Artículos de revistas sobre el tema "Colorado. Office of Boxing"

In fall 2006, Colorado State University Libraries in Fort Collins, Colorado, underwent an administrative reorganization. Part of this reorganization involved changing Morgan Libraries’ Reference Desk to an Information Desk from which staff and student assistants would provide reference referrals to librarians. To gather statistics and track the success of this new service, the College Liaison Librarians, formerly known as Subject Librarians, implemented an office statistics database to record and track referrals received in their offices from Information Desk staff. This database evolved to also provide a centralized online area to collect numbers of office reference transactions. This paper discusses the reasons behind the office statistics database’s creation and the statistics it provides CSU Libraries College Liaison Librarians.

Data supports the success of Colorado Master Gardener sm (MG) of Boulder County outreach beyond the Cooperative Extension office at outlying clinic sites. Initially unique in Colorado, MG plant clinics at area nurseries and garden centers has gained acceptance in other counties of Colorado. Exploration of benefits and investments for programs interested in expanding outreach to the public are discussed to provide a blueprint for clinics start-up. MG clinics are set up to provide answers to questions from the public on Friday through Sundays from April through mid-July. This schedule, coupled with the Monday through Friday MG desk hours, provides seven day per week access to the public during the busiest part of the growing season. Clinics are conveniently located in all county communities at Green Industry locations. Participating businesses consider the clinics a benefit worth investing IN and justification of sites is uniform. Additional single-day clinics have spun off as an addition to fixed clinic schedule. High requirement of staff time, increased sample load and resource investment is offset by the benefits of increased visibility of program in the community leading to increased recruitment of volunteers. Knowledge gained by the public has brought about measurable positive changes in pesticide use and responsible cultural practices. Volunteer retention is favorably affected with increased flexibility of scheduling opportunities and communications. Information on setting up clinic sites, what the sites receive, staff time and services requirements, and refinements as a result of clinic survey will be given.

Objective – The purpose of this study was to analyze the data from a reference statistics-gathering mechanism at Colorado State University (CSU) Libraries. It aimed primarily to better understand patron behaviours, particularly in an academic library with no reference desk. Methods – The researchers examined data from 2007 to 2010 of College Liaison Librarians’ consultations with patrons. Data were analyzed by various criteria, including patron type, contact method, and time spent with the patron. The information was examined in the aggregate, meaning all librarians combined, and then specifically from the Liberal Arts and Business subject areas. Results – The researchers found that the number of librarian reference consultations is substantial. Referrals to librarians from CSU’s Morgan Library’s one public service desk have declined over time. The researchers also found that graduate students are the primary patrons and email is the preferred contact method overall. Conclusion – The researchers found that interactions with patrons in librarians’ offices – either in person or virtually – remain substantial even without a traditional reference desk. The data suggest that librarians’ efforts at marketing themselves to departments, colleges, and patrons have been successful. This study will be of value to reference, subject specialist, and public service librarians, and library administrators as they consider ways to quantify their work, not only for administrative purposes, but in order to follow trends and provide services and staffing accordingly.

In October 2016, the University of Colorado-Boulder (CU Boulder) and the Government Publishing Office (GPO) signed the nation’s first Preservation Steward Memorandum of Agreement (MOA). CU Boulder, the Regional Federal Depository for the state of Colorado, has pledged to retain and preserve three large collections of legislative history: the U.S. Congressional Serial Set, the bound Congressional Record, and Congressional Hearings. In turn, GPO will cover shipping costs to fill collection gaps and facilitate communication between CU Boulder and other libraries that plan to withdraw large runs of relevant documents. The purpose of this article is to provide a historical context for the Preservation Steward agreement, describe how CU Boulder implemented the MOA, and encourage other depository libraries to become Preservation Stewards.

It was in July 1956 when the senior writer of this paper was requested to prepare a program for investigations and studies required in connection with the proposed deep-draft channel from the Gulf of Mexico to Point Comfort. During 1938 to 19^0, the senior writer had attempted to analyze the available field and model study data which were then available on Galveston Bay in the hope of thus being able to reduce the shoaling in the various deep draft channels in Galveston Bay. In 19^0, the senior writer had been in charge of two field parties one of which measured the flow of water in the Colorado River and the Gulf Intracoastal Waterway near their crossing near Matagorda, Texas. A peak discharge of about 80,000 cubic feet per second was measured in the Colorado River at the Palacios Road bridge, about 15 miles upstream from its mouth during this period. At that time there were no locks nor gates in the Intracoastal Waterway adjacent to the Colorado River. It was found then that about one third of this peak river discharge flowed southwest through the Intracoastal Waterway. On the basis of the above experience and the information obtained from a review of the Matagorda Ship Channel, Texas, project report (l) and other literature, then, available (2) thru (5) a program was formulated in June 1958 and submitted to the Division Engineer in Dallas with the request that the Office of the Chief of Engineers, the Southwestern Division Engineer Office, the Beach Erosion Board and the Committee on Tidal Hydraulics review the program.

Abstract Historically large snowpack across the upper Colorado basin and the Great Basin in 2011 presented the potential for widespread and severe flooding. While widespread flooding did occur, its impacts were largely moderated through a combination of sustained cool weather during the melt season and mitigation measures based on forecasts. The potential for more severe flooding persisted from April through the first part of July as record-high snowpacks slowly melted. NOAA's Colorado Basin River Forecast Center (CBRFC) is the primary office responsible for generating river forecasts in support of emergency and water management within the Colorado River basin. This paper describes the 2011 runoff season in the basin and examines the skill of CBRFC forecasts for that season. The primary goal of this paper is to raise awareness of the research and development areas that could, if successfully integrated into the CBRFC river forecasting system, improve forecasts in similar situations in the future. The authors identify three areas of potential forecast improvement: 1) improving week two to seasonal weather and climate predictions, 2) incorporation of remotely sensed snow-covered area, and 3) improving coordination between reservoir operations and forecasts.

In June of 2017, the Office for Intellectual Freedom got its first ever intellectual freedom challenge to a library database. The case was in Colorado and involved the Cherry Creek School District. According to a parent in the district, EBSCO, a periodical database, was promoting obscene and pornographic content to middle school students. At this writing, the campaign has spread to almost a dozen other states from the southeast to the northwest. Some schools immediately, and without much analysis, shut down access to EBSCO. Others have followed their policies and procedures and retained it, despite persistent attempts at political pressure.

OBJECTIVES/SPECIFIC AIMS: Opioid use disorder (OUD) is a national epidemic and identified as a top priority by the practices and communities in rural Colorado. Until recently, few resources existed to address OUD in rural communities. In addition to training primary care and behavioral health practice teams in medication assisted treatment (MAT), Implementing Technology and Medication Assisted Treatment and Team Training and in Rural Colorado (IT MATTTRs Colorado) engaged local community members to alter the community conversation around OUD and treatment. For IT MATTTRs, the High Plains Research Network and the Colorado Research Network engaged community members in a 8-10 month process known as Boot Camp Translations (BCT) to translate medical information and jargon around OUD and MAT into concepts, messages, and materials that are meaningful and actionable to community members. The resulting community interventions are reported here. METHODS/STUDY POPULATION: IT MATTTRs conducted separate BCTs in Eastern Colorado and the south central San Luis Valley. Community partners included non-health professionals with diverse backgrounds, public health and primary care professionals, law enforcement, and others. The BCT process includes a comprehensive education on OUD and MAT and facilitated meetings and calls to develop messages and dissemination strategies. Each BCT lasted around 8-10 months. RESULTS/ANTICIPATED RESULTS: The BCT process elicited unique contextual ideas and constructs for messages, materials, and dissemination strategies. Themes common to both BCTs include the prevalence of OUD and that help is available in the local primary care office. Community-tailored messages are distributed through posters and flyer inserts, drink coasters, newspaper articles, letters to local judges, restaurant placemats, and websites. Examples of the materials and messages will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: Local community members are eager to help address the OUD crisis. Built on community-based participatory research principles, BCT can be used to translate complex information and guidelines around OUD and MAT into messages and materials that reflect local culture and community needs.

Abstract A key development in archaeology is the increasing agency of the digital tools brought to bear on archaeological practice. Roles and tasks that were previously thought to be uncomputable are beginning to be digitalized, and the presumption that computerization is best suited to well-defined and restricted tasks is starting to break down. Many of these digital devices seek to reduce routinized and repetitive work in the office environment and in the field. Others incorporate data-driven methods to represent, store, and manipulate information in order to undertake tasks previously thought to be incapable of being automated. Still others substitute the human component in environments which would be otherwise be inaccessible or dangerous. Whichever applies, separately or in combination, such technologies are typically seen as black-boxing practice with often little or no human intervention beyond the allocation of their inputs and subsequent incorporation of their outputs in analyses. This paper addresses the implications of this shift to algorithmic automated practices for archaeology and asks whether there are limits to algorithmic agency within archaeology. In doing so, it highlights several challenges related to the relationship between archaeologists and their digital devices.

AbstractFrom nearly the moment the woman's suffrage movement began at Seneca Falls in 1848, anti-suffragists actively campaigned against it, claiming that woman suffrage would only destroy both American politics and the American family. However, despite their best efforts, states in the American West passed equal suffrage laws. Interestingly, once it passed in their states, anti-suffragists in the American West—albeit begrudgingly—exercised their right to vote. As equal suffrage continued to expand, the Western anti-suffragist strategy became the strategy of anti-suffragists everywhere. This essay examines three states that represent pivotal moments in the development of the anti-suffrage movement: Colorado, California, and Oklahoma. Shortly after Colorado passed equal suffrage in 1893 and California passed equal suffrage in 1911, anti-suffragists organized state and national associations. By the time Oklahoma passed its equal suffrage law in 1918, anti-suffragists were not only voting—they were also willing to run for office. Anti-suffragist strategy and rhetoric relied on how suffrage worked in the West, or at least anti-suffrage perceptions of it. In other words, women's suffrage in the West served as a catalyst for the anti-suffragist movement.

Title IX coordinators play an essential role in ensuring that schools are free of gender-based harassment and discrimination; however, a recent survey of coordinators in California and Colorado shows that many of them are poorly equipped to do this work. In their study, Elizabeth J. Meyer and Andrea Somoza-Norton found that contact information for Title IX coordinators is often difficult to find, that their job descriptions are too broad and complex, that they receive insufficient training, and that many are unaware of their role in assisting students, especially transgender students. The authors recommend that the Office of Civil Rights, district leaders, school boards, and Title IX coordinators themselves take action to bring clarity to this work.

During the Cold War, from the early 1950s through the 1970s, the US Office of Saline Water was instrumental in spearheading the basic research and development that incubated the desalting techniques we see today. American technical assistance programs were fundamental to the growth of desalination capacity in the Middle East and its eventual globalisation. However, the federal government's original target for desalination was southern California and the arid Southwest. Desalination was proposed as the emergency backstop in the event that California's unquenchable thirst would inevitably overtax the dams of the Colorado River. And yet, American desalination never fully came to fruition. Instead, the promise of domestic desalination was co-opted and cannibalised by Cold War foreign policy. This essay traces how the Office of Saline Water's domestic desalination plans were repackaged and exported to Israel and Saudi Arabia. This essay considers how and why the United States slipped from the vanguard of desalination research while the Middle East emerged as its global leader. By connecting and comparing the divergent experiences of the American West and the Middle East, it also sheds new light on the nexus between the production of desalinated water and its key ingredient, energy.

