingly analogous to the behaviours of Mary Summerland in 19th century colonial Western Australia, and Caroline Quinn in 2014, the self-preservation implicit in the “strategies of secrecy” (Gowing 87) surrounding unlicensed birth and child murder often left the mother of a dead baby as the only witness to her baby’s death (McMahon xvii 49-50).An Act to Prevent set in motion the legislation that was eventually used to prosecute Mary Summerland in colonial Western Australia (Jackson 7, Davies, 213) and remnants of it still linger in the present where they have been incorporated into the ‘concealment of birth law’ that prosecuted Caroline Quinn (Legal Online TLA [10.1.182]).Changing the ‘Script’Shame runs like a viral code through the centuries to resonate within the legal response to women who committed infanticide in colonial Western Australia. It continues on through the behaviours of, and legal responses to, the story of Caroline Quinn and her child. As Probyn observes, “shame reminds us about the promises we keep to ourselves” in turn revealing our desire for belonging and elements of our deepest fears (p. x). While Caroline may live in a society that no longer outwardly condemns women who give birth outside of marriage, it is fascinating that the suite of behaviours manifested in response to her pregnancy and the birth of her child—by herself, her friends, and the wider community—can be linked to the narratives surrounding the formation of “child murder” and “concealment” law nearly 400 years earlier. Caroline’s narrative also encompasses similar behaviours enacted by Mary Summerland in 1832, in particular that Caroline knew to say that her child was “born dead” and that she had merely concealed her or his body—nothing more. This behaviour appears to have secured the release of both women as although both Mary and Caroline faced criminal investigation, neither was convicted of any crime. Yet, neither of these women or their small communities were alone in their responses. My research has uncovered 55 cases linked to child murder in Western Australia and the people involved in all of these incidences share unusually similar behaviours (Gardiner). Perhaps, it is only through the wider community becoming aware of the resonance of child murder law echoing through the centuries, that certain women who are pregnant with unwanted children will be able to write a different script for themselves, and their “unlicensed” children. ReferencesButler, Sara, M. "A Case of Indifference? Child Murder in Later Medieval England." Journal of Women's History 19.4 (2007): 59-82. Collins, Padraig. "Case against Irish Woman for Concealing Birth Dropped." The Irish Times 2 Oct. 2014. ---. "Irish Woman Held for Hiding Birth in Australia Allowed Return Home." The Irish Times 13 Aug. 2014. Coull, Kim. “The Womb Artist – A Novel: Translating Late Discovery Adoptee Pre-Verbal Trauma into Narrative”. Dissertation. Perth, WA: Edith Cowan University, 2014.Damme, Catherine. "Infanticide: The Worth of an Infant under Law." Medical History 22.1 (1978): 1-24. Davies, D.S. "Child-Killing in English Law." The Modern Law Review 1.3 (1937): 203-23. Dickinson, J.R., and J.A. Sharpe. "Infanticide in Early Modern England: The Court of Great Sessions at Chester, 1650-1800." Infanticide: Historical Perspectives on Child Murder and Concealment, 1550-2000. Ed. Mark Jackson. Hants: Ashgate, 2002. 35-51.Francus, Marilyn. "Monstrous Mothers, Monstrous Societies: Infanticide and the Rule of Law in Restoration and Eighteenth-Century England." Eighteenth-Century Life 21.2 (1997): 133-56. Gardiner, Amanda. "Sex, Death and Desperation: Infanticide, Neonaticide and Concealment of Birth in Colonial Western Australia." Dissertation. Perth, WA: Edith Cowan University, 2014.Gowing, Laura. "Secret Births and Infanticide in Seventeenth-Century England." Past & Present 156 (1997): 87-115. Hoffer, Peter C., and N.E.H. Hull. Murdering Mothers: Infanticide in England and New England 1558-1803. New York: New York University Press, 1984. Independent.ie. "Irish Woman Facing Up to Two Years in Jail for Concealing Death of Her Baby in Australia." 8 Aug. 2014. Law Reform Commission of Western Australia. "Chapter 3: Manslaughter and Other Homicide Offences." Review of the Law of Homicide: Final Report. Perth: Law Reform Commission of Western Australia, 2007. 85-117.Lee, Sally. "Irish Backpacker Charged over the Death of a Baby She Gave Birth to While Travelling in the Australia [sic] Outback." Daily Mail 8 Aug. 2014. Legal Online. "The Laws of Australia." Thomson Reuters 2010. McMahon, Vanessa. Murder in Shakespeare's England. London: Hambledon and London, 2004. Meyer, Jon'a. "Unintended Consequences for the Youngest Victims: The Role of Law in Encouraging Neonaticide from the Seventeenth to Nineteenth Centuries." Criminal Justice Studies 18.3 (2005): 237-54. O'Donovan, K. "The Medicalisation of Infanticide." Criminal Law Review (May 1984): 259-64. Osborne, Judith A. "The Crime of Infanticide: Throwing Out the Baby with the Bathwater." Canadian Journal of Family Law 6 (1987): 47-59. Rapaport, Elizabeth. "Mad Women and Desperate Girls: Infanticide and Child Murder in Law and Myth." Fordham Urban Law Journal 33.2 (2006): 527-69.Rose, Lionel. The Massacre of the Innocents: Infanticide in Britain, 1800-1939. London: Routledge & Kegan, 1986. Scheper-Hughes, Nancy. Death without Weeping: The Violence of Everyday Life in Brazil. Los Angeles: University of California Press, 1992. Swain, Shurlee, and Renate Howe. Single Mothers and Their Children: Disposal, Punishment and Survival in Australia. Cambridge: Cambridge University Press, 1995. Teichman, Jenny. Illegitimacy: An Examination of Bastardy. Oxford: Cornell University Press, 1982. Toone, William. The Magistrate's Manual: Or a Summary of the Duties and Powers of a Justice of the Peace. 2nd ed. London: Joseph Butterworth and Son, 1817.

Who Are Carers? A carer is any individual who provides unpaid care and support to a family member or friend who has a disability, mental illness, drug and/or alcohol dependency, chronic condition, terminal illness or who is frail. Carers come from all walks of life, cultural backgrounds and age groups. For many, caring is a 24 hour-a-day job with emotional, physical and financial impacts, with implications for their participation in employment, education and community activities. Carers exist in all communities, including amongst Aboriginal communities, those of culturally and linguistically diverse backgrounds, amongst Gay, Lesbian, Bisexual, Transgender, Intersex communities, and throughout metropolitan, regional and rural areas (Carers NSW). These broad characteristics mean that caring occurs across a wide variety of situations and care responsibilities can impact an even wider group of people. The ubiquitous nature of informal care warrants its consideration as a major social issue, as well as the potential impacts that these roles can have on carers in both short and long term contexts. Caring for a loved one is often an unseen component of people’s domestic lives. As will be outlined below, the potentially burdensome nature of care can have negative influences on carers’ wellbeing. As such, factors that can enhance the resilience of carers in the face of such adversity have been widely investigated. This being said, individual differences exist in carers’ responses to their caring responsibilities. The caring experience can therefore be argued to exist on a continuum, from the adversity in relation to stressful challenges through to prosperity in light of their caring responsibilities. By considering the experience of care as existing along this continuum, the place of resilience within people’s domestic spaces can be viewed as a mechanism towards identifying and developing supportive practices. Negative Impacts of Care A significant body of research has identified potential negative impacts of caring. Many of the most commonly cited outcomes relate to negative effects on mental health and/or psychological functioning, including stress, anxiety and depression (e.g. Baker et al.; Barlow, Cullen-Powell and Cheshire; Cheshire, Barlow and Powell; Dunn et al.; Gallagher et al.; Hastings et al.; Lach et al.; Singer; Sörensen et al.; Vitaliano, Zhang and Scanlan; Whittingham et al.; Yamada et al.). These feelings can be exacerbated when caring responsibilities become relentlessly time consuming, as demonstrated by this comment from a carer of a person with dementia: “I can’t get away from it” (O'Dwyer, Moyle and van Wyk 758). Similarly, emotional responses such as sorrow, grief, anger, frustration, and guilt can result from caring for a loved one (Heiman; Whittingham et al.). Negative emotional responses are not necessarily a direct result of caring responsibilities as such, but an understanding of the challenges faced by the person requiring their care. The following quote from the carer of a child with autism exemplifies the experience of sorrow: “It was actually the worst day of our lives, that was the day we came to terms with the fact that we had this problem” (Midence and O’Neill 280). Alongside these psychological and emotional outcomes, physical health may also be negatively impacted due to certain demands of the caring role (Lach et al.; Sörensen et al.; Vitaliano, Zhang and Scanlan). Outcomes such as these are likely to vary across individual caring circumstances, dictated by variables such as the specific tasks required of the carer, and individual personality characteristics of both the carer and the person for whom they care. Nevertheless, an awareness of these potential outcomes is particularly important when considering the place of resilience in the domestic space of individuals caring for a loved one. This conceptualisation of caring as being a burdensome task reflects many publicly held perceptions. If caring is widely viewed as compromising carers’ wellbeing, then there is likely to be an increased likelihood of carers viewing themselves as victims. This is particularly true amongst children and adolescents with caring responsibilities, since young people are most susceptible to having their personal identities shaped by others’ perceptions (Andreouli, Skovdal and