Journal articles on the topic 'Stay'n Out (Program)'

The incarceration of persons found guilty of various crimes who are also chronic substance abusers presents an important opportunity for treatment. It is an important opportunity because they would be unlikely to seek treatment on their own, without treatment they are very apt to continue their drug use and criminality after release, and cost effective drug abuse treatment methods are now available to treat them while in custody (both during incarceration and aftercare) and significantly alter their lifestyles. Correctional authorities should now feel optimistic that chronic heroin and cocaine users with predatory criminal histories can be treated effectively. This article shares the success of the Stay'n Out and Cornerstone Programs that have been successful with serious drug abusing offenders, and the factors that make for success. It is the proper program components joined by thoughtful leadership in the right setting. These principles are generalizable and transferable to many locations.

BACKGROUND: The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol protocols recommend the use of Pooled Cohort Equations to estimate 10-year and life time Atherosclerotic cardio-vascular disease (ASCVD) risk as a guide for primary prevention treatment options. Many providers underutilize this important tool.OBJECTIVES: To observe resident physicians’ HMG COA inhibitor (statins) prescribing pattern, with particular attention to appropriate dosing as per 2013 ACC/AHA Cholesterol Guidelines, at the University of Toledo Family Medicine Residency Program and to increase Resident Physicians’ awareness of the ASCVD risk calculator as a tool to improve appropriate statin dosing.METHODS: A retrospective, observational, cross-sectioned chart review was performed to analyze pre-existing data collected from a patient population within a defined time period. The study included 237 patient charts, who received care from among 12 Family Medicine Residents.RESULTS: The success rate for correct statins prescriptions for first year residents was 63%, including 24 correct dose prescriptions out of 38 patients total. Second year residents’ success rate increased to 73%, representing 58 correct dose prescriptions out of 80 patients total. Third year residents success rate was 63% with 75 correct dose prescriptions out of 119 patients total.CONCLUSION: Out of 237 chart reviewed, 157 patients received appropriately dosed statin prescriptions, representing a success rate of 66%. This suggests that across all levels of resident training, there is room of improvement in the utilization of the 2013 ACC/AHA lipid lowering guidelines.

For the past few years, Soviet historians have fixed their attention on the problem of "alternatives," a shorthand for wide-ranging attempts to free historical thinking from the overly determinist schemes of Stalinist orthodoxy. The question is posed most often as the possibility of a more humane alternative to Stalin and the political order associated with his name. Some historians and publicists, however, have gone beyond the Stalin period to reflect on, for example, how even the 1917 revolutions might have been avoided. The leadership under Mikhail Gorbachev and reformist allies among the intelligentsia have singled out the New Economic Policy, or NEP, as the legitimate socialist forerunner to the present reformist programs. In so doing, they approach consensus with an influential group of western historians, including Stephen Cohen, Moshe Lewin, and Robert Tucker, who have kept alive the memory of Nikolai Bukharin in particular, but a non-Stalinist path to socialism as well.

This article examines the state-sponsored rise of local patriotism in the post- 1961 period, interpreting it as part of the effort to strengthen popular support for and the legitimacy of the Soviet regime during the second phase of de- Stalinization. It shifts the analytical focus away from the Secret Speech of 1956, the time of Nikita Khrushchev's full-scale assault on Iosif Stalin and his legacy, to the Twenty-Second Party Congress of 1961, the inauguration of a Utopian and pioneering plan to build communism by 1980. I consider how this famously forward-looking program gave rise to an institutionalized retrospectivism, as Soviet policymakers turned to the past to mobilize popular support for socialist construction. I examine how this process played out in the Russian northwest, where Soviet citizens were encouraged to turn inward, to examine their local history and traditions, and to reread these through a socialist lens.

Aim. To determine the features and main problems of statin therapy, as well as assess the possibility of achieving the target level of lipid pattern in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Material and methods. The design of the “PRIORITET” observational program is an open observational study. Patients with high and very high CVR were divided into 3 groups in accordance with the initial data: (1) not taking statins, (2) taking statins, but not reaching the target low-density lipoprotein cholesterol (LDL-C) level, (3) taking statins with the achievement of the target LDL-C level, which is justified in replacing the statin inside the class — adverse effects (AE), high price, etc. Within 12 weeks 3 visits of patients to hospitals were carried out: baseline visit (B0), visit 1 month after the study initiation (B1) and visit 3 months after the study initiation (B3). The choice of atorvastatin or rosuvastatin was assessed by the doctors.Results. Groups 1, 2 and 3 included 112, 170 and 16 people, respectively. At B0, 145 (48,7%) patients were prescribed atorvastatin, and 153 (51,3%) — rosuvastatin. Three people dropped out of the study to B3, 295 patients completed the program. Lipid pattern of 285 patients were analyzed: 121 (41%) people (101 with very high CVR and 20 with high CVR) achieved the target LDL-C level, the remaining 164 (59%) patients (CVR — 156 and 8, respectively) — no. The most pronounced dynamics of LDL=C level was revealed in group 1, the differences between group 1 and groups 2 and 3 are highly statistically significant (p<0,0001). There were no differences in the frequency of reaching the target LDL-C level between patients taking atorvastatin or rosuvastatin. The target level of LDL-C (p=0,003) in the treatment of rosuvastatin in patients with high CVR was reached significantly more often than in patients with very high CVR. Also 3 non-serious AEs were reported. On average, in 9% of cases, reaching the target level of LDL-С during visits B1 and B3 was wrong interpreted by the attending physicians.Conclusion. The main problems of statin therapy in real clinical practice are the wrong interpretation of reaching the target level of LDL-C, inertness of doctors in titrating of statins doses and achieving the target level of lipid pattern. It may be the cause of reduced efficiency and deterioration of lipid-lowering therapy results in patients with high and very high CVR. The results of the “PRIORITET” study demonstrated the possibility of improving the practice of statins use and its accordance with clinical guidelines.Skibitsky V. V. on behalf of the working group of the “PRIORITET” researchWorking Group of the “PRIORITET” study: Voronina V. P. (Moscow), Zelenova T. I. (Moscow), Sladkova T.A. (Moscow), Alekseeva A. I. (Tula), Barabanova T. Yu. (Tula), Zotova A. S. (Tula), Kolomeitseva T. M. (Tula), Prikhod’ko T. N. (Tula), Pazelt E. A. (Nizhny Novgorod), Khramushev N. Yu. (Nizhny Novgorod), Skibitsky A. V. (Krasnodar), Alekseeva V. V. (Saratov), Lazareva E. V. (Saratov).

Aim. To determine the features and main problems of statin therapy, as well as assess the possibility of achieving the target level of lipid pattern in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Material and methods. The design of the “PRIORITET” observational program is an open observational study. Patients with high and very high CVR were divided into 3 groups in accordance with the initial data: (1) not taking statins, (2) taking statins, but not reaching the target low-density lipoprotein cholesterol (LDL-C) level, (3) taking statins with the achievement of the target LDL-C level, which is justified in replacing the statin inside the class — adverse effects (AE), high price, etc. Within 12 weeks 3 visits of patients to hospitals were carried out: baseline visit (B0), visit 1 month after the study initiation (B1) and visit 3 months after the study initiation (B3). The choice of atorvastatin or rosuvastatin was assessed by the doctors.Results. Groups 1, 2 and 3 included 112, 170 and 16 people, respectively. At B0, 145 (48,7%) patients were prescribed atorvastatin, and 153 (51,3%) — rosuvastatin. Three people dropped out of the study to B3, 295 patients completed the program. Lipid pattern of 285 patients were analyzed: 121 (41%) people (101 with very high CVR and 20 with high CVR) achieved the target LDL-C level, the remaining 164 (59%) patients (CVR — 156 and 8, respectively) — no. The most pronounced dynamics of LDL=C level was revealed in group 1, the differences between group 1 and groups 2 and 3 are highly statistically significant (p<0,0001). There were no differences in the frequency of reaching the target LDL-C level between patients taking atorvastatin or rosuvastatin. The target level of LDL-C (p=0,003) in the treatment of rosuvastatin in patients with high CVR was reached significantly more often than in patients with very high CVR. Also 3 non-serious AEs were reported. On average, in 9% of cases, reaching the target level of LDL-С during visits B1 and B3 was wrong interpreted by the attending physicians.Conclusion. The main problems of statin therapy in real clinical practice are the wrong interpretation of reaching the target level of LDL-C, inertness of doctors in titrating of statins doses and achieving the target level of lipid pattern. It may be the cause of reduced efficiency and deterioration of lipid-lowering therapy results in patients with high and very high CVR. The results of the “PRIORITET” study demonstrated the possibility of improving the practice of statins use and its accordance with clinical guidelines.Skibitsky V. V. on behalf of the working group of the “PRIORITET” researchWorking Group of the “PRIORITET” study: Voronina V. P. (Moscow), Zelenova T. I. (Moscow), Sladkova T.A. (Moscow), Alekseeva A. I. (Tula), Barabanova T. Yu. (Tula), Zotova A. S. (Tula), Kolomeitseva T. M. (Tula), Prikhod’ko T. N. (Tula), Pazelt E. A. (Nizhny Novgorod), Khramushev N. Yu. (Nizhny Novgorod), Skibitsky A. V. (Krasnodar), Alekseeva V. V. (Saratov), Lazareva E. V. (Saratov).

On 1 December 2016, British Columbia’s (BC) provincial drug insurance program changed which medications in certain classes would benefit under the insurance program in an attempt to reduce expenditure. As part of the modernization, HMG-CoA reductase inhibitors (Statins), Angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers (CCB) were affected. Prescribers and pharmacists had six months to discuss the changes with patients, and change medications if deemed necessary. Purpose: To quantify the changes made to prescriptions and to adjust to the Modernized Reference Drug Program. Methods: A retrospective chart review was conducted at two clinics in Prince George, BC. Charts for patients that were prescribed any drugs in the affected classes were reviewed to determine if, and when, they had been changed, and by which health care professional. In December 2016, a clinical pharmacist, integrated within the study clinics, informed prescribers of the changes, and made patient-specific clinical notes within the charts. The notes described the changes and recommended alternative agents and appropriate dosing in order to assist the prescriber to have a conversation with the patient regarding the switch. Results: Out of 429 unique patients, 233 patients were prescribed a Statin, 229 patients an ACEI, 110 an ARB and, 83 a CCB. Sixty-five drug changes were indicated to reflect the modernization, and with guidance from a clinical pharmacist, nurse practitioners (NPs), and family physicians (FPs), 65% of these identified drugs were switched to reflect the modernization. Community pharmacists made no drug changes in the study sample, despite the prescriptive authority and compensation available to do so. Province-wide, approximately 21% to 33% of affected drugs were switched during the same time-frame. Direct collaboration between a clinical pharmacist, working alongside NPs and FPs, was more successful in optimizing these medications when compared to standard practice, or community pharmacists alone.

