Artículos de revistas sobre el tema "Superior Court Department"

Introduction: Child and Adolescent Forensic Psychiatry involves a multidisciplinary assessment at the courts’ requested to assist them in the process of justice delivery.Material and Methods: Retrospective study which included 233 forensic requests to two child and adolescent psychiatrists from Coimbra’s HP-CHUC Child and Adolescent Psychiatry Department between 1998 and 2012.Results: Biographic, psychopathology, social and family aspects were analyzed. The response time throughout the process, the origin and nature of the request’s and the type of process which originated the request were also assessed. The authors identified the involved professionals and whether they needed to go to court. When there were questions, they evaluated the capacity to answer them, the forensic difficulties and solutions found, and the presence of recommendations.Discussion: The obtained results met the clinical experience and literature regarding demography and psychopathology. As for the difficulties, there were a number of aspects which could be improved by both parts, aiming to ameliorate the articulation between Health and Justice.Conclusion: With this study it was possible to reflect on the authors forensic practice, in order to develop a closer partnership with the courts to promote the real ‘best interests’ of children/adolescents and their families.

Abstract The prosecutor’s protest is a legal mean by which the prosecutor supervises the observance of law by public authorities. District offices, cadastral departments decide on the deposit of property rights to real estate, as well as on ownership rights to agricultural land, and also decide on the protest of the prosecutor. If the relevant District office, cadastral department, or its superior authority does not remove the non–compliance by issuing a decision or a measure that complies with the law, the prosecutor may bring the case to court. The court may annul the contested decision or measure. The aim of the paper is to collect and analyse data and evaluate the institute of prosecutor’s protest as an effective tool of agricultural land protection in connection with its acquisition or transfer. The paper compares the individual years in the observed period of time and also compares different regions in Slovakia. The result is a comparison and evaluation of the observed time periods.

As a result of defects in the South African civil justice system, the Department of Justice and Constitutional Development introduced voluntary court-annexed mediation (CAM) in the magistrates’ courts in 2014. CAM was chosen under the broader need for greater access to justice because it has the potential to make dispute resolution efficient, amicable, and affordable. It can, therefore, contribute to access to justice for all members of society. Since the amendment of the Magistrates’ Court Rules to provide for CAM, the uptake of mediation in terms of the CAM system has unfortunately been inadequate. The aim of this article is to identify reasons for the inefficacy of CAM since its implementation. We use normative research to critically analyse existing court rules and authority. We conclude that there are several reasons for CAM’s inefficacy which are elucidated in the main text. It is important to understand these reasons, as the legislature presents CAM as a mechanism to improve access to justice. From this platform, we evaluate the mechanisms for court-connected alternative dispute resolutions provided by the Nigerian Multi-Door Courthouse (MDC) system. This reveals policies and practices that could potentially improve the efficacy of CAM in South Africa, as these relate to the factors identified as impediments to the optimal functioning of CAM in our civil justice system. As such, we identify valuable lessons that can be learned from this comparison. Building hereon, and on the conclusions reached elsewhere in the article, we postulate that the mediation scheme, as contemplated by Rule 41A of the Uniform Rules of Court (as applied in the superior courts), should also be implemented in the magistrates’ courts. The article concludes that improving CAM in South Africa is of critical importance to advancing access to justice and departing from a culture of conventional adversarial dispute resolution.

The Soroka v. Dayton-Hudson case is popularly known as the “Target” case because it was the Target Department Stores against whom the case was filed as a class action by S. Soroka on September 7, 1989, in the Superior Court, Alameda County, California Involved in the case as a major issue were the charges by the plaintiffs that the Rotlgers Condensed CPI-MMPI (RCCM), used in the pre-employment screening of applicants for Store Security Officer, violated the applicants' rights to privacy which are protected by the Constitution of the State of California. Also sought by the plaintiffs were sanctions against unfair discriminatory application of tests and subjugation of the applicants to inquiries regarding sexual orientation and religious beliefs. The parties reached an out-of-court settlement on September 23, 1993. The substantive issues relating to sound test theory and test practices are discussed along with a review of the court proceedings.

This paper explores the legal right to retrench employees from a human resource management perspective in Malaysia. The paper is based on the analysis of the relevant statues on retrenchment such the Employment Act 1955, The Industrial Relations Act 1967, the Employment (Termination and Lay-Off Benefits) Regulations 1980 and the Code of Conduct for Industry Harmony 1975. The author has also used criterion based sampling of the Industrial Court and Superior Court awards to analyze retrenchment cases and to provide recommendations to human resource management practitioners. Findings from these cases analyses reveal that many of the retrenchment awards were made against the employers due to poor selection of workforce for retrenchment, and the handling of the retrenchment exercise itself which violated the relevant statutes and the established procedures. The author suggests that retrenchment should not be viewed as a reactive but a proactive exercise, which begins with effective human resource planning aligned with the organizational strategic plan. The retrenchment exercise should also need be seen as a last resort when limiting recruitment, reduction in working hours, helping the employees (workmen) to find alternative employment, encouraging early retirement, offer of voluntary separation scheme (VSS) and other measures have been exhausted. The author hopes with many proactive measures, taken by employers in the management of retrenchment, the number of unfair retrenchment claims made to the Industrial Relations Department will be reduced.

Mining is an activity that generates inputs to different production chains, making it essential for any country’s development. However, it causes environmental, economic, and social impacts that must be considered. The Mining Law provides guidelines, through laws and regulations, so the activity can be carried out in an environmentally, economically, and socially sustainable way. In this paper, an analysis was conducted of the application of some peculiar characteristics of Brazilian Mining Law (locational rigidity, priority granting, among others) according to the parameters established in the Federal Constitution, in the Mining Code and its updates, and in the National Department of Mineral Production, Environment Ministry, and Mines and Energy Ministry normative acts. Moreover, the Superior Court of Justice Jurisprudence was analyzed to understand how the Mining Law is applied, in practice. It was verified that the Brazilian legislation is not perfect, but it has mechanisms to protect and benefit the miner, the society, and the environment. However, there are many shortcomings like the lack of speed in judging processes and the flaws in the applicability of some principles that compromise sustainability in the activity’s development, especially regarding the environmental and social liabilities left after mine closure.

Natural justice and fairness (the « new natural justice ») are well known notions of administrative law. They constitute traditional and newer limits on administrative action. This article analyses these two principles, both as to their nature and the extent to which they are respected by administrative bodies and by government (the Crown and central departments). This latter aspect is illustrated by cases pertaining to the judicial control exercised by the Federal Court of Canada and the Ontario and Quebec superior courts. The approach followed is a comparative one. The paper attempts to identify those judicial trends within the three systems studied which [emphasize] [differences and similarities] in their responses to the various practical issues raised by natural justice and fairness and their respect in administrative decision-making processes. Thus, the study attempts to retrieve from the case law considered those notional and methodological elements, or principles, which structure judicial control and judical reasoning in solving the issues raised by the processes in motion.

A comparative study of bacterial qualities of raw milk of cow and sheep was conducted at Livestock production and management (unit), Department of NRM, faculty of agriculture, MGCGV Chitrakoot–Satna (M.P.) during January to February 2021. All sanitary precaution were followed to produce clean milk. The sample of the raw milk of three animal each were replicated ten time and tested to deyermine the standard plate count (SPC) (10t), lactic acid bacteria count (LABC) ( 10³), lipolytic bacteria count (LBC) (10²) proteolytic bacteria count (PBC) (10²) and coliform count (CC) in the raw milk. The data obtained for the a foresaid tests were subjected to statitical analysis. The result of the statical analysis showed that the differences in mean values of SPC 10t,LABC/10³,LBC/10² and PBC,10². In view of the finding and result presented above, results that the milk of all the animals was of superior quality, due to low bacteria count and absence of coliform. The bacteria quality of milk of cow was found superior than sheep milk due to minimum bacteria count of SPC, LABC, LBC and PBC and absence of coliform.

Leucocytes, especially neutrophils featuring pro- and anti-cancerous characteristics, are involved in nearly every stage of tumorigenesis. Phenotypic and functional differences among mature and immature neutrophil fractions are well reported, and their correlation with tumor progression and therapy has emerging implications in modern oncology practices. Technological advancements enabled modern hematology analyzers to generate extended information (research parameters) during complete blood cell count (CBC) analysis. We hypothesized that neutrophil and lymphocyte fractions-related extended differential leucocytes count (DLC) parameters hold superior diagnostic utility over routine modalities. The present study was carried out over a four-and-a-half-year period wherein extended neutrophil (immature granulocyte [IG] and mature neutrophil [NEUT#&]), and lymphocyte (activated/high fluorescence lymphocyte count [HFLC] and resting lymphocyte [LYMP#&]) parameters were challenged over routine neutrophil [NEUT#] and lymphocyte [LYMP#] items in a study population of 1067 hematological neoplasm patients. Extending the classical statistical approaches, machine-learning-backed data visualization was used to explore trends in the study parameters. As a whole, extended neutrophil and lymphocyte count outperformed and was diagnostically more relevant than routine neutrophil and lymphocyte parameters by showing the least difference from their respective (gold-standard) manual DLC counts. The mature neutrophil count was compared to IG, and resting lymphocyte count was compared to HFLC by calling the function ‘correlation’ as a ‘clustering function’ for heatmap based visualization. The aforementioned study parameters displayed close clustering (rearrangement) for their respective study items by presenting distinct trends of equally valuable weights (deviated values), advocating fractions-based extended DLC reporting. Importantly, using a Bland and Altman analysis analogously to a manual neutrophil count, the mature neutrophil count [NEUT#&] remained unbiased since a routine neutrophil count [NEUT#] was found to be a negatively biased. The extended DLC-parameter-driven fractions-based reporting has superior diagnostic utility over classical routine approaches; this finding can largely minimize labor-intensive manual DLC practices, especially in hematology–oncology departments.

Abstract This experiment was conducted in the poultry farm of the Animal Production Department/College of Agriculture/Anbar University, from 8/12/2019 until 23/3/2019 for 6 weeks. The experiment aim to compare the addition of two different levels of chitosan and a group of antibiotics to the corn-soybean diet and their effect in physiological and microbial performance at 42 days. The experiment included T1 (control of corn diet without any addition), T2 (0.2 g oxytetracycline/kg corn diet), T3 (1 g chitosan/kg corn diet), and T4 (2g chitosan/kg corn diet). In the experiment, 144 birds (Ross) at the age of 7 days were used with an average weight of 40 g. The chicks were distributed randomly to 4 treatments, with 3 replicates, and in each repeater, 12 birds. The results of the physiological parameters indicated that there were T4 increased significantly (P≤0.05) compared to other treatments in H/L and monocyte count at 42 days, while the results showed that were no significant differences in the biochemical characteristics of blood. As for the tissue of Jejunum, treatment T3 was significantly (P≤0.05) superior to the rest of the treatments in the height, thickness of villi and depth of crypts over the experimental treatment. There was a significant decrease (P≤0.05) for the T3 and T4 compared to the T1 control treatment on the total bacterial count and colon bacterial count.

Background: Allergic rhinitis (AR) is one of the most prevalent atopic disorders that affect productivity and quality of life. Although individually olopatadine and rupatadine are efficacious in AR, data on the head to head study of these drugs in Indian population are scanty, so present study was undertaken with an aim to compare the efficacy, safety, and cost effectiveness of rupatadine and olopatadine in patients’ of allergic rhinitis.Methods: A prospective, randomized, double blind, parallel group, comparative 2 weeks clinical study conducted in eighty patients of AR in the Department of Pharmacology, Index Medical College Hospital and Research Centre, Indore. Following inclusion and exclusion criteria, 67 patients were recruited and randomized to two treatment groups and received the respective drugs for 2 weeks. At follow-up, parameters assessed were total nasal symptom score (TNSS), change in total and differential count of eosinophil.Results: In olopatadine group, there was a significantly higher reduction in TNSS (P < 0.05) than that of rupatadine. Both the drugs significantly reduced the absolute eosinophil count, but olopatadine (P <0.001) was found to be superior. The incidence of adverse effects was found to be less in olopatadine group when compared with rupatadine group.Conclusions: Both rupatadine and olopatadine provide effective relief of the symptoms of AR. However, clinical benefit occurs significantly more with olopatadine. However, rupatadine was more cost‑effective than olopatadine in treating the patients of AR in term of effectiveness.

Background: Meningitis is one of the most common central nervous system infections by bacteria, virus or fungus encountered in infants and children.Early diagnosis of meningitis and differentiation of bacterial from non-bacterial/ viral meningitis tends to play an important role in the emergency management of children with suspected meningitis. While cerebrospinal fluid analysis is popular, along with biomarkers: C-reactive protein and white blood cell count, serum procalcitonin seems to offer an even better specificity.Methods: A hospital based cross-sectional-study was conducted in department of neurology in collaboration with department of pathology, Medanta, Medicity, Gurugram, for a period of one year from March 2018 to 2019. 100 children aged 4 months to 12 years, with suspected meningitis were enrolled. The study group was further subdivided into two groups, based upon their bacteriological profile: bacterial meningitis and viral meningitis.Results: For both the groups, the common clinical presentations were fever (100% and 96.88%), convulsions (58.33% and 45.31%), vomiting (25% and 43.75%), The demographic and clinical profile of the 2 groups was largely comparable. Serum PCT levels were significantly higher in bacterial meningitis group compared to non-bacterial meningitis with p<0.001. The sensitivity of serum PCT was found to be 97% and superior to CRP in terms of accuracy in identification and to assess the severity. Procalcitonin is an ideal marker with highest accuracy for bacterial infections.Conclusions: Serum PCT can act as a more sensitive and specific diagnostic tool in early differentiation of bacterial from non-bacterial meningitis in children.

Aim: In this study, we sought to examine the optimal cutoff values for predicting different stages of liver fibrosis, and to determine the level of agreement between shear wave elastography and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores in patients with chronic liver disease. Methodology: A descriptive, cross-sectional study was performed at the Radiology Department of Shaukat Khanum Memorial Hospital Lahore from 1 Jun 2019 until 1 June 2020. FIB-4 and APRI scores were determined by the following formula: FIB-4 = (age × AST) ÷ (platelet count × (√ (ALT)) and APRI = (AST÷AST upper limit of normal) ÷ platelet × 100. Data was analyzed with the help of SPSS version 24.0 and Microsoft Excel 2013. Results: Eighty individuals were conveniently selected, of which 62.5% were men and 37.5% were women. The mean age of the subjects was 43.47 SD ± 13.85 years. APRI and FIB-4 scores predicted F4 patients using the cutoff values of 0.47 (Sn. 72%, Sp. 70%) and 1.27 (Sn. 78%, Sp. 73%), respectively. The cutoff values of 0.46 for APRI and 1.27 for FIB-4 predicted F3–F4 patients (Sn. 74% and 77%; Sp. 76% and 76%), respectively. To predict F1–F4 compared to F0, the cutoff value was 0.34 (Sn. 68%, Sp. 75%) for APRI, while the cutoff value for FIB was 0.87 (Sn. 72%, Sp. 75%). The findings suggest that FIB-4 shows better diagnostic accuracy than APRI. Conclusion: This study provides optimal cutoff values for different groups of fibrosis patients for both serum markers. Also, the diagnostic accuracy of FIB-4 for predicting liver fibrosis was found to be superior to APRI in all disease stages.