Campbell). Resilience in Caring Adversity Despite the widely acknowledged potential for caring to have negative consequences for carers, it must be noted that the occurrence of these outcomes are not inevitable. In fact, much of the research that has identified increased stress amongst carers also finds that the majority cope well with the demands of their role (Barnett et al.). These carers have been considered by many researchers to demonstrate resilience (e.g. Barnett et al.; O'Dwyer, Moyle and van Wyk). The ability to respond positively despite exposure to risk or adversity is a key feature of most definitions of resilience (Luthar, Cicchetti and Becker; Masten and Obradović; Zauszniewski, Bekhet and Suresky). Resilience in this context can thus be defined as a psychological process that facilitates healthy functioning in response to intense life stressors (Johnson et al.). Since caring experiences are likely to continue for an extended period of time, resilience is likely to be necessary on an ongoing basis, rather than in response to a single traumatic event. A resilient carer is therefore one who is able to effectively and adaptively cope with extenuating pressures of caring for a loved one. This involves the presence of personal, social, familial, or institutional protective factors that enable carers to resist stress (Kaplan et al.). For example, support from health professionals, family, or community has been found to effectively support carers in coping with their role (Bekhet, Johnson and Zauszniewski; Gardiner and Iarocci; Heiman; Whittingham et al.). The benefit of support networks in assisting carers to cope in their role is widely reported in the associated research, reinforced by many examples such as the following from a carer of a person with dementia: “It’s a social thing, like, I’ve got friends on there… I find that is my escape” (O'Dwyer, Moyle and van Wyk 758). At an individual level, those who demonstrate resilient in the face of adversity demonstrate optimistic or hopeful outlooks (Ekas, Lickenbrock and Whitman; Lloyd and Hastings; Whittingham et al.), while simultaneously holding realistic expectations of the future (Rasmussen et al.; Wrosch, Miller, et al.; Wrosch, Scheier, et al.). Such attitudes are particularly significant amongst people caring for family members or friends with disabilities or illnesses. The following attitude held by a carer of a child with cerebral palsy exemplifies this optimistic outlook: “I look at the glass half full and say that “well, it’s only his walking, everything else is fine”. “So, get over [it] and deal with it” (Whittingham et al. 1451). Those who cognitively process information, rather than reacting in a highly emotion way have also been found to cope better (Bekhet, Johnson and Zauszniewski; Heiman; Monin et al.; Pennebaker, Mayne and Francis), as have those with a greater sense of self-efficacy or an internal locus of control (Bekhet, Johnson and Zauszniewski; Kuhn and Carter). However effective these coping strategies prove to be, this is unlikely to provide the full picture of caring experiences, or the place of resilience within that space. Associating resilience with adversity presumes a consensus on what constitutes adversity. Taking the typical approach to investigating resilience amongst carers risks making undue assumptions of the nature of individual carers’ experiences – namely, that caring equates to adversity. The following paragraphs will outline how this is not necessarily the case. And furthermore, that the concept of resilience still has a place in considering informal caring, regardless of whether adversity is considered to be present. Benefits of Care While a great deal of evidence suggests that caring for a loved one can be a stressful experience, research has also demonstrated the existence of positive impacts of care. In many instances, carers not only cope, but also thrive in their caring roles (Turnbull et al.). Elements such as positive relationships within caring relationships can both challenge and strengthen individuals – factors that only exist due to the specific nature of the individual caring role (Bayat; Heiman). Such positive elements of the caring experience have been reflected in the literature, illustrated by quotes such as: “In some sense, this makes our family closer” (Bayat 709). Rather than viewing carers from a perspective of victimisation (which is particularly prominent in relation to children and young people with caring responsibilities), recognising the prevalence of positive wellbeing within this population provides a more nuanced understanding of the lived experiences of all carers (Aldridge). Reported benefits of caring tend to revolve around personal relationships, particularly in reference to parents caring for their children with special needs. Reflective of the parental relationship, carers of children with disabilities or chronic illnesses generally report feelings of love, joy, optimism, strength, enjoyment, and satisfaction with their role (Barnett et al.; Heiman). The views of such carers do not reflect an attitude of coping with adversity, but rather a perspective that considers their children to be positive contributors to carers’ quality of life and the wellbeing of the wider family (King et al.). This point of view suggests an additional dimension to resilience; in particular, that resilience in the relative absence of risk factors, can cause carers to flourish within their caring role and relationships. In addition to benefits in relationships, carers may also prosper through their own personal growth and development in the course of their caring (Knight). This includes factors such as the development of life skills, maturity, purpose, social skills, a sense of responsibility, and recognition – particularly amongst young people in caring roles (Earley, Cushway and Cassidy; Early, Cushway and Cassidy; Jurkovic, Thirkield and Morrell; Skovdal and Andreouli; Stein, Rotheram-Borus and Lester; Tompkins). Recognition of the potential personal benefits of caring for a loved one is not intended to suggest that the view of carers coping with adversity is universally applicable. While it is likely that individual caring situations will have an impact on the extent to which a carer faces adversity (e.g. intensity of caring responsibilities, severity of loved one’s impairment, etc.), it is important to recognise the benefits that carers can experience alongside any challenges they may face. Circumstances that appear adversarial may not be thought of as such by those within that context. Defining resilience as an ability to cope with adversity therefore will not apply to such contexts. Rather, the concept of resilience needs to incorporate those who not only cope, but also prosper. Carers who do not perceive their role as burdensome, but identify positive outcomes, can therefore be said to demonstrate resilience though contextually different from those coping with adversity. This is not to suggest that resilience is the sole contributing factor in terms of prospering in the caring role. We must also consider individual circumstances and nuances differ between carers, those they care for, interpersonal relationships, and wider caring situations. Continuum of Care Awareness of the range of impacts that caring can have on carers leads to a recognition of the broad spectrum of experience that this role entails. Not only do caring experiences exhibit large variations in terms of practical issues (such as functional capacities, or type and severity of illness, disability, or condition), they include carers’ diverse personal responses to caring responsibilities. These responses can reflect either positive or negative dimensions, or a combination of both (Faso, Neal-Beevers and Carlson). In this way, caring experiences can be conceptualised as existing along a continuum. At one end of the spectrum, experiences align with the traditional view of caring as a struggle with and over adversity. More specifically, carers experience burdens as a result of their additional caring responsibilities, with negative outcomes likely to occur. At the other end of the spectrum, however, carers prosper in the role, experiencing significant personal benefits that would not have been possible without the caring role. This continuum makes a case for an expanded approach to stress and coping models of resilience to include positive concepts and a benefit-orientated perspective (Cassidy and Giles). In contrast to research that has argued for a progression from stress and coping models to strengths-based approaches (e.g. Glidden, Billings and Jobe; Knight), the continuum of care acknowledges the benefits of each of these theoretical positions, and thus may prove more comprehensive in attempting to understand the everyday lived experiences of carers. The framework provided by a representation of a continuum allows for the individual differences in caring situations and carers’ personal responses to be acknowledged, as well as accounting for any changes in these circumstances. Further, the experience and benefits of resilience in different contextual spheres can be identified. The flexibility afforded by such an approach is particularly important in light of individual differences in the ways carers respond to their situations, their changing caring contexts, and their subsequent individual needs (Monin et al.; Walsh; Whittingham et al.). As the caring experience can be dynamic and fluctuate in both directions along the continuum, resilience may be seen as the mechanism by which such movement occurs. In line with stress and coping models, resilience can assist carers to cope with adversarial circumstances at that end of the continuum. Similarly, it may be argued that those who prosper in their caring role exhibit characteristics of resilience. In other words, it is resilience that enables carers to cope with adversity at one end of the continuum and also to prosper at the other. Furthermore, by supporting the development of resilient characteristics, carers may be assisted in shifting their experiences along the continuum, from adversity to prosperity. This view extends upon traditional approaches