Henry Fairfield Osborn, vertebrate paleontologist at the American Museum of Natural History, did virtually all of his fieldwork by proxy. Working mostly from his New York office, he detailed a score of fieldworkers to locate and claim fossil localities in advance of collectors from rival museums. This history of a long-forgotten Jurassic dinosaur reconnaissance in the San Juan Basin, which was materially unsuccessful, explores how Osborn found and evaluated potential new field localities. He was relentless in pursuit of fossils, especially in the face of worthy competition. He received his first unsolicited tip about fossils along the Colorado-Utah border in 1893. A collector sent to scout the locality found Jurassic dinosaurs in poor condition and left them behind. Following a second tip about fossils in the same region in 1899—at the height of the second Jurassic dinosaur rush—Osborn sent two more expeditions to search the area. Both of these parties returned empty-handed also. Reliable locality data regarding the presence of typical Jurassic vertebrates would have been very useful to geologists like Whitman Cross, who was then attempting to correlate beds west of the Rockies with better-known strata on the eastern slope. But, in order to maintain a competitive advantage, Osborn kept this locality data to himself.

The authors describe the implementation of a depression care management (DCM) program at Colorado Access, a public sector health plan, and describe the program’s clinical and system outcomes for members with chronic medical conditions. High medical risk, high cost Medicaid health plan members were identified and systematically screened for depression. A total of 370 members enrolled in the DCM program. Longitudinal analyses revealed significantly reduced depression severity scores at 3, 6, and 12 months after intervention as compared to baseline depression scores. At 12 months, 56% of enrollees in the DCM program had either a 50% reduction in PHQ-9 scores or a PHQ-9 score < 10. Longitudinal economic analyses comparing 12 months before and after intervention revealed a significant but modest increase in ER visits, outpatient office visits, and overall medical and pharmacy costs when adjusted for months enrolled in DCM. Limitations and recommendations for the integrated depression care management are discussed.

Abstract The issuance of timely warnings for the occurrence of severe-class hail (hailstone diameters of 2.5 cm or larger) remains an ongoing challenge for operational forecasters. This study examines the application of two remotely sensed data sources between 0100 and 0400 UTC 14 July 2011 when pulse-type severe thunderstorms occurred in the jurisdiction of the Denver/Boulder National Weather Service (NWS) Forecast Office in Colorado. First, a developing hailstorm was jointly observed by the dual-polarization Colorado State University–University of Chicago–Illinois State Water Survey (CSU–CHILL) research radar and by the operational, single-polarization NWS radar at Denver/Front Range (KFTG). During the time period leading up to the issuance of the initial severe thunderstorm warning, the dual-polarization radar data near the 0 °C altitude contained a positive differential reflectivity ZDR column (indicating a strong updraft lofting supercooled raindrops above the freezing level). Correlation coefficient ρHV reductions to ~0.93, probably due to the presence of growing hailstones, were observed above the freezing level in portions of the developing &gt;55-dBZ echo core. Second, data from the National Lightning Detection Network (NLDN), including the locations and polarity of cloud-to-ground (CG) discharges produced by several of the evening’s storms, were processed. Some association was found between the prevalence of positive CGs and storms that produced severe hail. The analyses indicate that the use of the dual-polarization data provided by the upgraded Weather Surveillance Radar-1988 Doppler (WSR-88D), in combination with the NLDN data stream, can assist operational forecasters in the real-time identification of thunderstorms that pose a severe hail threat.

The Vera Institute of Justice, funded by the Prison Law Office, facilitated a project whose aim was to coordinate discussions between American and European policymakers about successful corrections policies and practices in the respective countries. The Colorado Department of Corrections was honored to be one of 3 state correctional teams to participate in this project. The teams spent 3 days in Germany and 3 days in the Netherlands in which much time was spent collaborating with Corrections officials to determine the practices of the respective countries and discussing best practice efforts. The significant differences in cultures affect not only the way the offenders are managed, but also the crimes that are committed in European countries. These variables were fascinating to the American Correctional counterparts as we explored the means by which European offenders are sentenced, managed during incarceration and reintegrated into their communities. The various American state agencies came back with innovative strategies to evolve the management of offenders in the United States – even to the point of challenging century old philosophies of imprisonment.

Introduction. Widespread use of antibiotics has led to drug-resistant bacteria and reports of drug-resistant infections. A continuing medical education (CME) campaign was used to improve antibiotic use among primary care providers. Methods. The Office of CME and Professional Development at the University of Colorado School of Medicine produces a semiannual, week-long course for primary care providers. A 2-year multifaceted CME campaign consisted of course content on antibiotic use, a practice audit, and two surveys to measure perceptions of the problem of antibiotic overuse, potential barriers to achieving appropriate use, and strategies to overcome barriers. Results. The overall response rate in the 2nd part of the campaign was 68.4%. Sixty-six percent of respondents had implemented at least one strategy to reduce antibiotic overuse. The rate was significantly higher among those who had attended previous reviews (81.0%) compared with those who had attended neither (54%, p=0.0002). However, there was no “dose effect” on the rate of implementing a new strategy. Conclusions. Overuse of antibiotic therapy has important public health implications. Results suggest that mixed interactive and didactic CME program was effective in increasing awareness of antibiotic overuse and strategies for reducing antibiotic administration.

Several years ago, i read an item in Mathematics Teaching in the Middle School from an author who used information from her summer vacation to design lessons for a middle school mathematics class (fisher 1999). on one summer vacation while hiking through arches national park in moab, utah, i thought that surely there was mathematics in the science and geology of the sandstone rock formations around me. The park office and souvenir store sold books containing information that would help me discover some of the mathematics of the arches (Baars 1993; Johnson 1985).While reading these books and having taught middle school mathematics for many years, it occurred to me that lessons could be written about large numbers. The sandstone cliffs, from which the arches were formed, date back 140 million years; in addition, they are on the colorado plateau, which dates back 200 million years. The erosion that formed currentday arches began 2 million years ago. a lesson on geometry and measurement could also be written, since the area was part of the paradox Basin, a 10,000 squaremile depression. however, could some relevant algebra be found in the data about the history and geology of arches national park?

Occupant behavior can significantly influence the operation and performance of buildings. Many occupant-centric key performance indicators (KPIs) rely on having accurate counts of the number of occupants in a building, which is very different to how occupancy information is currently collected in the majority of buildings today. To address this gap, the authors develop a standardized methodology for the calculation of percent space utilization for buildings, which is formulated with respect to two prevalent operational data schemas: the Brick Schema and Project Haystack. The methodology is scalable across different levels of spatial granularity and irrespective of sensor placement. Moreover, the methods are intended to make use of typical occupancy sensors that capture presence level occupancy and not counts of people. Since occupant-hours is a preferable metric to use in KPI calculations, a method to convert between percent space utilization and occupant-hours using the design occupancy for a space is also developed. The methodology is demonstrated on a small commercial office space in Boulder, Colorado using data collected between June 2018 and February 2019. A multiple linear regression is performed that shows strong evidence for a relationship between building energy consumption and percent space utilization.

Abstract This article discusses two important cases that involve the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). First, in Vargas v Industrial Com’n of Arizona, a claimant had a pre-existing non–work-related injury to his right knee as well as a work-related injury, and the issue was apportionment of the pre-existing injury. The court held that, under Arizona's statute, the impairment from the pre-existing injury should be subtracted from the current work-related impairment. In the second case, Colorado courts addressed the issue of apportionment in a workers’ compensation claim in which the pre-existing injury was asymptomatic at the time of the work-related injury (Askey v Industrial Claim Appeals Office). In this case, the court held that the worker's benefits should not be reduced to account for an asymptomatic pre-existing condition that could not be rated accurately using the AMA Guides. The AMA Guides bases impairment ratings on anatomic or physiologic loss of function, and if an examinee presents with two or more sequential injuries and calculable impairments, the AMA Guides can be used to apportion between pre-existing and subsequent impairments. Courts often use the AMA Guides to decide statutorily determined benefits and are subject to interpretation by courts and administrative bodies whose interpretations may vary from state to state.

Since the 1970's, the Colorado Master Gardenersm (MG) program in Boulder County has had volunteer opportunities external to the extension office site. Collaboration occurs with various green industry locations via “clinics”. Volunteers are on location Friday through Sunday, April through mid-July to answer questions for the public at large. Due to the length of time this program had been in place, the staff time and resources committed to it, and budget cutbacks, need for a study of impact and effectiveness of this program was identified. A three-year study was conducted to determine efficacy, pertinence and should this system remain status quo. In year 1, a sampling of the general public was conducted to determine: behavioral change as a result of receiving information (such as a diagnosis); was the information delivered in a timely fashion; satisfaction level; pesticide usage trends; continuance of this program and other data points. In year 2, active MG's in Boulder County were surveyed about participation at various facilities, information about clientele activity, and success rate with clients. Additionally, their comfort level on ability to assist clients plus their perception of the value of clinics to the community were surveyed. Data on diagnostics was correlated with weekly statistics. In year 3, partnering Green Industry collaborators were surveyed to gauge satisfaction with clinic service, timeliness of clinic schedule, and value of clinic service to business, and overall benefits to their staff resources. Reports on each survey will be delivered.

The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

In 1958 Marcel Duchamp and a friend gained access to the modernist poet Mina Loy's apartment on stanton street near the Bowery in New York, so that they could display the art she was storing there in a one-woman show of her assemblage artwork (Burke, Becoming 433–34). The show, which Loy herself couldn't attend since she was unwell and living with family in Aspen, Colorado, was known as the Bodley Gallery Exhibition and generated considerable interest, even drawing the increasingly reclusive Djuna Barnes to its lively opening (434). The show was described by Stuart Preston in a New York Times review as a boxing match between the popular art of the time and “Mina Loy's shocking and macabre big collages, composed most graphically of refuse, and inspired by scenes near the Bowery” (qtd. in Burke, Becoming 434). Loy's dadaist assemblages, Preston's review made clear, were a formidable opponent not only of mainstream art but also of the larger politics of art at the time: the “alliance” they reflected “between Dada and social comment,” he wrote, was “downright sinister,” and they contained a slightly apocalyptic undercurrent of social critique. Loy's artwork incorporated discarded objects, such as bottles and pieces of cardboard, from New York City's liminal spaces—especially the Bowery's alleys and abandoned buildings, places where the homeless and unemployed gathered in desperate conditions. Transporting the gutter to the gallery, this body of work depended on her close relationship to the city's so-called refuse, the homeless people she befriended who helped her collect the objects she recycled as art. It has been almost impossible to know what Loy's body of assemblage artwork—carefully dusted off and hung up by Duchamp—looked like at the Bodley Gallery show. But one fellow Bowery artist, the American photographer Berenice Abbott, had photographed Loy's assemblages. Abbott and Loy had been friends since the 1920s, when they frequented the same art scene in Paris, where Abbott was Man Ray's assistant. Abbott photographed Loy's children, and the two artists are pictured together, along with Tristan Tzara, Jane Heap, and Margaret Anderson, in a famous photograph taken at a party in Constantin Brancusi's studio in 1920.1 In this image, Loy and Abbott fill the center of the frame; Abbott's eyes confront the camera, as if to say, “I know what you're up to,” her confident head emerging over Loy's right shoulder—Loy looking as ethereal as she does glamorous. Their friendship picked up again in New York in the 1940s and 1950s, where it was defined by Abbott's interest in Loy's success and well-being.