Objectives: This study was carried out to evaluate the patients of familial hypercholesterolemia (FH) on statin therapy for general biochemical abnormalities. Study Design: Case-Control observational study. Setting: Department of Chemical Pathology (Army Medical College/Military Hospital Rawalpindi) in collaboration with center for research in experimental and applied medicine (CREAM lab). Periods: From Jan 2017 to Jan 2018. Material & Methods: A total of one hundred participants were recruited in this study. These hundred cases were further divided into two groups. First group comprised of fifty disease free healthy cases, while the second group included the patients of familial hypercholesterolemia diagnosed on the basis of Simon Broom criteria. This second group was categorized into further two groups on the basis of patients taking statin therapy or not. Fasting blood sample was taken from these cases complete blood count, liver function tests, fasting plasma glucose, glycosylated hemoglobin, lipid profile and renal function tests were performed on these blood samples and the results were compared to find out any biochemical variance in control and cases. Results of this study were analyzed on SPSS v.23. Results: The analysis of lipid profile including total cholesterol (T.Ch), triglycerides (TRG), low-density lipoprotein cholesterol (LDL-C) and high density cholesterol (HDL-C) showed a highly significant difference in cases and controls. Alanine aminotransferease (ALT), alkaline phosphatase (ALP) and bilirubin also showed a significant variation. While diabetic profile, urea, creatinine, hemoglobin and body mass index didn’t show any significant variation among cases and controls. Conclusion: It is well-known that statins prove to be more superior to other classes of anti-hyperlipidemic, but at same time use of statins are also associated with other biochemical derangements. Diabetes mellitus is one of them. Therefore, a close monitoring protocol is required during statin therapy.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and lead to catastrophic events. Accurate prognostic tool for patients with exacerbation who required hospital admission is needed to predict the risk of in-hospital mortality and help physicians to select the appropriate level of care. Aim The aim was to compare the ability of conventional DECAF (dyspnea, eosinopenia, consolidation, acidemia, frequency of hospital admission) and modified DECAF scores to expect the in-hospital mortality rate. Patients and Methods: A prospective, observational study was carried out on 100 patients with AECOPD admitted at the respiratory ICU and chest department. All patients were subjected to complete medical history taking, chest examination, dyspnea assessment by extended modified Medical Research Council Dyspnea, complete blood count, chest radiograph, ECG, and arterial blood gas analysis. Both conventional DECAF score [(D) dyspnea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) atrial fibrillation] and modified DECAF score [(D) dyspnea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) frequency of hospital admission] were calculated. In-hospital mortality was recorded. Results: Nine (9%) patients died during their hospital stay. The modified DECAF score showed a good prediction of in-hospital mortality (area under the receiver operating characteristic curve=0.95) and was higher in accuracy than the original DECAF score (area under the receiver operating characteristic curve=0.92). Both were (sensitive 100%) but the modified DECAF was more specific (specificity=86.81) than the DECAF score (specificity=80.22). Conclusion: Both the conventional DECAF score and the modified DECAF score are practical and can be calculated easily using simple questions and routine investigations available during the initial admission. Both were good predictors of mortality and the requirement of invasive mechanical ventilation. The modified DECAF was superior in predicting in-hospital mortality in AECOPD than the original score.

Abstract Abstract 4105 Considering our Pediatric Hematology Unit (PHU), as a social security national reference Unit, one third of the hospitalized children population have acute leukemia in the Pediatrics Department of the National Hospital Hospital Edgardo Rebagliatti Martins- ESSALUD, Lima - Perú. PURPOSE: To analyze survival outcome and behavioral of the disease in children with acute lymphoblastic leukemia (ALL) in a Social Security Hospital of a Developing country. PATIENTS AND METHODS: We analyze 100 pediatrics patients (less than 14 years old) diagnosed with acute lymphoblastic leukemia (ALL) since 2005 to 2008. Disease-free survival (DFS) was computed according to the Kaplan-Meier method and long rank test, using the SPSS 15.0. RESULTS: A total of 100 children were evaluated. The major incidence according to age was in the group of children between 1 and 9 years old (76%); there were no difference between gender: 51% females and 49% males. The B type was the most common diagnosed leukemia: The B CALLA positive (CD10, CD19, HLA, DR) was the most frequent inmunophenotype, present in 87 children (87%). T-cell ALL was seen in 7%, bi-phenotype and Pro B in 3%. According to our risk stratification protocol, 34 patients were in the very high risk group (VHR), 47 patients in the high risk (HR) group and 19 patients in the intermediate-low risk (ILR) group. About Kariotype evaluation, the most common presentations were normal and hyperdiploid kariotype (67%). We achieved Complete Remission in 95% of our patients post 4 weeks Induction therapy (“A” Induction period). The Total 4th year disease free survival was 48.9% (36.3% VHR, 50.4% HR and 75.9% ILR); of these 61.8 ± 6.2% had DFS after 2 years of therapy and 55.9±6.9 % after 3 years. The Disease Free Survival was significantly increased on those with the following risk factors at diagnosis: white blood cell count &lt; 100 000/mm3 (P= 0.002), normal or hyperdiploid kariotype (P&lt;0.0001). However age, gender and type of ALL in our small group do not have statistical significance. The groups of patients not responding to prednisone have identical DFS than the Responding patients, but the no responding patients received treatment as an immediately superior group (High or Very High Risk). All the patients that have more than 1% of Minimal Residual Disease after a 4 week Induction therapy and achieved a Complete Remission with other chemotherapy treatment, had a poor DFS of less than 10 months (P = 0.015). CONCLUSION: The Total DFS was 48.9%. WBC count below 100,000 mm3; normal and hyperdiploid kariotypes, correlate with best DFS. The MDR &gt;1%, was correlated with poor DFS (less than 10 months). The no responding prednisone group must receive a more intensive chemotherapy (the treatment of the immediately superior risk group). The poor DFS at 4 years explain the reason of our therapeutic decision to perform a sibling stem cell Transplant, in those pediatric patients with HR or VHR Acute Lymphoblastic Leukemia (BMT with a 12 year disease free survival of 59.8%). Disclosures: No relevant conflicts of interest to declare.

Abstract Introduction: Thrombotic microangiopathy (TMA) is clinical syndrome characterized by microvascular thrombosis, consumptive thrombocytopenia and microangiopathic hemolytic anemia (MAHA). It is a feature of a number of clinical conditions, most prominently thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) and rarely an initial manifestation of systemic malignancy. Case: A previously healthy 31-year-old black woman presented to the emergency department with a 2 week history of lower back pain and hematuria and 1 week history of dyspnea on exertion and dizziness. She denied diarrhea, hematochezia, fever, or abdominal pain. Physical findings were unremarkable with normal blood pressure. Initial laboratory results revealed a white blood cell count of 4.4 x103/µL, hemoglobin of 4.4 g/dL, hematocrit 12.9%, platelets 43 x103/µL, absolute reticulocyte count 259.8 x103/µL, reticulocyte percentage 23.1%, haptoglobin &lt;10 L mg/dL, LDH 1424 units/L, creatinine 0.7 mg/dL, total bilirubin 1.6 mg/dL, negative pregnancy test, and 10-15 white blood cells and &gt;50 red blood cells per high powered field on microscopic urinalysis. Coombs test results were negative, the coagulation profile was normal, and peripheral blood smear revealed evidence of thrombocytopenia and MAHA (figure 1a). Diagnosis of TTP was made and treatment with daily therapeutic plasma exchange (TPE) was initiated. On hospital day 4, ADAMTS13 level drawn at diagnosis before initiation of plasma exchange returned at 94%, prompting further investigation as to the cause of her TMA. Serologic tests for hepatitis B & C virus, human immunodeficiency virus, antinuclear antibody (ANA), cardiolipin and beta-2 glycoprotein antibodies and computerized tomography (CT) scan of the abdomen and pelvis were all negative. Despite daily TPE for 6 days, she remained thrombocytopenic and continued to have ongoing hemolysis. Therefore, on hospital day 6, bone marrow aspiration and biopsy (figure 1b) was performed which showed a normocellular bone marrow for age (cellularity 70%) with full-spectrum trinlineage hematopoiesis, involved by metastatic signet-cell ring carcinoma. Immunostains were positive for CK7, CK20, CK 8/18, CDX2, pancytokeratin, and negative for PAX-8 and mammoglobin. TPE was discontinued and she was supported with packed red blood cell and platelet transfusions. Positron emission tomography–computed tomography (PET-CT) revealed a heterogeneously enhancing mass in the midline superior anterior wall of the bladder measuring 2.7 x 5.1 cm, but without abnormal uptake on PET. She underwent cystourethroscopy and a transurethral resection of bladder tumor which revealed a 6 cm solid sessile mass. Final pathology confirmed the diagnosis of moderate to poorly differentiated invasive urachal adenocarcinoma with mucinous and signet-ring cell features. Given the presence of metastatic disease, she was treated with a chemotherapy regimen consisting of cisplatin, fluorouracil, and leucovorin on days 1 through 5. Gemcitabine was held due to elevated liver transaminases. On day 1 of treatment, platelet count was 24 x103/µL and hemoglobin 8.1 g/dL. By treatment day 7, platelets had risen to 79 x103/µL. She last required a PRBC transfusion on treatment day 4. Discussion: TMA can occur in a variety of disorders, including TTP, HUS, malignant hypertension, scleroderma, antiphospholipid antibody syndrome, systemic lupus erythematosus, preeclampsia, HIV infection, and disseminated malignancy. Patients presenting with evidence of TMA and thrombocytopenia should elicit a high clinical suspicion for TTP and be urgently treated with plasma exchange. Deficiency of the von Willebrand factor-cleaving metalloproteinase ADAMTS13, or the presence of antibodies to ADAMTS13 plays a key role in the pathogenesis of primary TTP, although these findings are not necessary to make the diagnosis. However, patients with a high or normal ADAMTS13 level and without antibodies to ADAMTS13, especially those who do not improve with plasma exchange, should prompt an investigation for other causes of TMA. To our knowledge, we report the first case of metastatic urachal carcinoma presenting with features of MAHA and thrombocytopenia. Conclusion: TMA associated with malignancy is a rare, but potentially fatal condition. Recognition of this rare entity is critical to the initiation of appropriate treatment of underlying malignancy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Abstract Introduction Allogeneic hematopoietic stem cell transplantation (allo-SCT) has become a therapeutic option for patients (pts) with high risk CLL. The major cause of allo-SCT failure is relapse or disease progression. No standard treatment is available for pts who failed allo-SCT and post-SCT immune manipulation, and the prognosis of these pts is largely unknown. Methods We performed a retrospective intention-to-treat analysis of pts with CLL who failed allo-SCT and post-SCT immune manipulation between 1998 and 2012 and were referred to the Leukemia Department at MD Anderson Cancer Center for further treatment. Results Seventy-three pts with CLL (n=40, 55%) or Richter's transformation (RT, n=33, 45%) who failed or progressed after allo-SCT were referred for further management at a median of 7 months (range 0-85 months) after allo-SCT. Most pts (n=63, 86%) had received non-myeloablative conditioning and 32 (44%) received post allo-SCT donor lymphocyte infusion (DLI). Six patients (8%) had early (4 pts) or late (2 pts) graft failure. Fifty four (74%) pts were male and the median age at time of failure/progression was 59 yrs (range 32–73 yrs). Of the 73 pts, 68 (93%) received salvage therapy, 1 pt died before treatment was initiated, and 4 pts were considering treatment options at time of last follow-up. A median of 2 treatment regimens (range 0 - 8) were administered between time of post-SCT progression and last follow-up. The most common salvage treatment regimens were chemo-immunotherapy with rituximab (R): R-HyperCVAD (n=24, 33%), OFAR (n=13, 18%), FCR, FBR, PCR, BR (n=24, 33%), immune-modulators thalidomide or lenalidomide (n=21, 29%), alemtuzumab with or without chemotherapy (n=12, 16%), and Bruton's Tyrosine Kinase (BTK) inhibitor (n=5, 7%). At time of last follow up, 26 pts (36%) were alive. The median overall survival (OS) from time of progression after allo-SCT was 33 months (95% CI, 27– 39) and 60% of the pts were alive 2 years from time of progression. Median OS after allo-SCT failure/progression was 53 months (95% CI, 9–97) for CLL pts and 28 months (95% CI, 12–44) for pts with RT (Log Rank: P<0.0001) (Figure 1). Only 4 pts achieved CR following first salvage treatment. The OS of these pts was 152, 41, 26+, 38+ months (the latter 2 are still alive). Pts with partial response (PR), no-response (NR) or progression after first salvage treatment had similar OS. To identify the best treatment modality we analyzed the OS from progression and from time of initiation of treatment to last follow-up of all regimens used. We found that patients treated with either FCR, alemtuzumab or combination chemotherapy did not have significant difference in OS. Remarkably, 4 of 5 pts treated with BTK inhibitor were alive at time of last follow-up. Univariable analyses showed shorter OS for pts with a higher ECOG performance status (PS; P=0.036), low hemoglobin (Hb) (P=0.0001), low albumin (P=0.0001), complex cytogenetic abnormalities at last follow up (P=0.026) and RT (P=0.0001). The multivariable Cox model analyses including age, sex, previous DLI, unfavorable cytogenetic abnormalities before or after allo-SCT, albumin, absolute lymphocyte count and platelet count, identified only Hb (P=0.009, 95% CI; 0.58 - 0.93), ECOG 3 (P=0.036, 95% CI; 1.12 - 30.04) and RT (P=0.002, 95% CI: 1.51 - 6.50) as independently associated with shorter OS. Conclusions The median OS of pts with high-risk CLL or RT from time of allo-SCT failure/progression was 33 months. The longest OS was observed in pts who attained CR after first salvage treatment (4/73, 6%). At the time of analysis, the 50% OS of pts treated with BTK inhibitors was not reached, however, no treatment modality appeared to be superior. Future studies of treatment options for pts that progress after allo-SCT are warranted. Disclosures: Off Label Use: Ibrutinib for CLL therapy.

Abstract HPC mobilization with plerixafor (Plex) plus G-CSF (G+P) results in superior CD34+ cell yield, when compared to mobilization with G-CSF alone in patients with myeloma and lymphoid malignancies. However, Plex-based approaches are associated with high mobilization costs. To circumvent higher costs, several institutions use a so-called JIT approach, where Plex is only administered to patients likely to fail mobilization with G-CSF alone. Whether such a JIT-Plex approach is cost effective has not been confirmed to date. We present here, a single institution comparative analysis of 137 patients with myeloma and lymphoma who underwent mobilization with 2 different approaches of Plex utilization. Between Jan 2010-Oct 2012 (n=77) patients received mobilization G-CSF (10 μg/kg) for 5 days and Plex (0.24 mg/kg) on the evening of day four, 11 hours before apheresis the following day (G+P). To reduce mobilization costs between Nov 2012-Jun 2014 (n=60) patients were mobilized with JIT-Plex where Plex was only administered to patients likely to fail mobilization with G-CSF alone (i.e. patients with a day 4 peripheral blood (PB) CD34+ count of <10/μL, or those with day 1 yield of < 1.0 X 106 cells/kg or day 1+2 yield of <1.5 X 106 cells/kg ABW. Mobilization failure was defined as inability to collect at least 2 X 106 /kg CD 34+ cells. Patients in G+P had a higher mean peak PB CD34+ cell count (77 vs. 33.1 cells/μL, p<0.001) and a higher mean CD34+ cell yield on day 1 of collection (4.4 X 106 vs. 2.4 X 106 cells/kg ABW, p=0.0005). The mean total CD34+ cell collection was also higher in G+P (6.64 X 106 vs. 4.81 X 106 cells/kg ABW, p=0.0068). In the JIT-Plex group 41% (n=24) completed adequate HPC collection without Plex. Mobilization failure was noted in 5 patients in the G+P group (3 were salvaged with bone marrow harvest) and 2 patients in the JIT-Plex group. Two patients in either group did not proceed to AHCT as a result of mobilization failure. The mean Plex doses utilized in JIT-Plex was lower (1.3 vs. 2.1, p=0.0002), however 21% (n=16) in the G+P group completed apheresis on day 1 compared to only 6.9% (n=4) in JIT-Plex, p=0.0094. Cost analysis was estimated based on actual sales price (actual wholesale price AWP – (AWP X 0.2)) for mobilization agents and the United states (US) Department of Health and Human Services Centers for Medicaid Services (HHS/CMS) reimbursement rates for procedural costs associated with mobilization, apheresis or cryopreservation. The mean estimated cost was higher in the G+P group ($28,448 vs. $24,852, p=0.0315). Our analyses, for the first time confirms that mobilization with JIT-Plex allows for a safe, adequate and cost efficient strategy for HPC collection. Baseline Patent Characteristics at Time of Mobilization Table Mobilization Strategy Upfront Plerixafor + G-CSF (n=77) G-CSF + Just-in-time Plerixafor (n=60) p-value Disease Myeloma Lymphoma 46 (60%) 31 (40%) 30 (50%) 30 (50%) 0.29 Mean age, years (range) 58 (23-75) 57 (22-75) 0.45 Male gender 42 (55%) 33 (57%) 0.92 Race: Caucasian 73 (97%) 57 (98%) 1.0 Lines of prior therapy, mean 1.5 1.8 0.3 Prior Radiation 13 (18%) 12 (21%) 0.66 Mean KPS (range) 80 (70-100) 80 (60-100) 0.75 HCT-CI Score (mean) 2 2 0.36 Abbreviations: G-CSF-granulocyte-colony stimulating factor (filgrastim); KPS-Karnofsky performance status; HCT-CI- hematopoietic cell transplantation-specific comorbidity index Disclosures No relevant conflicts of interest to declare.