reported in the stress and coping literature by contending that caring experiences may progress beyond positions of coping with adversity, to a position where caring is not understood in terms of adversity at all, but rather in terms of benefits. The individual circumstances of any carer must be taken into consideration with this framework of resilience and the continuum of care. It is unrealistic to assume that all caring situations will allow for the possibility of reaching the end point of this continuum. Carers with particularly high demands in terms of time, resources, effort, or energy may not reach a stage where they no longer consider their caring role to involve any personal burden. However, the combination of a coping and strengths-based approach suggests that there is always the possibility of moving away from perceptions of adversity and further towards an attitude of prosperity. Implications for Supportive Practice From the perspective of this continuum of care, the protective factors and coping strategies identified in previous literature provide a valuable starting point for the facilitation of resilience amongst carers. Enhancing factors such as these can assist carers to move from situations of adversity towards experiences of prosperity (Benzies and Mychasiuk). Research has suggested that carers who are less analytical in their thinking and less optimistic about their personal situations may find particular benefit from support systems that assist them in redirecting their attention towards positive aspects of their daily lives, such as the benefits of caring outlined earlier (Monin et al.). The principle of focusing on positive experiences and reframing negative thoughts is thought to benefit carers across all levels of functioning and adaptive experience (Monin et al.). While those entrenched in more burdensome mindsets are likely to experience the greatest benefit from supportive interventions, there is still merit in providing similar supports to carers who do not appear to experience the similar experiences of burden, or demonstrate greater resilience or adaptation to their situation. The dynamic view of caring situations and resilience suggested by a continuum of care incorporates benefits of stress and coping models as well as strengths-based approaches. This has implications for supportive practice in that the focus is not on determining whether or not a carer is resilient, but identifying the ways in which they already are resilient (Simon, Murphy and Smith). For carers who experience their role through a lens of adversity, resilience may need to be purposefully fostered in order to better enable them to cope and develop through the ongoing stresses of their role. For carers at the other end of the spectrum, resilience is likely to take on a substantially different meaning. Under these circumstances, caring for a loved one is not considered a burdensome task; rather, the positive impact of the role is pre-eminent. This point of view suggests that carers are resilient, not only in terms of an ability to thrive despite adversity, but in prospering to the extent that adversity is not considered to exist. The attitudes and approaches of services, support networks, and governments towards carers should remain flexible enough to acknowledge the wide variety of caring circumstances that exist. The continuum of care provides a framework through which certain aspects of caring and variations in resilience can be interpreted, as well as the type of support required by individual carers. Furthermore, it must be noted that caring circumstances can change – either gradually or suddenly – with the extent to which carers experience adversity, coping or prosperity also changing. Any attempts to provide support to carers or acknowledge their resilience should demonstrate an awareness of the potential for such fluctuation. The fundamental view that carers always have the potential to move towards more positive outcomes has the potential to reframe perceptions of carers as victims, or as simply coping, to one that embraces the personal strengths and resilience of the individual. As such, carers can be supported when faced with adversity, and to flourish beyond that position. This in turn has the potential to safeguard against any detrimental effects of adversity that may arise in the future. References Aldridge, Jo. "All Work and No Play? Understanding the Needs of Children with Caring Responsibilities." Children & Society 22.4 (2008): 253-264. Andreouli, Eleni, Morten Skovdal, and Catherine Campbell. "‘It Made Me Realise That I Am Lucky for What I Got’: British Young Carers Encountering the Realities of Their African Peers." Journal of Youth Studies (2013): 1-16. Baker, Bruce L., et al. "Behavior Problems and Parenting Stress in Families of Three-Year-Old Children with and without Developmental Delays." American Journal on Mental Retardation 107.6 (2002): 433-44. Barlow, J. H., L. A. Cullen-Powell, and A. Cheshire. "Psychological Well-Being among Mothers of Children with Cerebral Palsy." Early Child Development and Care 176.3-4 (2006): 421-428. Barnett, Douglas, et al. "Building New Dreams: Supporting Parents' Adaptation to Their Child with Special Needs." Infants and Young Children 16.3 (2003): 184. Bayat, M. "Evidence of Resilience in Families of Children with Autism." Journal of Intellectual Disability Research 51.9 (2007): 702-714. Bekhet, Abir K., Norah L. Johnson, and Jaclene A. Zauszniewski. "Resilience in Family Members of Persons with Autism Spectrum Disorder: A Review of the Literature." Issues in Mental Health Nursing 33.10 (2012): 650-656. Benzies, Karen, and Richelle Mychasiuk. "Fostering Family Resiliency: A Review of the Key Protective Factors." Child and Family Social Work 14 (2009): 103-114. Carers NSW. Carers NSW Strategic Directions 2012-2015. 2012. Cassidy, Tony, and Melanie Giles. "Further Exploration of the Young Carers Perceived Stress Scale: Identifying a Benefit-Finding Dimension." British Journal of Health Psychology 18.3 (2013): 642-655. Cheshire, Anna, Julie H. Barlow, and Lesley A. Powell. "The Psychosocial Well-Being of Parents of Children with Cerebral Palsy: A Comparison Study." Disability and Rehabilitation 32.20 (2010): 1673-1677. Dunn, Michael E., et al. "Moderators of Stress in Parents of Children with Autism." Community Mental Health Journal 37.1 (2001): 39-52. Earley, Louise, Delia Cushway, and Tony Cassidy. "Children's Perceptions and Experiences of Care Giving: A Focus Group Study." Counselling Psychology Quarterly 20.1 (2007): 69-80. Early, Louise, Delia Cushway, and Tony Cassidy. "Perceived Stress in Young Carers: Development of a Measure." Journal of Child and Family Studies 15.2 (2006): 165-176. Ekas, Naomi V., Diane M. Lickenbrock, and Thomas L. Whitman. "Optimism, Social Support, and Well-Being in Mothers of Children with Autism Spectrum Disorder." Journal of Autism and Developmental Disorders 40.10 (2010): 1274-1284. Faso, Daniel J., A. Rebecca Neal-Beevers, and Caryn L. Carlson. "Vicarious Futurity, Hope, and Well-Being in Parents of Children with Autism Spectrum Disorder." Research in Autism Spectrum Disorders 7.2 (2013): 288-297. Gallagher, Stephen, et al. "Predictors of Psychological Morbidity in Parents of Children with Intellectual Disabilities." Journal of Pediatric Psychology 33.10 (2008): 1129-1136. Gardiner, Emily, and Grace Iarocci. "Unhappy (and Happy) in Their Own Way: A Developmental Psychopathology Perspective on Quality of Life for Families Living with Developmental Disability with and without Autism." Research in Developmental Disabilities 33.6 (2012): 2177-2192. Glidden, L. M., F. J. Billings, and B. M. Jobe. "Personality, Coping Style and Well-Being of Parents Rearing Children with Developmental Disabilities." Journal of Intellectual Disability Research 50.12 (2006): 949-962. Hastings, Richard P., et al. "Coping Strategies in Mothers and Fathers of Preschool and School-Age Children with Autism." Autism 9.4 (2005): 377-91. Heiman, Tali. "Parents of Children with Disabilities: Resilience, Coping, and Future Expectations." Journal of Developmental and Physical Disabilities 14.2 (2002): 159-171. Johnson, Douglas C., et al. "Development and Initial Validation of the Response to Stressful Experiences Scale." Military Medicine 176.2 (2011): 161-169. Jurkovic, GregoryJ, Alison Thirkield, and Richard Morrell. "Parentification of Adult Children of Divorce: A Multidimensional Analysis." Journal of Youth and Adolescence 30.2 (2001): 245-257. Kaplan, Carol P., et al. "Promoting Resilience Strategies: A Modified Consultation Model." Children & Schools 18.3 (1996): 158-168. King, G. A., et al. "A Qualitative Investigation of Changes in the Belief Systems of Families of Children with Autism or Down Syndrome." Child: Care, Health and Development 32.3 (2006): 353-369. Knight, Kathryn. "The Changing Face of the ‘Good Mother’: Trends in Research into Families with a Child with Intellectual Disability, and Some Concerns." Disability & Society 28.5 (2013): 660-673. Kuhn, Jennifer C., and Alice S. Carter. "Maternal Self-Efficacy and Associated Parenting Cognitions among Mothers of Children with Autism." American Journal of Orthopsychiatry 76.4 (2006): 564-575. Lach, Lucyna M., et al. "The Health and Psychosocial Functioning of Caregivers of Children with Neurodevelopmental Disorders." Disability and Rehabilitation 31.8 (2009): 607-18. Lloyd, T. J., and R. Hastings. "Hope as a Psychological Resilience Factor in Mothers and Fathers of Children with Intellectual Disabilities." Journal of Intellectual Disability Research 53.12 (2009): 957-68. Luthar, Suniya S., Dante Cicchetti, and Bronwyn Becker. "The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work." Child Development 71.3 (2000): 543-62. Masten, Ann S., and Jelena Obradović. "Competence and Resilience in Development." Annals of the New York Academy of Sciences 1094.1 (2006): 13-27. Midence, Kenny, and Meena O’Neill. "The Experience of Parents in the Diagnosis of Autism: A Pilot Study." Autism 3.3 (1999): 273-85. Monin, Joan K., et al. "Linguistic Markers of Emotion Regulation and Cardiovascular Reactivity among Older Caregiving Spouses." Psychology and Aging 27.4 (2012): 