A comparison has been made of two methods for electron-density map improvement by the introduction of atomicity, namely the iterative skeletonization procedure of the CCP4 program DM [Cowtan & Main (1993). Acta Cryst. D49, 148–157] and the pseudo-atom introduction followed by the refinement protocol in the program suite DEMON/ANGEL [Vellieux, Hunt, Roy & Read (1995). J. Appl. Cryst. 28, 347–351]. Tests carried out using the 3.0 Å resolution electron density resulting from iterative 12-fold non-crystallographic symmetry averaging and solvent flattening for the Pseudomonas aeruginosa ornithine transcarbamoylase [Villeret, Tricot, Stalon & Dideberg (1995). Proc. Natl Acad. Sci. USA, 92, 10762–10766] indicate that pseudo-atom introduction followed by refinement performs much better than iterative skeletonization: with the former method, a phase improvement of 15.3° is obtained with respect to the initial density modification phases. With iterative skeletonization a phase degradation of 0.4° is obtained. Consequently, the electron-density maps obtained using pseudo-atom phases or pseudo-atom phases combined with density-modification phases are much easier to interpret. These tests also show that for ornithine transcarbamoylase, where 12-fold non-crystallographic symmetry is present in the P1 crystals, G-function coupling leads to the simultaneous decrease of the conventional R factor and of the free R factor, a phenomenon which is not observed when non-crystallographic symmetry is absent from the crystal. The method is far less effective in such a case, and the results obtained suggest that the map sorting followed by refinement stage should be by-passed to obtain interpretable electron-density distributions.

Background and aim: This study was to evaluate atorvastatin in the management of hypercholesterolemia of cardiovascular risk patients as well as the implication of National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines in Bangladesh.Methods: A total 1685 patients aged 28 years or older who had evidence of hypercholesterolemia with or without Coronary Heart Diseases (CHD) and cardiovascular risk factors were assigned to receive atorvastatin for 2 months. The change of fasting LDL at baseline visit and after 2 months of the statin treatment was measured.Results: One thousand six hundred (95%) patients out of 1685 who were assigned to receive atorvastatin with TLC were found significant mean reduction (26.1%?) in their LDL levels from baseline visit. Triglycerides and total cholesterols were also reduced (16.6% ? and 21.6% ? respectively) wheras high-density lipoprotein was increased (16.5% ?) significantly. LDL of 23% patients was decreased more than 30 mg/dl after 2 months of atorvastatin treatment. Fifty nine percent of the patients reached the treatment goal of reducing LDL > 20 mg/dl.Conclusion: Atorvastatin would achieve a good effective control in the management of hypercholesterolemic patients with or without CHD and risk factors following the guidelines of US NCEP ATP III. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12354 Birdem Med J 2012; 2(1) 5-13

Background: Leptospirosis is a bacterial, zoonotic disease associated with environmental factors and human behavior related to occupation. This research aimed to investigate the association between human behavior and leptospirosis. Case mapping and topographical mapping were done for a comprehensive visualization.Methods: A matched case-control study design was conducted in Gunungkidul, Indonesia, from December 2017 to January 2018. Cases were selected from those reported as suspicious of leptospirosis by the Gunungkidul District Health Office during 2017 and controls were matched according to sex and age. Chi-squared, Fisher exact test, and Odds ratios were employed to find out the association between exposure and outcome for a significance level of 0.05. Quantum GIS-Web Map-Stamen terrain was used to overlay case and landscape.Results: Bivariate analysis showed that four exposure variables that enhanced the risk for leptospirosis though not significantly associated were history of injuries, habit of taking a bath or wash the clothes in the river, not using personal protection during work and presence of an animal fence surrounding the house. Most of the leptospirosis cases (>70%) resided in a hilly area. This finding assists in developing prevention strategies concerning leptospirosis infection.Conclusions: Human behaviour is vital in leptospirosis prevention. Accordingly, this study can broaden the understanding horizon, particularly for a decision-maker where and how to implement the Leptospirosis prevention program. Prevention should address the current situation in the field and based on population and local wisdom to result in the successful implementation.

Background. In patients after liver transplantation cardiovascular complications is the third main reason of death afer allograf failure and infections. The most important factors in the development of cardiovascular diseases are dyslipidemia and impaired renal function. The aim of the study was to investigate the lipid spectrum and renal function in liver recipients in real clinical practice and the correspondence of their correction to current clinical recommendations for the diagnosis and treatment of dyslipidemia and chronic kidney disease (CKD). Methods. A retrospective analysis of lipid spectrum and renal function in patients who underwent OLT in Research Institute – Regional Clinical Hospital №1, Krasnodar was performed. The level of creatinine, GFR and lipid spectrum was studied before and 36 months after liver transplantation. The GFR was calculated using the formula CKD‑EPI (Chronic Kidney Disease Epidemiology Collaboration). Statistical analysis of the study results was made using the program Statistica 10. Results. Liver recipients have a significantly higher total cholesterol by 31.0% (p<0.01) in comparison with the baseline before surgery. Total cholesterol was increased in 13.7% (p<0.01), triglycerides in 12.3% (p<0.01) before transplantation. Tree years after transplantation, the increasion in cholesterol was registered in 42.6% (p<0.01) and triglycerides in 37.9% (p <0.01), respectively. 3 years after transplantation reduction of GFR was observed in comparison with the baseline by 22.6% (p=0.00006). Verification of chronic kidney disease and statin administration in patients were carried out in some cases. The levels of total cholesterol and triglycerides had a reliable inverse correlation with GFR (r = ‑0.42; p<0.01 and r = ‑0.36; p<0.05). Conclusions. In the long‑term postoperative period there was an impaired lipid metabolism and decreased level of GFR. Dyslipidemia was closely related to the progression of renal dysfunction in liver recipients, an inverse correlation was established between the glomerular filtration rate and the increasion in cholesterol and triglyceride levels. It is necessary to increase the attention of physicians with regard to timely correction of lipid metabolism disorders and detection of initial manifestations of renal dysfunction.

Aim. To study adherence to treatment with generic statins prescribed to patients with high and very high cardiovascular risk in routine clinical practice, as well as the possible impact of educational training of doctors on compliance with clinical guidelines and changes in patient adherence to treatment. Material and methods. The study was prospective, with educational training for physicians on the main provisions of current clinical guidelines prior to the program. It included 3 visits over 12 weeks: inclusion visit (V0), and visits after 1 and 3 months of follow-up (V1 and V3). The use of generic atorvastatin or rosuvastatin was recommended for all patients. To assess adherence the following surveys were used: medical survey (all visits), the original questionnaire to assess the potential and the actual commitment to taking statins and the causes of non-adherence, and the Morisky-Green 8-question test (visits V0 and V3) to evaluate overall adherence to drug treatment. The patients who started the drug taking according to the medical recommendations and continued it during the study were considered as adherents. Patients who started but stopped taking the drug for 12 weeks were considered as partially non-adherent. Patients who refused to take the recommended statin were considered as non-adherents. The prescribed doses of statins and medical tactics in the titration of doses, as well as the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) were evaluated. Results. 112 (37.5%) of the 298 patients with baseline indications for taking statins did not take these drugs. According to the medical survey at V0 a total of 286 (96%) patients were potential adherents to medical recommendations; at V3 262 (88%) patients were adherent to statin treatment; 34 patients were partially non-adherent, 1 – was non-adherent, and 1 – dropped out of the study immediately after V0. According to the original questionnaire, potential adherence was assessed in 281 patients: 244 (86.8%) were potentially adherent, 37 (13.2%) – partially non-adherent. At V3, out of 294 patients who filled in the original questionnaire, 260 (88.5%) were adherent, 26 (8.8%) – partly non-adherent, 8 (2.7%) – nonadherent. The Morisky-Green questionnaire was filled in by 292 patients: at V0, 106 patients (36.3%) had treatment adherence, non-adherence – 186 patients (63.7%). By V3, an increase in total adherence was found: 159 patients (54.5%) were adherent, and 133 (45.5%) – non-adherent. The lipid profile was evaluated in 231 patients in V1 and in 285 ones – in V3. The target LDL cholesterol level was reached by V1 in 47 (20.3%) patients, and in 184 (79.7%) patients – was not. Dose titration occurred in 56 patients. By V3, 121 (42.4%) patients reached the target level of LDL cholesterol, and 164 – did not. The results of the lipid profile analysis were erroneously interpreted in 21 patients. Conclusion The results of the medical survey and the original questionnaire for assessing adherence predominantly coincided. The Morisky-Green test does not accurately reflect patients' commitment to taking a particular drug. Clinical inertness of doctors in the titration of statin doses and achievement of target LDL cholesterol levels were found as well as erroneous interpretation of the LDL cholesterol level. Educational trainings for doctors had a positive effect on the implementation of clinical guidelines, and also contributed to increasing patient adherence to medical recommendations.

Dyslipidemia is major risk factor for cardiovascular disease in diabetes mellitus (DM). Early detection and treatment of dyslipidemia in type 2 DM can prevent the risk for atherosclerosis. Objectives: To determine the frequency of dyslipidemia in patients with type 2 diabetes mellitus presenting in DHQ Teaching Hospital, Sahiwal for routine check-up. Study Design: Cross Sectional, Observational, Descriptive study. Setting: Medical Unit 1, DHQ Teaching Hospital, Sahiwal, Pakistan. Period: 05-05-2018 to 05-11-2018. Material & Methods: Total 180 patients fulfilling selection criteria were enrolled in the study. Blood samples were obtained and sent to the Pathology Laboratory of the hospital for assessment of lipid profile. Reports were assessed and if cholesterol>200mg/dl and triglyceride>150mg/dl, then dyslipidemia was labeled. All this information was recorded on pro-formas. Results: In this study dyslipidemia was diagnosed in 81(45%) patients. Frequency of dyslipidemia was higher in age group 51-60 years (44.4%) as well as among female patients (56.8%). Overweight patients and patients with normal BMI had the highest frequency of dyslipidemia. Conclusion: the results of this study showed high frequency of dyslipidemia among type II diabetic patients. Type II diabetes is very much common in our population so there is a need to design screening programs in which blood lipid levels screening should be monitored on regular intervals to rule out dyslipidemia timely and for effective and proper management with statin therapy.