Background: The advantage of Magnetic resonance imaging include multiplanar capabilities and soft-tissue contrast resolution, which is superior to that of CT. Magnetic resonance (MR) imaging is a powerful diagnostic tool that can be used to help evaluate spinal infection and to help distinguish between an infection and other clinical conditions. Aim of the current study is to evaluate various spectrum and types of spinal infections, and discussing the role of MRI in diagnosing them and their characterization. Subjects & Methods: This Hospital-based prospective study consists 30 patients with clinically suspected spinal infections and chronic non-resolving low backache referred to the department of Radiodiagnosis in a period of 2 years. Investigations include Complete blood count, ESR, sputum analysis for acid-fast bacilli and MRI of the spine. Results: 20 cases involved the lumbar spine, of which 12 were tubercular, seven were pyogenic, and one case was actinomycosis. In total 21 tubercular cases, 12 cases involved lumbar spine (57%), 8 cases affects the thoracic spine (38%), and 1 case involves the cervical spine (P = 0.562). the incidence of spondylodiscitis is common overall in the lumbar spine. 23.8% of tubercular and 12.5 %of pyogenic cases involved more than two vertebrae. T1 hypointensity is seen in 18 cases of tuberculosis (85%), 8 cases of pyogenic (75%), and 1 case of actinomycosis (100%) (P = 0.801). 4 cases showed preservation of disc height, among which three are tubercular (75%), and 1 was actinomycosis (25%). 85 % of tubercular and 100% of pyogenic cases showed disc narrowing. 81 % of tubercular and 100 % of pyogenic cases showed disc hyperintensity. Nine cases of tuberculosis (42.9%) and 3 cases of pyogenic (37.5 %) showed epidural abscess. 26 cases showed para vertebral extension of which 18 were tubercular (69.2 %), 7 were pyogenic (26.9 %) and 1 was actinomycosis (3.8 %). 94% of tubercular and 42 % of pyogenic abscesses showed a well-defined para spinal signal in cases of paraspinal extension. 15 of the 18(83%) tuberculosis, 3 of the 7 (42%)cases of pyogenic, and 1 case of actinomycosis showed subligamentous spread along more than three vertebrae. Heterogenous enhancement was noted in 12 of the 15 (80%) tubercular cases, 1 of the 3 (33%) pyogenic cases, and 1(100%) actinomycosis case. 71% tubercular cases and 2 of 8 (25%) cases showed predominant anterior 2/3rd involvement. Grade III or more (>50%) vertebral destruction was seen in 16 tubercular (76%) and 2 pyogenic cases (25%). Six cases showed skip lesions of which 5were tubercular and 1 was pyogenic. 5 of the 21 (23.8%) tubercular and 1 of the 8 (12.5%) pyogenic cases showed skip lesions. Conclusion: Awareness of atypical MR imaging at early infectious spondylitis is important to avoid diagnostic delay and unnecessary other diagnostic procedures. Several non-infectious conditions may simulate the spinal infections. Hence It is helpful to be aware of these diseases and their MR imaging features. With these points in mind, MR imaging can be very beneficial to patients with spinal infection.

BackgroundConventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) are the cornerstone first-line treatment in psoriatic arthritis (PsA), although there is a paucity of evidence for the effectiveness of csDMARDs and especially their combination. Assessing the efficacy and safety of combinations of csDMARDs compared with csDMARD monotherapy has been prioritized on the EULAR research agenda. We hypothesized that combining csDMARDs might be more effective than csDMARD monotherapy.ObjectivesWe aimed to investigate whether a combination of methotrexate (MTX) and leflunomide (LEF) is superior to MTX monotherapy on improvement in disease activity in patients with PsA.MethodsPatients with a clinical diagnosis of PsA and active disease (≥2 swollen joints) were included in this randomised, placebo-controlled, double-blind trial. Patients were randomised (1:1) to MTX plus LEF or MTX plus placebo. Patients received MTX 15 mg/week for four weeks and thereafter 25 mg/week, combined with two LEF 10 mg tablets or two placebo tablets daily. The primary outcome was the difference between the MTX plus LEF group and the MTX plus placebo group on the psoriatic arthritis disease activity score (PASDAS) at week 16 adjusted for baseline PASDAS. Key secondary outcomes included safety and the achievement of minimal disease activity (MDA) criteria and PASDAS low disease activity (LDA) (≤3.2).ResultsA total of 78 PsA patients (MTX + LEF n=39; MTX + placebo n=39) were included. The mean age was 53.1 (SD=12.8) years and 36% (n=28) of the patients were female. The mean PASDAS at baseline was 4.9 (SD=1) in both treatment groups. Table 1 shows that MTX plus LEF was superior to MTX plus placebo at week 16 (PASDAS 3.1, SD=1.4 vs 3.7, SD=1.3; treatment difference= -0.6, 90% CI -1.0 to -0.1, one-sided P-value=0.025). Similar and significant results were found for achievement of MDA criteria (59% vs 33%, one-sided P-value=0.013) and PASDAS LDA (59% vs 35%, one-sided P-value=0.019) (Figure 1 and Table 1). Other favorable and significant outcomes for the MTX plus LEF group included -among others- the improvement in swollen joint count (SJC) (median [IQR] = -3 [-5, -2] vs -2 [-4, 0], one-sided P-value=0.039) and the proportion of patients with active psoriasis (i.e. body surface area score >0) at week 16 (44% vs 68%, one-sided P-value=0.014). Generally mild adverse events and treatment discontinuation (MTX+LEF n/N=10/39; MTX + placebo n/N=3/39) occurred more frequently in the MTX plus LEF group.Table 1.Primary and secondary outcomes at week 16MTX + LEF(N=39)MTX + placebo (N=38)*Absolute difference [90% CI]P-valueOne-sidedPrimary endpointPASDAS at week 163.1 (1.4)3.7 (1.3)-0.6 [-1.0, -0.1]0.025Selected secondary endpointsFulfilling PASDAS LDA, N (%)23 (59)13 (35)24% [6, 42]0.019Fulfilling MDA criteria, N (%)23 (59)12 (33)26% [7, 44]0.013SJC66, change from baseline, median (Q1, Q3)-3 (-5, -2)-2 (-4, 0)..0.039TJC68, change from baseline, median (Q1, Q3)-2 (-4, 0)-2 (-5, 0)..0.457VAS physician global, change from baseline, mean (SD)-22.0 (21.9)-12.2 (19.7)-9.8 [-17.7, -1.9]0.021VAS patient global, change from baseline, mean (SD)-20.9 (24.4)-13.9 (28.3)-7.0 [-17.0, 3.0]0.124Active psoriasis, N (%)17 (44)26 (68)-25% [-43, -7]0.014* One patient in the MTX + LEF group was excluded from the efficacy analysis due to change of diagnosis.Figure 1.Proportion of patients meeting different PsA responder criteria for low disease activity at week 16* = one-sided P-value <0.05DAPSA = Disease Activity in Psoriatic ArthritisConclusionMTX plus LEF combination therapy resulted in a significantly greater improvement in disease activity according to PASDAS and MDA than treatment with MTX monotherapy in patients with PsA after 16 weeks. In addition, a greater improvement in psoriasis was found for the combination group. However, there are indications that MTX plus LEF combination is less well tolerated than MTX monotherapy.AcknowledgementsWe would like to thank all the patients that participated in this study; all rheumatologists from the Sint Maartenskliniek that helped with the patient inclusion; our patient partners and especially R. van den Griend; Dr. E. Mahler for her suggestions and advice with regard to the study design; Dr. C. Popa and Dr. D. Telgt for being members of our data safety monitoring board and the rheumatology nurses of our center for their assistance with collecting the data.Disclosure of InterestsMichelle L.M. Mulder: None declared, Johanna E. Vriezekolk Speakers bureau: Eli Lilly Netherlands BV and Galapagos Biopharma Netherlands BV, Tamara van Hal Speakers bureau: Eli Lilly and Novartis, Grant/research support from: support for attending meetings from UCB (personal funding), Lieke Nieboer: None declared, Nathan den Broeder: None declared, E.M.G.J. de Jong Speakers bureau: AbbVie, Almirall, Janssen Pharmaceutica, Novartis, Lily, Celgene, Leo Pharma, Sanofi, UCB and Galapagos (all funding is not personal but goes to the independent research fund of the department of dermatology of Radboud university medical centre Nijmegen, the Netherlands), Consultant of: AbbVie, Almirall, Janssen Pharmaceutica, Novartis, Lily, Celgene, Leo Pharma, Sanofi, UCB and Galapagos (all funding is not personal but goes to the independent research fund of the department of dermatology of Radboud university medical centre Nijmegen, the Netherlands), Grant/research support from: AbbVie, Novartis, Janssen Pharmaceutica, Leo Pharma and UCB for research on psoriasis, Alfons den Broeder: None declared, Frank van den Hoogen: None declared, Philip Helliwell Speakers bureau: Pfizer, Abbvie, Novartis and Janssen, Consultant of: Eli Lilly, Mark Wenink: None declared

Abstract Background Small bowel obstruction (SBO) due to internal hernia (IH) is a well-known late complication after laparoscopic Roux-en-Y gastric bypass (LRYGB), with an incidence between 0.5 and 10% as reported by Iannelli et al. (Obes Surg. 17(10):1283–6, 2007). It is reported most frequently 1–2 years after surgery because of the greater weight loss at that time, with rapid loss of the mesenteric fat consequently as discussed by Stenberg et al. (Lancet. 387(10026):1397–404, 2016). Currently, women constitute more than 50% of the patients undergoing bariatric surgery and most of them are of childbearing age as reported by the World Health Organization (2015). SBO, due to IH, is a rare complication during pregnancy, mostly occurring during the third trimester as discussed by Torres-Villalobos et al. (Obes Surg 19(7):944–50, 2009), and can result in fetal and maternal morbidity and even mortality as reported by Vannevel et al. (Obstet Gynecol. 127(6):1013–20, 2016). Moreover, the physiologic changes of pregnancy can mask the symptoms of SBO after LRYGB, leading to significant diagnostic and therapeutic delays as detailed by Wax et al. (Am J Obstet Gynecol 208(4):265–71, 2013). Therefore, an early surgical exploration is necessary in this particular and uncommon situation as discussed by Webster et al. (Ann R Coll Surg Engl 97(5):339–44, 2015). Methods A 32-year-old female patient, with Ehlers-Danlos syndrome and chronic pain, was in the 28th week of her first pregnancy after bariatric surgery. She had had an antecolic LRYGB 6 years ago in another institution, resulting in a 35-kg weight loss. She presented to the emergency department with severe and persistent epigastric pain associated with nausea and vomiting during 24 h. On physical examination, her abdomen was painful and tender at the epigastrium and left hypochondrium, and her vital signs were normal. The blood tests were in the normal range except the white blood cell count at 12′000 G/l. The obstetric and neonatal team was involved, and fetal heart monitoring was normal. Abdominal ultrasonography ruled out other causes of pain. An abdominal MRI was performed and displayed a distended proximal small bowel, free abdominal fluid, and bowel mesenteric edema in the left upper quadrant with compression of the superior mesenteric vein. Internal hernia with intestinal suffering was suspected, and the patient consented for emergency laparoscopy. Results The laparoscopic exploration, reduction of the internal hernia, and closure of the mesenteric defects are demonstrated step-by-step in the presented intraoperative video. The postoperative course was uncomplicated for both patient and fetus. Oral feeding was resumed at day 1, with no residual symptom, and the patient was discharged on postoperative day 3. At 1-month follow-up, she had no complaint and her pregnancy had resumed a normal course. She delivered a healthy baby at 36 weeks without any complication. Conclusions Internal herniation after LRYGB represents a rare, high-risk complication during pregnancy. A low threshold for imaging, preferably by abdominal MRI, is recommended. Multidisciplinary management, including obstetricians and bariatric surgeons, is necessary in order to avoid maternal and fetal adverse outcomes. During surgery, recognition of the anatomy is often difficult, and parts of the bowel are distended and fragile. Starting to run the bowel backwards from the ileocecal valve is a crucial surgical step for reducing internal hernias during LRYGB, and reduces both the risk to worsen the situation and of bowel injury, making its management less hazardous.

Abstract Introduction: Ixazomib (Ninlaro) is the first orally administered proteasome inhibitor (PI) approved in more than 50 countries worldwide, including China. The TOURMALINE-MM1 study was a large randomized, double-blind, global registration study assessing treatment with either ixazomib or placebo added to lenalidomide and dexamethasone. The China Continuation Study (CCS) was a separate regional expansion of the global study that used the same study design. (Panel A) In the global study, IRd treatment extended progression-free survival (PFS), the primary endpoint, by 35% (HR=0.74) vs Rd. Here we report results of a pooled analysis of data from a subgroup of Asian patients enrolled in these two studies. Demographics and Methods: Asian patients from China (n=6 from the global study; n=115 from the CCS), Singapore (n=6), South Korea (n=6), and 3 non-Asian countries (n=5) were included in this pooled analysis. Overall response rate (ORR) was based on the International Myeloma Working Group criteria. The median OS and PFS were calculated using the Kaplan-Meier method. Comparative analysis of treatment groups used stratified log rank tests and the Cox proportional hazard regression model. Safety assessments were based on treatment-emergent adverse events (TEAEs), changes in laboratory parameters, and 12-lead electrocardiogram results. Results: Data from 138 pts were analyzed (67 IRd; 71 Rd). Baseline characteristics were balanced between the treatment groups; overall median age was 61 (range, 30-80) years, 67% of pts were < 65 years; 97% of pts had Eastern Cooperative Oncology Group Performance Scores 0-1; 37% had International Staging System (ISS) stages II/III; and 72% had lytic bone disease. The median number of prior treatments was 2, with 82% exposed to thalidomide of which 61% were thalidomide refractory, 61% were exposed to bortezomib, and 48% exposed to both drugs. The ORR was 57% in the IRd group vs 37% in the Rd group. Median OS was 25.8 mos and 15.8 mos in the IRd and Rd treatment groups, respectively (HR=0.346). (Panel B). OS also was longer with IRd therapy regardless of prior exposure to bortezomib (HR=0.322) or thalidomide (HR=0.317) as well as in pts with thalidomide refractory tumors (HR=0.273). (Panel C). The median PFS was 7.3 mos and 4.6 mos in the IRd and Rd treatment groups, respectively (HR=0.559). Longer PFS was also observed with IRd treatment in pts with prior exposure to bortezomib (HR=0.467) or thalidomide (HR= 0.580) as well as pts with thalidomide refractory tumors (HR= 0.631). The rates of drug-related TEAEs (IRd, 96%; Rd, 97%), serious TEAEs (IRd, 37%; Rd, 34%), Grade 3/4 TEAEs (IRd, 74%; Rd, 73%) and discontinuations due to AEs (IRd, 12%; Rd, 13%) were similar in both treatment groups. Grade 3/4 TEAEs reported in ≥10% of either treatment group were anemia (IRd, 14%; Rd, 31%), lower respiratory infection (IRd, 23%; Rd, 21%), neutrophil count decrease (IRd, 13%; Rd, 16%), platelet count decrease (IRd, 15%; Rd, 13%), neutropenia (IRd, 17%; Rd, 9%), thrombocytopenia (IRd 11%; Rd 6%). There was no increased cardiotoxicity, renal toxicity, hepatoxicity or secondary primary malignancy in the IRd group. Conclusions: Asian pts with RRMM treated with oral IRd showed superior OS and PFS vs those treated with Rd. The benefit was consistent regardless of prior exposure to thalidomide and bortezomib. The addition of ixazomib to Rd was well-tolerated, and no new safety signals were identified. The safety profile of IRd was consistent with the safety findings of the large global study (Moreau P, Masszi T, Grzasko N, et al. for the TOURMALINE-MM1 Study group. N Engl J Med. 2016;374:1621-1634.) Disclosures Jin: College of Medicine, Zhejiang University: Employment; The National Natural Science Foundation of China: Research Funding. Chng:Amgen: Consultancy, Honoraria, Other: Travel, accommodation, expenses; Janssen: Consultancy, Honoraria, Other: Travel, accommodation, expenses, Research Funding; Celgene: Consultancy, Honoraria, Other: Travel, accommodation, expenses, Research Funding; Merck: Research Funding; Aslan: Research Funding; Takeda: Consultancy, Honoraria, Other: Travel, accommodation, expenses. Goh:Johnson & Johnson: Consultancy, Honoraria; Bristol-Myers-Squibb: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Sanofi-Aventis: Consultancy, Honoraria; Astellas: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Wu:Takeda Pharmaceuticals: Employment. Wang:Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda: Employment. Liu:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Skacel:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment; Department of Hematology, Charles University General Hospital, Prague, Czech Republic: Other: Affiliation. Wan:Takeda Pharmaceuticals International Co.: Employment. Berg:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment.