AbstractThe Flash Flood and Intense Rainfall (FFaIR) Experiment developed within the Hydrometeorology Testbed (HMT) of the Weather Prediction Center (WPC) is a pseudo-operational platform for participants from across the weather enterprise to test emerging flash flood forecasting tools and issue experimental forecast products. This study presents the objective verification portion of the 2017 edition of the experiment, which examines the performance from a variety of guidance tools (deterministic models, ensembles, and machine-learning techniques) and the participants’ forecasts, with occasional reference to the participants’ subjective ratings. The skill of the model guidance used in the FFaIR Experiment is evaluated using performance diagrams verified against the Stage IV analysis. The operational and FFaIR Experiment versions of the excessive rainfall outlook (ERO) are evaluated by assessing the frequency of issuances, probabilistic calibration, Brier skill score (BSS), and area under relative operating characteristic (AuROC). An ERO first-guess field called the Colorado State University Machine-Learning Probabilities method (CSU-MLP) is also evaluated in the FFaIR Experiment. Among convection-allowing models, the Met Office Unified Model generally performed optimally throughout the FFaIR Experiment when using performance diagrams (at the 0.5- and 1-in. thresholds; 1 in. = 25.4 mm), whereas the High-Resolution Rapid Refresh (HRRR), version 3, performed best subjectively. In terms of subjective and objective ensemble scores, the HRRR ensemble scored optimally. The CSU-MLP overpredicted lower risk categories and underpredicted higher risk categories, but it shows future promise as an ERO first-guess field. The EROs issued by the FFaIR Experiment forecasters had improved BSS and AuROC relative to the operational ERO, suggesting that the experimental guidance may have aided forecasters.

On 1 March 2006, Missouri became the 11th state to join the Community Collaborative Rain, Hail, and Snow Network (CoCoRaHS). CoCoRaHS is a national volunteer network of individuals who have agreed to measure and report precipitation observations daily. This program was established in 1998 by the Colorado State Climate Office. On 12 March, 2006 CoCoRaHs quickly demonstrated its usefulness during the severe weather events of that day when there were several reports of large hail. Since then, Missouri CoCoRaHS network receives about 250 reports per day. This data can be used to study severe weather events such as the passage of Tropical Depression Gustav and Tropical Storm Ike through Missouri over a 10 day period bookended by 4 and 14 September 2008. Here we will compare the CoCoRaHS volunteer rainfall totals to RADAR derived estimates taken from the National Weather Service (NWS) as well as the Cooperative Site measurements. CoCoRaHS data was even incorporated by the local NWS to summarize these events. CoCoRaHS data is currently used by all six NWS offices and the four River Forecast Centers that serve the state of Missouri as well as by other state and federal agencies and several television stations. The data have been used to dispatch flash flood information to the NWS and to make flood and drought assessments for the Missouri departments of Agriculture and Natural Resources. Public works departments, insurance companies, contractors and farmers have also used the data for documentation and management decisions. The Missouri CoCoRaHS network has proven to be a very valuable tool for precipitation measurement, and here we demonstrate this by comparing the CoCoRaHS data to different types of precipitation graphics provided by the NWS.

Abstract Introduction Individual differences in cognition during sleep restriction and circadian misalignment have been shown to be trait-like. Here we explored the consistency of individual differences in cardiovascular responses to the cold pressor test (CPT) measured by changes in the distal-proximal skin temperature gradient (DPG) using the contralateral hand to that immersed in the ice water bath, which reflects a reflex cutaneous vasoconstriction. Methods Eighteen healthy participants (8 females) mean (±SD) age 25.28 (±4.3), underwent two identical in-laboratory combined sleep restriction and circadian misalignment protocols preceded by an 8h baseline in-laboratory sleep opportunity. The participants were given a 3h sleep opportunity on night 2 and a 3h sleep opportunity on days 3 and 4 followed by recovery sleep. The CPT occurred the morning after the baseline sleep opportunity and the morning before recovery sleep. Participants maintained a seated posture beginning 30 min prior to the CPT and skin temperature was assessed starting 15 min before until 45 min after the CPT. DPG (proximal=subclavicular; distal=hand palmar) data were averaged into 3 min bins. Changes in DPG from pre-CPT and 5 min post-CPT were assessed as the primary outcome using mixed-model ANOVAs. Intra-class correlation coefficients (ICC) were calculated to measure consistency of individual differences for DPG responses. Results Mixed-model ANOVA revealed significant effects of time and combined sleep restriction and circadian misalignment on DPG during the CPT (both p&lt;0.05), such that the DPG was wider (i.e., more negative) post-CPT and during sleep restriction and circadian misalignment. Participants showed moderately consistent DPG responses across visits 1 and 2 at baseline (ICC=0.59) and substantially consistent DPG responses during sleep restriction and circadian misalignment (ICC=0.67). Further, participants showed moderately consistent DPG responses when comparing changes between baseline and sleep restriction and circadian misalignment across visits (ICC=0.58). Conclusion Findings support that combined sleep restriction and circadian misalignment is associated with sympathetic activation and that individual differences in the DPG response to cold pressor stress are consistent. Support (if any) Office of Naval Research MURI grant N00014-15-1-2809, NIH/NCATS Colorado CTSA Grant UL1TR002535

Background: Point-of-care (POC) lipid testing is increasingly used in community-and office-based practice. Two analyzers commonly used in the US are CardioChek PA and Cholostech LDX. Both directly measure total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), mandatory values in calculating a Framingham Risk Score (FRS). The FRS in turn informs the clinician of the need for lipid-modifying therapy and the degree of therapeutic intensity. Objective: To compare the performance of CardioChek PA and Cholestech LDX. Methods: Staff members from the Colorado Prevention Center were included in the study, with all having fasted for 12 hours beforo the testing. No medical history was obtained. A venous blood sample was collected for lipid measurements conducted in a laboratory, and 2 finger sticks were obtained at that time and analyzed immediately on-site using the POC analyzers. Intraclass correlation coefficients (ICCs) were determined for each analyzer versus the laboratory analysis, with values greater than 0.75 defined as Indicators of excellent reproducibility. We then assessed how interanalyzer differences in TC or HDL-C impacted the FRS lipid categorization. Results: Thirty-four adults (aged 24-56 y) participated in the study. The ICC between Cholestech LDX and the laboratory standard exceeded 075 for all 4 lipid categories (TC, p = 0.96; HDL-C, p = 0.88; low-density lipoprotein cholesterol, ρ = 0.87; triglycerides, ρ = 0.99). By contrast, the only ICC exceeding 0.75 using CardioChek PA was for triglycerides (ρ = 0.84). When applied in calculating the FRS, the Cholestech LDX analyzer misclassified fewer individuals for TC versus the CardioChek PA analyzer (5 vs 21). Overall, Cholestech LDX provided TC and HDL-C values in the correct FRS category more frequently versus CardioChek PA (TC, p < 0.001; HDL-C, p > 0.001). Limitations of the study include use of only 2 POC products and small sample size with no known risk factors. This project does not prove superior accuracy of either device, but reflects a real-world comparison of the analyzers conducted at a single center. Conclusions: The Cholestech LDX analyzer demonstrated better reproducibility than the CardioChek PA analyzer when compared with laboratory gold standard analysis and allowed more accurate categorization for FRS. Since results obtained from these analyzers have the potential to impact treatment decisions, larger, prospective, comparative studies seem warranted.

Abstract Background: Heavy menstrual bleeding (HMB) occurs frequently in adolescent females and a significant proportion have an underlying bleeding disorder. As diagnostic techniques for platelet function disorders (PFD) improve, these disorders are now recognized to commonly cause HMB and may be as prevalent as von Willebrand disease. Limited data exists about the prevalence of PFD in adolescents with HMB. Even less is reported on management and treatment outcomes in patients with HMB and PFD. HMB can negatively impact quality of life and cause serious adverse effects. In order to appropriately treat heavy menstrual bleeding in adolescent females with PFD, more information is needed about the prevalence, clinical manifestations, and management of these patients. Objectives: To evaluate the prevalence, clinical features, management, and outcomes of HMB in adolescent females with platelet function disorders Methods: A retrospective, single center chart review was performed of female patients aged 9-21 years with HMB and a diagnosed PFD treated at a tertiary care pediatric hospital from January 1, 2000 until December 31, 2017. Heavy menstrual bleeding was defined as menses lasting longer than 7 days, use of 8 or more pads or tampons per day during menstrual cycle, pictorial bleeding assessment chart score greater than 100, or symptomatic anemia. Patients were identified from our Hemophilia Treatment Center (HTC) registry, review of patients seen at a comprehensive clinic staffed by pediatric hematologists and gynecologists for adolescent females with HMB and bleeding disorders, and by an Electronic Medical Record (EMR) query of admission and discharge diagnoses of HMB and anemia. Data obtained included demographics, clinical features, laboratory results, treatment modalities, and outcomes. Results: 41 patients with PFD who achieved menarche were identified. 36 of these (88%) met criteria for HMB. The median age at presentation of HMB was 14 years (range 10-18). 35/36 patients had documented abnormal platelet aggregometry (PA) and the majority of patients (27/35) had at least 2 sets of abnormal PA. All patients were diagnosed with non-specific PFD. 15 of the 36 patients (41%) required hospitalization and packed red blood cell transfusion for severe anemia at time of presentation. Mean and median hemoglobin at presentation of HMB respectively were 9.5 gm/dL and 11.3 gm/dL (range 3.1-14.8) and 21 patients (58%) were anemic at presentation. 26 patients had ferritin obtained at presentation and 18 (69%) were iron deficient using our lab's reference range of ferritin less than 13 ng/dL. Half of the patients (18/36, 50%) failed first-line treatment. Successful first-line treatment included hormonal therapy alone (4 patients), hemostatic therapy alone with tranexamic acid (4 patients), hormonal plus hemostatic therapy (7 patients), and intra-uterine device plus hemostatic therapy (1 patient). The mean duration of HMB until report of resolution was 8.2 months (median 5 months; range 1-24). 8% (3/33) of patients reported continued HMB at last documented clinic visit. Conclusions: HMB occurred in the majority of adolescent female patients with PFD. These patients were frequently anemic and iron deficient. Severe and life-threatening anemia requiring hospitalization and packed red blood cell transfusion was common. First line treatment of HMB was not uniform and failed in 50% of the patients. Prospective studies are needed to standardize treatment of HMB in adolescents with PFD. Disclosures Carpenter: Kedrion Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Bayer: Honoraria; CSL Behring: Speakers Bureau; Kane County State's Attorney: Consultancy; National Hemophilia Foundation (Impact Education): Speakers Bureau; HEMA Biologics: Consultancy; Novo Nordisk: Consultancy; Nationwide Children's Hospital: Speakers Bureau; American Academy of Pediatrics: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Genentech Incorporated: Membership on an entity's Board of Directors or advisory committees; Kedrion Biopharmaceuticals: Consultancy; 4th Judicial District Attorney's Office- Colorado: Consultancy; Novo Nordisk Pharmaceuticals, Inc: Consultancy.