903-11. O'Dwyer, Siobhan, Wendy Moyle, and Sierra van Wyk. "Suicidal Ideation and Resilience in Family Carers of People with Dementia: A Pilot Qualitative Study." Aging & Mental Health 17.6 (2013): 753-60. Pennebaker, James W., Tracy J. Mayne, and Martha E. Francis. "Linguistic Predictors of Adaptive Bereavement." Journal of Personality and Social Psychology 72.4 (1997): 863-71. Rasmussen, Heather N., et al. "Self-Regulation Processes and Health: The Importance of Optimism and Goal Adjustment." Journal of Personality 74.6 (2006): 1721-48. Simon, Joan B., John J. Murphy, and Shelia M. Smith. "Understanding and Fostering Family Resilience." The Family Journal 13.4 (2005): 427-36. Singer, George H. S. "Meta-Analysis of Comparative Studies of Depression in Mothers of Children with and without Developmental Disabilities." American Journal on Mental Retardation 111.3 (2006): 155-69. Skovdal, Morten, and Eleni Andreouli. "Using Identity and Recognition as a Framework to Understand and Promote the Resilience of Caregiving Children in Western Kenya." Journal of Social Policy 40.03 (2011): 613-30. Sörensen, Silvia, et al. "Dementia Care: Mental Health Effects, Intervention Strategies, and Clinical Implications." The Lancet Neurology 5.11 (2006): 961-73. Stein, Judith A., Mary Jane Rotheram-Borus, and Patricia Lester. "Impact of Parentification on Long-Term Outcomes among Children of Parents with Hiv/Aids." Family Process 46.3 (2007): 317-33. Tompkins, Tanya L. "Parentification and Maternal HIV Infection: Beneficial Role or Pathological Burden?" Journal of Child and Family Studies 16.1 (2007): 108-18. Turnbull, Ann P., et al. "Conceptualization and Measurement of Family Outcomes Associated with Families of Individuals with Intellectual Disabilities." Mental Retardation and Developmental Disabilities Research Reviews 13.4 (2007): 346-56. Vitaliano, Peter P., Jianping Zhang, and James M. Scanlan. "Is Caregiving Hazardous to One's Physical Health? A Meta-Analysis." Psychological Bulletin 129.6 (2003): 946-72. Walsh, Froma. "Family Resilience: A Framework for Clinical Practice." Family Process 42.1 (2003): 1-18. Whittingham, Koa, et al. "Sorrow, Coping and Resiliency: Parents of Children with Cerebral Palsy Share Their Experiences." Disability and Rehabilitation 35.17 (2013): 1447-52. Wrosch, Carsten, et al. "Giving Up on Unattainable Goals: Benefits for Health?" Personality and Social Psychology Bulletin 33.2 (2007): 251-65. Wrosch, Carsten, et al. "The Importance of Goal Disengagement in Adaptive Self-Regulation: When Giving Up Is Beneficial." Self and Identity 2.1 (2003): 1-20. Yamada, Atsurou, et al. "Emotional Distress and Its Correlates among Parents of Children with Pervasive Developmental Disorders." Psychiatry and Clinical Neurosciences 61.6 (2007): 651-57. Zauszniewski, Jaclene A., Abir K. Bekhet, and M. J. Suresky. "Resilience in Family Members of Persons with Serious Mental Illness." Nursing Clinics of North America 45.4 (2010): 613-26.

I was born illegitimate. Born on an existential precipice. My unwed mother was 36 years old when she relinquished me. I was the fourth baby she was required to give away. After I emerged blood stained and blue tinged – abject, liminal – not only did the nurses refuse me my mother’s touch, I also lost the sound of her voice. Her smell. Her heart beat. Her taste. Her gaze. The silence was multi-sensory. When they told her I was dead, I also lost, within her memory and imagination, my life. I was adopted soon after but not told for over four decades. It was too shameful for even me to know. Imprinted at birth with a psychological ‘death’, I fell, as a Late Discovery Adoptee (LDA), into a socio-cultural and psychological abyss, frozen at birth at the bottom of a parturitive void from where, invisible within family, society, and self I was unable to form an undamaged sense of being.Throughout the 20th century (and for centuries before) this kind of ‘social abortion’ was the dominant script. An adoptee was regarded as a bastard, born of sin, the mother blamed, the father exonerated, and silence demanded (Lynch 28-74). My adoptive mother also sinned. She was infertile. But, in taking me on, she assumed the role of a womb worthy woman, good wife, and, in her case, reluctant mother (she secretly didn’t want children and was privately overwhelmed by the task). In this way, my mother, my adoptive mother, and myself are all the daughters of bereavement, all of us sacrificed on the altar of prejudice and fear that infertility, sex outside of marriage, and illegitimacy were unspeakable crimes for which a price must be paid and against which redemptive protection must be arranged. If, as Thomas Keneally (5) writes, “original sin is the mother fluid of history” then perhaps all three of us all lie in its abject waters. Grotevant, Dunbar, Kohler and Lash Esau (379) point out that adoption was used to ‘shield’ children from their illegitimacy, women from their ‘sexual indiscretions’, and adoptive parents from their infertility in the belief that “severing ties with birth family members would promote attachment between adopted children and parents”. For the adoptee in the closed record system, the socio/political/economic vortex that orchestrated their illegitimacy is born out of a deeply, self incriminating primal fear that reaches right back into the recesses of survival – the act of procreation is infested with easily transgressed life and death taboos within the ‘troop’ that require silence and the burial of many bodies (see Amanda Gardiner’s “Sex, Death and Desperation: Infanticide, Neonaticide, and Concealment of Birth in Colonial Western Australia” for a palpable, moving, and comprehensive exposition on the links between 'illegitimacy', the unmarried mother and child murder). As Nancy Verrier (24) states in Coming Home to Self, “what has to be understood is that separation trauma is an insidious experience, because, as a society, we fail to see this experience as a trauma”. Indeed, relinquishment/adoption for the baby and subsequent adult can be acutely and chronically painful. While I was never told the truth of my origins, of course, my body knew. It had been there. Sentient, aware, sane, sensually, organically articulate, it messaged me (and anyone who may have been interested) over the decades via the language of trauma, its lexicon and grammar cellular, hormonal, muscular (Howard & Crandall, 1-17; Pert, 72), the truth of my birth, of who I was an “unthought known” (Bollas 4). I have lived out my secret fatality in a miasmic nebula of what I know now to be the sequelae of adoption psychopathology: nausea, physical and psychological pain, agoraphobia, panic attacks, shame, internalised anger, depression, self-harm, genetic bewilderment, and generalised anxiety (Brodzinsky 25-47; Brodzinsky, Smith, & Brodzinsky 74; Kenny, Higgins, Soloff, & Sweid xiv; Levy-Shiff 97-98; Lifton 210-212; Verrier The Primal Wound 42-44; Wierzbicki 447-451) – including an all pervading sense of unreality experienced as dissociation (the experience of depersonalisation – where the self feels unreal – and derealisation – where the world feels unreal), disembodiment, and existential elision – all characteristics of Post Traumatic Stress Disorder (PTSD). In these ways, my body intervened, acted out, groaned in answer to the social overlay, and from beyond “the dermal veil” tried to procure access, as Vicky Kirby (77) writes, to “the body’s opaque ocean depths” through its illnesses, its eloquent, and incessantly aching and silent verbosities deepened and made impossibly fraught because I was not told. The aim of this paper is to discuss one aspect of how my body tried to channel the trauma of my secret fatality and liminality: my pre-disclosure art work (the cellular memory of my trauma also expressed itself, pre-disclosure, through my writings – poetry, journal entries – and also through post-coital glossolalia, all discussed at length in my Honours research “Womb Tongues” and my Doctoral Dissertation “The Womb Artist – A Novel: Translating Pre-verbal Late Discovery Adoption Trauma into Narrative”). From the age of thirty onwards I spent twelve years in therapy where the cause of my childhood and adult psychopathology remained a mystery. During this time, my embodied grief and memories found their way into my art work, a series of 5’ x 3’ acrylic paintings, some of which I offer now for discussion (figures 1-4). These paintings map and express what my body knew but could not verbalise (without language to express my grief, my body found other ways to vent). They are symptom and sign of my pre-verbal adoption trauma, evidence that my body ‘knew’ and laboured ceaselessly and silently to find creative ways to express the incarcerated trauma. Post disclosure, I have used my paintings as artefacts to inform, underpin, and nourish the writing of a collection of poetry “Womb Tongues” and a literary novel/memoir “The Womb Artist” (TWA) in an ongoing autoethnographical, performative, and critical inquiry. My practice-led research as a now conscious and creative witness, fashions the recontextualisation of my ‘self’ into my ‘self’ and society, this time with cognisant and reparative knowledge and facilitates the translation of my body’s psychopathology and memory (explicit and implicit) into a healing testimony that explores the traumatised body as text and politicizes the issues surrounding LDAs (Riley 205). If I use these paintings as a memoirist, I use them second hand, after the fact, after they have served their initial purpose, as the tangible art works of a baby buried beneath a culture’s prejudice, shame, and judgement and the personal cries from the illegitimate body/self. I use them now to explore and explain my subclinical and subterranean life as a LDA.My pre-disclosure paintings (Figures 1-4) – filled with vaginal, fetal, uterine, and umbilical references – provide some kind of ‘evidence’ that my body knew what had happened to me as if, with the tenacity of a poltergeist, my ‘spectral self’ found ways to communicate. Not simply clues, but the body’s translation of the intra-psychic landscape, a pictorial and artistic séance into the world, as if my amygdala – as quasar and signal, homing device