Objective: To investigate the efficacy and safety of common clinical chemotherapy regimens in the treatment of elderly patients with AML, and to explore the effects of age stratification, gene mutation and leucocyte stratification on the survival of elderly patients with AML. Method: Part I: Collect all the literature published to January 2019 on the efficacy and adverse reactions of "3+7" regimen in the treatment of elderly AML patients compared with "3+7" regimen, or decitabine(DAC) combined with pre-excitation regimen. Evidence-based evidence is obtained by evaluating the efficacy and adverse reactions of "3+7" regimen compared with DAC regimen, pre-excitation regimen and DAC combined with pre-excitation regimen, respectively. The difference of efficacy and adverse reactions between the above schemes was confirmed. Part II: Retrospective analysis of clinical data of 90 elderly patients with AML (non-M3) hospitalized in the Department of Hematology, Sichuan Provincial People's Hospital from January 31, 2015 to January 31, 2019. These patients were divided into "3 + 7" group, the DAC group, and the DAC combined with the pre-excitation group according to the chemotherapy regimen. Complete response rate, partial response rate, and overall survival of each group were compared to evaluate the efficacy response. And explore the effects of genetic mutation, risk stratification, age stratification, ECOG score, white blood cell stratification on the survival of elderly AML. Results: Part I: A total of 12 articles were included, including 1715 elderly patients with AML. Through subgroup analysis, the results showed that the "3+7" regimen was superior to the DAC regimen in terms of CR; the infection of the "3+7" chemotherapy regimen was higher than that of the pre-excitation regimen. The mortality rate of "3+7" group was higher than that of pre-excitation group. Part II: The study included 90 patients, "3+7" group included 42 patients, DAC group included 12 patients, DAC combined pre-excitation group included 36 patients. In the three groups, the CR rate of the "3+7" chemotherapy group was 61.9%; the CR rate of the DAC group was 58.3%, while DAC combined with HAG or CAG treatment was 52.8%(P>0.05). In low risk group, the CR rate of the "3+7" chemotherapy regimen was 75%, the DAC group was 60%, while DAC+HAG/CAG was 75% (P=0.401). But the DAC+HAG/CAG group showed a survival advantage compared with the "3+7" group. There was no significant difference in survival between patients with FLT3-ITD mutations compared with those who without mutations. The OS of patients between 60 to 65 years were significantly better. The white blood cells were divided into <30×10^9/L group, 30-50×10^9/L group, 50-100×10^9/L group, and there was no difference in CR and OS in the group. About the time of neutropenia, the "3+7" chemotherapy regimen lasted for 15 (2-23) days, the DAC group was 11 (8-22) days, and the DAC+HAG/CAG was 16 (8-36) days, the difference between groups was between the DAC group and the DAC combined pre-excitation group (P=0.031). About platelet recovery time, "3+7" chemotherapy regimen lasted 12.5 (2-23) days, while DAC group lasted 11 (8-20) days and DAC+HAG/CAG group lasted 8 (5-16) days. Statistical differences could be observed in platelet recovery time between DAC group and DAC combined pre-excitation group (P=0.017). Lung infection rate was 83.3% in the "3+7" group, 77.8% in the DAC combined pre-excitation group, and the DAC group infection rate was 73.8%. 83.3%. Conclusion: Compared with other age groups, patients aged 60-65 have survival advantages. DAC-based drugs are more beneficial to patients than 3+7 chemotherapy. OS of patients without poor prognosis genome was significantly better than those with three or more poor prognosis genomes, while FLT3-ITD mutation had little effect on OS of elderly AML patients. The prognosis of patients with hyper-leucocyte is worse than that of patients without hyper-leucocyte, but WBC count has little effect on the long-term survival of patients with non- hyper-leucocyte. DAC group had obvious inhibitory effect on megakaryocytes. Disclosures Zheng: Pfizer: Research Funding.

Introduction: In children with sickle cell anemia (SCA) without transcranial Doppler (TCD) screening, the incidence rates of ischemic strokes is approximately the same among children living in low- and high- low-resource settings (Pediatr Neurol. 2019;95:73-78.) with a prevalence of ~ 11%. However, in high-income settings, the standard use of TCD ultrasonography, coupled initially with monthly blood transfusion therapy has dropped the stroke prevalence to &lt; 1%. In a low-income setting, such as Nigeria, where 50% of children in the world with SCA are born (150,000 per year), initial monthly blood transfusion therapy is not practical for most children. In the Stroke Prevention in Nigeria (SPIN) Feasibility Trial (NCT01801423), fixed moderate-dose hydroxyurea was associated with a decreased rate of strokes in children with SCA and abnormal time-averaged mean of the maximum velocity (TAMMV) TCD measurements (≥200cm/sec) when compared to no treatment in the STOP Trial, 0.76 and 10.7 strokes per 100 person-years, repsectively (Am J Hematol. 2020). Based on the success of the SPIN trial, plus the challenges of real-world implementation of a government-supported primary stroke prevention programs for estimated 40,0000 children with SCA in three states in Nigeria, we tested the hypothesis that fixed-moderate dose (~20 mg/kg/day) hydroxyurea therapy for primary stroke prevention results in a 66% relative risk reduction (9 to 3 events per 100 person-years) when compared to fixed low-dose hydroxyurea (~10 mg/kg/day) therapy in a randomized controlled trial (The SPRING Trial; NCT02560935). Methods: In this partial-blind controlled phase III trial, we randomly assigned children between 5 and 12 years of age with SCA and a TCD time-averaged mean of the maximum velocity (TAMMV) ≥ 200 cm/sec measured independently twice or TAMMV ≥220 cm/sec once at study screening to receive fixed low-dose or fixed moderate-dose hydroxyurea. The primary endpoint was a clinical stroke or a transient ischemic attack (TIA). Myelosuppression was assessed with monthly complete blood counts (CBCs). Adherence to hydroxyurea was primarily based on an increase in MCV from baseline and monthly pill count return as a percent of dispensed pills. Hemoglobin F levels were measured at baseline, annually and upon trial exit. To evaluate the safety of hydroxyurea in the trial, children attending the same SCA clinics with TCD (TAMMV) &lt;200 cm/sec at study screening were prospectively followed with biweekly phone calls and annual research visits. Results: A total of 220 children (mean age: 7.5 years, 51.8% female) were randomly assigned to fixed low- (10 mg/kg/day) or moderate- (20 mg/kg/day) dose hydroxyurea, and were followed for a median of 2.4 years (IQR 2.0-2.8). NINDS Clinical Trials leaders stopped the trial early because of futility for the primary outcome. In the fixed low- and moderate-dose hydroxyurea groups, the incidence rates of strokes per 100 person-years were 1.19 and 1.92 respectively, with an incidence rate ratio of 1.60 (95% CI: 0.31-10.34), p = 0.768. The incidence rate ratio of mortality when comparing the children treated with low- and moderate- fixed-dose hydroxyurea to the non-elevated TCD group (no hydroxyurea therapy, n= 211) was 1.97 (95% CI: 0.64-6.02) and 0.47 (95% CI: 0.05-2.38), p = 0.265 and 0.545, respectively. Returned pills during the trial was 5.4% and 4.8% in the fixed low- and moderate-dose groups, respectively, p= 0.144. MCV from baseline to endpoint increased 1.5fl and 7.2 fl in the fixed low- and moderate-dose groups, respectively, p&lt;0.001. Upon exit from the trial 29.4% and 66.7% of the fixed- low and moderate -dose groups, respectively, had either hemoglobin level ≥ 9.0 g/dl, or a fetal hemoglobin level ≥ 20%. Conclusions: For primary stroke prevention in children with SCA, fixed low-dose, when compared to fixed moderate-dose hydroxyurea therapy, demonstrated no difference in the incidence rate of strokes. Both fixed low- and moderate -dose hydroxyurea doses are superior to no treatment for primary stroke prevention with abnormal TCD values. In partnership with Katsina, Kano, and Kaduna health department's leaders in Nigeria, 9 distinct SCA and primary stroke prevention clinics have been established, with the provision of free fixed low-dose hydroxyurea therapy (Bond Chemical, Nigeria; $0.15 per 500 mg) for abnormal TCD values, and biannual CBCs as standard care ,for over 40,000 children with SCA. Disclosures DeBaun: Global Blood Therapeutics (GBT): Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: fixed low and moderate dose hydroxyurea for primary stroke prevention in sickle cell

Abstract Background: In early studies of venetoclax (ven) in CLL, severe tumor lysis syndromes (TLS) were observed leading to the implementation of multiple safety measures including a 5-week ramp up schedule. Since then, studies have consistently reported low rates of TLS in ven-treated patients (pts), most likely as a result of strict prophylactic and laboratory monitoring measures. Various lead-in regimens prior to the administration of ven were shown to be feasible and effective in reducing the risk of TLS in pts with CLL. However, no comparison of different pretreatment regimens has been performed so far in a prospective randomized trial. Using the set-up of the GAIA trial, we compared TLS incidence and formal TLS risk reduction between 3 different ven-based combinations. Methods: The phase 3 GAIA (CLL13) trial compared 3 different time-limited ven-based combinations against standard chemoimmunotherapy (CIT) in fit, treatment-naïve pts with CLL. Pts were randomized to receive CIT (FCR in pts ≤65 years; BR in pts &gt;65 years), ven and rituximab (RVe), ven and obinutuzumab (GVe), or ven, obinutuzumab and ibrutinib (GIVe). In RVe, GVe and GIVe, ven was added at cycle 1 day 22 (ramp up day 1) after a 21-day pretreatment with rituximab (1 dose), obinutuzumab (3 doses) or obinutuzumab (3 doses) plus ibrutinib (continuous) (Figure 1A). The safety population (i.e. all pts who received study treatment) of the ven-containing arms was used for this analysis. TLS was reported according to Cairo-Bishop criteria (Cairo M, Bishop M. Br J Haematol. 2004). For TLS risk evaluation, the most recent available CT/MRI and absolute lymphocyte count (ALC) were used. TLS risk was evaluated at baseline and at ramp up day 1, before the first dose of ven. The patients were categorized retrospectively according to the following TLS risk categories: high (any lymph node [LN] with largest diameter ≥10 cm or any LN with largest diameter ≥5 cm and ALC ≥25 G/L), intermediate (any LN ≥5 cm to &lt;10 cm or ALC ≥25 G/L), low (all LN &lt;5 cm and ALC &lt;25 G/L). Results: The safety population of all ven-containing arms comprised of 696 pts (RVe: 237, GVe: 228, GIVe: 231). Baseline TLS risk was high in 22%, 23% and 19% of pts in the RVe, GVe and GIVe arm, intermediate in 62%, 65%, 67% and low in 10.5%, 14.7% and 12.4% of pts, respectively. After the first 21 days of treatment (i.e. at ramp up day 1), the fraction of pts with a reduction in TLS risk varied between the treatment arms with 31.7% (RVe), 71.4% (GVe) and 47.3% (GIVe) of pts decreasing by at least one TLS risk category (Figure 1B). With regard to TLS risk reduction, GVe was superior to RVe (p&lt;0.001) and GIVe (p&lt;0.001) while GIVe was superior to RVe (p=0.001)). At ramp up day 1, 2 patients (1.0%) in the GVe arm versus 60 patients (29.6%) in the GIVe arm had an ALC ≥25 G/L, likely as a correlate of ibrutinib-associated redistribution of lymphocytes to the peripheral blood, readily explaining part of the difference in TLS risk reduction between GVe and GIVe. In total, 36, 30 and 19 cases of TLS occurred in 29 (12.2%), 26 (11.4%) and 19 (8.2%) pts in the RVe, GVe and GIVe arm. The majority of TLS cases were categorized as CTC grade 3 (28 [RVe], 19 [GVe], 12 [GIVe]), only few CTC grade 4 TLS were reported (1 [RVe], 2 [GVe], 3 [GIVe]). There were no cases of fatal TLS and no pts requiring dialysis due to TLS. In the obinutuzumab arms the majority of TLS cases occurred before ramp up day 1 (GVe: 76.7%, GIVe: 68.4%), i.e. before any venetoclax intake, in contrast 80.6% of TLS cases in the RVe arm were reported during ven ramp up (Figure 2). While there was no significant difference in the cumulative TLS incidence between the treatment arms (p=0.334), there was an increase in TLS occurring after ramp up day 1 in the RVe arm compared to GVe (p&lt;0.001) and GIVe (p=0.002). Conclusions: This analysis represents the first comparison of the formal TLS risk reduction and actual TLS incidence of different ven-based combinations in a randomized trial. GVe led to the highest TLS risk reduction, while the lowest number of TLS cases occurred in the GIVe arm. Most TLS cases in the GVe and GIVe arms occurred before the start of ven. RVe was least effective in reducing TLS risk and in contrast to the obinutuzumab-containing arms, the vast majority of TLS cases was reported during the ven ramp up. The relatively high incidence of TLS in comparison to other trials might partly be a consequence of using different reporting criteria (Cairo-Bishop vs Howard criteria). No fatal TLS occurred in any of the treatment arms. Figure 1 Figure 1. Disclosures Von Tresckow: AbbVie: Honoraria, Other: advisory board, travel grant; Celgene: Other: travel grant; AstraZeneca: Honoraria, Other; Roche: Honoraria, Other: Reasearch support, travel grant; Janssen: Honoraria, Other: Reasearch support, travel grant. Niemann: Novo Nordisk Foundation: Research Funding; CSL Behring, Genmab, Takeda, Octapharma: Consultancy; Abbvie, AstraZeneca, Janssen: Consultancy, Research Funding. Kater: Abbvie: Honoraria, Other: Ad Board, Research Funding; Janssen, AstraZeneca: Other: Ad Board, steering committee, Research Funding; Genmab, LAVA: Other: Ad Board, Steering Committee; BMS, Roche/Genentech: Other: Ad Board, , Research Funding. Staber: Roche: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Astra Zeneca: Consultancy, Honoraria; Takeda: Consultancy, Research Funding; MSD: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Incyte: Consultancy, Honoraria, Research Funding; Beigene: Consultancy, Honoraria. Tadmor: Janssen: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding. Levin: Roche, Janssen, Abbvie: Other: Travel Expenses, Ad-Board. Poulsen: Janssen: Consultancy; Abbvie: Consultancy. Janssens: Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Trael Grant, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Consultancy; Beigene, AstraZeneca: Consultancy, Speakers Bureau; Abbvie, Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Noesslinger: AbbVie: Honoraria; Celgene: Honoraria; Roche: Honoraria; Jansen: Honoraria; AstraZeneca: Honoraria; Gilead: Honoraria. Simon: Gilead: Other: Travel support. Fink: AbbVie: Other: travel grant; Janssen: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Research Funding; Celgene: Research Funding. Fischer: Abbvie: Honoraria; Roche: Honoraria, Other: Travel Grants. Wendtner: Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding; Genentech: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding; AstraZeneca: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding; F. Hoffmann-LaRoche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding; GlaxoSmithKline: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding; Janssen Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding; Mundipharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding; Pharmacyclics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding. Ritgen: MSD: Consultancy, Other: Travel support; Chugai: Consultancy; Abbvie: Consultancy, Other: Travel support, Research Funding; Roche: Consultancy, Other: Travel support, Research Funding; Celgene: Other: Travel support. Brüggemann: Amgen: Other: Advisory Board, Travel support, Research Funding, Speakers Bureau; Incyte: Other: Advisory Board; Janssen: Speakers Bureau. Stilgenbauer: AbbVie, Amgen, AstraZeneca, Celgene, Gilead, GSK, Hoffmann-La Roche, Janssen, Novartis, Sunesis: Honoraria; AbbVie, Amgen, AstraZeneca, Celgene, Gilead, GSK, Hoffmann-La Roche, Janssen, Novartis, Sunesis: Other: Research Support; AbbVie, Amgen, AstraZeneca, Celgene, Gilead, GSK, Hoffmann-La Roche, Janssen, Novartis, Sunesis: Research Funding; AbbVie, Amgen, AstraZeneca, Celgene, Gilead, GSK, Hoffmann-La Roche, Janssen, Novartis, Sunesis: Consultancy. Hallek: Roche: Honoraria, Speakers Bureau; Gilead: Honoraria, Speakers Bureau; Mundipharma: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Celgene: Honoraria, Speakers Bureau; Pharmacyclics: Honoraria, Speakers Bureau. Eichhorst: Gilead: Membership on an entity's Board of Directors or advisory committees, Other: Travel, accomodation, expenses, Research Funding, Speakers Bureau; F. Hoffmann-La Roche Ltd: Membership on an entity's Board of Directors or advisory committees, Other: Travel, accomodation, expenses, Research Funding, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees, Other: Travel, accomodation, expenses, Research Funding, Speakers Bureau; BeiGene: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Travel, accomodation, expenses, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Other: Travel, accomodation, expenses, Speakers Bureau; Adaptive Biotechnologies: Speakers Bureau; Hexal: Speakers Bureau; ArQule: Membership on an entity's Board of Directors or advisory committees; Oxford Biomedica (UK): Membership on an entity's Board of Directors or advisory committees; MSD: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees, Other: Travel, accomodation, expenses, Research Funding, Speakers Bureau; Consultant Department I for Internal Medicine: Consultancy; University Hospital of Cologne: Current Employment. OffLabel Disclosure: The combination of obinutuzumab, venetoclax and ibrutinib is not approved for the treatment of CLL

This article aims to bring to the forefront the issue of public legal aid by carrying out an analysis that combines the theoretical perspective with the jurisprudential one. It presents the normative framework, the doctrinal approaches, the legal practice in the field, with emphasis on the legal provision that generated non-unitary practice. The article presents the attempts to harmonize the legal practice, displaying the opinions expressed during the Meetings of the representatives of the Superior Council of Magistracy with the presidents of the civil department of the High Court of Cassation and Justice and the courts of appeal. Taking into account that public legal aid is one of the prerequisites for free access to justice – fundamental law, constitutionally guaranteed, it is particularly important to present the case law of the Romanian Constitutional Court in the matter, focusing on the acceptance of ECHR case law within the constitutional control of the public legal aid framework regulation – Government Emergency Ordinance no. 51/2008.