Abstract Background: Heavy menstrual bleeding (HMB) in adolescents can be severe and life-threatening. Up to 30% of young women who are hospitalized with anemia due to HMB have a bleeding disorder. Guidelines from the American College of Obstetrics and Gynecology (ACOG) and the National Heart, Lung, and Blood Institute (NHLBI) recommend evaluation for bleeding disorders in such patients. ACOG recommendations include testing for von Willebrand disease (VWD) and specify that consultation with a hematologist may help in interpreting results. NHLBI recommends testing for vWD be done in conjunction with a hematologist. As von Willebrand factor is an acute phase reactant, testing when patients are severely anemic and bleeding may not provide accurate results. ACOG guidelines do not include testing for platelet function disorders (PFD), though PFD may be as prevalent as VWD in females with HMB. Early and accurate diagnosis of bleeding disorders is important for health and quality of life, yet limited data exists on the diagnostic evaluation for bleeding disorders in adolescent females hospitalized for HMB. Objectives: To evaluate the diagnostic evaluation of bleeding disorders in adolescent females hospitalized for HMB. Methods: A retrospective, single center chart review of female patients aged 9-21 years hospitalized for HMB and anemia at a tertiary care children's hospital from January 1, 2000 until December 31, 2017 was done. HMB was defined as menses ≥7 days in length, use of 8 or more pads or tampons per day during menses, pictorial bleeding assessment chart (PBAC) score greater than 100, or symptomatic anemia. Patients were identified from our Hemophilia Treatment Center (HTC) registry, review of patients seen at a comprehensive clinic staffed by pediatric hematologists and gynecologists for adolescent females with HMB and bleeding disorders, and by an Electronic Medical Record (EMR) query of admission and discharge diagnoses of HMB and anemia. Data obtained included clinical features, diagnostic evaluation, and laboratory results. Results: 118 patients hospitalized for HMB and anemia were included. Inpatient Hematology consult or outpatient referral occurred in 68 (58%) of the patients; 60/68 (88%) had a bleeding disorder evaluation completed. 34 patients had a hematologic disorder. PFD was the most common (15/34; 44%) followed by VWD (9/34; 26%). 42% (50/118) of the patients did not have a Hematology consult or outpatient referral (Table 1). While hospitalized for HMB and anemia, 29 of the 50 patients had testing for vWD performed and only 4/29 (14%) had testing repeated as an outpatient once hemoglobin normalized. No patients tested for VWD while inpatient had results consistent with the diagnosis. Platelet function testing was performed in 10/50 patients using the platelet function analyzer (PFA-100) in 8 patients and platelet aggregometry in 2 patients. Conclusions: Despite national guidelines and the presence of known risk factors such as HMB since menarche and HMB causing severe anemia, the hematology service was not involved in the diagnostic process for a significant number of adolescent females. In these patients, testing often occurred while patients were hospitalized and was not repeated. Testing for platelet function disorders occurred infrequently and mainly consisted of the PFA-100 which lacks sensitivity and specificity. When patients were evaluated by Hematology and tested for bleeding disorders, a large proportion had a bleeding disorder, of which PFD were most common. This study demonstrates the need for standardization of the evaluation of adolescent females hospitalized for HMB. Guidelines should be updated to include testing for PFD. Hematologists should be involved when females are hospitalized for HMB and anemia. Disclosures Carpenter: Genentech Incorporated: Membership on an entity's Board of Directors or advisory committees; Nationwide Children's Hospital: Speakers Bureau; Bayer: Honoraria; Kedrion Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk Pharmaceuticals, Inc: Consultancy; HEMA Biologics: Consultancy; American Academy of Pediatrics: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novo Nordisk: Consultancy; National Hemophilia Foundation (Impact Education): Speakers Bureau; Kane County State's Attorney: Consultancy; CSL Behring: Speakers Bureau; 4th Judicial District Attorney's Office- Colorado: Consultancy; Kedrion Biopharmaceuticals: Consultancy.

Abstract BACKGROUND Hemophilia A is an X-linked inherited disorder which affects 1 in 5,000 males and is caused by mutations in the factor VIII (FVIII) gene. Hemophilia is typically diagnosed by measurement of FVIII procoagulant (FVIII:C) activity. Molecular genetic testing of the FVIII gene identifies pathogenic variants in as many as 98% of individuals with hemophilia A. The specific genetic test performed varies and must take into account the severity of hemophilia and the gene affected. Hemophilia A families with severe disease may have genetic analysis for intron 22 and intron 1 mutation performed followed by DNA sequencing if intron analysis is uninformative. Families with mild to moderate disease often need upfront gene sequencing for diagnosis. OBJECTIVE To describe a case series of siblings with FVIII gene mutation having normal Factor VIII activity levels, with grandfather found to have similar gene mutation DESIGN/METHOD: Case Series RESULTS Case 1 An 8 year old boy with presumed Von Willebrand disease (VWD) was seen in our clinic for evaluation for bleeding disorders. Testing prior to being seen in clinic showed Factor VIII level of 37%, Von Willebrand factor activity of 53% and Von Willebrand factor antigen of 103%. He had post-operative hemorrhage after tonsillectomy and adenoidectomy at 3 years of age, as well as frequent epistaxis. Family history was significant for sibling with epistaxis, a maternal grandfather with VWD and sister with menorrhagia. Subsequently, his maternal grandfather was found to have mild hemophilia A based on genetic testing which brought into question the child's diagnosis of mild Type 1 VWD. Repeat testing showed Factor VIII 64%, Von Willebrand factor antigen 126% and Ristocetin cofactor activity 93%. Genetic testing revealed he was hemizygous for the pathogenic variant, c.1621A>T (p.Thr541Ser), in the FVIII gene. He is doing well with normal Factor VIII levels, without significant bleeding episodes and remains on DDAVP as needed. Case 2 A 7 year old boy with presumed history of type 1 VWD was seen in our clinic for evaluation for a bleeding disorder. He had a history of cephalohematoma after skull fracture, as well as frequent epistaxis. Testing prior to being seen in our clinic showed Von Willebrand factor antigen of 87%, Von Willebrand factor activity of 69%, and Factor VIII activity of 32%. Family history was as reported for his sibling (Case 1). In our clinic, he had genetic testing performed that was not consistent with VWD Type 2N (Normandy phenotype). Repeat labs in our clinic showed Von Willebrand factor antigen of 100%, Von Willebrand factor activity of 92%, and Factor VIII activity of 50%. He was treated with Von Willebrand factor replacement prior to planned foot surgery as well as DDAVP. Subsequent to identification of a FVIII gene mutation in his maternal grandfather and brother, testing revealed he was hemizygous for the same mutation detailed in Case 1. He is doing well with normal Factor VIII levels, no significant bleeding and remains on DDAVP as needed for bleeding. CONCLUSION The c.1621A>T (p.Thr541Ser) variant which occurs in exon 11 of the FVIII gene, has been is known to cause mild hemophilia A. The Thr541Ser substitution is rare and is present in ~0.009% of the NHLBI exome sequencing project. This is a unique case series of siblings with a rare mutation having normal Factor VIII levels and grandfather with similar mutation who was eventually also diagnosed with mild hemophilia A. The underlying gene mutation is an important but not sole determinant of residual FVIII:C in hemophilia A patients. As our understanding of pathophysiologic process of causative genetic event and baseline FVIII:C in patients is limited, this case series highlights the current diagnostic challenges in the mild Hemophilia A population and the importance of appropriate diagnostic techniques to avoid delayed diagnosis. Correct identification of mutations also provides the opportunity to define molecular consequences and identify residues important for factor VIII activity. Disclosures Carpenter: Bayer: Honoraria; Kedrion Biopharmaceuticals: Consultancy; Nationwide Children's Hospital: Speakers Bureau; Kane County State's Attorney: Consultancy; 4th Judicial District Attorney's Office- Colorado: Consultancy; Kedrion Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; HEMA Biologics: Consultancy; CSL Behring: Speakers Bureau; National Hemophilia Foundation (Impact Education): Speakers Bureau; Genentech Incorporated: Membership on an entity's Board of Directors or advisory committees; American Academy of Pediatrics: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novo Nordisk Pharmaceuticals, Inc: Consultancy; Novo Nordisk: Consultancy.

Introduction: Hospitalization rates for acute myocardial infarction (AMI), coronary heart disease (CHD), and stroke have decreased over time, although trends are debatable for heart failure (HF). These trends are unequally distributed. There is a growing literature documenting the relationship between social and economic characteristics of people’s communities and cardiovascular disease (CVD). Based on a social ecological model of health through the life course, we descriptively examined associations between CVD hospitalization rates and patient characteristics and census tract (CT)-level community environment. Hypothesis: CVD hospitalization rates will be higher in community environments with higher percentages of individuals living below the federal poverty level, racial/ethnic minority groups, and non-residential (i.e., commercial/office, industrial, open space, public/civic, vacant, and miscellaneous space) vs. residential land use. Methods: Colorado Hospital Association (2009-2013) data were used to measure ICD-9 coded hospitalization rates (per 1,000) for Denver, Colorado residents ≥20 years. Data were merged with American Community Survey (2009-2013) and Denver County land use (2010) data. Using chi-square analysis, we examined associations between age-adjusted CVD hospitalization rates (N=15,521) and CT-level community environment (in quartiles) (N=144). Results: Denver’s annual CVD hospitalization rate was 6.6. Patient-level AMI (1.7), CHD (2.8), and HF (2.2) rates were higher among men. Women had higher stroke-related rates (2.4). Across CVD types, rates for those ≥65 years (6.5-13.5) were higher than middle-aged groups (2.1-3.4). Average annual age-adjusted AMI hospitalization rates were higher in CTs with the highest quartile of Hispanic Americans (2.0), Native Americans (1.9), and individuals below poverty (1.9). CHD rates were higher in CTs with higher percentages of Hispanic Americans (3.1), individuals below poverty (3.1), and Native Americans (3.1). HF rates were higher in CTs with higher percentages of industrial/office land use (3.5), individuals below poverty (3.3), and Hispanic Americans (3.2). Stroke rates were higher in CTs with higher percentages of Native Americans (3.0), industrial/office land use (3.0), and African Americans (3.0). The largest disparities for rate ratios comparing the highest to the lowest quartiles for each exposure by CVD outcome were the percentage of individuals below poverty (AMI 2.2; CHD 2.1; HF 2.4; Stroke 1.7), non-Hispanic Whites (AMI 0.7; CHD 0.7; HF 0.7; Stroke 0.7), Hispanic Americans (AMI 1.5; CHD 1.5; HF 1.5), and Native Americans (Stroke 1.30). Conclusions: In conclusion, associations exist between community environment and CVD hospitalization rates, suggesting opportunities for health policy development in Denver’s city government, council districts, and neighborhoods .