and history lesson (a measure, container, and memoir) – knew how to paint a snap shot or an x-ray of the psyche, of my cellular marrow memories (a term formulated from fellow LDA Sandy McCutcheon’s (76) memoir, The Magician’s Son when he says, “What I really wanted was the history of my marrow”). If, as Salveet Talwar suggests, “trauma is processed from the body up”, then for the LDA pre-discovery, non-verbal somatic signage is one’s ‘mother tongue’(25). Talwar writes, “non-verbal expressive therapies such as art, dance, music, poetry and drama all activate the sub-cortical regions of the brain and access pre-verbal memories” (26). In these paintings, eerily divinatory and pointed traumatic, memories are made visible and access, as Gussie Klorer (213) explains in regard to brain function and art therapy, the limbic (emotional) system and the prefrontal cortex in sensorimotor integration. In this way, as Marie Angel and Anna Gibbs (168) suggest, “the visual image may serve as a kind of transitional mode in thought”. Ruth Skilbeck in her paper First Things: Reflections on Single-lens Reflex Digital Photography with a Wide-angled Lens, also discusses (with reference to her photographic record and artistic expression of her mother’s death) what she calls the “dark matter” – what has been overlooked, “left out”, and/or is inexplicable (55) – and the idea of art work as the “transitional object” as “a means that some artists use, conceptually and yet also viscerally, in response to the extreme ‘separation anxiety’ of losing a loved one, to the void of the Unknown” (57). In my case, non-disclosure prevented my literacy and the evolution of the image into language, prevented me from fully understanding the coded messages left for me in my art work. However, each of my paintings is now, with the benefit of full disclosure, a powerful, penetrating, and comprehensible intra and extra sensory cry from the body in kinaesthetic translation (Lusebrink, 125; Klorer, 217). In Figure 1, ‘Embrace’, the reference to the umbilical is palpable, described in my novel “The Womb Artist” (184) this way; “two ropes tightly entwine as one, like a dark and dirty umbilical cord snaking its way across a nether world of smudged umbers”. There is an ‘abject’ void surrounding it. The cord sapped of its colour, its blood, nutrients – the baby starved of oxygen, breath; the LDA starved of words and conscious understanding. It has two parts entwined that may be seen in many ways (without wanting to reduce these to static binaries): mother/baby; conscious/unconscious; first person/third person; child/adult; semiotic/symbolic – numerous dualities could be spun from this embrace – but in terms of my novel and of the adoptive experience, it reeks of need, life and death, a text choking on the poetic while at the same time nourished by it; a text made ‘available’ to the reader while at the same narrowing, limiting, and obscuring the indefinable nature of pre-verbal trauma. Figure 1. Embrace. 1993. Acrylic on canvas.The painting ‘Womb Tongues’ (Figure 2) is perhaps the last (and, obviously, lasting) memory of the infinite inchoate universe within the womb, the umbilical this time wrapped around in a phallic/clitorial embrace as the baby-self emerges into the constrictions of a Foucauldian world, where the adoptive script smothers the ‘body’ encased beneath the ‘coils’ of Judeo-Christian prejudice and centuries old taboo. In this way, the reassigned adoptee is an acute example of power (authority) controlling and defining the self and what knowledge of the self may be allowed. The baby in this painting is now a suffocated clitoris, a bound subject, a phallic representation, a gagged ‘tongue’ in the shape of the personally absent (but socially imposing) omni-present and punitive patriarchy. Figure 2. Womb Tongues. 1997. Acrylic on canvas.‘Germination’ (Figure 3) depicts an umbilical again, but this time as emerging from a seething underworld and is present in TWA (174) this way, “a colony of night crawlers that writhe and slither on the canvas, moving as one, dozens of them as thin as a finger, as long as a dream”. The rhizomic nature of this painting (and Figure 4), becomes a heaving horde of psychosomatic and psychopathological influences and experiences, a multitude of closely packed, intense, and dendridic compulsions and symptoms, a mass of interconnected (and by nature of the silence and lie) subterranean knowledges that force the germination of a ‘ghost baby/child/adult’ indicated by the pale and ashen seedling that emerges above ground. The umbilical is ghosted, pale and devoid of life. It is in the air now, reaching up, as if in germination to a psychological photosynthesis. There is the knot and swarm within the unconscious; something has, in true alien fashion, been incubated and is now emerging. In some ways, these paintings are hardly cryptic.Figure 3. Germination.1993. Acrylic on canvas.In Figure 4 ‘The Birthing Tree’, the overt symbolism reaches ‘clairvoyant status’. This could be read as the family ‘tree’ with its four faces screaming out of the ‘branches’. Do these represent the four babies relinquished by our mother (the larger of these ‘beings’ as myself, giving birth to the illegitimate, silenced, and abject self)? Are we all depicted in anguish and as wraithlike, grotesquely simplified into pure affect? This illegitimate self is painted as gestating a ‘blue’ baby, near full-term in a meld of tree and ‘self’, a blue umbilical cord, again, devoid of blood, ghosted, lifeless and yet still living, once again suffocated by the representation of the umbilical in the ‘bowels’ of the self, the abject part of the body, where refuse is stored and eliminated: The duodenum of the damned. The Devil may be seen as Christopher Bollas’s “shadow of the object”, or the Jungian archetypal shadow, not simply a Judeo-Christian fear-based spectre and curmudgeon, but a site of unprocessed and, therefore, feared psychological material, material that must be brought to consciousness and integrated. Perhaps the Devil also is the antithesis to ‘God’ as mother. The hell of ‘not mother’, no mother, not the right mother, the reluctant adoptive mother – the Devil as icon for the rich underbelly of the psyche and apophatic to the adopted/artificial/socially scripted self.Figure 4. The Birthing Tree. 1995. Acrylic on canvas.These paintings ache with the trauma of my relinquishment and LDA experience. They ache with my body’s truth, where the cellular and psychological, flesh and blood and feeling, leak from my wounds in unspeakable confluence (the two genital lips as the site of relinquishment, my speaking lips that have been sealed through non-disclosure and shame, the psychological trauma as Verrier’s ‘primal wound’) just as I leaked from my mother (and society) at birth, as blood and muck, and ooze and pus and death (Grosz 195) only to be quickly and silently mopped up and cleansed through adoption and life-long secrecy. Where I, as translator, fluent in both silence and signs, disclose the baby’s trauma, asking for legitimacy. My experience as a LDA sets up an interesting experiment, one that allows an examination of the pre-verbal/pre-disclosure body as a fleshed and breathing Rosetta Stone, as an interface between the language of the body and of the verbalised, painted, and written text. As a constructed body, written upon and invented legally, socially, and psychologically, I am, in Hélène Cixous’s (“To Live the Orange” 83) words, “un-forgetting”, “un-silencing” and “unearthing” my ‘self’ – I am re-writing, re-inventing and, under public scrutiny, legitimising my ‘self’. I am a site of inquiry, discovery, extrapolation, and becoming (Metta 492; Poulus 475) and, as Grosz (vii) suggests, a body with “all the explanatory power” of the mind. I am, as I embroider myself and my LDA experience into literary and critical texts, authoring myself into existence, referencing with particular relevance Peter Carnochan’s (361) suggestion that “analysis...acts as midwife to the birth of being”. I am, as I swim forever amorphous, invisible, and unspoken in my mother’s womb, fashioning a shore, landscaping my mind against the constant wet, my chronic liminality (Rambo 629) providing social landfall for other LDAs and silenced minorities. As Catherine Lynch (3) writes regarding LDAs, “Through the creation of text and theory I can formulate an intimate space for a family of adoptive subjects I might never know via our participation in a new discourse in Australian academia.” I participate through my creative, self-reflexive, process fuelled (Durey 22), practice-led enquiry. I use the intimacy (and also universality and multiplicity) and illegitimacy of my body as an alterative text, as a site of academic and creative augmentation in the understanding of LDA issues. The relinquished and silenced baby and LDA adult needs a voice, a ‘body’, and a ‘tender’ place in the consciousness of society, as Helen Riley (“Confronting the Conspiracy of Silence” 11) suggests, “voice, validation, and vindication”. Judith Herman (3) argues that, “Survivors challenge us to reconnect fragments, to reconstruct history, to make meaning of their present symptoms in the light of past events”. I seek to use the example of my experience – as Judith Durey (31) suggests, in “support of evocative, creative modes of representation as valid forms of research in their own right” – to unfurl the whole, to give impetus and precedence for other researchers into adoption and advocate for future babies who may be bought, sold, arranged, and/or created by various means. The recent controversy over Gammy, the baby boy born with Down Syndrome in Thailand, highlights the urgent and moral need for legislation with regard to surrogacy (see Kajsa Ekis Ekman’s Being and Being Bought: Prostitution, Surrogacy and the Split Self for a comprehensive examination of surrogacy issues). Indeed, Catherine Lynch in her paper Doubting Adoption Legislation links the experiences of LDAs and the children of born of surrogacy, most effectively arguing that, “if the fate that closed record adoptees suffered was a misplaced solution to the question of what to do with children already conceived how can you justify the