El presente artículo ha sido derivado de un proyecto de investigación, cuyo objetivo general consistió en la construcción de un modelo de gestión estratégica aplicado al fortalecimiento de las estructuras organizacionales de las unidades de emprendimiento empresarial (MGEC) en el departamento de La Guajira. El abordaje metodológico fue de corte empírico-analítico de tipo, con un diseño transeccional no experimental. Para tal efecto, se diseñó una muestra probabilística de 367 participantes del nivel de educación superior estimada con 95% de confianza y 5% de error, a quienes se les administró una escala Likert sobre emprendimiento y empresarismo, la cual obtuvo un nivel de confiabilidad alpha de Cronbach (?:.986). Los principales hallazgos permitieron identificar que a partir de la implementación del (MGEC) se evidenciaron cambios en las prácticas y factores asociados con la efectividad y operatividad de la formación para el emprendimiento y el empresarismo. Estos resultados constituyeron un punto de partida en la formulación de acciones estratégicas orientadas a la articulación de los ejercicios educativos con las políticas de desarrollo empresarial; replanteando su estructura y mejorando su proceso misional, y el reconocimiento de la importancia que tienen las competencias empresariales y personales en los procesos de liderazgo y creación de negocios de alta pertinencia y relevancia frente a las políticas de desarrollo y crecimiento económico del departamento de LaGuajira.ABSTRACTThis article has been derived from a research project, whose overall goal consisted in the construction of a model of strategic management applied to the strengthening of the organizational structures of units of entrepreneurship (MGEC) in the department of La Guajira. The methodological approach of court was empirical-analytical type, with a transactional non-experimental design.For this purpose, we will design a probability sample of 367 participants of the level of higher education estimated with 95% confidence and 5% error, who were administered a Likert scale on entrepreneurship and entrepreneurship, which obtained a level of reliability by Cronbach's Alpha (?: .986). The major findings, allowed us to identify that depart from the implementation of the (MGEC) changes were evidenced in the practices and factors associated with the effectiveness and operation of the training for entrepreneurship and entrepreneurship. These results constitute a starting point for the formulation of strategic actions aimed at the articulation of learning exercises with the enterprise development policies; rethinking its structure and improve its missional process, and the recognition of the importance of business skills and personal in the processes of leadership and building a business of high relevance and relevance to the policies of economic growth and development of the department of La Guajira.

An in vitro trial was conducted in the Department of Entomology, Dr. Balasaheb Sawant Konkan Krishi Vidyapeeth, Dapoli, Ratnagiri, Maharashtra; to determine the compatibility of green muscardine fungus, Metarhizium anisopliae (Metachnikoff) Sorokin with pesticides and its pathogenicity against A. craccivora. Azadirachtin, Buprofezin and Sulphur were the most suitable pesticides as it showed significantly superior growth on potato dextrose agar media over untreated control. However, Emamectin benzoate, Azadirachtin, Profenophos, Indoxacarb, Thiophanate, Paraquat Dichloride and Glyphosate showed significantly higher mean mycelial weight over the untreated control on potato broth medium. At the same time, amongst pesticides used in the experiment; only insecticides (Emamectin benzoate, Azadirachtin and Deltamethrin) reported synergistic increase in conidial count with the untreated control, while fungicides and herbicides reported drastic reduction in conidial count. The pathogenicity of M. anisopliae harvested from the pesticide treatments against A. craccivora revealed that all the pesticides investigated had reduced its pathogenicity in comparison to untreated control. However Emamectin benzoate, Indoxacarb and Paraquat dichloride showed maximum per cent mortality and can be used in combination with M. anisopliae.

Abstract Background The development of tools that could help emergency department clinicians recognize stroke during triage could reduce treatment delays and improve patient outcomes. Growing evidence suggests that stroke is associated with several changes in circulating cell counts. The aim of this study was to determine whether machine-learning can be used to identify stroke in the emergency department using data available from a routine complete blood count with differential. Methods Red blood cell, platelet, neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts were assessed in admission blood samples collected from 160 stroke patients and 116 stroke mimics recruited from three geographically distinct clinical sites, and an ensemble artificial neural network model was developed and tested for its ability to discriminate between groups. Results Several modest but statistically significant differences were observed in cell counts between stroke patients and stroke mimics. The counts of no single cell population alone were adequate to discriminate between groups with high levels of accuracy; however, combined classification using the neural network model resulted in a dramatic and statistically significant improvement in diagnostic performance according to receiver-operating characteristic analysis. Furthermore, the neural network model displayed superior performance as a triage decision making tool compared to symptom-based tools such as the Cincinnati Prehospital Stroke Scale (CPSS) and the National Institutes of Health Stroke Scale (NIHSS) when assessed using decision curve analysis. Conclusions Our results suggest that algorithmic analysis of commonly collected hematology data using machine-learning could potentially be used to help emergency department clinicians make better-informed triage decisions in situations where advanced imaging techniques or neurological expertise are not immediately available, or even to electronically flag patients in which stroke should be considered as a diagnosis as part of an automated stroke alert system.

Aims: The current study envisages experimental design enabled rapid, sensitive, and stability-indicating RP-UPLC method to quantify Aliskiren in its pharmaceutical formulations. Study Design: Box-Benkhen experimental Design using Response surface methodology. Place and Duration of Study: Department of Analytical Research and Development, Brawn laboratories ltd., Gurugram, India, and Department of Pharmacy KL College Pharmacy, KL Deemed to be University, Vaddesearam, Guntur, Andhra Pradesh, between May 2021 and September 2021. Methodology: The chromatographic partitioning was achieved on a Waters Acuity H class UPLC system, with BEH 130οA, C18 column (100 x 2.1 mm,1.7 μm) having isocratic elution containing (50:50 %v/v) of 0.2% Glacial acetic acid (GAA) : acetonitrile, at constant flow rate using PDA detection. The optimum conditions were delineated, selecting three influential factors (CMPs), i.e., mobile phase composition, flow rate, and injection volume. Systematic optimization was accomplished by 32 Box-Benkhen design using response surface methodology (RSM). Results: The selected variables are evaluated for obtained responses (CAAs), i.e., peak area, retention time (Rt), USP Plate count. The final optimized method employed, organic phase composition 0.2 % GAA (pH 3.0) and acetonitrile 50:50 (% v/v) with 0.3 mL min-1 flow rate. The injection volume was maintained as 2μL with 2 minutes run time and λmax 280 nm. Conclusion: The method was linear for 5-300 ppm, with regression co-efficient (R2) 0.9995. As per ICH guidelines, forced degradation studies were carried out to analyse the stability profile of drug. The short Rt 1.214, minute implies superior robustness, sensitivity, and cost-effectiveness for routine analysis. The results exhibited that RSM approach of QbD will be competently used to optimize the RP-UPLC method with fewer experimental trials and error-free investigation.

Aims: To study the role of two combination therapies in the treatment of rheumatoid arthritis. Study Design: This an open-label, randomized 180-days clinical trial. Place and Duration of Study: This study was conducted in the Department of Pharmacology and Therapeutics, BMSI and Medical unit ward 6. Methodology: Eighty-nine patients were enrolled (69 women, 20 men; age range 28-62 years). A and B were the groups assigned to the patients. MTX 7.5-20 mg/ week orally and SSZ 10-20 mg / day orally as maximally tolerated were prescribed to the 55 patients of group A. MTX 7.5-20 mg/ week orally and HCQ 200 mg twice daily were prescribed to the 54 patients of group B.. Results: When we compared group A with group B, group A showed major progress in mean swollen joint count (1.9 ± 0.97) as compared to group B (2.7 ± 1.78). Group B showed major progress in mean physician’s global assessment (2.7 ± 0.92) as compared to group A (3.8 ± 1.22). For that reason, our study showed that patients receiving both the combinations responded equally in terms of efficacy but the combination of MTX and HCQ is better tolerated than the combination of MTX and SSZ. Conclusion: Both combinations of MTX & SSZ and MTX & HCQ were equally effective but the combination of MTX & HCQ was superior in terms of tolerability than the combination of MTX and SSZ.

A 58-year-old man with history of left parietal lobe ischemic stroke, multifocal lacunar infarctions with residual mild right sided weakness, ongoing tobacco abuse, and hypertension presented to the emergency department with an initial complaint of right sided throbbing headache, right neck, arm, and leg pain that started acutely 3 hours prior. Patient denied new weakness or numbness from his baseline and was ambulatory. While undergoing triage, he acutely developed right arm and leg flaccid paralysis. Upon evaluation by the stroke team he was noted to have an NIHSS of 11. CT head demonstrated chronic infarctions, and CT angiogram head and neck did not show large vessel occlusion, dissection, or focal intracranial atherosclerosis. Initial screening labs included complete blood count with differential, glucose, and complete metabolic panel all within normal range. Patient was administered rTPA and admitted to the neurologic intensive care unit. MRI brain without gadolinium did not reveal an acute infarction, but showed known prior left superior middle cerebral artery division stroke and prior lacunar infarctions. On hospital day 1 there was subjective improvement in right hemibody weakness, but also new left sided sensory deficits. Examination was notable for 4-/5 right upper extremity strength, 5-/5 right lower extremity strength, nearly at baseline from prior ischemic stroke, except for increased right hand weakness. Sensory examination demonstrated new left sided diffuse loss to pain and temperature in the upper and lower extremity with bilaterally intact vibration and proprioception.

Abstract A 49-year-old man without cardiovascular risk factors, recently diagnosed of asthma and rino-sinusal polyposis, entered the Emergency Department for chest pain, shortness of breath and non-productive cough. The patient was in stable conditions. Laboratory exams showed eosinophilic leucocytosis (WBC 33.000/sqmm, 60% eosinophils) and a mild elevation of C-reactive protein (CRP 2,2 mg/dL). ECG showed a sinus rhythm with flat T-waves in the antero-lateral leads. Troponin values were high but not suggestive of acute myocardial damage (9900 - 9700 ng/L). Echocardiography showed normal biventricular volumes with moderately depressed left ventricular ejection fraction (40%), hypokinesia of the antero-lateral wall in the mid-apical segments and mild pericardial effusion. During the hospital stay he developed progressive respiratory failure, and he was transferred to a tertiary center to perform an endomyocardial biopsy (EMB) in the suspicion of acute myocarditis. EMB showed multifocal interstitial and sub-endocardial inflammatory infiltrates (predominantly eosinophils) with foci of myocellular damage, small vessels wall inflammation with hypertrophy of the muscular tunica. The overall picture was consistent with diffuse moderate eosinophilic myocarditis with small vessels vasculitis. The right heart cath performed in the same procedure and during diuretic therapy showed a normal hemodynamic profile (RAP 5 mmHg, PCWP 13 mmHg, CI 3,7 L/min/sqm). The patient was treated with high dose steroids, first intravenously (methylprednisolone 125 mg/day for three days), then orally (prednisone 80 mg/day) in slow decalage until a maintenance dose of 12.5 mg daily. The recent-onset of asthma with hyper-eosinophilia and rhino-sinus-bronchial syndrome in the light of the present cardiac condition was consistent with eosinophilic granulomatosis with polyangiitis (EGPA). Chest CT showed two areas of ground glass at the left superior and right superior lobes. Other potential haematological and infective causes of hyper eosinophilia and viral causes of myocarditis were ruled out. After the treatment, his clinical conditions improved, ECG was completely normalized, left ventricular systolic function improved (LVEF 50%) and eosinophil count was significantly reduced (Eosinophils 830/sqmm, 8,9%), whereas CT showed resolution of the lung infiltrates. One month after discharge, the patient was still asymptomatic. Cardiac MRI showed normal biventricular ejection fraction (LVEF 55%) with circumferential subendocardial fibrosis involving only the left ventricle. EMB showed a complete resolution of the inflammatory infiltrates and of the vasculitic aspects. Eosinophil count was elevated (5660/sqmm, 36%). Therefore, steroidal dose was raised to 50 mg/day. After rheumatologic evaluation, a steroidal sparing strategy with cyclophosphamide and anti-IL5 antibody Mepolizumab was adopted, with good laboratory response. Three months later, cardiac MRI showed no signs of active disease. No further EMB was scheduled. Through the presentation of this unusual cause of acute myocarditis, we want to underscore the importance of an early referral to a tertiary level center of patients with suspected myocarditis and reduced systolic function and the usefulness of histology to guide medical therapy in specific forms of myocarditis that can lead to a potential complete recovery.

BackgroundGiven the similarities in clinical manifestations of cystic-solid pituitary adenomas (CS-PAs) and craniopharyngiomas (CPs), this study aims to establish and validate a nomogram based on preoperative imaging features and blood indices to differentiate between CS-PAs and CPs.MethodsA departmental database was searched to identify patients who had undergone tumor resection between January 2012 and December 2020, and those diagnosed with CS-PAs or CPs by histopathology were included. Preoperative magnetic resonance imaging (MRI) features as well as blood indices were retrieved and analyzed. Radiological features were extracted from the tumor on contrast-enhanced T1 (CE-T1) weighted and T2 weighted sequences. The two independent samples t-test and principal component analysis (PCA) were used for feature selection, data dimension reduction, and radiomics signature building. Next, the radiomics signature was put in five classification models for exploring the best classifier with superior identification performance. Multivariate logistic regression analysis was then used to establish a radiomic-clinical model containing radiomics and hematological features, and the model was presented as a nomogram. The performance of the radiomics-clinical model was assessed by calibration curve, clinical effectiveness as well as internal validation.ResultsA total of 272 patients were included in this study: 201 with CS-PAs and 71 with CPs. These patients were randomized into training set (n=182) and test set (n=90). The radiomics signature, which consisted of 18 features after dimensionality reduction, showed superior discrimination performance in 5 different classification models. The area under the curve (AUC) values of the training set and the test set obtained by the radiomics signature are 0.92 and 0.88 in the logistic regression model, 0.90 and 0.85 in the Ridge classifier, 0.88 and 0.82 in the stochastic gradient descent (SGD) classifier, 0.78 and 0.85 in the linear support vector classification (Linear SVC), 0.93 and 0.86 in the multilayers perceptron (MLP) classifier, respectively. The predictive factors of the nomogram included radiomic signature, age, WBC count, and FIB. The nomogram showed good discrimination performance (with an AUC of 0.93 in the training set and 0.90 in the test set) and good calibration. Moreover, decision curve analysis (DCA) demonstrated satisfactory clinical effectiveness of the proposed radiomic-clinical nomogram.ConclusionsA personalized nomogram containing radiomics signature and blood indices was proposed in this study. This nomogram is simple yet effective in differentiating between CS-PAs and CPs and thus can be used in routine clinical practice.