Better energy performance (i.e., net-zero or carbon neutral) is not the only dimension where better buildings quality is needed. It may just be the easiest one to measure. Three interrelated dimensions—productivity and its cousins, health and comfort—are the next in line. The building of the future will bring far more intelligence—and quality—to those dimensions, in order to compete for occupants and potentially to help to pay for the efficiency needed on the energy side. The economics of productivity and health gains or losses can dwarf—in upside or downside—what happens on the energy front. This paper describes specific drivers of health and productivity and comfort, and discusses their use in the design and occupancy of Rocky Mountain Institute’s (RMI’s) new net-zero building in Colorado as a test case to look at design and occupant engagement issues. The paper details the most important design and behavior tradeoffs encountered, and discusses paths to effectively resolving them and accelerating change.

<p class="MsoNormal" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-size: 10pt;"><span style="font-family: Times New Roman;">Wireless technology is rapidly expanding market in business. A survey of literature and executives in Colorado indicates extensive use of cell phones predominating in all businesses.<span style="mso-spacerun: yes;">&nbsp; </span>Secondary wireless technology (wireless mouse, LAN, keyboards, PDA) is gradually expanding. The future holds additional expansion in Hot Spots for use away form the home/office environment.<span style="mso-spacerun: yes;">&nbsp; </span>Major concerns with wireless technology involve both security and standardization, which will determine expanded use in the future.</span></span></p>

Universities help shape cities. Historical forms of racial domination repeat themselves, reproducing spatial subordination. In Denver, residences and businesses owned by families of color will be cleared as Colorado State University (CSU), two museums, and the mayor’s office redevelop the area to build an educational hub. An examination of Citizens Advisory Committee (CAC) meeting transcripts shows that relationships between the higher education institution and the city are changing in racialized ways, as normative institutions overpower low-income communities of color. Reading discursive events from CAC meetings through a theoretical lens reveals the CSU expansion to be an instance of a predominantly white institution working with city leaders to remove people from land so it can be used to better fulfill economic ambitions, exemplifying theories about the spatialization of race and the racialization of space (Lipsitz, 2006, 2007, 2011). This occurrence has implications for higher education researchers and municipal leaders beyond Denver.

On November 26, 1985, during the early morning hours, the roof structure at a recently completed shopping center in Longmont, Colorado collapsed following several days of snow and freezing rain. Fortunately, the structure was unoccupied. Photographs taken after the collapse are shown in Figures 1 and 2. Representatives from the architect and structural engineer on site immediately after the collapse conducted density measurements and determined the weight of snow to be on the order of 10.5 to 14 psf. The specified design snow load was 40 psf. Our office was contacted and arrived at the site on December 3, 1985. With a large portion of the snow melted we had to rely on the density measurements conducted by the previous investigators. However, with all of the collapsed trusses in the original failed position, we were able to obtain dimensions of the failed members. Our investigation included

Background: Medication adherence is extremely important in the treatment of hypertension. Most medication adherence metrics are based on refill rates from pharmacy claims databases and require at least two drug dispensings for the calculations. Little is known about individuals who demonstrate early non-adherence to antihypertensive medications, either by never filling a prescription (primary non-adherence) or by filling a prescription only once (early non-persistence). Methods: We conducted a retrospective cohort study of 6,393 Kaiser Permanente Colorado enrollees with hypertension who received a first prescription for an antihypertensive medication between January 1, 2007 and June 30, 2008. We linked prescription orders to medication dispensings and then classified patients into primary non-adherent, early non-persistent, or ongoing dispensings groups. Multivariate logistic modeling was performed to investigate potential predictors of primary non-adherence compared to ongoing dispensings. Results: Five percent (331 of 6,393) of patients were primarily non-adherent, 26% (1,672 of 6,393) demonstrated early non-persistence, and 69% (4,390 of 6,393) received ongoing dispensings. In a multivariate model, the following characteristics were associated with a higher likelihood of exhibiting primary non-adherence compared to receiving ongoing dispensings: Hispanic (OR 1.74, 95% CI 1.20-2.52) or other racial/ethnic minority (1.48, 1.13-1.95), an enrollment period less than 10 years (1.28,1.00-1.62), more than four comorbidities compared to no comorbidities (1.76, 1.02-3.02), and fewer than five health care contacts in the six months after the medication was prescribed (1.31, 1.02-1.67). The copayment amount for office visits or medications was not associated with primary non-adherence. The c-statistic for the model containing demographic characteristics, comorbidities, and health care plan information was 0.63. Conclusions: A substantial number of individuals newly prescribed an antihypertensive medication exhibited early non-adherence. Our multivariate model had limited discrimination, indicating that further research is needed to better characterize these individuals and explore barriers to early adherence.

Sudden cardiac death (SCD) is accompanied by preceding symptoms in a significant proportion of victims, with a median duration of up to 2 hours in some cases. The purpose of this study was to describe the characteristics of SCD victims with heralding symptoms who refused medical care. We conducted a secondary data analysis of interview data from witnesses of 99 cases of out-of-hospital presumed myocardial infarction death with known symptoms. Qualitative description methods were used to analyze qualitative data. Logistic regression was used to test the influence of type of symptoms (chest pain vs. non-chest pain), history of heart disease, and age on refusal of medical care. Categorization as refusal of medical care required conversation with someone where refusal was expressed verbally by the victim. There were 19 cases (19%) that refused medical care; their mean age was 72. The majority were male (16/19, 84%). Fifteen cases involved persistent refusal, defined as refusing care until collapse (range of <15 minutes to 60 hours). Four victims initially refused care and then permitted access to medical care. The suggestion for seeking medical care came from someone else in all but one case, and usually included multiple attempts. The care options offered but refused included calling 911 or a doctor, as well as going to the hospital, emergency department or a doctor’s office. Reasons for refusal of medical care (more than one reason in some cases) included stating the symptoms were due to something not urgent (n=10), other obligations (n=3), expressed dislike of hospitals or doctors (n=4), or recent medical reassurance of health status (n=7). Controlling for age, victims with chest pain vs. non-chest pain symptoms were more likely (OR = 3.56, p = .036, 95% CI = 1.09 –11.66) to refuse medical care and those with a history of heart disease were less likely (OR = .16, p = .004, 95% CI = .05–.55) to refuse medical care. Patients with chest pain and no history of heart disease are more likely to refuse advice to seek medical care. Public health messages about how to respond to cardiac symptoms should include strategies to overcome the reasons people refuse medical care. This research has received full or partial funding support from the American Heart Association, AHA Pacific/Mountain Affiliate (Alaska, Arizona, Colorado, Hawaii, Idaho, Montana, Oregon, Washington & Wyoming).