Background Managing noncommunicable diseases through primary healthcare has been identified as the key strategy to achieve universal health coverage but is challenging in most low- and middle-income countries. Stroke is the leading cause of death and disability in rural China. This study aims to determine whether a primary care-based integrated mobile health intervention (SINEMA intervention) could improve stroke management in rural China. Methods and findings Based on extensive barrier analyses, contextual research, and feasibility studies, we conducted a community-based, two-arm cluster-randomized controlled trial with blinded outcome assessment in Hebei Province, rural Northern China including 1,299 stroke patients (mean age: 65.7 [SD:8.2], 42.6% females, 71.2% received education below primary school) recruited from 50 villages between June 23 and July 21, 2017. Villages were randomly assigned (1:1) to either the intervention or control arm (usual care). In the intervention arm, village doctors who were government-sponsored primary healthcare providers received training, conducted monthly follow-up visits supported by an Android-based mobile application, and received performance-based payments. Participants received monthly doctor visits and automatically dispatched daily voice messages. The primary outcome was the 12-month change in systolic blood pressure (BP). Secondary outcomes were predefined, including diastolic BP, health-related quality of life, physical activity level, self-reported medication adherence (antiplatelet, statin, and antihypertensive), and performance in “timed up and go” test. Analyses were conducted in the intention-to-treat framework at the individual level with clusters and stratified design accounted for by following the prepublished statistical analysis plan. All villages completed the 12-month follow-up, and 611 (intervention) and 615 (control) patients were successfully followed (3.4% lost to follow-up among survivors). The program was implemented with high fidelity, and the annual program delivery cost per capita was US$24.3. There was a significant reduction in systolic BP in the intervention as compared with the control group with an adjusted mean difference: −2.8 mm Hg (95% CI −4.8, −0.9; p = 0.005). The intervention was significantly associated with improvements in 6 out of 7 secondary outcomes in diastolic BP reduction (p < 0.001), health-related quality of life (p = 0.008), physical activity level (p < 0.001), adherence in statin (p = 0.003) and antihypertensive medicines (p = 0.039), and performance in “timed up and go” test (p = 0.022). We observed reductions in all exploratory outcomes, including stroke recurrence (4.4% versus 9.3%; risk ratio [RR] = 0.46, 95% CI 0.32, 0.66; risk difference [RD] = 4.9 percentage points [pp]), hospitalization (4.4% versus 9.3%; RR = 0.45, 95% CI 0.32, 0.62; RD = 4.9 pp), disability (20.9% versus 30.2%; RR = 0.65, 95% CI 0.53, 0.79; RD = 9.3 pp), and death (1.8% versus 3.1%; RR = 0.52, 95% CI 0.28, 0.96; RD = 1.3 pp). Limitations include the relatively short study duration of only 1 year and the generalizability of our findings beyond the study setting. Conclusions In this study, a primary care-based mobile health intervention integrating provider-centered and patient-facing technology was effective in reducing BP and improving stroke secondary prevention in a resource-limited rural setting in China. Trial registration ClinicalTrials.gov NCT03185858.

Objective: To evaluate the impact of incorporating pre-advanced pharmacy practice experience (pre-APPE) student pharmacists into three different population health management (PHM) projects. Methods: The prospective quality improvement projects incorporated three third-year student pharmacists who developed and conducted individual PHM projects over the course of three to seven months. The projects included hypoglycemia screening, hepatitis C virus and human immunodeficiency virus screening, and statin use evaluations for atherosclerotic cardiovascular disease risk reduction. Under the guidance of a clinical pharmacist, students developed project materials, conducted patient chart reviews, and contacted patients to make interventions such as recommendations for therapy, ambulatory patient monitoring, patient education, and arranging provider follow-up. Student impact was evaluated through the number of patients screened, the number of eligible patients contacted, and the total number of interventions or recommendations made. Student time spent was tracked throughout the projects. Results: Out of 244 patients screened, 198 patients met inclusion criteria and 162 patients were contacted or assessed by a student pharmacist. Students made a total of 319 interventions, including patient education (132), patient monitoring (132), pharmacotherapy recommendations (28), and arranging follow-up (27). On average students screened 33 patients per month, and, per patient, required 8.6 minutes for eligibility assessment and approximately 6 minutes for telephone interviews. Conclusion: This report demonstrates that pre-APPE student pharmacists are well-equipped to design and implement PHM projects. Utilization of student pharmacists in similar PHM programs can expand the pharmacist’s impact on patient care in the ambulatory care setting. Article Type: Original Research

The idea of replacing revenues from alcohol sale with income from cinema attendance was put forward by L. Trotsky in Soviet Russia in the early 1920s. At the stage of transition from silent cinema to the sound one this idea received a significant number of supporters. Anyhow attendance statistics proved a considerable gap between alcohol profitability and yield, calculated on theatre booking. In order to heal the situation quite a number of new cinemas had to be built. Since the state did not have adequate resources at its disposal, it was decided to refurbish the churches into cinema theatres. As a result the two important aims were to be gained: efficient increase of attendance and effective antireligious propaganda. Achievements of Soviet cinema in the early 1930s supported the idea of cinema to triumph over alcohol. Iosif Stalin proclaimed the replacement of the income from vodka with income from cinema as an official party and state program: expanding industrial base of the Soviet cinema, making more films, increasing the film circulation, building more cinemas. I. Stalins idea was to be realized by the chairman of the GUKF B. Shumyatsky. Acquainted with American and European experience, he proposed a number of reforms in the film industry, the key to which was the creation of the Cinema city in the South of the country, the Soviet Hollywood. As a result, the Soviet film industry had to be increased 10 times. But the project of the Cinema city was not approved by the government. While B. Shumyatsky was working over this project, the assets of the Soviet cinema were actually put on the slide. As a result, the output of film production in Russia decreased significantly, not allowing to execute the annual plan. Thus the idea to replace vodka income into cinema one turned out unfulfilled.

The aim – to study and analyze the clinical and functional characteristics and parameters of lipid metabolism in patients after acute myocardial infarction (MI), depending on the progression of atherosclerosis according to the data of repeated coronary angiography (CAG) during a three-year follow-up.Materials and methods. The study prospectively included 91 patients with primary Q-MI, 47 of whom underwent a full cardiac rehabilitation (CR) program with physical training (FT), 44 patients – had only complexes of physical exercises and distance walking in accordance with the terms of MI. For three years, CAG was performed in 38 patients, in 18 (group 1) of whom the progression of the atherosclerotic process was established, in 20 (group 2) progression was not visualized in CAG. 53 patients (group 3) had a stable satisfactory condition and refused to repeat CAG. Treatment was performed in accordance with modern guidelines with urgent stenting of the infarct-dependent coronary artery. All patients underwent dosed testing on a bicycle ergometer, echocardiography and an evaluation of lipid metabolism indicators. Control examinations were carried out at discharge on the 10-15th day of myocardial infarction and in dynamics after 1 and 3 years.Results and discussion. Undesirable cardiovascular events (recurrent MI, coronary artery bypass grafting, restenosis, and hemodynamic significant stenoses) occurred only in the 1st group: 7 events – during the first year, also 7 – during the second year, and the last 14 – during the third year. In the second group, in the first week of myocardial infarction stent thrombosis occurred in 2 patients, coronary bypass grafting was performed according to the data of urgent coronary angiography also in 2 patients. During the 3-years follow up in the group with the progression of atherosclerosis the number of patients with diabetes mellitus tripled, and there was also a tendency to an increase in body mass index. According to the results of the exercise test on a bicycle ergometer and echocardiography, significant differences in the groups were not established, however, a positive trend in the dynamics of observation was noted in patients of the 2nd group without progression of atherosclerosis. Low-density lipoprotein cholesterol values ​​were obtained on the 5–7th day of myocardial infarction at the background of high-intensity statin therapy and were considered as basic. Further results showed the best performance in the first 6–12 months after myocardial infarction with better adherence to medical recommendations in the period as close as possible to acute MI. In the group of patients with progression of atherosclerosis, the maximum decrease in the level of low-density lipoprotein cholesterol (up to 2.10 (1.79–2.38) mmol/L) was observed after 6 months, followed by an increase in 1 and 3 years to a level exceeding the baseline. Variations in this indicator in patients without progression were 1.85–2.02–1.83 mmol/L, which was close to the recommended target values ​​(up to 2019).Conclusions. In the group with the progression of the atherosclerotic process, the number of patients with diabetes mellitus increased over 3 years and a tendency towards an increase in body mass index was observed. Most of the patients returned to smoking by the end of the first year after myocardial infarction, but then 3 years later, some of the patients in group 2 stopped smoking again, which may indicate the effectiveness of training and the psychological component of cardiac rehabilitation in the group without progression of the atherosclerotic process. The results of echocardio­­graphy and the level of exercise tolerance at the time of examination did not differ in patients with and without progression of the atherosclerotic process. Maintaining the target levels of LDL cholesterol is possible only under the condition of long-term high-intensity statin therapy under the supervision of a physician, adherence to the comprehensive recommendations of stage III CR at each contact with the patient.

Abstract Introduction According to NICE Guidelines, the Best medical therapy (BMT) for secondary prevention of peripheral arterial disease includes antiplatelet and statin therapy unless contraindicated. Junior Doctors are usually allocated the job of prescribing patients’ medications. Due to discrepancies in their exposure to vascular surgery in earlier training, we implemented an introductory teaching session for them regarding this BMT and audited the efficacy of this intervention. Method A retrospective review of admission and discharge medications of all vascular ward patients from August 12th to 30th September 2019 was done, and the data was analysed via Excel. Results Out of 127 patients (median age 70), 67% and 64% had antiplatelet and statin medications respectively,while on admission. 1 in each patient cohort was found discharged without either medication. The GP of the patient discharged without antiplatelets was contacted to ensure this was rectified. The other patient had refused statin therapy and thus a discharge note to their GP was conducted to reflect this. Conclusions A teaching session as part of a vascular departmental induction emphasising the evidence base for antiplatelet and statin therapy can contribute to improving prescription practices of junior doctors starting in the department.

Background: Evidence for statin use comes primarily from select clinical trial populations that are often younger without comorbidities. Stroke patients and their caregivers are in need of real-world effectiveness data to better inform decision-making on statin use after stroke. Methods: PROSPER is a PCORI-funded research program designed with stroke survivors to evaluate the effectiveness of therapies post-stroke. We linked data from Get With The Guidelines-Stroke patients >65 years of age to Medicare claims to capture post-discharge outcomes. Primary outcomes prioritized by patients were: 1) Home time (days alive and out of acute or post-acute care) and 2) Major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, all-cause readmission, CV readmission, and hemorrhagic stroke. We used negative binomial and Cox models to evaluate discharge statins and outcomes with inverse probability weighting (IPW) to adjust for baseline differences by treatment group. Results: Of 77,468 statin-naïve ischemic stroke patients hospitalized from 2007-2011, n=54,991 (71%) were discharged on statin therapy. Compared with those not receiving a statin, patients receiving a statin were younger and more likely to be smokers. Unadjusted rates of MACE, mortality and CV readmission within 2 years were lower for statin patients compared with those not receiving a statin. After IPW adjustment, statin therapy was associated with 28 more days of home time in the 2-year post-discharge period (P <.001), 9% lower hazard of MACE (P <.001), 16% lower hazard of mortality (P <.001), and 7% lower hazard of readmission (P <.001). Statin use was not associated with increased risk of hemorrhagic stroke (P=0.56). Conclusions: In a real-world population of older statin-naïve ischemic stroke patients, discharge statin therapy was associated with more days spent at home during the 2-year period after hospitalization and lower risk of both MACE and all-cause mortality.