One of the most distinct places the politics of affect have played out in Australia of late has been in the struggles around the mandatory detention of undocumented migrants; specifically, in arguments about the amount of compassion border control practices should or do entail. Indeed, in 1990 the newly established Joint Standing Committee on Migration (JSCM) published its first report, Illegal Entrants in Australia: Balancing Control and Compassion. Contemporaneous, thought not specifically concerned, with the establishment of mandatory detention for asylum seekers, this report helped shape the context in which detention policy developed. As the Bureau of Immigration and Population Research put it in their summary of the report, “the Committee endorsed a tough stance regarding all future illegal entrants but a more compassionate stance regarding those now in Australia” (24). It would be easy now to frame this report in a narrative of decline. Under a Labor government the JSCM had at least some compassion to offer; since the 1996 conservative Coalition victory any such compassion has been in increasingly short supply, if not an outright political liability. This is a popular narrative for those clinging to the belief that Labor is still, in some residual sense, a social-democratic party. I am more interested in the ways the report’s subtitle effectively predicted the framework in which debates about detention have since been constructed: control vs. compassion, with balance as the appropriate mediating term. Control and compassion are presented as the poles of a single governmental project insofar as they can be properly calibrated; but at the same time, compassion is presented as an external balance to the governmental project (control), an extra-political restriction of the political sphere. This is a very formal way to put it, but it reflects a simple, vernacular theory that circulates widely among refugee activists. It is expressed with concision in Peter Mares’ groundbreaking book on detention centres, Borderlines, in the chapter title “Compassion as a vice”. Compassion remains one of the major themes and demands of Australian refugee advocates. They thematise compassion not only for the obvious reasons that mandatory detention involves a devastating lack thereof, and that its critics are frequently driven by intense emotional connections both to particular detainees and TPV holders and, more generally, to all who suffer the effects of Australian border control. There is also a historical or conjunctural element: as Ghassan Hage has written, for the last ten years or so many forms of political opposition in Australia have organised their criticisms in terms of “things like compassion or hospitality rather than in the name of a left/right political divide” (7). This tendency is not limited to any one group; it ranges across the spectrum from Liberal Party wets to anarchist collectives, via dozens of organised groups and individuals varying greatly in their political beliefs and intentions. In this context, it would be tendentious to offer any particular example(s) of compassionate activism, so let me instead cite a complaint. In November 2002, the conservative journal Quadrant worried that morality and compassion “have been appropriated as if by right by those who are opposed to the government’s policies” on border protection (“False Refugees” 2). Thus, the right was forced to begin to speak the language of compassion as well. The Department of Immigration, often considered the epitome of the lack of compassion in Australian politics, use the phrase “Australia is a compassionate country, but…” so often they might as well inscribe it on their letterhead. Of course this is hypocritical, but it is not enough to say the right are deforming the true meaning of the term. The point is that compassion is a contested term in Australian political discourse; its meanings are not fixed, but constructed and struggled over by competing political interests. This should not be particularly surprising. Stuart Hall, following Ernesto Laclau and others, famously argued that no political term has an intrinsic meaning. Meanings are produced – articulated, and de- or re-articulated – through a dynamic and partisan “suturing together of elements that have no necessary or eternal belongingness” (10). Compassion has many possible political meanings; it can be articulated to diverse social (and antisocial) ends. If I was writing on the politics of compassion in the US, for example, I would be talking about George W. Bush’s slogan of “compassionate conservatism”, and whatever Hannah Arendt meant when she argued that “the passion of compassion has haunted and driven the best men [sic] of all revolutions” (65), I think she meant something very different by the term than do, say, Rural Australians for Refugees. As Lauren Berlant has written, “politicized feeling is a kind of thinking that too often assumes the obviousness of the thought it has” (48). Hage has also opened this assumed obviousness to question, writing that “small-‘l’ liberals often translate the social conditions that allow them to hold certain superior ethical views into a kind of innate moral superiority. They see ethics as a matter of will” (8-9). These social conditions are complex – it isn’t just that, as some on the right like to assert, compassion is a product of middle class comfort. The actual relations are more dynamic and open. Connections between class and occupational categories on the one hand, and social attitudes and values on the other, are not given but constructed, articulated and struggled over. As Hall put it, the way class functions in the distribution of ideologies is “not as the permanent class-colonization of a discourse, but as the work entailed in articulating these discourses to different political class practices” (139). The point here is to emphasise that the politics of compassion are not straightforward, and that we can recognise and affirm feelings of compassion while questioning the politics that seem to emanate from those feelings. For example, a politics that takes compassion as its basis seems ill-suited to think through issues it can’t put a human face to – that is, the systematic and structural conditions for mandatory detention and border control. Compassion’s political investments accrue to specifiable individuals and groups, and to the harms done to them. This is not, as such, a bad thing, particularly if you happen to be a specifiable individual to whom a substantive harm has been done. But compassion, going one by one, group by group, doesn’t cope well with situations where the form of the one, or the form of the disadvantaged minority, constitutes not only a basis for aid or emancipation, but also violently imposes particular ideas of modern western subjectivity. How does this violence work? I want to answer by way of the story of an Iranian man who applied for asylum in Australia in 2004. In the available documents he is referred to as “the Applicant”. The Applicant claimed asylum based on his homosexuality, and his fear of persecution should he return to Iran. His asylum application was rejected by the Refugee Review Tribunal because the Tribunal did not believe he was really gay. In their decision they write that “the Tribunal was surprised to observe such a comprehensive inability on the Applicant’s part to identify any kind of emotion-stirring or dignity-arousing phenomena in the world around him”. The phenomena the Tribunal suggest might have been emotion-stirring for a gay Iranian include Oscar Wilde, Alexander the Great, Andre Gide, Greco-Roman wrestling, Bette Midler, and Madonna. I can personally think of much worse bases for immigration decisions than Madonna fandom, but there is obviously something more at stake here. (All quotes from the hearing are taken from the High Court transcript “WAAG v MIMIA”. I have been unable to locate a transcript of the original RRT decision, and so far as I know it remains unavailable. Thanks to Mark Pendleton for drawing my attention to this case, and for help with references.) Justice Kirby, one of the presiding Justices at the Applicant’s High Court appeal, responded to this with the obvious point, “Madonna, Bette Midler and so on are phenomena of the Western culture. In Iran, where there is death for some people who are homosexuals, these are not in the forefront of the mind”. Indeed, the High Court is repeatedly critical and even scornful of the Tribunal decision. When Mr Bennett, who is appearing for the Minister for Immigration in the appeal begins his case, he says, “your Honour, the primary attack which seems to be made on the decision of the –”, he is cut off by Justice Gummow, who says, “Well, in lay terms, the primary attack is that it was botched in the Tribunal, Mr Solicitor”. But Mr Bennett replies by saying no, “it was not botched. If one reads the whole of the Tribunal judgement, one sees a consistent line of reasoning and a conclusion being reached”. In a sense this is true; the deep tragicomic weirdness of the Tribunal decision is based very much in the unfolding of a particular form of homophobic rationality specific to border control and refugee determination. There have been hundreds of applications for protection specifically from homophobic persecution since 1994, when the first such application was made in Australia. As of 2002, only 22% of those applications had been successful, with the odds stacked heavily against lesbians – only 7% of lesbian applicants were successful, against a shocking enough 26% of gay men (Millbank, Imagining Otherness 148). There are a number of reasons for this. The Tribunal has routinely decided that even if persecution had occurred on the basis of homosexuality, the Applicant would be able to avoid such persecution if she or he acted ‘discreetly’, that is, hid their sexuality. The High Court ruled out this argument in 2003, but the Tribunal maintains an array of effective techniques of homophobic exclusion. For example, the Tribunal often uses the Spartacus International Gay Guide to find out about local conditions of lesbian and gay life even though it is a tourist guide book aimed at Western gay men with plenty of disposable income (Dauvergne and Millbank 178-9). And even in cases which have found in favour of particular lesbian and gay asylum seekers, the Tribunal has often gone out of its way to assert that lesbians and gay men are, nevertheless, not the subjects of human rights. States, that is, violate no rights when they legislate against lesbian and gay identities and practices, and the victims of such legislation have no rights to protection (Millbank, Fear 252-3). To go back to Madonna. Bennett’s basic point with respect to the references to the Material Girl et al is that the Tribunal specifically rules them as irrelevant. Mr Bennett: The criticism which is being made concerns a question which the Tribunal asked and what is very much treated in the Tribunal’s judgement as a passing reference. If one looks, for example, at page 34 – Kirby J: This is where Oscar, Alexander and Bette as well as Madonna turn up? Mr Bennett: Yes. The very paragraph my learned friend relies on, if one reads the sentence, what the Tribunal is saying is, “I am not looking for these things”. Gummow J: Well, why mention it? What sort of training do these people get in decision making before they are appointed to this body, Mr Solicitor? Mr Bennett: I cannot assist your Honour on that. Gummow J: No. Well, whatever it is, what happened here does not speak highly of the results of it. To gloss this, Bennett argues that the High Court are making too much of an irrelevant minor point in the decision. Mr Bennett: One would think [based on the High Court’s questions] that the only things in this judgement were the throwaway references saying, “I wasn’t looking for an understanding of Oscar Wilde”, et cetera. That is simply, when one reads the judgement as a whole, not something which goes to the centre at all… There is a small part of the judgement which could be criticized and which is put, in the judgement itself, as a subsidiary element and prefaced with the word “not”. Kirby J: But the “not” is a bit undone by what follows when I think Marilyn [Monroe] is thrown in. Mr Bennett: Well, your Honour, I am not sure why she is thrown in. Kirby J: Well, that is exactly the point. Mr Bennett holds that, as per Wayne’s World, the word “not” negates any clause to which it is attached. Justice Kirby, on the other hand, feels that this “not” comes undone, and that this undoing – and the uncertainty that accrues to it – is exactly the point. But the Tribunal won’t be tied down on this, and makes use of its “not” to hold gay stereotypes at arm’s length – which is still, of course, to hold them, at a remove that will insulate homophobia against its own illegitimacy. The Tribunal defends itself against accusations of homophobia by announcing specifically and repeatedly, in terms that consciously evoke culturally specific gay stereotypes, that it is not interested in those stereotypes. This unconvincing alibi works to prevent any inconvenient accusations of bias from butting in on the routine business of heteronormativity. Paul Morrison has noted that not many people will refuse to believe you’re gay: “Claims to normativity are characteristically met with scepticism. Only parents doubt confessions of deviance” (5). In this case, it is not a parent but a paternalistic state apparatus. The reasons the Tribunal did not believe the applicant [were] (a) because of “inconsistencies about the first sexual experience”, (b) “the uniformity of relationships”, (c) the “absence of a “gay” circle of friends”, (d) “lack of contact with the “gay” underground” and [(e)] “lack of other forms of identification”. Of these the most telling, I think, are the last three: a lack of gay friends, of contact with the gay underground, or of unspecified other forms of identification. What we can see here is that even if the Tribunal isn’t looking for the stereotypical icons of Western gay culture, it is looking for the characteristic forms of Western gay identity which, as we know, are far from universal. The assumptions about the continuities between sex acts and identities that we codify with names like lesbian, gay, homosexual and so on, often very poorly translate the ways in which non-Western populations understand and describe themselves, if they translate them at all. Gayatri Gopinath, for example, uses the term “queer diaspor[a]... in contradistinction to the globalization of “gay” identity that replicates a colonial narrative of development and progress that judges all other sexual cultures, communities, and practices against a model of Euro-American sexual identity” (11). I can’t assess the accuracy of the Tribunal’s claims regarding the Applicant’s social life, although I am inclined to scepticism. But if the Applicant in this case indeed had no gay friends, no contact with the gay underground and no other forms of identification with the big bad world of gaydom, he may obviously, nevertheless, have been a Man Who Has Sex With Men, as they sometimes say in AIDS prevention work. But this would not, either in the terms of Australian law or the UN Convention, qualify him as a refugee. You can only achieve refugee status under the terms of the Convention based on membership of a ‘specific social group’. Lesbians and gay men are held to constitute such groups, but what this means is that there’s a certain forcing of Western identity norms onto the identity and onto the body of the sexual other. This shouldn’t read simply as a moral point about how we should respect diversity. There’s a real sense that our own lives as political and sexual beings are radically impoverished to the extent we fail to foster and affirm non-Western non-heterosexualities. There’s a sustaining enrichment that we miss out on, of course, in addition to the much more serious forms of violence others will be subject to. And these are kinds of violence as well as forms of enrichment that compassionate politics, organised around the good refugee, just does not apprehend. In an essay on “The politics of bad feeling”, Sara Ahmed makes a related argument about national shame and mourning. “Words cannot be separated from bodies, or other signs of life. So the word ‘mourns’ might get attached to some subjects (some more than others represent the nation in mourning), and it might get attached to some objects (some losses more than others may count as losses for this nation)” (73). At one level, these points are often made with regard to compassion, especially as it is racialised in Australian politics; for example, that there would be a public outcry were we to detain hypothetical white boat people. But Ahmed’s point stretches further – in the necessary relation between words and bodies, she asks not only which bodies do the describing and which are described, but which are permitted a relation to language at all? If “words cannot be separated from bodies”, what happens to those bodies words fail? The queer diasporic body, so reductively captured in that phrase, is a case in point. How do we honour its singularity, as well as its sociality? How do we understand the systematicity of the forces that degrade and subjugate it? What do the politics of compassion have to offer here? It’s easy for the critic or the cynic to sneer at such politics – so liberal, so sentimental, so wet – or to deconstruct them, expose “the violence of sentimentality” (Berlant 62), show “how compassion towards the other’s suffering might sustain the violence of appropriation” (Ahmed 74). These are not moves I want to make. A guiding assumption of this essay is that there is never a unilinear trajectory between feelings and politics. Any particular affect or set of affects may be progressive, reactionary, apolitical, or a combination thereof, in a given situation; compassionate politics are no more necessarily bad than they are necessarily good. On the other hand, “not necessarily bad” is a weak basis for a political movement, especially one that needs to understand and negotiate the ways the enclosures and borders of late capitalism mass-produce bodies we can’t put names to, people outside familiar and recognisable forms of identity and subjectivity. As Etienne Balibar has put it, “in utter disregard of certain borders – or, in certain cases, under covers of such borders – indefinable and impossible identities emerge in various places, identities which are, as a consequence, regarded as non-identities. However, their existence is, none the less, a life-and-death question for large numbers of human beings” (77). Any answer to that question starts with our compassion – and our rage – at an unacceptable situation. But it doesn’t end there. References Ahmed, Sara. “The Politics of Bad Feeling.” Australian Critical Race and Whiteness Studies Association Journal 1.1 (2005): 72-85. Arendt, Hannah. On Revolution. Harmondsworth: Penguin, 1973. Balibar, Etienne. We, the People of Europe? Reflections on Transnational Citizenship. Trans. James Swenson. Princeton: Princeton UP, 2004. Berlant, Lauren. “The Subject of True Feeling: Pain, Privacy and Politics.” Cultural Studies and Political Theory. Ed. Jodi Dean. Ithaca and Cornell: Cornell UP, 2000. 42-62. Bureau of Immigration and Population Research. Illegal Entrants in Australia: An Annotated Bibliography. Canberra: Australian Government Publishing Service, 1994. Dauvergne, Catherine and Jenni Millbank. “Cruisingforsex.com: An Empirical Critique of the Evidentiary Practices of the Australian Refugee Review Tribunal.” Alternative Law Journal 28 (2003): 176-81. “False Refugees and Misplaced Compassion” Editorial. Quadrant 390 (2002): 2-4. Hage, Ghassan. Against Paranoid Nationalism: Searching for Hope in a Shrinking Society. Annandale: Pluto, 2003. Hall, Stuart. The Hard Road to Renewal: Thatcherism and the Crisis of the Left. London: Verso, 1988. Joint Standing Committee on Migration. Illegal Entrants in Australia: Balancing Control and Compassion. Canberra: The Committee, 1990. Mares, Peter. Borderline: Australia’s Treatment of Refugees and Asylum Seekers. Sydney: UNSW Press, 2001. Millbank, Jenni. “Imagining Otherness: Refugee Claims on the Basis of Sexuality in Canada and Australia.” Melbourne University Law Review 26 (2002): 144-77. ———. “Fear of Persecution or Just a Queer Feeling? Refugee Status and Sexual orientation in Australia.” Alternative Law Journal 20 (1995): 261-65, 299. Morrison, Paul. The Explanation for Everything: Essays on Sexual Subjectivity. New York: New York UP, 2001. Pendleton, Mark. “Borderline.” Bite 2 (2004): 3-4. “WAAG v MIMIA [2004]. HCATrans 475 (19 Nov. 2004)” High Court of Australia Transcripts. 2005. 17 Oct. 2005 http://www.austlii.edu.au/au/other/HCATrans/2004/475.html>. Citation reference for this article MLA Style McGrath, Shane. "Compassionate Refugee Politics?." M/C Journal 8.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0512/02-mcgrath.php>. APA Style McGrath, S. (Dec. 2005) "Compassionate Refugee Politics?," M/C Journal, 8(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0512/02-mcgrath.php>.