deliberate conception of a child with the intention even before its creation of cruelly removing that child from their mother?” (6). Cixous (xxii) confesses, “All I want is to illustrate, depict fragments, events of human life and death...each unique and yet at the same time exchangeable. Not the law, the exception”. I, too, am a fragment, an illustration (a painting), and, as every individual always is – paradoxically – a communal and, therefore, deeply recognisable and generally applicable minority and exception. In my illegitimacy, I am some kind of evidence. Evidence of cellular memory. Evidence of embodiment. Evidence that silenced illegitimacies will manifest in symptom and non-verbal narratives, that they will ooze out and await translation, verification, and witness. This paper is offered with reverence and with feminist intention, as a revenant mouthpiece for other LDAs, babies born of surrogacy, and donor assisted offspring (and, indeed, any) who are marginalised, silenced, and obscured. It is also intended to promote discussion in the psychological and psychoanalytic fields and, as Helen Riley (202-207) advocates regarding late discovery offspring, more research within the social sciences and the bio-medical field that may encourage legislators to better understand what the ‘best interests of the child’ are in terms of late discovery of origins and the complexity of adoption/conception practices available today. As I write now (and always) the umbilical from my paintings curve and writhe across my soul, twist and morph into the swollen and throbbing organ of tongues, my throat aching to utter, my hands ready to craft latent affect into language in translation of, and in obedience to, my body’s knowledges. It is the art of mute witness that reverses genesis, that keeps the umbilical fat and supple and full of blood, and allows my conscious conception and creation. Indeed, in the intersection of my theoretical, creative, psychological, and somatic praxis, the heat (read hot and messy, insightful and insistent signage) of my body’s knowledges perhaps intensifies – with a ripe bouquet – the inevitably ongoing odour/aroma of the reproductive world. ReferencesAngel, Maria, and Anna Gibbs. “On Moving and Being Moved: The Corporeality of Writing in Literary Fiction and New Media Art.” Literature and Sensation, eds. Anthony Uhlmann, Helen Groth, Paul Sheehan, and Stephan McLaren. Newcastle upon Tyne, UK: Cambridge Scholars Publishing, 2009: 162-172. Bollas, Christopher. The Shadow of the Object: Psychoanalysis of the Unthought Known. New York: Columbia UP, 1987. Brodzinsky, David. “Adjustment to Adoption: A Psychosocial Perspective.” Clinical Psychology Review 7 (1987): 25-47. doi: 10.1016/0272-7358(87)90003-1.Brodzinsky, David, Daniel Smith, and Anne Brodzinsky. Children’s Adjustment to Adoption: Developmental and Clinical Issues. California: Sage Publications, 1998.Carnochan, Peter. “Containers without Lids”. Psychoanalytic Dialogues 16.3 (2006): 341-362.Cixous, Hélène. “To Live the Orange”. The Hélène Cixous Reader: With a Preface by Hélène Cixous and Foreword by Jacques Derrida, ed. Susan Sellers. Oxford, UK: Routledge, 1979/1994. 81-92. ---. “Preface.” The Hélène Cixous Reader: With a Preface by Hélène Cixous and Foreword by Jacques Derrida, ed. Susan Sellers. Oxford, UK: Routledge, 1994. xv-xxii.Coull, Kim. “Womb Tongues: A Collection of Poetry.” Honours Thesis. Perth, WA: Edith Cowan University, 2007. ---. “The Womb Artist – A Novel: Translating Late Discovery Adoptee Pre-Verbal Trauma into Narrative”. Dissertation. Perth, WA: Edith Cowan University, 2014. Durey, Judith. Translating Hiraeth, Performing Adoption: Art as Mediation and Form of Cultural Production. Dissertation. Perth, WA: Murdoch University, 2010. 22 Sep. 2011 .Ekis Ekman, Kajsa. Being and Being Bought: Prostitution, Surrogacy and the Split Self. Trans. S. Martin Cheadle. North Melbourne: Spinifex Press, 2013. Gardiner, Amanda. “Sex, Death and Desperation: Infanticide, Neonaticide, and Concealment of Birth in Colonial Western Australia”. Dissertation. Perth, WA: Edith Cowan University, 2014. Grosz, Elizabeth. Volatile Bodies. NSW: Allen &. Unwin, 1994. Grotevant, Harold D., Nora Dunbar, Julie K. Kohler, and Amy. M. Lash Esau. “Adoptive Identity: How Contexts within and beyond the Family Shape Developmental Pathways.” Family Relations 49.3 (2000): 79-87.Herman, Judith L. Trauma and Recovery: From Domestic Abuse to Political Terror. London: Harper Collins, 1992. Howard, Sethane, and Mark W. Crandall. Post Traumatic Stress Disorder: What Happens in the Brain. Washington Academy of Sciences 93.3 (2007): 1-18.Keneally, Thomas. Schindler’s List. London: Serpentine Publishing Company, 1982. Kenny, Pauline, Daryl Higgins, Carol Soloff, and Reem Sweid. Past Adoption Experiences: National Research Study on the Service Response to Past Adoption Practices. Research Report 21. Australian Institute of Family Studies, 2012.Kirby, Vicky. Telling Flesh: The Substance of the Corporeal. New York and London: Routledge, 1997. Klorer, P. Gussie. “Expressive Therapy with Severely Maltreated Children: Neuroscience Contributions.” Journal of the American Art Therapy Association 22.4 (2005): 213-220. doi:10.1080/07421656.2005.10129523.Levy-Shiff, Rachel. “Psychological Adjustment of Adoptees in Adulthood: Family Environment and Adoption-Related Correlates. International Journal of Behavioural Development 25 (2001): 97-104. doi: 1080/01650250042000131.Lifton, Betty J. “The Adoptee’s Journey.” Journal of Social Distress and the Homeless 11.2 (2002): 207-213. doi: 10.1023/A:1014320119546.Lusebrink, Vija B. “Art Therapy and the Brain: An Attempt to Understand the Underlying Processes of Art Expression in Therapy.” Journal of the American Art Therapy Association 21.3 (2004): 125-135. doi:10.1080/07421656. 2004.10129496.Lynch, Catherine. “An Ado/aptive Reading and Writing of Australia and Its Contemporary Literature.” Australian Journal of Adoption 1.1 (2009): 1-401.---. Doubting Adoption Legislation. n.d.McCutcheon, Sandy. The Magician’s Son: A Search for Identity. Sydney, NSW: Penguin, 2006. Metta, Marilyn. “Putting the Body on the Line: Embodied Writing and Recovery through Domestic Violence.” Handbook of Autoethnography, eds. Stacy Holman Jones, Tony Adams, and Carolyn Ellis. Walnut Creek, CA: Left Coast Press, 2013: 486-509.Pert, Candace. Molecules of Emotion: The Science behind Mind-body Medicine. New York: Touchstone, 2007. Rambo, Carol. “Twitch: A Performance of Chronic Liminality.” Handbook of Autoethnography, eds. Stacy Holman Jones, Tony Adams, and Carolyn Ellis. Walnut Creek, CA: Left Coast Press, 2013: 627-638.Riley, Helen J. Identity and Genetic Origins: An Ethical Exploration of the Late Discovery of Adoptive and Donor-insemination Offspring Status. Dissertation. Brisbane: Queensland University of Technology, 2012.---. “Confronting the Conspiracy of Silence and Denial of Difference for Late Discovery Persons and Donor Conceived People.” Australian Journal of Adoption 7.2 (2013): 1-13.Skilbeck, Ruth. “First Things: Reflection on Single-Lens Reflex Digital Photography with a Wide-Angle Lens.” International Journal of the Image 3 (2013): 55-66. Talwar, Savneet. “Accessing Traumatic Memory through Art Making: An Art Therapy Trauma Protocol (ATTP)." The Arts in Psychotherapy 34 (2007): 22-25. doi:10.1016/ j.aip.2006.09.001.Verrier, Nancy. The Primal Wound: Understanding the Adopted Child. Baltimore, MD: Gateway Press, 1993.---. The Adopted Child Grows Up: Coming Home to Self. Baltimore, MD: Gateway Press, 2003. Wierzbicki, Michael. “Psychological Adjustment of Adoptees: A Meta-Analysis.” Journal of Clinical Child Psychology 22.4 (1993): 447-454. doi:10.1080/ 01650250042000131.

In mid-2001, in a cultural policy discussion at Arts Queensland, an Australian state government arts policy and funding apparatus, a senior arts bureaucrat seeking to draw a funding client’s gaze back to the bigger picture of what the state government was trying to achieve through its cultural policy settings excused his own abstracting comments with the phrase, “but then I might just be a policy ‘wank’”. There was some awkward laughter before one of his colleagues asked, “did you mean a policy ‘wonk’”? The incident was a misstatement of a term adopted in the 1990s to characterise the policy workers in the Clinton Whitehouse (Cunningham). This was not its exclusive use, but many saw Clinton as an exemplary wonk: less a pragmatic politician than one entertained by the elaboration of policy. The policy work of Clinton’s kitchen cabinet was, in part, driven by a pervasive rationalist belief in the usefulness of ordered policy processes as a method of producing social and economic outcomes, and, in part, by the seductions of policy-play: its ambivalences, its conundrums, and, in some sense, its aesthetics (Klein 193-94). There, far from being characterised as unproductive “self-abuse” of the body-politic, policy processes were alive as a pragmatic technology, an operationalisation of ideology, as an aestheticised field of play, but more than anything as a central rationalist tenant of government action. This final idea—the possibilities of policy for effecting change, promoting development, meeting government objectives—is at the centre of the bureaucratic imagination. Policy is effective. And a concomitant belief is that ordered or organised policy processes result in the best policy and the best outcomes. Starting with Harold Lasswell, policy theorists extended the general rationalist suppositions of Western representative democracies into executive government by arguing for the value of information/knowledge and the usefulness of ordered process in addressing thus identified policy problems. In the post-war period particularly, a case can be made for the usefulness of policy processes to government—although, in a paradox, these rationalist conceptions of the policy process were strangely irrational, even Utopian, in their view of transformational capacities possibilities of policy. The early policy scientists often moved beyond a view of policy science as a useful tool, to the advocacy of policy science and the policy scientist as panaceas for public ills (Parsons 