Background: Statins perceived to have favorable safety profile. Although many people on statin therapy do well but no drug is without potential for side effects. Awareness about risks as well as benefits of drugs is needed particularly drugs which are used on wide scale like statins because even uncommon side effects can have significant health impact. Objectives of the Study: To determine side effects occurrence among Saudi patients taking statins and to evaluate drug-drug interactions in Saudi patients taking statins. Methodology: Self administered cross sectional study conducted during a period of four months from October 2018 to January 2019 in Turaif general hospital, Saudi Arabia on random sample of 500 Saudi patients out of which 330 participants were included in the study which were taking different types of statins medication using self-administered questionnaire in Arabic language specially designed for the research purpose after obtaining verbal consent and the data analyzed by SPSS program. Results: A total of 330 patients; 128 (39%) females and 202 (61%) males—participated in the study. The majority 165 (50%) were in the age-group of 50 – 59 years. Simvastatin was the most commonly used statin among study participants 136 (41%) followed by rosuvastatin 114 (35%). Among the participants, there were some patients who take drugs which have drug interactions with statins; there were 64 (19%) take Amlodipine with simvastatin, 13 (4%) and 6 (2%) take esomeprazole and ompeprazole respectively with statins. Only 9 (3%) reported that they were advised by pharmacist to avoid grape fruit. Majority of participants 309 (94%) reported neck pain, difficulty in walking, frequently fatigue after starting on statin. Also majority of participants 320 (97%) suffer from muscle pain after starting statins medications. Conclusion: The percentage of statin related side effects in this study population is high especially myopathy. Also some patients in this study taking medications that have drug interaction with statins, Counseling to patient regarding statin therapy appear to be insufficient. So, this study indicate that there's a need for more efforts from the physicians and pharmacist to avoid prescribing or dispensing medication that have drug-drug interaction with statins and provide counseling to patients regarding their statin therapy.

Abstract Background Vaccination programs have been launched worldwide to halt the spread of COVID-19. However, the identification of existing, safe compounds with combined treatment and prophylactic properties would be beneficial to individuals who are waiting to be vaccinated, particularly in less economically developed countries, where vaccine availability may be initially limited. Methods We used a data-driven approach, combining results from the screening of a large transcriptomic database (L1000) and molecular docking analyses, with in vitro tests using a lung organoid model of SARS-CoV-2 entry, to identify drugs with putative multimodal properties against COVID-19. Results Out of thousands of FDA-approved drugs considered, we observed that atorvastatin was the most promising candidate, as its effects negatively correlated with the transcriptional changes associated with infection. Atorvastatin was further predicted to bind to SARS-CoV-2’s main protease and RNA-dependent RNA polymerase, and was shown to inhibit viral entry in our lung organoid model. Conclusions Small clinical studies reported that general statin use, and specifically, atorvastatin use, are associated with protective effects against COVID-19. Our study corroborrates these findings and supports the investigation of atorvastatin in larger clinical studies. Ultimately, our framework demonstrates one promising way to fast-track the identification of compounds for COVID-19, which could similarly be applied when tackling future pandemics.