If I find out that you have bought a $90 red light sabre, Tara, well there's going to be trouble. -- Kevin Brabazon A few Saturdays ago, my 71-year old father tried to convince me of imminent responsibilities. As I am considering the purchase of a house, there are mortgages, bank fees and years of misery to endure. Unfortunately, I am not an effective Big Picture Person. The lure of the light sabre is almost too great. For 30 year old Generation Xers like myself, it is more than a cultural object. It is a textual anchor, and a necessary component to any future history of the present. Revelling in the aura of the Australian release for Star Wars: The Phantom Menace, this paper investigates popular memory, an undertheorised affiliation between popular culture and cultural studies.1 The excitement encircling the Star Wars prequel has been justified in terms of 'hype' or marketing. Such judgements frame the men and women cuing for tickets, talking Yodas and light sabres as fools or duped souls who need to get out more. My analysis explores why Star Wars has generated this enthusiasm, and how cultural studies can mobilise this passionate commitment to consider notions of popularity, preservation and ephemerality. We'll always have Tattooine. Star Wars has been a primary popular cultural social formation for a generation. The stories of Luke Skywalker, Princess Leia, Han Solo, Chewbacca, Darth Vader, Yoda, C-3PO and R2D2 offer an alternative narrative for the late 1970s and 1980s. It was a comfort to have the Royal Shakespearian tones of Alec Guinness confirming that the Force would be with us, through economic rationalism, unemployment, Pauline Hanson and Madonna discovering yoga. The Star Wars Trilogy, encompassing A New Hope, The Empire Strikes Back and Return of the Jedi, was released between 1977 and 1983. These films have rarely slipped from public attention, being periodically 'brought back' through new cinematic and video releases. The currency of Star Wars is matched with the other great popular cultural formations of the post-war period: the James Bond series and Star Trek. One reason for the continued success of these programmes is that other writers, film makers and producers cannot leave these texts alone. Bond survives not only through Pierce Brosnan's good looks, but the 'Hey Baby' antics of Austin Powers. Star Trek, through four distinct series, has become an industry that will last longer than Voyager's passage back from the Delta Quadrant. Star Wars, perhaps even more effectively than the other popular cultural heavyweights, has enmeshed itself into other filmic and televisual programming. Films like Spaceballs and television quizzes on Good News Week keep the knowledge system and language current and pertinent.2 Like Umberto Eco realised of Casablanca, Star Wars is "a living example of living textuality" (199). Both films are popular because of imperfections and intertextual archetypes, forming a filmic quilt of sensations and affectivities. Viewers are aware that "the cliches are talking among themselves" (Eco 209). As these cinematic texts move through time, the depth and commitment of these (con)textual dialogues are repeated and reinscribed. To hold on to a memory is to isolate a moment or an image and encircle it with meaning. Each day we experience millions of texts: some are remembered, but most are lost. Some popular cultural texts move from ephemera to popular memory to history. In moving beyond individual reminiscences -- the personal experiences of our lifetime -- we enter the sphere of popular culture. Collective or popular memory is a group or community experience of a textualised reality. For example, during the Second World War, there were many private experiences, but certain moments arch beyond the individual. Songs by Vera Lynn are fully textualised experiences that become the fodder for collective memory. Similarly, Star Wars provides a sense-making mechanism for the 1980s. Like all popular culture, these texts allow myriad readership strategies, but there is collective recognition of relevance and importance. Popular memory is such an important site because it provides us, as cultural critics, with a map of emotionally resonant sites of the past, moments that are linked with specific subjectivities and a commonality of expression. While Star Wars, like all popular cultural formations, has a wide audience, there are specific readings that are pertinent for particular groups. To unify a generation around cultural texts is an act of collective memory. As Harris has suggested, "sometimes, youth does interesting things with its legacy and creatively adapts its problematic into seemingly autonomous cultural forms" (79). Generation X refers to an age cohort born between the mid-1960s and the mid-1970s. Finally cultural studies theorists have found a Grail subculture. Being depthless, ambivalent, sexually repressed and social failures, Xers are a cultural studies dream come true. They were the children of the media revolution. Star Wars is integral to this textualised database. A fan on the night of the first screening corrected a journalist: "we aren't Generation X, we are the Star Wars generation" (Brendon, in Miller 9). An infatuation and reflexivity with the media is the single framework of knowledge in which Xers operate. This shared understanding is the basis for comedy, and particularly revealed (in Australia) in programmes like The Panel and Good News Week. Television themes, lines of film dialogue and contemporary news broadcasts are the basis of the game show. The aesthetics of life transforms television into a real. Or, put another way, "individual lives may be fragmented and confused but McDonald's is universal" (Hopkins 17). A group of textual readers share a literacy, a new way of reading the word and world of texts. Nostalgia is a weapon. The 1990s has been a decade of revivals: from Abba to skateboards, an era of retro reinscription has challenged linear theories of history and popular culture. As Timothy Carter reveals, "we all loved the Star Wars movies when we were younger, and so we naturally look forward to a continuation of those films" (9). The 1980s has often been portrayed as a bad time, of Thatcher and Reagan, cold war brinkmanship, youth unemployment and HIV. For those who were children and (amorphously phrased) 'young adults' of this era, the popular memory is of fluorescent fingerless gloves, Ray Bans, 'Choose Life' t-shirts and bubble skirts. It was an era of styling mousse, big hair, the Wham tan, Kylie and Jason and Rick Astley's dancing. Star Wars action figures gave the films a tangibility, holding the future of the rebellion in our hands (literally). These memories clumsily slop into the cup of the present. The problem with 'youth' is that it is semiotically too rich: the expression is understood, but not explained, by discourses as varied as the educational system, family structures, leisure industries and legal, medical and psychological institutions. It is a term of saturation, where normality is taught, and deviance is monitored. All cultural studies theorists carry the baggage of the Birmingham Centre into any history of youth culture. The taken-for-granted 'youth as resistance' mantra, embodied in Resistance through Rituals and Subculture: The Meaning of Style, transformed young people into the ventriloquist's puppet of cultural studies. The strings of the dancing, smoking, swearing and drinking puppet took many years to cut. The feminist blade of Angela McRobbie did some damage to the fraying filaments, as did Dick Hebdige's reflexive corrections in Hiding in the Light. However, the publications, promotion and pedagogy of Gen X ended the theoretical charade. Gen X, the media sophisticates, played with popular culture, rather than 'proper politics.' In Coupland's Generation X, Claire, one of the main characters believed that "Either our lives become stories, or there's just no way to get through them." ... We know that this is why the three of us left our lives behind us and came to the desert -- to tell stories and to make our own lives worthwhile tales in the process. (8) Television and film are part of this story telling process. This intense connection generated an ironic and reflexive literacy in the media. Television became the basis for personal pleasures and local resistances, resulting in a disciplined mobilisation of popular cultural surfaces. Even better than the real thing. As the youngest of Generation Xers are now in their late twenties, they have moved from McJobs to careers. Robert Kizlik, a teacher trainer at an American community college expressed horror as the lack of 'commonsensical knowledge' from his new students. He conducted a survey for teachers training in the social sciences, assessing their grasp of history. There was one hundred percent recognition of such names as Madonna, Mike Tyson, and Sharon Stone, but they hardly qualify as important social studies content ... . I wondered silently just what it is that these students are going to teach when they become employed ... . The deeper question is not that we have so many high school graduates and third and fourth year college students who are devoid of basic information about American history and culture, but rather, how, in the first place, these students came to have the expectations that they could become teachers. (n. pag.) Kizlik's fear is that the students, regardless of their enthusiasm, had poor recognition of knowledge he deemed significant and worthy. His teaching task, to convince students of the need for non-popular cultural knowledges, has resulted in his course being termed 'boring' or 'hard'. He has been unable to reconcile the convoluted connections between personal stories and televisual narratives. I am reminded (perhaps unhelpfully) of one of the most famous filmic teachers, Mr Holland. Upon being attacked by his superiors for using rock and roll in his classes, he replied that he would use anything to instil in his students a love of music. Working with, rather than against, popular culture is an obvious pedagogical imperative. George Lucas has, for example, confirmed the Oprahfied spirituality of the current age. Obviously Star Wars utilises fables, myths3 and fairy tales to summon the beautiful Princess, the gallant hero and the evil Empire, but has become something more. Star Wars slots cleanly into an era of Body Shop Feminism, John Gray's gender politics and Rikki Lake's relationship management. Brian Johnson and Susan Oh argued that the film is actually a new religion. A long time ago in a galaxy far far away -- late 1970s California -- the known universe of George Lucas came into being. In the beginning, George created Star Wars. And the screen was without form, and void. And George said, 'Let there be light', and there was Industrial Light and Magic. And George divided the light from the darkness, with light sabres, and called the darkness the Evil Empire.... And George saw that it was good. (14) The writers underestimate the profound emotional investment placed in the trilogy by millions of people. Genesis narratives describe the Star Wars phenomenon, but do not analyse it. The reason why the films are important is not only because they are a replacement for religion. Instead, they are an integrated component of popular memory. Johnson and Oh have underestimated the influence of pop culture as "the new religion" (14). It is not a form of cheap grace. The history of ideas is neither linear nor traceable. There is no clear path from Plato to Prozac or Moses to Mogadon. Obi-Wan Kenobi is not a personal trainer for the ailing spirituality of our age. It was Ewan McGregor who fulfilled the Xer dream to be the young Obi Wan. As he has stated, "there is nothing cooler than being a Jedi knight" (qtd. in Grant 15). Having survived feet sawing in Shallow Grave and a painfully large enema in Trainspotting, there are few actors who are better prepared to carry the iconographic burden of a Star Wars prequel. Born in 1971, he is the Molly Ringwall of the 1990s. There is something delicious about the new Obi Wan, that hails what Hicks described as "a sense of awareness and self- awareness, of detached observation, of not taking things seriously, and a use of subtle dry humour" (79). The metaphoric light sabre was passed to McGregor. The pull of the dark side. When fans attend The Phantom Menace, they tend to the past, as to a loved garden. Whether this memory is a monument or a ruin depends on the preservation of the analogue world in the digital realm. The most significant theoretical and discursive task in the present is to disrupt the dual ideologies punctuating the contemporary era: inevitable technological change and progress.4 Only then may theorists ponder the future of a digitised past. Disempowered groups, who were denied a voice and role in the analogue history of the twentieth century, will have inequalities reified and reinforced through the digital archiving of contemporary life. The Web has been pivotal to the new Star Wars film. Lucasfilm has an Internet division and an official Website. Between mid November and May, this site has been accessed twenty million times (Gallott 15). Other sites, such as TheForce.net and Countdown to Star Wars, are a record of the enthusiasm and passion of fans. As Daniel Fallon and Matthew Buchanan have realised, "these sites represent the ultimate in film fandom -- virtual communities where like-minded enthusiasts can bathe in the aura generated by their favourite masterpiece" (27). Screensavers, games, desktop wallpaper, interviews and photo galleries have been downloaded and customised. Some ephemeral responses to The Phantom Menace have been digitally recorded. Yet this moment of audience affectivity will be lost without a consideration of digital memory. The potentials and problems of the digital and analogue environments need to be oriented into critical theories of information, knowledge, entertainment and pleasure. The binary language of computer-mediated communication allows a smooth transference of data. Knowledge and meaning systems are not exchanged as easily. Classifying, organising and preserving information make it useful. Archival procedures have been both late and irregular in their application.5 Bocher and Ihlenfeldt assert that 2500 new web sites are coming on-line every day ("A Higher Signal-to-Noise Ratio"). The difficulties and problems confronting librarians and archivists who wish to preserve digital information is revealed in the Australian government's PADI (Preserving Access to Digital Information) Site. Compared with an object in a museum which may lie undisturbed for years in a storeroom, or a book on a shelf, or even Egyptian hieroglyd on the wall of a tomb, digital information requires much more active maintenance. If we want access to digital information in the future, we must plan and act now. (PADI, "Why Preserve Access to Digital Information?") phics carve The speed of digitisation means that responsibility for preserving cultural texts, and the skills necessary to enact this process, is increasing the pressure facing information professionals. An even greater difficulty when preserving digital information is what to keep, and what to release to the ephemeral winds of cyberspace. 'Qualitative criteria' construct an historical record that restates the ideologies of the powerful. Concerns with quality undermine the voices of the disempowered, displaced and decentred. The media's instability through technological obsolescence adds a time imperative that is absent from other archival discussions.6 While these problems have always taken place in the analogue world, there was a myriad of alternative sites where ephemeral material was stored, such as the family home. Popular cultural information will suffer most from the 'blind spots' of digital archivists. While libraries rarely preserve the ephemera of a time, many homes (including mine) preserve the 'trash' of a culture. A red light sabre, toy dalek, Duran Duran posters and a talking Undertaker are all traces of past obsessions and fandoms. Passion evaporates, and interests morph into new trends. These objects remain in attics, under beds, in boxes and sheds throughout the world. Digital documents necessitate a larger project of preservation, with great financial (and spatial) commitments of technology, software and maintenance. Libraries rarely preserve the ephemera -- the texture and light -- of the analogue world. The digital era reduces the number of fan-based archivists. Subsequently forfeited is the spectrum of interests and ideologies that construct the popular memory of a culture. Once bits replace atoms, the recorded world becomes structured by digital codes. Only particular texts will be significant enough to store digitally. Samuel Florman stated that "in the digital age nothing need be lost; do we face the prospect of drowning in trivia as the generations succeed each other?" (n. pag.) The trivia of academics may be the fodder (and pleasures) of everyday life. Digitised preservation, like analogue preservation, can never 'represent' plural paths through the past. There is always a limit and boundary to what is acceptable obsolescence. The Star Wars films suggests that "the whole palette of digital technology is much more subtle and supple; if you can dream it, you can see it" (Corliss 65). This film will also record how many of the dreams survive and are archived. Films, throughout the century, have changed the way in which we construct and remember the past. They convey an expressive memory, rather than an accurate history. Certainly, Star Wars is only a movie. Yet, as Rushkoff has suggested, "we have developed a new language of references and self-references that identify media as a real thing and media history as an actual social history" (32). The build up in Australia to The Phantom Menace has been wilfully joyful. This is a history of the present, a time which I know will, in retrospect, be remembered with great fondness. It is a collective event for a generation, but it speaks to us all in different ways. At ten, it is easy to be amazed and enthralled at popular culture. By thirty, it is more difficult. When we see Star Wars, we go back to visit our memories. With red light sabre in hand, we splice through time, as much as space. Footnotes The United States release of the film occurred on 19 May 1999. In Australia, the film's first screenings were on 3 June. Many cinemas showed The Phantom Menace at 12:01 am, (very) early Thursday morning. The three main players of the GNW team, Paul McDermott, Mikey Robbins and Julie McCrossin, were featured on the cover of Australia's Juice magazine in costumes from The Phantom Menace, being Obi-Wan, Yoda and Queen Amidala respectively. Actually, the National Air and Space Museum had a Star Wars exhibition in 1997, titled "Star Wars: The Magic of Myth". For example, Janet Collins, Michael Hammond and Jerry Wellington, in Teaching and Learning with the Media, stated that "the message is simple: we now have the technology to inform, entertain and educate. Miss it and you, your family and your school will be left behind" (3). Herb Brody described the Net as "an overstuffed, underorganised attic full of pictures and documents that vary wildly in value", in "Wired Science". The interesting question is, whose values will predominate when the attic is being cleared and sorted? This problem is extended because the statutory provision of legal deposit, which obliges publishers to place copies of publications in the national library of the country in which the item is published, does not include CD-ROMs or software. References Bocher, Bob, and Kay Ihlenfeldt. "A Higher Signal-to-Noise Ratio: Effective Use of WebSearch Engines." State of Wisconsin Department of Public Instruction Website. 13 Mar. 1998. 15 June 1999 <http://www.dpi.state.wi.us/dpi/dlcl/lbstat/search2.php>. Brody, Herb. "Wired Science." Technology Review Oct. 1996. 15 June 1999 <http://www.techreview.com/articles/oct96/brody.php>. Carter, Timothy. "Wars Weary." Cinescape 39 (Mar./Apr. 1999): 9. Collins, Janet, Michael Hammond, and Jerry Wellington. Teaching and Learning with Multimedia. London: Routledge, 1997. Corliss, Richard. "Ready, Set, Glow!" Time 18 (3 May 1999): 65. Count Down to Star Wars. 1999. 15 June 1999 <http://starwars.countingdown.com/>. Coupland, Douglas. Generation X. London: Abacus, 1991. Eco, Umberto. Travels in Hyper-Reality. London: Picador, 1987. Fallon, Daniel, and Matthew Buchanan. "Now Screening." Australian Net Guide 4.5 (June 1999): 27. Florman, Samuel. "From Here to Eternity." MIT's Technology Review 100.3 (Apr. 1997). Gallott, Kirsten. "May the Web Be with you." Who Weekly 24 May 1999: 15. Grant, Fiona. "Ewan's Star Soars!" TV Week 29 May - 4 June 1999: 15. Hall, Stuart, and Tony Jefferson, eds. Resistance through Rituals. London: Hutchinson, 1976. Harris, David. From Class Struggle to the Politics of Pleasure: the Effects of Gramscianism on Cultural Studies. London: Routledge, 1992. Hebdige, Dick. Hiding in the Light. London: Routledge, 1988. Hopkins, Susan. "Generation Pulp." Youth Studies Australia Spring 1995. Johnson, Brian, and Susan Oh. "The Second Coming: as the Newest Star Wars Film Illustrates, Pop Culture Has Become a New Religion." Maclean's 24 May 1999: 14-8. Juice 78 (June 1999). Kizlik, Robert. "Generation X Wants to Teach." International Journal of Instructional Media 26.2 (Spring 1999). Lucasfilm Ltd. Star Wars: Welcome to the Official Site. 1999. 15 June 1999 <http://www.starwars.com/>. Miller, Nick. "Generation X-Wing Fighter." The West Australian 4 June 1999: 9. PADI. "What Digital Information Should be Preserved? Appraisal and Selection." Preserving Access to Digital Information (PADI) Website. 11 March 1999. 15 June 1999 <http://www.nla.gov.au/padi/what.php>. PADI. "Why Preserve Access to Digital Information?" Preserving Access to Digital Information (PADI) Website. <http://www.nla.gov.au/padi/why.php>. Rushkoff, Douglas. Media Virus. Sydney: Random House, 1994. Citation reference for this article MLA style: Tara Brabazon. "A Red Light Sabre to Go, and Other Histories of the Present." M/C: A Journal of Media and Culture 2.4 (1999). [your date of access] <http://www.uq.edu.au/mc/9906/sabre.php>. Chicago style: Tara Brabazon, "A Red Light Sabre to Go, and Other Histories of the Present," M/C: A Journal of Media and Culture 2, no. 4 (1999), <http://www.uq.edu.au/mc/9906/sabre.php> ([your date of access]). APA style: Tara Brabazon. (1999) A red light sabre to go, and other histories of the present. M/C: A Journal of Media and Culture 2(4). <http://www.uq.edu.au/mc/9906/sabre.php> ([your date of access]).