18-19). The Utopian ambitions of policy science finds one of their extremes in the contemporary interest in whole-of-government approaches to policy making. Whole-of-governmentalism, concern with co-ordination of policy and delivery across all areas of the state, can seen as produced out of Western governments’ paradoxical concern with (on one hand) order, totality, and consistency, and (on the other) deconstructing existing mechanisms of public administration. Whole-of-governmentalism requires a horizontal purview of government goals, programs, outputs, processes, politics, and outcomes, alongside—and perhaps in tension with—the long-standing vertical purview that is fundamental to ministerial responsibility. This often presents a set of public management problems largely internal to government. Policy discussion and decision-making, while affecting community outcomes and stakeholder utility, are, in this circumstance, largely inter-agency in focus. Any eventual policy document may well have bureaucrats rather than citizens as its target readers—or at least as its closest readers. Internally, cohesion of objective, discourse, tool and delivery are pursued as a prime interests of policy making. Failing at Policy So what happens when whole-of-government policy processes, particularly cultural policy processes, break down or fail? Is there anything productive to be retrieved from a failed fantasy of policy cohesion? This paper examines the utility of a failure to cohere and order in cultural policy processes. I argue that the conditions of contemporary cultural policy-making, particularly the tension between the “boutique” scale of cultural policy-making bodies and the revised, near universal, remit of cultural policy, require policy work to be undertaken in an environment and in such a way that failure is almost inevitable. Coherence and cohesions are fundamental principles of whole-of-government policy but cultural policy ambitions are necessarily too comprehensive to be achievable. This is especially so for the small arts or cultural offices government that normally act as lead agencies for cultural policy development within government. Yet, that these failed processes can still give rise to positive outcomes or positive intermediate outputs that can be taken up in a productive way in the ongoing cycle of policy work that categorises contemporary cultural governance. Herein, I detail the development of Building the Future, a cultural policy planning paper (and the name of a policy planning process) undertaken within Arts Queensland in 1999 and 2000. (While this process is now ten years in the past, it is only with a decade past that as a consultant I am in apposition to write about the material.) The abandonment of this process before the production of a public policy program allows something to be said about the utility and role of failure in cultural policy-making. The working draft of Building the Future never became a public document, but the eight months of its development helped produce a series of shifts in the discourse of Queensland Government cultural policy: from “arts” to “creative industries”; and from arts bureaucracy-centred cultural policy to the whole-of-government policy frameworks. These concepts were then taken up and elaborated in the Creative Queensland policy statement published by Arts Queensland in October 2002, particularly the concern with creative industries; whole-of-government cultural policy; and the repositioning of Arts Queensland as a service agency to other potential cultural funding-bodies within government. Despite the failure of the Building the Future process, it had a role in the production of the policy document and policy processes that superseded it. This critique of cultural policy-making rather than cultural policy texts, announcements and settings is offered as part of a project to bring to cultural policy studies material and theoretical accounts of the particularities of making cultural policy. While directions in cultural policy have much to do with the overall directions of government—which might over the past decade be categorised as focus on de-regulation, out-sourcing of services—there are developments in cultural policy settings and in cultural policy processes that are particular to cultural policy and cultural policy-making. Central to the development of cultural policy studies and to cultural policy is a transformational broadening of the operant definition of culture within government (O'Regan). Following Raymond Williams, the domain of culture is broadened to include the high culture, popular culture, folk culture and the culture of everyday life. Accordingly, in some sense, every issue of governance is deemed to have a cultural dimension—be it policy questions around urban space, tourism, community building and so on. Contemporary governments are required to act with a concern for cultural questions both within and across a number of long-persisting and otherwise discrete policy silos. This has implications for cultural policy makers and for program delivery. The definition of culture as “everyday life”, while truistically defendable, becomes unwieldy as an imprimatur or a container for administrative activity. Transforming cultural policy into a domain incorporating most social policy and significant elements of economic policy makes the domain titanically large. Potentially, it compromises usual government efforts to order policy activity through the division or apportionment of responsibility (Glover and Cunningham 19). The problem has given rise to a new mode of policy-making which attends to the co-ordination of policy across and between levels of government, known as whole-of government policy-making (see O’Regan). Within the domain of cultural policy the task of whole-of-government cultural policy is complicated by the position of, and the limits upon, arts and cultural bureaux within state and federal governments. Dedicated cultural planning bureaux often operate as “boutique” agencies. They are usually discrete line agencies or line departments within government—only rarely are they part of the core policy function of departments of a Premier or a Prime Minister. Instead, like most line agencies, they lack the leverage within the bureaucracy or policy apparatus to deliver whole-of-government cultural policy change. In some sense, failure is the inevitable outcome of all policy processes, particularly when held up against the mechanistic representation of policy processes in policy typical of policy handbooks (see Bridgman and Davis 42). Against such models, which describe policy a series of discrete linear steps, all policy efforts fail. The rationalist assumptions of early policy models—and the rigid templates for policy process that arise from their assumptions—in retrospect condemn every policy process to failure or at least profound shortcoming. This is particularly so with whole-of-government cultural policy making To re-think this, it can be argued that the error then is not really in the failure of the process, which is invariably brought about by the difficulty for coherent policy process to survive exogenous complexity, but instead the error rests with the simplicity of policy models and assumptions about the possibility of cohesion. In some sense, mechanistic policy processes make failure endogenous. The contemporary experience of making policy has tended to erode any fantasies of order, clear process, or, even, clear-sightedness within government. Achieving a coherence to the policy message is nigh on impossible—likewise cohesion of the policy framework is unlikely. Yet, importantly, failed policy is not without value. The churn of policy work—the exercise of attempting cohrent policy-making—constitutes, in some sense, the deliberative function of government, and potentially operates as a force (and site) of change. Policy briefings, reports, and draft policies—the constitution of ideas in the policy process and the mechanism for their dissemination within the body of government and perhaps to other stakeholders—are discursive acts in the process of extending the discourse of government and forming its later actions. For arts and cultural policy agencies in particular, who act without the leverage or resources of central agencies, the expansive ambitions of whole-of-government cultural policy makes failure inevitable. In such a circumstance, retrieving some benefits at the margins of policy processes, through the churn of policy work towards cohesion, is an important consolation. Case study: Cultural Policy 2000 The policy process I wish to examine is now complete. It ran over the period 1999–2002, although I wish to concentrate on my involvement in the process in early 2000 during which, as a consultant to Arts Queensland, I generated a draft policy document, Building the Future: A policy framework for the next five years (working draft). The imperative to develop a new state cultural policy followed the election of the first Beattie Labor government in July 1998. By 1999, senior Arts Queensland staff began to argue (within government at least) for the development of a new state cultural policy. The bureaucrats perceived policy development as one way of establishing “traction” in the process of bidding for new funds for the portfolio. Arts Minister Matt Foley was initially reluctant to “green-light” the policy process, but eventually in early 1999 he acceded to it on the advice of Arts Queensland, the industry, his own policy advisors and the Department of Premier. As stated above, this case study is offered now because the passing of time makes the analysis of relatively sensitive material possible. From the outset, an abbreviated timeframe for consultation and drafting seem to guarantee a difficult birth for the policy document. This was compounded by a failure to clarity the aims and process of the project. In presenting the draft policy to the advisory group, it became clear that there was no agreed strategic purpose to the document: Was it to be an advertisement, a framework for policy ideas, an audit, or a report on achievements? Tied to this, were questions about the audience for the policy