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

On 10 September 2012, a cat named Tuxedo Stan launched his campaign for mayor of the Halifax Regional Municipality in Nova Scotia, Canada (“Tuxedo Stan for Mayor”). Backed by his human supporters in the Tuxedo Party, he ran on a platform of animal welfare: “Tuxedo Stan for Mayor Because Neglect Isn’t Working.” Artwork Courtesy of Joe Popovitch As a feline activist, Tuxedo Stan joins an unexpected—if not entirely unprecedented—cohort of cats that advocate for animal welfare through their “cute” appeals for humane treatment. From Tuxedo Stan’s internet presence to his appearance on Anderson Cooper’s CNN segment “The RidicuList,” Tuxedo Stan’s cute campaign opens space for a cultural imaginary that differently envisions animals’ and humans’ political responsibilities. Who Can Be a Moral Agent? Iris Marion Young proposes “political responsibility” as a way to answer a question central to human and animal welfare: “How should moral agents—both individual and organizational—think about their responsibilities in relation to structural social injustice?” (7). In legal frameworks, responsibility is connected to liability: an individual acts, harm occurs, and the law decides how much liability the individual should assume. However, Young redefines responsibility in relation to structural injustices, which she conceptualizes as “harms” that result from “structural processes in which many people participate.” Young argues that “because it is therefore difficult for individuals to see a relationship between their own actions and structural outcomes, we have a tendency to distance ourselves from any responsibility for them” (7). Young presents political responsibility as a call to share the responsibility “to engage in actions directed at transforming the structures” and suggests that the less-advantaged might organize and propose “remedies for injustice, because their interests [are] the most acutely at stake” and because they are vulnerable to the actions of others “situated in more powerful and privileged positions” (15). Though Young does not address animals, her conception of responsible agency raises a question: who can be a moral agent? Arguably, the answer to this question changes as cultural imaginaries expand to accommodate difference, including gender- and species-difference. Corey Wrenn analyzes a selection of anti-suffragette postcards that equate granting votes to women as akin to granting votes to cats. Young shifts responsibility from a liability to a political frame, but Wrenn’s work suggests that a further shift is necessary where responsibility is gendered and tied to domestic, feminized roles: Cats and dogs are gendered in contemporary American culture…dogs are thought to be the proper pet for men and cats for women (especially lesbians). This, it turns out, is an old stereotype. In fact, cats were a common symbol in suffragette imagery. Cats represented the domestic sphere, and anti-suffrage postcards often used them to reference female activists. The intent was to portray suffragettes as silly, infantile, incompetent, and ill-suited to political engagement. (Wrenn) Dressing cats in women’s clothing and calling them suffragettes marks women as less-than-human and casts cats as the opposite of human. The frilly garments, worn by cats whose presence evoked the domestic sphere, suggest that women belong in the domestic sphere because they are too soft, or perhaps too cute, to contend with the demands of public life. In addition, the cards that feature domestic scenes suggest that women should account for their families’ welfare ahead of their own, and that women’s refusal to accept this arithmetic marks them as immoral—and irresponsible—subjects. Not Schrödinger's Cat In different ways, Jacques Derrida and Carey Wolfe explore the question Young’s work raises: who can be a moral agent? Derrida and Wolfe complicate the question by adding species difference: how should (human) moral agents think about their responsibilities (to animals)? Prompted by an encounter with his cat, Jacques Derrida follows the figure of the animal, through a variety of texts, in order to make sensible the trace of “the animal” as it has appeared in Western traditions. Derrida’s cat accompanies him as Derrida playfully, and attentively, deconstructs the rationalist, humanist discourses that structure Western philosophy. Discourses, whose tenets reflect the systems of beliefs embedded within a culture, are often both hegemonic and invisible; at least for those who enjoy privileged positions within the culture, discourses may simply appear as common sense or common knowledge. Derrida argues that Western, humanist thinking has created a discourse around “the human” and that this discourse deploys a reductive figure of “the animal” to justify human supremacy and facilitate human exceptionalism. Human exceptionalism is the doctrine that humans’ superiority to animals exempts humans from behaving humanely towards those deemed non-human, and it is the hegemony of the discourse of human exceptionalism that Derrida contravenes. Derrida interrupts by entering the discourse with “his” cat and creating a counter-narrative that troubles “the human” hegemony by redefining what it means to think. Derrida orients his intellectual work as surrender—he surrenders to the gaze of his cat and to his affectionate response to her presence: “the cat I am talking about is a real cat, truly, believe me, a little cat. The cat that looks at me naked and that is truly a little cat, this cat I am talking about…It comes to me as this irreplaceable living being that one day enters my space, into this place where it can encounter me, see me, even see me naked” (6-9, italics in original). The diminutive Derrida uses to describe his cat, she is little and truly a little cat, gestures toward affection, or affect, as the “thing…philosophy has, essentially, had to deprive itself of” (7). For Derrida, rationalist thinking hurries to “enclose and circumscribe the concept of the human as much as that of reason,” and it is through this movement toward enclosure that rationalist humanism fails to think (105). While Derrida questions the ethics of humanist philosophy, Carey Wolfe questions the ethics of humanism. Wolfe argues that “the operative theories and procedures we now have for articulating the social and legal relation between ethics and action are inadequate” because humanism imbues discourses about human and/or animal rights with utilitarian and contractarian logics that are inherently speciesist and therefore flawed (192). Utilitarian approaches attempt to determine the morality of a given action by weighing the act’s aggregate benefit against its aggregate harm. Contractarian approaches evaluate a given (human or animal) subject’s ability to understand and comply with a social contract that stipulates reciprocity; if a subject receives kindness, that subject must understand their implied, moral responsibility to return it. When opponents of animal rights designate animals as less capable of suffering than humans and decide that animals cannot enter moral contracts, animals are then seen as not only undeserving of rights but as incapable of bearing rights. As Wolfe argues, rights discourse—like rationalist humanism—reaches an impasse, and Wolfe proposes posthumanist theory as the way through: “because the discourse of speciesism…anchored in this material, institutional base, can be used to mark any social other, we need to understand that the ethical and philosophical urgency of confronting the institution of speciesism and crafting a posthumanist theory of the subject has nothing to do with whether you like animals” (7, italics in original). Wolfe’s strategic statement marks the necessity of attending to injustice at a structural level; however, as Tuxedo Stan’s campaign demonstrates, at a tactical level, how much you “like” an animal might matter very much. Seriously Cute: Tuxedo Stan as a Moral Agent Tuxedo Stan’s 2012-13 campaign pressed for improved protections for stray and feral cats in the Halifax Regional Municipality (HRM). While “cute” is a subjective, aesthetic judgment, numerous internet sites make claims like: “These 30 Animals With Their Adorable Miniature Versions Are The Cutest Thing Ever. Awwww” (“These 30 Animals”). From Tuxedo Stan’s kitten pictures to the plush versions of Tuxedo Stan, available for purchase on his website, Tuxedo Stan’s campaign positioned him within this cute culture (Chisolm “Official Tuxedo Stan Minion”). Photo Courtesy of Hugh Chisolm, Tuxedo Party The difference between Tuxedo Stan’s cute and the kind of cute invoked by pictures of animals with miniature animals—the difference that connects Tuxedo Stan’s cute to a moral or ethical position—is the narrative of political responsibility attached to his campaign. While existing animal protection laws in Halifax’s Animal Protection Act outlined some protections for animals, “there was a clear oversight in that issues related to cats are not included” (Chisolm TuxedoStan.com). Hugh Chisholm, co-founder of the Tuxedo Party, further notes: There are literally thousands of homeless cats — feral and abandoned— who live by their willpower in the back alleys and streets and bushes in HRM…But there is very little people can do if they want to help, because there is no pound. If there’s a lost or injured dog, you can call the pound and they will come and take the dog and give it a place to stay, and some food and care. But if you do the same thing with a cat, you get nothing, because there’s nothing in place. (Mombourquette) Tuxedo Stan’s campaign mobilizes cute images that reveal the connection between unnoticed and unrelieved suffering. Proceeds from Tuxedo Party merchandise go toward Spay Day HRM, a charity dedicated to “assisting students and low-income families” whose