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To use the overworked metaphor of the movie reviewers, Adaptation (2002)—directed by Spike Jonze and written by Charlie Kaufman—is that rare Hollywood flower, a “literary” film that succeeds both with the critics and at the box office. But Kaufman’s literary colleagues, his fellow screenwriters whose opinions are rarely noticed by movie reviewers or the public, express their support in more interesting terms. Robert McKee, the real-life screenwriter and teacher played by Brian Cox in the movie, writes about Kaufman as one of the few to “step out of screenwriting anonymity to gain national recognition as an artist—without becoming a director” (131). And the screenwriter Stephen Schiff (Lolita [Adrian Lyne, 1997], The Deep End of the Ocean [Ulu Grosbard, 1999]) embraces the film as a manifesto, claiming that Kaufman’s work offers “redemption” to him and his fellow screenwriters who are “struggling to adapt to the world’s dismissive view of adaptation.” The comments by Kaufman’s colleagues suggest that new respect for the work of adaptation, and the role of the screenwriter go hand in hand. The director—whom auteur theory, the New Wave, and film schools helped to establish as the primary creative agent behind a film—has long overshadowed the screenwriter, but Kaufman’s acclaim as a screenwriter reflects a new sensibility. This was illustrated by the controversy among Academy Award voters in 2002. They found that year’s nominees, including Adaptation, unsettled the Academy’s traditional distinction between “original screenplay” and “adapted screenplay”, debating whether a nominee for best original screenplay, such as My Big Fat Greek Wedding (Joel Zwik, 2002), was more like an adaptation, while Adaptation, a nominee for best adapted screenplay, was more like an original screenplay. The Academy’s confusion on this score is not without precedents; nonetheless, as Rick Lyman of The New York Times reports, it led some to wonder, “in an age of narrative deconstruction and ‘reality television’,” whether the distinction between original and adaptation was still valid. If, as the famed critic Alexandre Astruc claimed, the director should be seen as someone who uses the camera as a pen to “write” the movie, then the screenwriter, in Ben Stoltzfus’s words, is increasingly seen as someone who uses the pen to “shoot” the movie. While this appreciation of the screenwriter as an “adaptor” who directs the movie opens new possibilities within Hollywood filmmaking, it also occurs in a Hollywood where TV shows, video games, and rides at Disneyland are adapted to film as readily as literary works once were. Granted, some stand to gain, but who or what is lost in this new hyper-adaptive environment? While there is much to be said for Kaufman’s movie, I suggest its optimistic account of adaptation—both as an existential principle and cinematic practice—is one-sided. Part of the dramatic impact of the movie’s one word title is the way it shoves the act of adaptation out from the wings and places it front and center in the filmmaking process. An amusing depiction of the screenwriter’s marginalisation occurs at the movie’s beginning, immediately following Charlie’s (Nicholas Cage) opening monologue delivered against a black screen. It is presented as a flashback to the making of Being John Malkovich (Spike Jonze, 1999), the movie for which Kaufman wrote his first screenplay, making him “a name” in Hollywood. Although scripted, the scene is shot with a hand-held video camera and looks as though it is occurring in real time. The central character is John Malkovich in costume as a woman who shouts orders at everyone on the set—deftly illustrating how the star’s power in the new Hollywood enables him or her to become “the director” of the movie. His directions are then followed by ones from the first assistant director and the cinematographer. Meanwhile, Charlie stands silently and awkwardly off to the side, until he is chased away by the first assistant director—not even the director or the cinematographer—who tells him, “You. You’re in the eyeline. Can you please get off the stage?” (Kaufman and Kaufman, 3). There are other references that make the movie’s one-word title evocative. It forces one to think about the biological and literary senses of the word—evolution as a narrative process and narrative as an evolutionary process—lifting the word’s more colloquial meaning of “getting along” to the level of an existential principle. Or, as Laroche (Chris Cooper) explains to Orlean (Meryl Streep), “Adaptation’s a profound process. It means you figure out how to thrive in the world” (Kaufman and Kaufman, 35). But Laroche’s definition of adaptation, which the movie endorses and dramatises, is only half the story. In fact evolutionary science shows that nature’s “losers” vastly outnumber nature’s “winners.” As Peter Bowler expresses it in his historical account of the theory of natural selection, “Evolution becomes a process of trial and error based on massive wastage and the death of vast numbers of unfit creatures”(6). Turning the “profound process” of adaptation into a story about the tiny fraction who “figure out how to thrive in the world” has been done before. It manifested itself in Herbert Spencer’s late-nineteenth-century philosophical “adaptation” of Charles Darwin’s work on natural selection, coining the phrase, “survival of the fittest.” Both the scientist Darwin and the philosopher Spencer, as Bowler points out, would have been horrified at how their work was used to justify the rapacious capitalism and harsh social policies of American industry (301). Nonetheless, although by now largely discredited in the academy, the ideology of social Darwinism persists within the broader culture in various watered-down or subterranean forms. Perhaps in the movie’s violent climax when Laroche is killed by an alligator—a creature that represents one of the more impressive examples of adaptation in the natural world—Kaufman is suggesting the darker side to the story of natural selection in which adaptation is not only a story about the mutable and agile orchid that “figure[s] out how to thrive in the world.” There are no guarantees for the tiny fraction of species that do survive, whether they are as perfectly adapted to their environment as orchids and alligators or, for that matter, individuals like Laroche with his uncanny ability to adapt to whatever life throws at him. But after the movie’s violent eruption, which does away not only with Laroche but also Donald (Nicholas Cage) and in effect Orlean, Charlie emerges as the sole survivor, reassuring the viewer that the story of adaptation is about nature’s winners. The darker side to the story of natural selection is subsumed within the movie’s layers of meta-commentary, which make the violence at the movie’s end an ironic device within Charlie’s personal and artistic evolution—a way for him to maintain a critical distance on the Hollywood conventions he has resisted while simultaneously incorporating them into his art. A cinematically effective montage dramatically represents the process of evolution. However, as with the movie’s one-sided account of adaptation, as a story about those who “figure out how to thrive in the world,” this depiction of evolution is framed, both figuratively and literally, by Charlie’s personal growth—as though the logical and inevitable endpoint of the evolutionary process is the human individual. The montage is instigated by Charlie’s questions to himself, “Why am I here? How did I get here?” and concludes with a close-up on the bawling face of a newborn baby, whom the viewer assumes is Charlie (Kaufman and Kaufman, 3). This assumption is reinforced by the next scene, which begins with a close-up on the face of the adult Charlie who is sweating profusely as he struggles to survive a business luncheon with the attractive studio executive Valerie (Tilda Swinton). Although Orlean’s novel doesn’t provide a feminist reading of Darwin, she does alert her readers to the fact that he was a Victorian man and, as such, his science might reflect the prejudices of his day. In discussing Darwin’s particular fondness for his “‘beloved Orchids’” (47), she recounts his experiments to determine how they release their pollen: “He experimented by poking them with needles, camel-hair brushes, bristles, pencils, and his fingers. He discovered that parts were so sensitive that they released pollen upon the slightest touch, but that ‘moderate degrees of violence’ on the less sensitive parts had no effect ….” (48). In contrast to this humorous view of Darwin as the historically situated man of science, the movie depicts Darwin (Bob Yerkes) as the stereotypical Man of Science. Kaufman does incorporate some of Orlean’s discussion of Darwin’s study of orchids, but the portion he uses advances the screenplay’s sexualisation/romanticisation of Orlean’s relationship with Laroche. At an orchid show, Laroche lectures to Orlean about Darwin’s theory that a particular orchid, Angraecum sesquipedale, is pollinated by a moth with a twelve-inch proboscis. When Orlean takes exception to Laroche for telling her that proboscis means “nose,” he chides her, “Hey, let’s not get off the subject. This isn’t a pissing contest” (23). After this scene bristling with phallic imagery—and with his female pupil sufficiently chastised—Laroche proceeds to wax poetic about pollination as a “little dance” (24) between flower and insect. “[The] only barometer you have is your heart …” (24) he tells Orlean, who is clearly impressed by the depth of his soliloquy. On the literary and social level, a one-sided reading of adaptation as a positive process may be more justified, although here too one may question what the movie slights or ignores. What about the human ability to adapt to murderous and dehumanising social systems: slavery, fascism, colonialism, and so on? Or, more immediately, even if one acknowledges the writer’s “maturity,” as T.S. Eliot famously phrased it, in “stealing” from his or her source, what about the element of compromise implicit in the concept of adaptation? Several critics question whether the film’s ending, despite the movie’s self-referential ironies, ultimately reinforces the Hollywood formulas it sets out to critique. But only Stuart Klawans of The Nation connects it to the movie’s optimistic, one-sided view of adaptation. “Still,” he concludes, “I’m disappointed by that crashing final act. I wonder about the environmental pressure that must bear down on today’s filmmakers as they struggle to adapt, even when they’re as prodigious as Charlie Kaufman.” Oddly, for a self-reflexive movie about the creative process, it has little to say about the “environmental pressure” of the studio system and its toll on the artist. There are incisive character sketches of studio types, such as the attractive and painfully earnest executive, Valerie, who hires Charlie to write the screenplay for Orlean’s book, or Charlie’s sophomoric agent, Marty (Ron Livingston), who daydreams about anal sex with the women in his office while talking to his client. And, of course, a central plot line of the movie is the competition, at least as one of them sees it, between Charlie and his twin brother Donald. Charlie, the self-conscious Hollywood screenwriter who is stymied by his success and notions of artistic integrity, suffers defeat after humiliating defeat as Donald, the screenwriting neophyte who will stoop to any cliché or cheap device to advance his screenplay, receives a six-figure contract for his first effort: a formulaic and absurd serial-killer movie, The Three, that their mother admires as a cross between Psycho (Alfred Hitchcock, 1960) and Silence of the Lambs (Jonathan Demme, 1991). Because of the emotional arc of the brothers’ personal relationship, however, any qualms about Donald selling out look churlish at best. When Donald excitedly tells his brother about his good fortune, Charlie responds approvingly, rather than with one of the snide putdowns the viewer has grown to expect from him, signaling not only Charlie’s acceptance of his brother but the new awareness that will enable him to overcome his writer’s block. While there is a good deal of satire directed at the filmmaking process—as distinct from the studio system—it is ultimately a cherishing sort of satire. It certainly doesn’t reach the level of indictment found in Robert Altman’s The Player (1992) or Joel and Ethan Cohen’s Barton Fink (1991) for example. But the movie most frequently compared to Adaptation is Frederico Fellini’s masterpiece of auteurist self-reflexivity, 8 ½ (1963). This is high praise indeed, although the enthusiastic endorsements of some film critics do not stop there. Writing for the Observer, Philip French cites such New Wave movies as Jean-Luc Godard’s Le Mepris (1963), Francois Truffaut’s La Nuit Americaine (1973), and Alain Robbe-Grillet’s Trans-Europ-Express (1966). However, in passing, he qualifies the comparison by pointing out that, unlike the French auteurs, “Kaufman and Jonze are concerned with turning someone else’s idea into a piece of commercial cinema.” Some would argue the filmmakers’ ability to playfully adapt Orlean’s artistry to the commercial environment of Hollywood is what saves Adaptation’s meta-commentary from the didactic and elitist seriousness of many of its literary and cinematic precursors (Miller). This is a valid preference, but it slights the “environmental pressure” of the new studio system and how it sets the terms for success and failure. While Fellini and the New Wave auteurs were not entirely free of commercial cinema, they could claim an opposition to it that Kaufman, even if he wanted to, cannot. Film scholar Timothy Corrigan argues that the convergence of the new media, in particular television and film, radically alters the meaning and function of “independent” cinema: a more flexible and varied distribution network has responded to contemporary audiences, who now have the need and the power to pick and choose among the glut of images in contemporary television and film culture. Within this climate and under these conditions, the different, the more peculiar, the controversial enter the marketplace not as an opposition but as a revision and invasion of an audience market defined as too large and diverse by the dominant blockbusters. (25-6) Corrigan’s argument explains the qualitative differences between the sense of adaptation employed by the older auteurs and the new sense of adaptation required by contemporary auteurs fully incorporated within the new studio system and its new distribution technologies. Not everyone is disturbed by this state of affairs. A. O. Scott, writing for the New York Times, notes a similar “two-tier system” in Hollywood—with studios producing lavish “critic- and audience-proof franchise pictures” on the one hand and “art” or “independent” movies on the other—which strikes him as “a pretty good arrangement.” Based on what Adaptation does and does not say about the studio system, one imagines that Kaufman would, ultimately, concur. In contrast, however, a comment by Michel Gondry, the director Kaufman worked with on Human Nature (2001), gives a better indication of the costs incurred by adapting to the current system when he expresses his frustration with the delayed release of the picture by New Line Cinema: ‘First they were, like, “O.K. if Rush Hour 2 [Brett Ratner, 2001] does good business, then we’re in a good position,”’ Mr. Gondry said. ‘You fight to do something original and then you depend on Rush Hour 2 for the success of your movie? It’s like you are the last little thing on the bottom of the scale and you’re looking up watching the planets colliding. It’s been so frustrating.’ (Rochlin) No doubt, when Fellini and Godard thought about doing “something original” they also had considerable obstacles to face. But at least the success of 8 ½ or Le Mepris wasn’t dependent upon the success of films like Rush Hour 2. Given this sort of environmental pressure, as Klawans and Corrigan remind us, we need to keep in mind what might be lost as the present system’s winners adapt to what is generally understood as “a pretty good arrangement.” Another indication of the environmental pressure on artists in Hollywood’s present arrangement comes from Adaptation’s own story of adaptation—not the one told by Kaufman or his movie, but the one found in Susan Orlean’s account of how she and her novel were “adapted” by the filmmakers. Although Orlean is an enthusiastic supporter of the movie, when she first read the screenplay, she thought, “the whole thing ‘seemed completely nuts’” and wondered whether she wanted “that much visibility” (Boxer). She decided to give her consent on the condition they not use her name. This solution, however, wouldn’t work because she didn’t want her book “in a movie with someone else’s name on it” (Boxer). Forced to choose between an uncomfortable visibility and the loss of authorship, she chose the former. Of course, her predicament is not Kaufman’s fault; nonetheless, it is important to stress that the process of adaptation did not enforce a similar “choice” upon him. Her situation, like that of Gondry, indicates that successful adaptation to any system is a story of losing as well as winning. References Astruc, Alexandre. “The Birth of a New Avant-Garde: Le Camera-Stylo.” Film and Literature: An Introduction and Reader. Ed. Timothy Corrigan. Saddle River, NJ: Prentice Hall, 1999, 158-62. Bowler, Peter J. Evolution: The History of an Idea. 3rd ed. Berkeley, CA: U of California P, 2003. Boxer, Sarah. “New Yorker Writer Turns Gun-Toting Floozy? That’s Showbiz.” The New York Times 9 Dec. 2002, sec. E. Corrigan, Timothy. A Cinema without Walls. New Brunswick, NJ: Rutgers UP, 1991. Eliot, T.S. “Philip Massinger.” The Sacred Wood: Essays on Poetry and Criticism. 1922. http://www.bartleby.com/> French, Philip. “The Towering Twins.” The Observer 2 Mar. 2003. Guardian Unlimited. 12 Feb. 2007. http://film.guardian.co.uk/News_Story/Critic_Review>. Kaufman, Charlie and Donald Kaufman. Adaptation: The Shooting Script. New York: Newmarket Press, 2002. Klawans, Stuart. “Adeptations.” The Nation 23 Dec. 2002. 12 Febr. 2007. http://www.thenation.com/doc/20021223/klawans>. Lyman, Rick. “A Jumble of Categories for Screenwriter Awards.” The New York Times 21 Feb. 2003. McKee, Robert. “Critical Commentary.” Adaptation: The Shooting Script. New York: Newmarket Press, 2002. 131-5. Miller, Laura. “This Is the Way We Live Now.” The New York Times Magazine 17 Nov. 2002. Orlean, Susan. The Orchid Thief. New York: Ballantine Books, 1998. Rochlin, Margy. “From an Untamed Mind Springs an Ape Man.” The New York Times 7 Apr. 2002. Schiff, Stephen. “All Right, You Try: Adaptation Isn’t Easy.” The New York Times 1 Dec. 2002. Scott, A. O. “As Requested My Thoughts on the Oscars.” The New York Times 9 Feb. 2003. Stoltzfus, Ben. “Shooting with the Pen.” Writing in a Film Age. Ed. Keith Cohen. Niwot, CO: UP of Colorado, 1991. 246-63. Citation reference for this article MLA Style Rizzo, Sergio. "Adaptation and the Art of Survival." M/C Journal 10.2 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0705/02-rizzo.php>. APA Style Rizzo, S. (May 2007) "Adaptation and the Art of Survival," M/C Journal, 10(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0705/02-rizzo.php>.