statement. Was it aimed at the public, the arts industry, bureaucrats inside Arts Queensland, or, in keeping with the whole-of-government inflection to the document and its putative use in bidding for funds inside government, bureaucrats outside of Arts Queensland? My own conception of the document was as a cultural policy framework for the whole-of-government for the coming five years. It would concentrate on cultural policy in three realms: Arts Queensland; the arts instrumentalities; and other departments (particularly the cultural initiatives undertaken by the Department of Premier and the Department of State Development). In order to do this I articulated (for myself) a series of goals for the document. It needed to provide the philosophical underpinnings for a new arts and cultural policy, discuss the cultural significance of “community” in the context of the arts, outline expansion plans for the arts infrastructure throughout Queensland, advance ideas for increased employment in the arts and cultural industries, explore the development of new audiences and markets, address contemporary issues of technology, globalisation and culture commodification, promote a whole-of-government approach to the arts and cultural industries, address social justice and equity concerns associated with cultural diversity, and present examples of current and new arts and cultural practices. Five key strategies were identified: i) building strong communities and supporting diversity; ii) building the creative industries and the cultural economy; iii) developing audiences and telling Queensland’s stories; iv) delivering to the world; and v) a new role for government. While the second aim of building the creative industries and the cultural economy was an addition to the existing Australian arts policy discourse, it is the articulation of a new role for government that is most radical here. The document went to the length of explicitly suggesting a series of actions to enable Arts Queensland to re-position itself inside government: develop an ongoing policy cycle; position Arts Queensland as a lead agency for cultural policy development; establish a mechanism for joint policy planning across the arts portfolio; adopt a whole-of-government approach to policy-making and program delivery; use arts and cultural strategies to deliver on social and economic policy agendas; centralise some cultural policy functions and project; maintain and develop mechanisms and peer assessment; establish long-term strategic relationships with the Commonwealth and local government; investigate new vehicles for arts and cultural investment; investigate partnerships between industry, community and government; and develop appropriate performance measures for the cultural industries. In short, the scope of the document was titanically large, and prohibitively expansive as a basis for policy change. A chief limitation of these aims is that they seem to place the cohesion and coherence of the policy discourse at the centre of the project—when it might have better privileged a concern with policy outputs and industry/community outcomes. The subsequent dismal fortunes of the document are instructive. The policy document went through several drafts over the first half of 2000. By August 2000, I had removed myself from the process and handed the drafting back to Arts Queensland which then produced shorter version less discursive than my initial draft. However, by November 2000, it is reasonable to say that the policy document was abandoned. Significantly, after May 2000 the working drafts began to be used as internal discussion documents with government. Thus, despite the abandonment of the policy process, largely due to the unworkable breadth of its ambition, the document had a continued policy utility. The subsequent discussions helped organise future policy statements and structural adjustments by government. After the re-election of the Beattie government in January 2001, a more substantial policy process was commenced with the earlier policy documents as a starting point. By early 2002 the document was in substantial draft. The eventual policy, Creative Queensland, was released in October 2002. Significantly, this document sought to advance two ideas that I believe the earlier process did much to mobilise: a whole-of-government approach to culture; and a broader operant definition of culture. It is important not to see these as ideas merely existing “textually” in the earlier policy draft of Building the Future, but instead to see them as ideas that had begun adhere themselves to the cultural policy mechanism of government, and begun to be deployed in internal policy discussions and in program design, before finding an eventual home in a published policy text. Analysis The productive effects of the aborted policy process in which I participated are difficult to quantify. They are difficult, in fact, to separate out from governments’ ongoing processes of producing and circulating policy ideas. What is clear is that the effects of Building the Future were not entirely negated by it never becoming public. Instead, despite only circulating to a readership of bureaucrats it represented the ideas of part of the bureaucracy at a point in time. In this instance, a “failed” policy process, and its intermediate outcomes, the draft policy, through the churn of policy work, assisted government towards an eventual policy statement and a new form of governmental organisation. This suggests that processes of cultural policy discussion, or policy churn, can be as productive as the public “enunciation” of formal policy in helping to organise ideas within government and determine programs and the allocation of resources. This is even so where the Utopian idealism of the policy process is abandoned for something more graspable or politic. For the small arts or cultural policy bureau this is an important incremental benefit. Two final implications should be noted. The first is for models of policy process. Bridgman and Davis’s model of the Australian policy cycle, despite its mechanistic qualities, is ambiguous about where the policy process begins and ends. In one instance they represent it as linear but strictly circular, always coming back to its own starting point (27). Elsewhere, however, they represent it as linear, but not necessarily circular, passing through eight stages with a defined beginning and end: identification of issues; policy analysis; choosing policy instruments; consultation; co-ordination; decision; implementation; and evaluation (28–29). What is clear from the 1999-2002 policy process—if we take the full period between when Arts Queensland began to organise the development of a new arts policy and its publication as Creative Queensland in October 2002—is that the policy process was not a linear one progressing in an orderly fashion towards policy outcomes. Instead, Building the Future, is a snapshot in time (namely early to mid-2000) of a fragmenting policy process; it reveals policy-making as involving a concurrency of policy activity rather than a progression through linear steps. Following Mark Considine’s conception of policy work as the state’s effort at “system-wide information exchange and policy transfer” (271), the document is concerned less in the ordering of resources than the organisation of policy discourse. The churn of policy is the mobilisation of information, or for Considine: policy-making, when considered as an innovation system among linked or interdependent actors, becomes a learning and regulating web based upon continuous exchanges of information and skill. Learning occurs through regulated exchange, rather than through heroic insight or special legislative feats of the kind regularly described in newspapers. (269) The acceptance of this underpins a turn in contemporary accounts of policy (Considine 252-72) where policy processes become contingent and incomplete Policy. The ordering of policy is something to be attempted rather than achieved. Policy becomes pragmatic and ad hoc. It is only coherent in as much as a policy statement represents a bringing together of elements of an agency or government’s objectives and program. The order, in some sense, arrives through the act of collection, narrativisation and representation. The second implication is more directly for cultural policy makers facing the prospect of whole-of-government cultural policy making. While it is reasonable for government to wish to make coherent totalising statements about its cultural interests, such ambitions bring the near certainty of failure for the small agency. Yet these failures of coherence and cohesion should be viewed as delivering incremental benefits through the effort and process of this policy “churn”. As was the case with the Building the Future policy process, while aborted it was not a totally wasted effort. Instead, Building the Future mobilised a set of ideas within Arts Queensland and within government. For the small arts or cultural bureaux approaching the enormous task of whole-of government cultural policy making such marginal benefits are important. References Arts Queensland. Creative Queensland: The Queensland Government Cultural Policy 2002. Brisbane: Arts Queensland, 2002. Bridgman, Peter, and Glyn Davis. Australian Policy Handbook. St Leonards: Allen & Unwin, 1998. Considine, Mark. Public Policy: A Critical Approach. South Melbourne: Palgrave Macmillan, 1996. Cunningham, Stuart. "Willing Wonkers at the Policy Factory." Media Information Australia 73 (1994): 4-7. Glover, Stuart, and Stuart Cunningham. "The New Brisbane." Artlink 23.2 (2003): 16-23. Glover, Stuart, and Gillian Gardiner. Building the Future: A Policy Framework for the Next Five Years (Working Draft). Brisbane: Arts Queensland, 2000. Klein, Joe. "Eight Years." New Yorker 16 & 23 Oct. 2000: 188-217. O'Regan, Tom. "Cultural Policy: Rejuvenate or Wither". 2001. rtf.file. (26 July): AKCCMP. 9 Aug. 2001. ‹http://www.gu.edu.au/centre/cmp>. Parsons, Wayne. Public Policy: An Introduction to the Theory and Practice of Policy Analysis. Aldershot: Edward Edgar, 1995.Williams, Raymond. Key Words: A Vocabulary of Culture and Society. London: Fontana, 1976.