financial situations may prevent them from paying for spay and neuter surgeries (Chisholm TuxedoStan.com). According to his e-book ME: The Tuxedo Stan Story, Stan “wanted to make a difference in the lives of tens of thousands of homeless, unneutered cats in [Halifax Regional Municipality]. We needed a low-cost spay/neuter clinic. We needed a Trap-Neuter-Return and Care program. We needed a sanctuary for homeless, unwanted strays to live out their lives in comfort” (Tuxedo Stanley and Chisholm 14). As does “his” memoir, Tuxedo Stan’s Pledge of Compassion and Action follows Young’s logic of political responsibility. Although his participation is mediated by human organizers, Tuxedo Stan is a cat pressing legislators to “pledge to help the cats” by supporting “a comprehensive feline population control program to humanely control the feline population and prevent suffering” and by creating “an affordable and accessible spay/neuter program” (Chisholm TuxedoStan.com). While framing the feral cat population as a “problem” that must be “fixed” upholds discourses around controlling subjected populations’ reproduction, Tuxedo Stan’s campaign also opens space for a counternarrative that destabilizes the human exceptionalism that encompasses his campaign. A Different ‘Logic’, a Different Cultural Imaginary As Tuxedo Stan launched his campaign in 2012, fellow feline Hank ran for the United States senate seat in Virginia – he received approximately 7,000 votes and placed third (Wyatt) – and “Mayor” Stubbs celebrated his 15th year as the honorary mayor of Talkeetna, Alaska, also in the United States: Fifteen years ago, the citizens of Talkeetna (pop. 800) didn’t like the looks of their candidates for mayor. Around that same time resident Lauri Stec, manager of Nagley’s General Store, saw a box of kittens and decided to adopt one. She named him Stubbs because he didn’t have a tail and soon the whole town was in love with him. So smitten were they with this kitten, in fact, that they wrote him in for mayor instead of deciding on one of the two lesser candidates. (Friedman) Though only Stan and Hank connect their candidacy to animal welfare activism, all three cats’ stories contribute to building a cultural imaginary that has drawn responses across social and news media. Tuxedo Stan’s Facebook page has 19,000+ “likes,” and Stan supporters submit photographs of Tuxedo Stan “minions” spreading Tuxedo Stan’s message. The Tuxedo Party’s website maintains a photo gallery that documents “Tuxedo Stan’s World Tour”: “Tuxedo Stan’s Minions are currently on their world tour spreading his message of hope and compassion for felines around the globe" (Chisholm TuxedoStan.com). Each minion’s photo in the gallery represents humans’ ideological and financial support for Tuxedo Stan. News media supported Tuxedo Stan, Hank for Senate, and Mayor Stubbs’s candidacies in a more ambiguous fashion. While Craig Medred argues that “Silly 'Alaska cat mayor' saga spotlights how easily the media can be scammed” (Medred), a CBC News video announced that Tuxedo Stan was “interested in sinking his claws into the top seat at City Hall” and ready to “mark his territory around the mayor's seat” (“Tuxedo Stan the cat chases Halifax mayor chair”), and Lauren Strapagiel reported on Halifax’s “cuddliest would-be mayor.” In an unexpected echo of Derrida’s language, as Derrida repeats that he is truly talking about a cat, truly a little cat, CNN journalist Anderson Cooper endorses Tuxedo Stan for mayor and follows his endorsement with this statement: If he’s serious about a career in politics, maybe he should come to the United States. Just look at the mayor of Talkeetna, Alaska. That’s Stubbs the cat, and he’s been the mayor for 15 years. I’m not kidding…Not only that, but right now, as we speak, there is a cat running for Senate from Virginia. (Cooper) As he introduces a “Hank for Senate” campaign video, again Cooper mentions that he is “not kidding.” While Cooper’s “not kidding” echoes Derrida’s “truly,” the difference in meanings is différance. For Derrida, his encounter with his cat is “a matter of developing another ‘logic’ of decision, of the response and of the event…a matter of reinscribing the différance between reaction and response, and hence this historicity of ethical, juridical, or political responsibility, within another thinking of life, of the living, within another relation of the living, to their own…reactional automaticity” (126). Derrida proceeds through the impasse, the limit he identifies within philosophical engagements with animals, by tracing the ways his little cat’s presence affects him. Derrida finds another logic, which is not logic but surrender, to accommodate what he, like Young, terms “political responsibility.” Cooper, however, applies the hegemonic logic of human exceptionalism to his engagement with feline interlocutors, Tuxedo Stan, Hank for Senate, and Mayor Stubbs. Although Cooper’s segment, called “The RidicuList,” makes a pretense of political responsibility, it is different in kind from the pretense made in Tuxedo Stan’s campaign. As Derrida argues, a “pretense…even a simple pretense, consists in rendering a sensible trace illegible or imperceptible” (135). Tuxedo Stan’s campaign pretends that Tuxedo Stan fits within humanist, hegemonic notions of mayoral candidacy and then mobilizes this cute pretense in aid of political responsibility; the pretense—the pretense in which Tuxedo Stan’s human fans and supporters engage—renders the “sensible” trace of human exceptionalism illegible, if not imperceptible. Cooper’s pretense, however, works to make legible the trace of human exceptionalism and so to reinscribe its discursive hegemony. Discursively, the political potential of cute in Tuxedo Stan’s campaign is that Tuxedo Stan’s activism complicates humanist and posthumanist thinking about agency, about ethics, and about political responsibility. Thinking about animals may not change animals’ lives, but it may change (post)humans’ responses to these questions: Who can be a moral agent? How should moral agents—both individual and organizational, both human and animal—“think” about how they respond to structural social injustice? Epilogue: A Political Response Tuxedo Stan died of kidney cancer on 8 September 2013. Before he died, Tuxedo Stan’s campaign yielded improved cat protection legislation as well as a $40,000 endowment to create a spay-and-neuter facility accessible to low-income families. Tuxedo Stan’s litter mate, Earl Grey, carries on Tuxedo Stan’s work. Earl Grey’s campaign platform expands the Tuxedo Party’s appeals for animal welfare, and Earl Grey maintains the Tuxedo Party’s presence on Facebook, on Twitter (@TuxedoParty and @TuxedoEarlGrey), and at TuxedoStan.com (Chisholm TuxedoStan.com). On 27 February 2014, Agriculture Minister Keith Colwell of Nova Scotia released draft legislation whose standards of care aim to prevent distress and cruelty to pets and to strengthen their protection. They…include proposals on companion animal restraints, outdoor care, shelters, companion animal pens and enclosures, abandonment of companion animals, as well as the transportation and sale of companion animals…The standards also include cats, and the hope is to have legislation ready to introduce in the spring and enacted by the fall. (“Nova Scotia cracks down”) References Chisolm, Hugh. “Tuxedo Stan Kitten.” Tuxedo Party Facebook Page, 20 Oct. 2012. 2 Mar. 2014. Chisholm, Hugh. “Official Tuxedo Stan Minion.” TuxedoStan.com. Tuxedo Stanley and the Tuxedo Party. 2 Mar. 2014. Chisolm, Hugh. “You're Voting for Fred? Not at MY Polling Station!” Tuxedo Party Facebook Page, 20 Oct. 2012. 2 Mar. 2014. Chisholm, Hugh, and Kathy Chisholm. TuxedoStan.com. Tuxedo Stanley and the Tuxedo Party. 2 Mar. 2014. Cooper, Anderson. “The RidicuList.” CNN Anderson Cooper 360, 24 Sep. 2012. 2 Mar. 2014. Crenshaw, Kimberlé. “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics.” University of Chicago Legal Forum 1989: 139–67. 2 Mar. 2014. Derrida, Jacques. The Animal That Therefore I Am. Trans. David Willis. New York: Fordham University Press, 2008. Friedman, Amy. “Cat Marks 15 Years as Mayor of Alaska Town.” Newsfeed.time.com, 17 July 2012. 2 March 2014. Medred, Craig. “Silly ‘Alaska Cat Mayor’ Saga Spotlights How Easily the Media Can Be Scammed.” Alaska Dispatch, 11 Sep. 2014. 2 Mar. 2014. Mombourquette, Angela. “Candidate’s Ethics Are as Finely Honed as His Claws.” The Chronicle Herald, 27 Aug. 2012. 2 Mar. 2014. “Nova Scotia Cracks Down on Tethering of Dogs.” The Chronicle Herald 27 Feb. 2014. 2 Mar. 2014. Pace, Natasha. “Halifax City Council Doles Out Cash to Help Control the Feral Cat Population.” Global News 14 May 2013. 2 Mar. 2014. Popovitch, Joe. “Tuxedo Stan for Mayor Because Neglect Isn’t Working.” RefuseToBeBoring.com. 2 Mar. 2014. Strapagiel, Lauren. “Tuxedo Stan, Beloved Halifax Cat Politician, Dead at 3.” OCanada.com, 9 Sep. 2013. 2 Mar. 2014. “These 30 Animals with Their Adorable Miniatures Are the Cutest Thing Ever. Awwww.” WorthyToShare.com, n.d. 2 Mar. 2014. “Tuxedo Stan for Mayor Dinner Highlights.” Vimeo.com, 2 Mar. 2014. Tuxedo Stanley, and Kathy Chisholm. ME: The Tuxedo Stan Story. Upper Tantallon, Nova Scotia: Ailurophile Publishing, 2014. 2 Mar. 2014. “Tuxedo Stan the Cat Chases Halifax Mayor Chair.” CBC News, 13 Aug. 2012. 2 Mar. 2014. Wolfe, Cary. Animal Rites: American Culture, the Discourse of Species, and Posthumanist Theory. Chicago: University of Chicago Press, 2003. Wrenn, Corey. “Suffragette Cats Are the Original Cat Ladies.” Jezebel.com, 6 Dec. 2013. 2 Mar. 2014. Wyatt, Susan. “Hank, the Cat Who Ran for Virginia Senate, Gets MMore than 7,000 Votes.” King5.com The Pet Dish, 7 Nov. 2012. 2 Mar. 2014. Young, Iris Marion. “Political Responsibility and Structural Injustice.” Lindley Lecture. Department of Philosophy, University of Kansas. 5 May 2003.