She leant lazily across the picnic hamper and reached for my hearing aid in my open-palmed hand. I jerked away from her, batting her hand away from mine. The glare of the summer sun blinded me. I struck empty air. Her tendril-fingers seized the beige seashell curve of my hearing aid and she lifted the cargo of sound towards her eyes. She peered at the empty battery-cage before flicking it open and shut as if it was a cigarette lighter, as if she could spark hearing-life into this trick of plastic and metal that held no meaning outside of my ear. I stared at her. A band of horror tightened around my throat, strangling my shout: ‘Don’t do that!’ I clenched my fist around the new battery that I had been about to insert into my hearing aid and imagined it speeding like a bullet towards her heart. This dream arrived as I researched my anthology of memoir-style essays on deafness, The Art of Being. I had already been reflecting and writing for several years about my relationship with my deaf-self and the impact of my deafness on my life, but I remained uneasy about writing about my deaf-life. I’ve lived all my adult life entirely in the hearing world, and so recasting myself as a deaf woman with something pressing to say about deaf people’s lives felt disturbing. The urgency to tell my story and my anxiety to contest certain assumptions about deafness were real, but I was hampered by diffidence. The dream felt potent, as if my deaf-self was asserting itself, challenging my hearing persona. I was the sole deaf child in a family of five muddling along in a weatherboard war commission house at The Grange in Brisbane during the nineteen fifties and nineteen sixties. My father’s resume included being in the army during World War Two, an official for the boxing events at the 1956 Melbourne Olympic Games and a bookie with a gift for telling stories. My mother had spent her childhood on a cherry orchard in Young, worked as a nurse in war-time Sydney and married my father in Townsville after a whirlwind romance on Magnetic Island before setting up home in Brisbane. My older sister wore her dark hair in thick Annie-Oakley style plaits and my brother took me on a hike along the Kedron Brook one summer morning before lunchtime. My parents did not know of any deaf relatives in their families, and my sister and brother did not have any friends with deaf siblings. There was just me, the little deaf girl. Most children are curious about where they come from. Such curiosity marks their first foray into sexual development and sense of identity. I don’t remember expressing such curiosity. Instead, I was diverted by my mother’s story of her discovery that I was deaf. The way my mother tells the story, it is as if I had two births with the date of the diagnosis of my deafness marking my real arrival, over-riding the false start of my physical birth three years earlier. Once my mother realized that I was deaf, she was able to get on with it, the ‘it’ being to defy the inevitability of a constrained life for her deaf child. My mother came out swinging; by hook or by crook, her deaf daughter was going to learn to speak and to be educated and to take her place in the hearing world and to live a normal life and that was that. She found out about the Commonwealth Acoustics Laboratory (now known as Australian Hearing Services) where, after I completed a battery of auditory tests, I was fitted with a hearing aid. This was a small metal box, to be worn in a harness around my body, with a long looping plastic cord connected to a beige ear-mould. An instrument for piercing silence, it absorbed and conveyed sounds, with those sounds eventually separating themselves out into patterns of words and finally into strings of sentences. Without my hearing aid, if I am concentrating, and if the sounds are made loudly, I am aware of the sounds at the deeper end of the scale. Sometimes, it’s not so much that I can hear them; it’s more that I know that those sounds are happening. My aural memory of the deep-register sounds helps me to “hear” them, much like the recollection of any tune replays itself in your imagination. With and without my hearing aids, if I am not watching the source of those sounds – for example, if the sounds are taking place in another room or even just behind me – I am not immediately able to distinguish whether the sounds are conversational or musical or happy or angry. I can only discriminate once I’ve established the rhythm of the sounds; if the rhythm is at a tearing, jagged pace with an exaggerated rise and fall in the volume, I might reasonably assume that angry words are being had. I cannot hear high-pitched sounds at all, with and without my hearing aids: I cannot hear sibilants, the “cees” and “esses” and “zeds”. I cannot hear those sounds which bounce or puff off from your lips, such as the letters “b” and “p”; I cannot hear that sound which trampolines from the press of your tongue against the back of your front teeth, the letter “t”. With a hearing-aid I can hear and discriminate among the braying, hee-hawing, lilting, oohing and twanging sounds of the vowels ... but only if I am concentrating, and if I am watching the source of the sounds. Without my hearing aid, I might also hear sharp and sudden sounds like the clap of hands or crash of plates, depending on the volume of the noise. But I cannot hear the ring of the telephone, or the chime of the door bell, or the urgent siren of an ambulance speeding down the street. My hearing aid helps me to hear some of these sounds. I was a pupil in an oral-deaf education program for five years until the end of 1962. During those years, I was variously coaxed, dragooned and persuaded into the world of hearing. I was introduced to a world of bubbles, balloons and fingers placed on lips to learn the shape, taste and feel of sounds, their push and pull of air through tongue and lips. By these mechanics, I gained entry to the portal of spoken, rather than signed, speech. When I was eight years old, my parents moved me from the Gladstone Road School for the Deaf in Dutton Park to All Hallows, an inner-city girls’ school, for the start of Grade Three. I did not know, of course, that I was also leaving my world of deaf friends to begin a new life immersed in the hearing world. I had no way of understanding that this act of transferring me from one school to another was a profound statement of my parents’ hopes for me. They wanted me to have a life in which I would enjoy all the advantages and opportunities routinely available to hearing people. Like so many parents before them, ‘they had to find answers that might not, for all they knew, exist . . . How far would I be able to lead a ‘normal’ life? . . . How would I earn a living? You can imagine what forebodings weighed on them. They could not know that things might work out better than they feared’ (Wright, 22). Now, forty-four years later, I have been reflecting on the impact of that long-ago decision made on my behalf by my parents. They made the right decision for me. The quality of my life reflects the rightness of their decision. I have enjoyed a satisfying career in social work and public policy embedded in a life of love and friendships. This does not mean that I believe that my parents’ decision to remove me from one world to another would necessarily be the right decision for another deaf child. I am not a zealot for the cause of oralism despite its obvious benefits. I am, however, stirred by the Gemini-like duality within me, the deaf girl who is twin to the hearing persona I show to the world, to tell my story of deafness as precisely as I can. Before I can do this, I have to find that story because it is not as apparent to me as might be expected. In an early published memoir-essay about my deaf girlhood, I Hear with My Eyes (in Schulz), I wrote about my mother’s persistence in making sure that I learnt to speak rather than sign, the assumed communication strategy for most deaf people back in the 1950s. I crafted a selection of anecdotes, ranging in tone, I hoped, from sad to tender to laugh-out-loud funny. I speculated on the meaning of certain incidents in defining who I am and the successes I have enjoyed as a deaf woman in a hearing world. When I wrote this essay, I searched for what I wanted to say. I thought, by the end of it, that I’d said everything that I wanted to say. I was ready to move on, to write about other things. However, I was delayed by readers’ responses to that essay and to subsequent public speaking engagements. Some people who read my essay told me that they liked its fresh, direct approach. Others said that they were moved by it. Friends were curious and fascinated to get the inside story of my life as a deaf person as it has not been a topic of conversation or inquiry among us. They felt that they’d learnt something about what it means to be deaf. Many responses to my essay and public presentations had relief and surprise as their emotional core. Parents have cried on hearing me talk about the fullness of my life and seem to regard me as having given them permission to hope for their own deaf children. Educators have invited me to speak at parent education evenings because ‘to have an adult who has a hearing impairment and who has developed great spoken language and is able to communicate in the community at large – that would be a great encouragement and inspiration for our families’ (Email, April 2007). I became uncomfortable about these responses because I was not sure that I had been as honest or direct as I could have been. What lessons on being deaf have people absorbed by reading my essay and listening to my presentations? I did not set out to be duplicitous, but I may have embraced the writer’s aim for the neatly curved narrative arc at the cost of the flinty self-regarding eye and the uncertain conclusion. * * * Let me start again. I was born deaf at a time, in the mid 1950s, when people still spoke of the ‘deaf-mute’ or the ‘deaf and dumb.’ I belonged to a category of children who attracted the gaze of the curious, the kind, and the cruel with mixed results. We were bombarded with questions we could either not hear and so could not answer, or that made us feel we were objects for exploration. We were the patronized beneficiaries of charitable picnics organized for ‘the disadvantaged and the handicapped.’ Occasionally, we were the subject of taunts, with words such as ‘spastic’ being speared towards us as if to be called such a name was a bad thing. I glossed over this muddled social response to deafness in my published essay. I cannot claim innocence as my defence. I knew I was glossing over it but I thought this was right and proper: after all, why stir up jagged memories? Aren’t some things better left unexpressed? Besides, keep the conversation nice, I thought. The nature of readers’ responses to my essay provoked me into a deeper exploration of deafness. I was shocked by the intensity of so many parents’ grief and anxiety about their children’s deafness, and frustrated by the notion that I am an inspiration because I am deaf but oral. I wondered what this implied about my childhood deaf friends who may not speak orally as well as I do, but who nevertheless enjoy fulfilling lives. I was stunned by the admission of a mother of a five year old deaf son who, despite not being able to speak, has not been taught how to Sign. She said, ‘Now that I’ve met you, I’m not so frightened of deaf people anymore.’ My shock may strike the average hearing person as naïve, but I was unnerved that so many parents of children newly diagnosed with deafness were grasping my words with the relief of people who have long ago lost hope in the possibilities for their deaf sons and daughters. My shock is not directed at these parents but at some unnameable ‘thing out there.’ What is going on out there in the big world that, 52 years after my mother experienced her own grief, bewilderment, anxiety and quest to forge a good life for her little deaf daughter, contemporary parents are still experiencing those very same fears and asking the same questions? Why do parents still receive the news of their child’s deafness as a death sentence of sorts, the death of hope and prospects for their child, when the facts show – based on my own life experiences and observations of my deaf school friends’ lives – that far from being a death sentence, the diagnosis of deafness simply propels a child into a different life, not a lesser life? Evidently, a different sort of silence has been created over the years; not the silence of hearing loss but the silence of lost stories, invisible stories, unspoken stories. I have contributed to that silence. For as long as I can remember, and certainly for all of my adult life, I have been careful to avoid being identified as ‘a deaf person.’ Although much of my career was taken up with considering the equity dilemmas of people with a disability, I had never assumed the mantle of advocacy for deaf people or deaf rights. Some of my early silence about deaf identity politics was consistent with my desire not to shine the torch on myself in this way. I did not want to draw attention to myself by what I did not have, that is, less hearing than other people. I thought that if I lived my life as fully as possible in the hearing world and with as little fuss as possible, then my success in blending in would be eloquence enough. If I was going to attract attention, I wanted it to be on the basis of merit, on what I achieved. Others would draw the conclusions that needed to be drawn, that is, that deaf people can take their place fully in the hearing world. I also accepted that if I was to be fully ‘successful’ – and I didn’t investigate the meaning of that word for many years – in the hearing world, then I ought to isolate myself from my deaf friends and from the deaf culture. I continued to miss them, particularly one childhood friend, but I was resolute. I never seriously explored the possibility of straddling both worlds, despite the occasional invitation to do so. For example, one of my childhood deaf friends, Damien, visited me at my parents’ home once, when we were both still in our teens. He was keen for me to join him in the Deaf Theatre, but I couldn’t muster the emotional dexterity that I felt this required. Instead, I let myself to be content to hear news of my childhood deaf friends through the grape-vine. This was, inevitably, a patchy process that lent itself to caricature. Single snippets of information about this person or that person ballooned into portrait-size depictions of their lives as I sketched the remaining blanks of their history with my imagination as my only tool. My capacity to be content with my imagination faltered. * * * Despite the construction of public images of deafness around the highly visible performance of hand-signed communication, the ‘how-small-can-we-go?’ advertorials of hearing aids and the cochlear implant with its head-worn speech processor, deafness is often described as ‘the invisible disability.’ My own experience bore this out. I became increasingly self-conscious about the singularity of my particular success, moderate in the big scheme of things though that may be. I looked around me and wondered ‘Why don’t I bump into more deaf people during the course of my daily life?’ After all, I am not a recluse. I have broad interests. I have travelled a lot, and have enjoyed a policy career for some thirty years, spanning the three tiers of government and scaling the competitive ladder with a reasonable degree of nimbleness. Such a career has got me out and about quite a bit: up and down the Queensland coast and out west, down to Sydney, Melbourne, Canberra, Adelaide and Hobart, and to the United Kingdom. And yet, not once in those thirty years did I get to share an office or a chance meeting or a lunch break with another deaf person. The one exception took place in the United Kingdom when I attended a national conference in which the keynote speaker was the Chairman of the Audit Commission, a man whose charisma outshines his profound deafness. After my return to Australia from the United Kingdom, a newspaper article about an education centre for deaf children in a leafy suburb of Brisbane, prompted me into action. I decided to investigate what was going on in the world of education for deaf children and so, one warm morning in 2006, I found myself waiting in the foyer for the centre’s clinical director. I flicked through a bundle of brochures and newsletters. They were loaded with images of smiling children wearing cochlear implants. Their message was clear: a cochlear implant brought joy, communication and participation in all that the world has to offer. This seemed an easy miracle. I had arrived with an open mind but now found myself feeling unexpectedly tense, as if I was about to walk a high-wire without the benefit of a safety net. Not knowing the reason for my fear, I swallowed it and smiled at the director in greeting upon her arrival. She is physically a small person but her energy is large. Her passion is bracing. That morning, she was quick to assert the power of cochlear implants by simply asking me, ‘Have you ever considered having an implant?’ When I shook my head, she looked at me appraisingly, ‘I’m sure you’d benefit from it’ before ushering me into a room shining with sun-dappled colour and crowded with a mess of little boys and girls. The children were arrayed in a democracy of shorts, shirts, and sandals. Only the occasional hair-ribbon or newly pressed skirt separated this girl from that boy. Some young mothers and fathers, their faces stretched with tension, stood or sat around the room’s perimeter watching their infant children. The noise in the room was orchestral, rising and falling to a mash of shouts, cries and squeals. A table had been set with several plastic plates in which diced pieces of browning apple, orange slices and melon chunks swam in a pond of juice. Some small children clustered around it, waiting to be served. When they finished their morning fruit, they were rounded up to sit at the front of the room, before a teacher poised with finger-puppets of ducks. I tripped over a red plastic chair – its tiny size designed to accommodate an infant’s bottom and small-sausage legs – and lowered myself onto it to take in the events going on around me. The little boys and girls laughed merrily as they watched their teacher narrate the story of a mother duck and her five baby ducks. Her hands moved in a flurry of duck-billed mimicry. ‘“Quack! Quack! Quack!” said the mother duck!’ The parents trilled along in time with the teacher. As I watched the children at the education centre that sunny morning, I saw that my silence had acted as a brake of sorts. I had, for too long, buried the chance to understand better the complex lives of deaf people as we negotiate the claims and demands of the hearing world. While it is true that actions speak louder than words, the occasional spoken and written word must surely help things along a little. I also began to reflect on the apparent absence of the inter-generational transfer of wisdom and insights born of experience rather than academic studies. Why does each new generation of parents approach the diagnosis of their newborn child’s disability or deafness with such intensity of fear, helplessness and dread for their child’s fate? I am not querying the inevitability of parents experiencing disappointment and shock at receiving unexpected news. I accept that to be born deaf means to be born with less than perfect hearing. All the same, it ought not to be inevitable that parents endure sustained grief about their child’s prospects. They ought to be illuminated as quickly as possible about all that is possible for their child. In particular, they ought to be encouraged to enjoy great hopes for their child. I mused about the power of story-telling to influence attitudes. G. Thomas Couser claims that ‘life writing can play a significant role in changing public attitudes about deafness’ (221) but then proceeds to cast doubt on his own assertion by later asking, ‘to what degree and how do the extant narratives of deafness rewrite the discourse of disability? Indeed, to what degree and how do they manage to represent the experience of deafness at all?’ (225). Certainly, stories from the Deaf community do not speak for me as my life has not been shaped by the framing of deafness as a separate linguistic and cultural entity. Nor am I drawn to the militancy of identity politics that uses terms such as ‘oppression’ and ‘oppressors’ to deride the efforts of parents and educators to teach deaf children to speak (Lane; Padden and Humphries). This seems to be unhelpfully hostile and assumes that deafness is the sole arbitrating reason that deaf people struggle with understanding who they are. It is the nature of being human to struggle with who we are. Whether we are deaf, migrants, black, gay, mentally ill – or none of these things – we are all answerable to the questions: ‘who am I and what is my place in the world?’ As I cast around for stories of deafness and deaf people with which I could relate, I pondered on the relative infrequency of deaf characters in literature, and the scarcity of autobiographies by deaf writers or biographies of deaf people by either deaf or hearing people. I also wondered whether written stories of deafness, memoirs and fiction, shape public perceptions or do they simply respond to existing public perceptions of deafness? As Susan DeGaia, a deaf academic at California State University writes, ‘Analysing the way stories are told can show us a lot about who is most powerful, most heard, whose perspective matters most to society. I think if we polled deaf/Deaf people, we would find many things missing from the stories that are told about them’ (DeGaia). Fighting my diffidence in staking out my persona as a ‘deaf woman’ and mustering the ‘conviction as to the importance of what [I have] to say, [my] right to say it’ (Olsen 27), I decided to write The Art of Being Deaf, an anthology of personal essays in the manner of reflective memoirs on deafness drawing on my own life experiences and supported by additional research. This presented me with a narrative dilemma because my deafness is just one of several life-events by which I understand myself. I wanted to find fresh ways of telling stories of deaf experiences while fashioning my memoir essays to show the texture of my life in all its variousness. A.N.Wilson’s observation about the precarious insensitivity of biographical writing was my guiding pole-star: the sense of our own identity is fluid and tolerant, whereas our sense of the identity of others is always more fixed and quite often edges towards caricature. We know within ourselves that we can be twenty different persons in a single day and that the attempt to explain our personality is doomed to become a falsehood after only a few words ... . And yet ... works of literature, novels and biographies depend for their aesthetic success precisely on this insensitive ability to simplify, to describe, to draw lines around another person and say, ‘This is she’ or ‘This is he.’ I have chosen to explore my relationship with my deafness through the multiple-threads of writing several personal essays as my story-telling vehicle rather than as a single-thread autobiography. The multiple-thread approach to telling my stories also sought to avoid the pitfalls of identity narrative in which I might unwittingly set myself up as an exemplar of one sort or another, be it as a ‘successful deaf person’ or as an ‘angry militant deaf activist’ or as ‘a deaf individual in denial attempting to pass as hearing.’ But in seeking to avoid these sorts of stories, what autobiographical story am I trying to tell? Because, other than being deaf, my life is not otherwise especially unusual. It is pitted here with sadness and lifted there with joy, but it is mostly a plateau held stable by the grist of daily life. Christopher Jon Heuer recognises this dilemma when he writes, ‘neither autobiography nor biography nor fiction can survive without discord. Without it, we are left with boredom. Without it, what we have is the lack of a point, a theme and a plot’ (Heuer 196). By writing The Art of Being Deaf, I am learning more than I have to teach. In the absence of deaf friends or mentors, and in the climate of my own reluctance to discuss my concerns with hearing people who, when I do flag any anxieties about issues arising from my deafness tend to be hearty and upbeat in their responses, I have had to work things out for myself. In hindsight, I suspect that I have simply ignored most of my deafness-related difficulties, leaving the heavy lifting work to my parents, teachers, and friends – ‘for it is the non-deaf who absorb a large part of the disability’ (Wright, 5) – and just got on with things by complying with what was expected of me, usually to good practical effect but at the cost of enriching my understanding of myself and possibly at the cost of intimacy. Reading deaf fiction and memoirs during the course of this writing project is proving to be helpful for me. I enjoy the companionability of it, but not until I got over my fright at seeing so many documented versions of deaf experiences, and it was a fright. For a while there, it was like walking through the Hall of Mirrors in Luna Park. Did I really look like that? Or no, perhaps I was like that? But no, here’s another turn, another mirror, another face. Spinning, twisting, turning. It was only when I stopped searching for the right mirror, the single defining portrait, that I began to enjoy seeing my deaf-self/hearing-persona experiences reflected in, or challenged by, what I read. Other deaf writers’ recollections are stirring into fresh life my own buried memories, prompting me to re-imagine them so that I can examine my responses to those experiences more contemplatively and less reactively than I might have done originally. We can learn about the diversity of deaf experiences and the nuances of deaf identity that rise above the stock symbolic scripts by reading authentic, well-crafted stories by memoirists and novelists. Whether they are hearing or deaf writers, by providing different perspectives on deafness, they have something useful to say, demonstrate and illustrate about deafness and deaf people. I imagine the possibility of my book, The Art of Being Deaf, providing a similar mentoring role to other deaf people and families.References Couser, G. Thomas. Recovering Bodies: Illness, Disablity, and Life Writing. Wisconsin: University of Wisconsin Press, 1997. Heuer, Christopher Jon. ‘Deafness as Conflict and Conflict Component.’ Sign Language Studies 7.2 (Winter 2007): 195-199. Lane, Harlan. When the Mind Hears: A History of the Deaf. New York: Random House, 1984 Olsen, Tillie. Silences. New York: Delta/Seymour Lawrence. 1978. Padden, Carol, and Tom Humphries. Deaf in America: Voices from a Culture. Cambridge, Mass.: Harvard University Press, 1998. Schulz, J. (ed). A Revealed Life. Sydney: ABC Books and Griffith Review. 2007 Wilson, A.N. Incline Our Hearts. London: Penguin Books. 1988. Wright, David. Deafness: An Autobiography. New York: Stein and Day, 1969.