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR) programs provide an opportunity to measure low density lipoprotein cholesterol (LDL-C) levels and optimise lipid lowering therapy (LLT) accordingly. New ESC guidelines released in August 2019 recommend lower absolute LDL-C target levels and an &gt;50% reduction from baseline in those at the highest risk. Purpose This study investigated the proportion of those patients who finished CR in 2019 that reached both their absolute and relative reduction in LDL-C levels, before and after the introduction of these new guidelines. We also analysed the choice and appropriateness of LLT. Methods A retrospective chart review of 163 patients who completed CR in 2019. A database was created containing baseline patient characteristics and LDL-C levels both prior and post CR; as well as the patient’s contemporary LLT. Those patients who did not have a previous diagnosis of atherosclerotic cardiovascular disease (ASCVD) were risk stratified as per ESC guidance. Baseline LDL-C levels were recorded, where possible, and otherwise calculated using pre-CR LDL profile with an adjustment made based on the projected effects of their LLT. Results Mean (SD) patient age was 62 (10) years, 123/163 (75%) were male and 142 (87%) patients had established ASCVD. 90/142 (63%) of very high-risk patients were treated with a high intensity LLT and 5/163 overall (3%) were prescribed ezetimibe. Overall, 96/163 (59%) patients in 2019 met their absolute LDL-C targets; 62% of applicable patients achieved an &gt;50% reduction in LDL-C levels. 104 (64%) of patients were treated in compliance with their contemporary guidelines. Both pre (n = 112) and post (n = 51) September 2019 cohorts were well matched. Fewer patients who were treated under the August 2019 guidelines reached their absolute LDL-C (51% v 63%, p &lt; 0.005) targets; achieved a &gt;50% reduction in LDL-C from baseline (48% vs 61%, p &lt; 0.005), or were compliant with the guidelines for their risk category (43% vs 73%, p &lt; 0.005). Conclusions Both high intensity statin therapy and ezetimibe are under-prescribed. Fewer patients are meeting the lower absolute LDL-C targets set out in the 2019 ESC guidelines. For those at high risk, determining the reduction in LDL-C from baseline reveals that even those meeting their absolute LDL-C targets may still be undertreated. LDL-C Target Achievement N Mean LDL Pre-CR (95% CI) Mean LDL-C Post CR (95% CI) Absolute LDL-C Target Met (%) Mean % LDL-C Reduction from Baseline (95% CI) &gt; 50% Reduction (% of applicable patients) Guidelines Achieved Pre-Sept"20 112 2.7 (2.46-2.93) 1.64 (1.49- 1.79) 70 (63) 61 (56-66) 50 (65) 82 (73) Post Sept 20 51 2.83 (2.41-3.25) 1.83 (1.41-2.25) 26 (51) 48 (37-59) 11 (34) 22 (43) Total 163 2.72 (2.52- 2.91) 1.69 (1.57-1.82) 96 (59) 57 (52- 62) 61 (52) 104 (64 LDL-C targets met, stratified by contemporary guidelines followed. Abstract Figure. Choice of lipid lowering therapy in 2019

Online shopping is all the rage these days and the murderabilia industry in particular, which specializes in selling serial killer artifacts, is booming. At Spectre Studios, sculptor David Johnson sells flexible plastic action figures of Ted Bundy, Jeffrey Dahmer, and John Wayne Gacy and plans to produce a figure of Jack the Ripper in the future. Although some might think that making action figures of serial killers is tasteless, Johnson hastens to assure the potential consumer that he does have standards: “I wouldn’t do Osama bin Laden . . . I have some personal qualms about that” (Robinson). At Serial Killer Central, you can buy a range of items made by serial killers themselves, including paintings and drawings by Angelo Buono (one of the “Hillside Stranglers”) and Henry Lee Lucas. For the more discerning consumer, Supernaught.com charges a mere $300 for a brick from Dahmer’s apartment building, while a lock of Charles Manson’s hair is a real bargain at $995, shipping and handling not included. The sale of murderabilia is just a small part of the huge serial killer industry that has become a defining feature of American popular culture over the last twenty-five years. This industry is, in turn, a prime example of what Mark Seltzer has described as “wound culture,” consisting of a “public fascination with torn and open bodies and torn and opened persons, a collective gathering around shock, trauma, and the wound” (1). According to Seltzer, the serial killer is “one of the superstars of our wound culture” (2) and his claim is confirmed by the constant stream of movies, books, magazines, television shows, websites, t-shirts, and a tsunami of ephemera that has given the figure of the serial murderer an unparalleled degree of visibility and fame in the contemporary American public sphere. In a culture defined by celebrity, serial killers like Bundy, Dahmer and Gacy are the biggest stars of all, instantly recognized by the vast majority of Americans. Not surprisingly, murderabilia has been the focus of a sustained critique by the (usually self-appointed) guardians of ‘decency’ in American culture. On January 2, 2003 The John Walsh Show, the daytime television vehicle of the long-time host of America’s Most Wanted, featured an “inside look at the world of ‘murderabilia,’ which involves the sale of artwork, personal effects and letters from well-known killers” (The John Walsh Show Website). Featured guests included Andy Kahan, Director of the Mayor’s Crime Victim Assistance Office in Houston, Texas; ‘Thomas,’ who was horrified to find hair samples from “The Railroad Killer,” the individual who killed his mother, for sale on the Internet; Elmer Wayne Henley, a serial killer who sells his artwork to collectors; Joe, who runs “Serial Killer Central” and sells murderabilia from a wide range of killers, and Harold Schechter, a professor of English at Queens College, CUNY. Despite the program’s stated intention to “look at both sides of the issue,” the show was little more than a jeremiad against the murderabilia industry, with the majority of airtime being given to Andy Kahan and to the relatives of crime victims. The program’s bias was not lost on many of those who visited Joe’s Serial Killer Central site and left messages on the message board on the day The John Walsh Show aired. There were some visitors who shared Walsh’s perspective. A message from “serialkillersshouldnotprofit@aol.com,” for example, stated that “you will rot in hell with these killers,” while “Smithpi@hotmail.com” had a more elaborate critique: “You should pull your site off the net. I just watched the John Walsh show and your [sic] a fucking idiot. I hope your [sic] never a victim, because if you do [sic] then you would understand what all those people were trying to tell you. You [sic] a dumb shit.” Most visitors, however, sympathized with the way Joe had been treated on the show: “I as well [sic] saw you on the John Walsh show, you should [sic] a lot of courage going on such a one sided show, and it was shit that they wouldnt [sic] let you talk, I would have walked off.” But whether the comments were positive or negative, one thing was clear: The John Walsh Show had created a great deal of interest in the Serial Killer Central site. As one of the messages put it, “I think that anything [sic] else he [John Walsh] has put a spark in everyones [sic] curiousity [sic] . . . I have noticed that you have more hits on your page today than any others [sic].” Apparently, even the most explicit rejection and condemnation of serial killer celebrity finds itself implicated in (and perhaps even unwittingly encouraging the growth of) that celebrity. John Walsh’s attack on the murderabilia industry was the latest skirmish in a campaign that has been growing steadily since the late 1990s. One of the campaign’s initial targets was the internet trading site eBay, which was criticized for allowing serial killer-related products to be sold online. In support of such criticism, conservative victims’ rights and pro-death penalty organizations like “Justice For All” organized online petitions against eBay. In November 2000, Business Week Online featured an interview with Andy Kahan in which he argued that the online sale of murderabilia should be suppressed: “The Internet just opens it all up to millions and millions more potential buyers and gives easy access to children. And it sends a negative message to society. What does it say about us? We continue to glorify killers and continue to put them in the mainstream public. That’s not right” (Business Week). Eventually bowing to public pressure, eBay decided to ban the sale of murderabilia items in May 2001, forcing the industry underground, where it continues to be pursued by the likes of John Walsh. Apart from highlighting how far the celebrity culture around serial killers has developed (so that one can now purchase the nail clippings and hair of some killers, as if they are religious icons), focusing on the ongoing debate around the ethics of murderabilia also emphasizes how difficult it is to draw a neat line between those who condemn and those who participate in that culture. Quite apart from the way in which John Walsh’s censoriousness brought more visitors to the Serial Killer Central site, one could also argue that few individuals have done more to disseminate information about violent crime in general and serial murder in particular to mainstream America than John Walsh. Of course, this information is presented in the unimpeachably moral context of fighting crime, but controversial features of America’s Most Wanted, such as the dramatic recreations of crime, pander to the same prurient public interest in crime that the program simultaneously condemns. An ABCNews.Com article on murderabilia inadvertently highlights the difficulty of distinguishing a legitimate from an illegitimate interest in serial murder by quoting Rick Staton, one of the biggest collectors and dealers of murderabilia in the United States, who emphasizes that the people he sells to are not “ghouls and creeps [who] crawl out of the woodwork”, but rather “pretty much your average Joe Blow.” Even his family, Staton goes on to say, who profess to be disgusted by what he does, act very differently in practice: “The minute they step into this room, they are glued to everything in here and they are asking questions and they are genuinely intrigued by it . . . So it makes me wonder: Am I the one who is so abnormal, or am I pretty normal?” (ABCNews.Com). To answer Staton’s question, we need to go back to 1944, when sociologist Leo Lowenthal published an essay entitled “Biographies in Popular Magazines,” an essay he later reprinted as a chapter in his 1961 book, Literature, Popular Culture And Society, under a new title: “The Triumph of Mass Idols.” Lowenthal argues that biographies in popular magazines underwent a striking change between 1901 and 1941, a change that signals the emergence of a new social type. According to Lowenthal, the earlier biographies indicate that American society’s heroes at the time were “idols of production” in that “they stem from the productive life, from industry, business, and natural sciences. There is not a single hero from the world of sports and the few artists and entertainers either do not belong to the sphere of cheap or mass entertainment or represent a serious attitude toward their art” (112-3). Sampling biographies in magazines from 1941, however, Lowenthal reaches a very different conclusion: “We called the heroes of the past ‘idols of production’: we feel entitled to call the present-day magazine heroes ‘idols of consumption’” (115). Unlike the businessmen, industrialists and scientists who dominated the earlier sample, almost every one of 1941’s heroes “is directly, or indirectly, related to the sphere of leisure time: either he does not belong to vocations which serve society’s basic needs (e.g., the worlds of entertainment and sport), or he amounts, more or less, to a caricature of a socially productive agent” (115). Lowenthal leaves his reader in no doubt that he sees the change from “idols of production” to “idols of consumption” as a serious decline: “If a student in some very distant future should use popular magazines of 1941 as a source of information as to what figures the American public looked to in the first stages of the greatest crisis since the birth of the Union, he would come to a grotesque result . . . the idols of the masses are not, as they were in the past, the leading names in the battle of production, but the headliners of the movies, the ball parks, and the night clubs” (116). With Lowenthal in mind, when one considers the fact that the serial killer is generally seen, in Richard Tithecott’s words, as “deserving of eternal fame, of media attention on a massive scale, of groupies” (144), one is tempted to describe the advent of celebrity serial killers as a further decline in the condition of American culture’s “mass idols.” The serial killer’s relationship to consumption, however, is too complex to allow for such a hasty judgment, as the murderabilia industry indicates. Throughout the edition of The John Walsh Show that attacked murderabilia, Walsh showed clips of Collectors, a recent documentary about the industry. Collectors is distributed by a small company named Abject Films and on their website the film’s director, Julian P. Hobbs, discusses some of the multiple connections between serial killing and consumerism. Hobbs points out that the serial killer is connected with consumerism in the most basic sense that he has become a commodity, “a merchandising phenomenon that rivals Mickey Mouse. From movies to television, books to on-line, serial killers are packaged and consumed en-masse” (Abject Films). But as Hobbs goes on to argue, serial killers themselves can be seen as consumers, making any representations of them implicated in the same consumerist logic: “Serial killers come into being by fetishizing and collecting artifacts – usually body parts – in turn, the dedicated collector gathers scraps connected with the actual events and so, too, a documentary a collection of images” (Abject Films). Along with Rick Staton, Hobbs implies that no one can avoid being involved with consumerism in relation to serial murder, even if one’s reasons for getting involved are high-minded. For example, when Jeffrey Dahmer was murdered in prison in 1994, the families of his victims were delighted but his death also presented them with something of a problem. Throughout the short time Dahmer was in prison, there had been persistent rumors that he was in negotiations with both publishers and movie studios about selling his story. If such a deal had ever been struck, legal restrictions would have prevented Dahmer from receiving any of the money; instead, it would have been distributed among his victims’ families. Dahmer’s murder obviously ended this possibility, so the families explored another option: going into the murderabilia business by auctioning off Dahmer’s property, including such banal items as his toothbrush, but also many items he had used in commission of the murders, such as a saw, a hammer, the 55-gallon vat he used to decompose the bodies, and the refrigerator where he stored the hearts of his victims. Although the families’ motives for suggesting this auction may have been noble, they could not avoid participating in what Mark Pizzato has described as “the prior fetishization of such props and the consumption of [Dahmer’s] cannibal drama by a mass audience” (91). When the logic of consumerism dominates, is anyone truly innocent, or are there just varying degrees of guilt, of implication? The reason why it is impossible to separate neatly ‘legitimate’ and ‘illegitimate’ expressions of interest in famous serial killers is the same reason why the murderabilia industry is booming; in the words of a 1994 National Examiner headline: “Serial Killers Are as American as Apple Pie.” Christopher Sharrett has suggested that: “Perhaps the fetish status of the criminal psychopath . . . is about recognizing the serial killer/mass murderer not as social rebel or folk hero . . . but as the most genuine representative of American life” (13). The enormous resistance to recognizing the representativeness of serial killers in American culture is fundamental to the appeal of fetishizing serial killers and their artifacts. As Sigmund Freud has explained, the act of disavowal that accompanies the formation of a fetish allows a perception (in this case, the Americanness of serial killers) to persist in a different form rather than being simply repressed (352-3). Consequently, just like the sexual fetishists discussed by Freud, although we may recognize our interest in serial killers “as an abnormality, it is seldom felt by [us] as a symptom of an ailment accompanied by suffering” (351). On the contrary, we are usually, in Freud’s words, “quite satisfied” (351) with our interest in serial killers precisely because we have turned them into celebrities. It is our complicated relationship with celebrities, affective as well as intellectual, composed of equal parts admiration and resentment, envy and contempt, that provides us with a lexicon through which we can manage our appalled and appalling fascination with the serial killer, contemporary American culture’s ultimate star. References ABCNews.Com. “Killer Collectibles: Inside the World of ‘Murderabilia.” 7 Nov. 2001. American Broadcasting Company. 9 May 2003 http://www.abcnews.com>. AbjectFilms.Com. “Collectors: A Film by Julian P. Hobbs.” Abject Films. 9 May 2003 http://www.abjectfilms.com/collectors.html>. BusinessWeek Online. 20 Nov. 2000. Business Week. 9 May 2003 http://www.businessweek.com/2000/00_47/b3708056.htm>. Freud, Sigmund. “Fetishism.” On Sexuality. Trans. James Strachey. London: Penguin Books, 1977. 351-7. The John Walsh Show. Ed. Click Active Media. 2 Jan. 2003. 9 May 2003 http://www.johnwalsh.tv/cgi-bin/topics/today/cgi?id=90>. Lowenthal, Leo. “The Triumph of Mass Idols.” Literature, Popular Culture and Society. Englewood Cliffs, NJ: Prentice-Hall, 1961. 109-40. National Examiner. “Serial Killers Are as American as Apple Pie.” 7 Jun. 1994: 7. Pizzato, Mark. “Jeffrey Dahmer and Media Cannibalism: The Lure and Failure of Sacrifice.” Mythologies of Violence in Postmodern Media. Ed. Christopher Sharrett. Detroit: Wayne State UP, 1999. 85-118. Robinson, Bryan. “Murder Incorporated: Denver Sculptor’s Serial Killer Action Figures Bringing in Profits and Raising Ire.” ABCNews.Com 25 Mar. 2002. American Broadcasting Company. 27 Apr. 2003 http://abcnews.com/>. Seltzer, Mark. Serial Killers: Death and Life in America’s Wound Culture. New York: Routledge, 1998. Sharrett, Christopher. “Introduction.” Mythologies of Violence in Postmodern Media. Ed. Christopher Sharrett. Detroit: Wayne State UP, 1999. 9-20. Tithecott, Richard. Of Men and Monsters: Jeffrey Dahmer and the Construction of the Serial Killer. Madison: U of Wisconsin P, 1997. Citation reference for this article MLA Style Schmid, David. "Murderabilia: Consuming Fame." M/C Journal 7.5 (2004). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0411/10-schmid.php>. APA Style Schmid, D. (Nov. 2004) "Murderabilia: Consuming Fame," M/C Journal, 7(5). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0411/10-schmid.php>.

IntroductionThe role, function, and future of the Western public intellectual have been highly contested over the last three decades. The dominant discourse, which predicts the decline of the public intellectual, asserts the institutionalisation of their labour has eroded their authority to speak publicly to power on behalf of others; and that the commodification of intellectual performance has transformed them from sages, philosophers, and men of letters into trivial media entertainers, pundits, and ideologues. Overwhelmingly the crisis debates link the demise of the public intellectual to shifts in public culture, which was initially conceptualised as a literary and artistic space designed to liberate the awareness of citizens through critique and to reflect upon “the chronic and persistent issues of life, meaning and representation” (McGuigan 430). This early imagining of public culture as an exclusively civilising space, however, did not last and Jurgen Habermas documented its decline in response to the commodification and politicisation of culture in the 20th century. Yet, as social activism continued to flourish in the public sphere, Habermas re-theorised public culture as a more pluralistic site which simultaneously accommodates “uncritical populism, radical subversion and critical intervention” (436) and operates as both a marketplace and a “site of communicative rationality, mutual respect and understanding (McGuigan 434). The rise of creative industries expanded popular engagement with public culture but destabilised the authority of the public intellectual. The accompanying shifts also affected the function of the curator, who, like the intellectual, had a role in legislating and arbitrating knowledge, and negotiating and authorising meaning through curated exhibitions of objects deemed sacred and significant. Jennifer Barrett noted the similarities in the two functions when she argued in Museums and the Public Sphere that, because museums have an intellectual role in society, curators have a public intellectual function as they define publics, determine modes of engagement, and shape knowledge formation (150). The resemblance between the idealised role of the intellectual and the curator in enabling the critique that emancipates the citizen means that both functions have been affected by the atomisation of contemporary society, which has exposed the power effects of the imposed coherency of authoritative and universal narratives. Indeed, just as Russell Jacoby, Allan Bloom, and Richard Posner predicted the death of the intellectual, who could no longer claim to speak in universal terms on behalf of others, so museums faced their own crisis of relevancy. Declining visitor numbers and reduced funding saw museums reinvent themselves, and in moving away from their traditional exclusive, authoritative, and nation building roles—which Pierre Bourdieu argued reproduced the “existing class-based culture, education and social systems” (Barrett 3)—museums transformed themselves into inclusive and diverse sites of co-creation with audiences and communities. In the context of this change the curator ceased to be the “primary producer of knowledge” (Barrett 13) and emerged to reproduce “contemporary culture preoccupations” and constitute the “social imagery” of communities (119). The modern museum remains concerned with explaining and interrogating the world, but the shift in curatorial work is away from the objects themselves to a focus upon audiences and how they value the artefacts, knowledge, and experiences of collective shared memory. The change in curatorial practices was driven by what Peter Vergo called a new “museology” (Barrett 2), and according to Macdonald this term assumes that “object meanings are contextual rather than inherent” or absolute and universal (2). Public intellectuals and curators, as the custodians of ideas and narratives in the contemporary cultural industries, privilege audience reception and recognise that consumers and/or citizens engage with public culture for a variety of reasons, including critique, understanding, and entertainment. Curators, like public intellectuals, also recognise that they can no longer assume the knowledge and experience of their audience, nor prescribe the nature of engagement with ideas and objects. Instead, curators and intellectuals emerge as negotiators and translators of cultural meaning as they traverse the divides in public culture, sequestering ideas and cultural artefacts and constructing narratives that engage audiences and communities in the process of re-imagining the past as a way of providing new insights into contemporary challenges.Methodology In exploring the idea that the public intellectual acts as a curator of ideas as he or she defines and privileges the discursive spaces of public culture, this paper begins by providing an overview of the cultural context of the contemporary public intellectual which enables comparisons between intellectual and curatorial functions. Second, this paper analyses a random sample of the content of books, newspaper and magazine articles, speeches, and transcripts of interviews drawn from The Australian, The Age, The Sydney Morning Herald, The Sydney Institute, the ABC, The Monthly, and Quadrant published or broadcast between 1996 and 2007, in order to identify the key themes of the History Wars. It should be noted that the History War debates were extensive, persistent, and complex—and as they unfolded over a 13-year period they emerged as the “most powerful” and “most disputed form of public intellectual work” (Carter, Ideas 9). Many issues were aggregated under the trope of the History Wars, and these topics were subject to both popular commentary and academic investigation. Furthermore, the History Wars discourse was produced in a range of mediums including popular media sources, newspaper and magazine columns, broadcasts, blogs, lectures, and writers’ forums and publications. Given the extent of this discourse, the sample of articles which provides the basis for this analysis does not seek to comprehensively survey the literature on the History Wars. Rather this paper draws upon Foucault’s genealogical qualitative method, which exposes the subordinated discontinuities in texts, to 1) consider the political context of the History War trope; and 2) identify how intellectuals discursively exhibited versions of the nation’s identity and in the process made visible the power effects of the past. Public Intellectuals The underlying fear of the debates about the public intellectual crisis was that the public intellectual would no longer be able to act as the conscience of a nation, speak truth to power, or foster the independent and dissenting public debate that guides and informs individual human agency—a goal that has lain at the heart of the Western intellectual’s endeavours since Kant’s Sapere aude. The late 20th century crisis discourse, however, primarily mourned the decline of a particular form of public authority attached to the heroic universal intellectual formation made popular by Emile Zola at the end of the 19th century, and which claimed the power to hold the political elites of France accountable. Yet talk of an intellectual crisis also became progressively associated with a variety of general concerns about globalising society. Some of these concerns included fears that structural shifts in the public domain would lead to the impoverishment of the cultural domain, the end of Western civilisation, the decline of the progressive political left, and the end of universal values. It was also expected that the decline in intellectuals would also enable the rise of populism, political conservatism, and anti-intellectualism (Jacoby Bloom; Bauman; Rorty; Posner; Furedi; Marquand). As a result of these fears, the function of the intellectual who engages publicly was re-theorised. Zygmunt Bauman suggested the intellectual was no longer the legislator or arbiter of taste but the negotiator and translator of ideas; Michel Foucault argued that the intellectual could be institutionally situated and still speak truth to power; and Edward Said insisted the public intellectual had a role in opening up possibilities to resolve conflict by re-imagining the past. In contrast, the Australian public intellectual has never been declared in crisis or dead, and this is probably because the nation does not have the same legacy of the heroic public intellectual. Indeed, as a former British colony labelled the “working man’s paradise” (White 4), Australia’s intellectual work was produced in “institutionalised networks” (Head 5) like universities and knowledge disciplines, political parties, magazines, and unions. Within these networks there was a double division of labour, between the abstraction of knowledge and its compartmentalisation, and between the practical application of knowledge and its popularisation. As a result of this legacy, a more organic, specific, and institutionalised form of intellectualism emerged, which, according to Head, limited intellectual influence and visibility across other networks and domains of knowledge and historically impeded general intellectual engagement with the public. Fears about the health and authority of the public intellectual in Australia have therefore tended to be produced as a part of Antonio Gramsci’s ideological “wars of position” (Mouffe 5), which are an endless struggle between cultural and political elites for control of the institutions of social reproduction. These struggles began in Australia in the 1970s and 1980s over language and political correctness, and they reappeared in the 1990s as the History Wars. History Wars“The History Wars” was a term applied to an ideological battle between two visions of the Australian nation. The first vision was circulated by Australian Labor Party Prime Minister Paul Keating, who saw race relations as central to 21st century global Australia and began the process of dealing with the complex and divisive Indigenous issues at home. He established the Council for Aboriginal Reconciliation in 1991; acknowledged in the 1992 Redfern speech that white settlers were responsible for the problems in Indigenous communities; and commissioned the Bringing Them Home report, which was completed in 1997 and concluded that the mandated removal of Indigenous children from their families and communities throughout the 20th century had violated their human rights and caused long-term and systemic damage to Indigenous communities.The second vision of Australia was circulated by Liberal Prime Minister John Howard, who, after he came to power in 1996, began his own culture war to reconstruct a more conservative vision of the nation. Howard believed that the stories of Indigenous dispossession undermined confidence in the nation, and he sought to produce a historical view of the past grounded in “Judeo-Christian ethics, the progressive spirit of the enlightenment and the institutions and values of British culture” (“Sense of Balance”). Howard called for a return to a narrative form that valorised Australia’s achievements, and he sought to instil a more homogenised view of the past and a coherent national identity by reviewing high school history programs, national museum appointments, and citizenship tests. These two political positions framed the subsequent intellectual struggles over the past. While a number of issues were implicated in the battle, generally, left commentators used the History Wars as a way to circulate certain ideas about morality and identity, including 1) Australians needed to make amends for past injustices to Indigenous Australians and 2) the nation’s global identity was linked to how they dealt with Australia’s first people. In contrast, the political right argued 1) the left had misrepresented and overstated the damage done to Indigenous communities and rewritten history; 2) stories about Indigenous abuse were fragmenting the nation’s identity at a time when the nation needed to build a coherent global presence; and 3) no apology was necessary, because contemporary Australians did not feel responsible for past injustices. AnalysisThe war between these two visions of Australia was fought in “extra-curricular sites,” according to Stuart Macintyre, and this included newspaper columns, writers’ festivals, broadcast interviews, intellectual magazines like The Monthly and Quadrant, books, and think tank lectures. Academics and intellectuals were the primary protagonists, and they disputed the extent of colonial genocide; the legitimacy of Indigenous land rights; the impact of the Stolen Generation on the lives of modern Indigenous citizens; and the necessity of a formal apology as a part of the reconciliation process. The conflicts also ignited debates about the nature of history, the quality of public debates in Australia, and exposed the tensions between academics, public intellectuals, newspaper commentators and political elites. Much of the controversy played out in the national forums can be linked to the Bringing Them Home: National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families report Stolen Generation inquiry and report, which was commissioned by Keating but released after Howard came to office. Australian public intellectual and professor of politics Robert Manne critiqued the right’s response to the report in his 2001 Quarterly Essay titled “In Denial: The Stolen Generation and The Right”. He argued that there was a right-wing campaign in Australia that sought to diminish and undermine justice for Aboriginal people by discounting the results of the inquiry, underestimating the numbers of those affected, and underfunding the report’s recommendations. He spoke of the nation’s shame and in doing so he challenged Australia’s image of itself. Manne’s position was applauded by many for providing what Kay Schaffer in her Australian Humanities Review paper called an “effective antidote to counter the bitter stream of vitriol that followed the release of the Bringing Them Home report”. Yet Manne also drew criticism. Historian Bain Attwood argued that Manne’s attack on conservatives was polemical, and he suggested that it would be more useful to consider in detail what drives the right-wing analysis of Indigenous issues. Attwood also suggested that Manne’s essay had misrepresented the origins of the narrative of the Stolen Generation, which had been widely known prior to the release of the Stolen Generation report.Conservative commentators focused upon challenging the accuracy of those stories submitted to the inquiry, which provided the basis for the report. This struggle over factual details was to characterise the approach of historian Keith Windschuttle, who rejected both the numbers of those stolen from their families and the degree of violence used in the settlement of Australia. In his 2002 book The Fabrication of Aboriginal History, Volume One, Van Diemen’s Land 1803–1847 he accused left-wing academics of exaggerating the events of Aboriginal history in order to further their own political agenda. In particular, he argued that the extent of the “conflagration of oppression and conflict” which sought to “dispossess, degrade, and devastate the Aboriginal people” had been overstated and misrepresented and designed to “create an edifice of black victimhood and white guilt” (Windschuttle, Fabrication 1). Manne responded to Windschuttle’s allegations in Whitewash: On Keith Windschuttle’s Fabrication of Aboriginal History, arguing that Windschuttle arguments were “unpersuasive and unsupported either by independent research or even familiarity with the relevant secondary historical literature” (7) and that the book added nothing to the debates. Other academics like Stephen Muecke, Marcia Langton and Heather Goodall expressed concerns about Windschuttle’s work, and in 2003 historians Stuart Macintyre and Anna Clark published The History Wars, which described the implications of the politicisation of history on the study of the past. At the same time, historian Bain Attwood in Telling the Truth About Aboriginal History argued that the contestation over history was eroding the “integrity of intellectual life in Australia” (2). Fractures also broke out between writers and historians about who was best placed to write history. The Australian book reviewer Stella Clarke wrote that the History Wars were no longer constructive discussions, and she suggested that historical novelists could colonise the territory traditionally dominated by professional historians. Inga Clendinnen wasn’t so sure. She wrote in a 2006 Quarterly Essay entitled “The History Question: Who Owns the Past?” that, while novelists could get inside events through a process of “applied empathy,” imagination could in fact obstruct the truth of reality (20). Discussion The History Wars saw academics engage publicly to exhibit a set of competing ideas about Australia’s identity in the nation’s media and associated cultural sites, and while the debates initially prompted interest they eventually came to be described as violent and unproductive public conversations about historical details and ideological positions. Indeed, just as the museum curator could no longer authoritatively prescribe the cultural meaning of artefacts, so the History Wars showed that public intellectuals could not adjudicate the identity of the nation nor prescribe the nature of its conduct. For left-wing public intellectuals and commentators, the History Wars came to signify the further marginalisation of progressive politics in the face of the dominant, conservative, and increasingly populist constituency. Fundamentally, the battles over the past reinforced fears that Australia’s public culture was becoming less diverse, less open, and less able to protect traditional civil rights, democratic freedoms, and social values. Importantly for intellectuals like Robert Manne, there was a sense that Australian society was less able or willing to reflect upon the moral legitimacy of its past actions as a part of the process of considering its contemporary identity. In contrast right-wing intellectuals and commentators argued that the History Wars showed how public debate under a conservative government had been liberated from political correctness and had become more vibrant. This was the position of Australian columnist Janet Albrechtsen who argued that rather than a decline in public debate there had been, in fact, “vigorous debate of issues that were once banished from the national conversation” (91). She went on to insist that left-wing commentators’ concerns about public debate were simply a mask for their discomfort at having their views and ideas challenged. There is no doubt that the History Wars, while media-orchestrated debates that circulated a set of ideological positions designed to primarily attract audiences and construct particular views of Australia, also raised public awareness of the complex issues associated with Australia’s Indigenous past. Indeed, the Wars ended what W.E.H Stanner had called the “great silence” on Indigenous issues and paved the way for Kevin Rudd’s apology to Indigenous people for their “profound grief, suffering and loss”. The Wars prompted conversations across the nation about what it means to be Australian and exposed the way history is deeply implicated in power surely a goal of both intellectual debate and curated exhibitions. ConclusionThis paper has argued that the public intellectual can operate like a curator in his or her efforts to preserve particular ideas, interpretations, and narratives of public culture. 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