One of the first challenges faced by new Australian Prime Minister, Kevin Rudd, was what to do with the former government’s controversial citizenship test. While a quick evaluation of the test shows that 93 percent of those who have sat it ‘passed’ (Hoare), most media controversy has focussed less on the validity of such a test than whether questions relating to Australian cricketing legend, Don Bradman, are appropriate (Hawley). While the citizenship test seems nothing more that a crude and populist measure imposed by the former Howard government in its ongoing nationalistic agenda, which included paying schools to raise the Australian flag (“PM Unfurls Flag”), its imposition seems a timely reminder of the challenge of understanding citizenship today. For as the demographic structures around us continue to change, so must our understandings of ‘citizenship’. More importantly, this fluid understanding of citizenship is not limited to academics, and policy-makers, but new technologies, the processes of globalisation including a globalised media, changing demographic patterns including migration, as well as environmental challenges that place pressure on limited resources is altering the citizens understanding of their own role as well as those around them. This paper aims to sketch out a proposed new research agenda that seeks to investigate this fluid and heterogenous nature of citizenship. The focus of the research has so far been Sydney and is enveloped by a broader aim of promoting an increased level of citizen engagement both within formal and informal political structures. I begin by sketching the complex nature of Sydney before presenting some initial research findings. Sydney – A Complex City The so-called ‘emerald city’ of Sydney has been described in many ways: from a ‘global’ city (Fagan, Dowling and Longdale 1) to an ‘angry’ city (Price 16). Sarah Price’s investigative article included research from the University of Western Sydney’s Centre of Culture Research, the Bureau of Crime Statistics and interviews with Tony Grabs, the director of trauma at St Vincent’s Hospital in inner city Darlinghurst. Price found that both injuries from alcohol and drug-related violence had risen dramatically over the last few years and seemed to be driven by increasing frustrations of a city that is perceived to be lacking appropriate infrastructure and rising levels of personal and household debt. Sydney’s famous harbour and postcard landmarks are surrounded by places of controversy and poverty, with residents of very backgrounds living in close proximity: often harmoniously and sometimes less so. According to recent research by Griffith University’s Urban Research Program, the city is becoming increasingly polarised, with the wealthiest enjoying high levels of access to amenities while other sections of the population experiencing increasing deprivation (Frew 7). Sydney is often segmented into different regions: the growth corridors of the western suburbs which include the ‘Aspirational class’; the affluent eastern suburb; the southern beachside suburbs surrounding Cronulla affectionately known by local residents as ‘the Shire’, and so on. This, however, hides that fact that these areas are themselves complex and heterogenous in character (Frew 7). As a result, the many clichés associated with such segments lead to an over simplification of regional characteristics. The ‘growth corridors’ of Western Sydney, for example, have, in recent times, become a focal point of political and social commentary. From the rise of the ‘Aspirational’ voter (Anderson), seen to be a key ‘powerbroker’ in federal and state politics, to growing levels of disenfranchised young people, this region is multifaceted and should not be simplified. These areas often see large-scale, private housing estates; what Brendan Gleeson describes as ‘privatopias’, situated next to rising levels of homelessness (“What’s Driving”): a powerful and concerning image that should not escape our attention. (Chamberlain and Mackenzie pay due attention to the issue in Homeless Careers.) It is also home to a growing immigrant population who often arrive as business migrants and as well as a rising refugee population traumatised by war and displacement (Collins 1). These growth corridors then, seem to simultaneously capture both the ambitions and the fears of Sydney. That is, they are seen as both areas of potential economic boom as well as social stress and potential conflict (Gleeson 89). One way to comprehend the complexity associated with such diversity and change is to reflect on the proximity of the twin suburbs of Macquarie Links and Macquarie Fields situated in Sydney’s south-western suburbs. Separated by the clichéd ‘railway tracks’, one is home to the growing Aspirational class while the other continues to be plagued by the stigma of being, what David Burchell describes as, a ‘dysfunctional dumping ground’ whose plight became national headlines during the riots in 2005. The riots were sparked after a police chase involving a stolen car led to a crash and the death of a 17 year-old and 19 year-old passengers. Residents blamed police for the deaths and the subsequent riots lasted for four nights – involving 150 teenagers clashing with New South Wales Police. The dysfunction, Burchell notes is seen in crime statistics that include 114 stolen cars, 227 burglaries, 457 cases of property damage and 279 assaults – all in 2005 alone. Interestingly, both these populations are surrounded by exclusionary boundaries: one because of the financial demands to enter the ‘Links’ estate, and the other because of the self-imposed exclusion. Such disparities not only provide challenges for policy makers generally, but also have important implications on the attitudes that citizens’ experience towards their relationship with each other as well as the civic institutions that are meant to represent them. This is particular the case if civic institutions are seen to either neglect or favour certain groups. This, in part, has given rise to what I describe here as a ‘citizenship surplus’ as well as a ‘citizenship deficit’. Research Agenda: Investigating Citizenship Surpluses and Deficits This changing city has meant that there has also been a change in the way that different groups interact with, and perceive, civic bodies. As noted, my initial research shows that this has led to the emergence of both citizenship surpluses and deficits. Though the concept of a ‘citizen deficits and surpluses’ have not emerged within the broader literature, there is a wide range of literature that discusses how some sections of the population lack of access to democratic processes. There are three broad areas of research that have emerged relevant here: citizenship and young people (see Arvanitakis; Dee); citizenship and globalisation (see Della Porta; Pusey); and citizenship and immigration (see Baldassar et al.; Gow). While a discussion of each of these research areas is beyond the scope of this paper, a regular theme is the emergence of a ‘democratic deficit’ (Chari et al. 422). Dee, for example, looks at how there exist unequal relationships between local and central governments, young people, communities and property developers in relation to space. Dee argues that this shapes social policy in a range of settings and contexts including their relationship with broader civic institutions and understandings of citizenship. Dee finds that claims for land use that involve young people rarely succeed and there is limited, if any, recourse to civic institutions. As such, we see a democratic deficit emerge because the various civic institutions involved fail in meeting their obligations to citizens. In addition, a great deal of work has emerged that investigates attempts to re-engage citizens through mechanisms to promote citizenship education and a more active citizenship which has also been accompanied by government programs with the same goals (See for example the Western Australian government’s ‘Citizenscape’ program ). For example Hahn (231) undertakes a comparative study of civic education in six countries (including Australia) and the policies and practices with respect to citizenship education and how to promote citizen activism. The results are positive, though the research was undertaken before the tumultuous events of the terrorist attacks in New York, the emergence of the ‘war on terror’ and the rise of ‘Muslim-phobia’. A gap rises, however, within the Australian literature when we consider both the fluid and heterogenous nature of citizenship. That is, how do we understand the relationship between these diverse groups living within such proximity to each other overlayed by changing migration patterns, ongoing globalised processes and changing political environments as well as their relations to civic institutions? Further, how does this influence the way individuals perceive their rights, expectations and responsibilities to the state? Given this, I believe that there is a need to understand citizenship as a fluid and heterogenous phenomenon that can be in surplus, deficit, progressive and reactionary. When discussing citizenship I am interested in how people perceive both their rights and responsibilities to civic institutions as well as to the residents around them. A second, obviously related, area of interest is ‘civic engagement’: that is, “the activities of people in the various organisations and associations that make up what scholars call ‘civil society’” (Portney and Leary 4). Before describing these categories in more detail, I would like to briefly outline the methodological processes employed thus far. Much of the research to this point is based on a combination of established literature, my informal discussions with citizen groups and my observations as ‘an activist.’ That is, over the last few years I have worked with a broad cross section of community-based organisations as well as specific individuals that have attempted to confront perceived injustices. I have undertaken this work as both an activist – with organisations such as Aid/Watch and Oxfam Australia – as well as an academic invited to share my research. This work has involved designing and implementing policy and advocacy strategies including media and public education programs. All interactions begin with a detailed discussion of the aims, resources, abilities and knowledge of the groups involved, followed by workshopping campaigning strategies. This has led to the publication of an ‘activist handbook’ titled ‘From Sitting on the Couch to Changing the World’, which is used to both draft the campaign aims as well as design a systematic strategy. (The booklet, which is currently being re-drafted, is published by Oxfam Australia and registered under a creative commons licence. For those interested, copies are available by emailing j.arvanitakis (at) uws.edu.au.) Much research is also sourced from direct feedback given by participants in reviewing the workshops and strategies The aim of tis paper then, is to sketch out the initial findings as well as an agenda for more formalised research. The initial findings have identified the heterogenous nature of citizenship that I have separated into four ‘citizenship spaces.’ The term space is used because these are not stable groupings as many quickly move between the areas identified as both the structures and personal situations change. 1. Marginalisation and Citizenship Deficit The first category is a citizenship deficit brought on by a sense of marginalisation. This is determined by a belief that it is pointless to interact with civic institutions, as the result is always the same: people’s opinions and needs will be ignored. Or in the case of residents from areas such as Macquarie Fields, the relationship with civic institutions, including police, is antagonistic and best avoided (White par. 21). This means that there is no connection between the population and the civic institutions around them – there is no loyalty or belief that efforts to be involved in political and civic processes will be rewarded. Here groups sense that they do not have access to political avenues to be heard, represented or demand change. This is leading to an experience of disconnection from political processes. The result is both a sense of disengagement and disempowerment. One example here emerged in discussions with protesters around the proposed development of the former Australian Defence Industry (ADI) site in St Marys, an outer-western suburb of Sydney. The development, which was largely approved, was for a large-scale housing estate proposed on sensitive bushlands in a locality that resident’s note is under-serviced in terms of public space. (For details of these discussions, see http://www.adisite.org/.) Residents often took the attitude that whatever the desire of the local community, the development would go ahead regardless. Those who worked at information booths during the resident protests informed me that the attitude was one best summarised by: “Why bother, we always get stuffed around any way.” This was confirmed by my own discussions with local residents – even those who joined the resident action group. 2. Privatisation and Citizenship Deficit This citizenship deficit not only applies to the marginalised, however, for there are also much wealthier populations who also appear to experience a deficit that results from a lack of access to civic institutions. This tends to leads to a privatisation of decision-making and withdrawal from the public arena as well as democratic processes. Consequently, the residents in the pockets of wealth may not be acting as citizens but more like consumers – asserting themselves in terms of Castells’s ‘collective consumption’ (par. 25). This citizenship deficit is brought on by ongoing privatisation. That is, there is a belief that civic institutions (including government bodies) are unable or at least unwilling to service the local community. As a result there is a tendency to turn to private suppliers and believe that individualisation is the best way to manage the community. The result is that citizens feel no connection to the civic institutions around them, not because there is no desire, but there are no services. This group of citizens has often been described as the ‘Aspirationals’ and are most often found in the growth corridors of Sydney. There is no reason to believe that this group is this way because of choice – but rather a failure by government authorities to service their needs. This is confirmed by research undertaken as early as 1990 which found that the residents now labelled Aspirational, were demanding access to public infrastructure services including public schools, but have been neglected by different levels of government. (This was clearly stated by NSW Labor MP for Liverpool, Paul Lynch, who argued for such services as a way to ensure a functioning community particularly for Western Sydney; NSWPD 2001.) As a result there is a reliance on private schools, neighbourhoods, transport and so on. Any ‘why bother’ attitude is thus driven by a lack of evidence that civic institutions can or are not willing to meet their needs. There is a strong sense of local community – but this localisation limited to others in the same geographical location and similar lifestyle. 3. Citizenship Surplus – Empowered Not Engaged The third space of citizenship is based on a ‘surplus’ even if there is limited or no political engagement. This group has quite a lot in common with the ‘Aspirationals’ but may come from areas that are higher serviced by civic institutions: the choice not to engage is therefore voluntary. There is a strong push for self-sufficiency – believing that their social capital, wealth and status mean that they do not require the services of civic institutions. While not antagonistic towards such institutions, there is often a belief is that the services provided by the private sector are ultimately superior to public ones. Consequently, they feel empowered through their social background but are not engaged with civic institutions or the political process. Despite this, my initial research findings show that this group has a strong connection to decision-makers – both politicians and bureaucrats. This lack of engagement changes if there is a perceived injustice to their quality of life or their values system – and hence should not be dismissed as NIMBYs (not in my backyard). They believe they have the resources to mobilise and demand change. I believe that we see this group materialise in mobilisations around proposed developments that threaten the perceived quality of life of the local environment. One example brought to my attention was the rapid response of local residents to the proposed White City development near Sydney’s eastern suburbs that was to see tennis courts and public space replaced by residential and commercial buildings (Nicholls). As one resident informed me, she had never seen any political engagement by local residents previously – an engagement that was accompanied by a belief that the development would be stopped as well as a mobilisation of some impressive resources. Such mobilisations also occur when there is a perceived injustice. Examples of this group can be found in what Hugh Mackay (13) describes as ‘doctor’s wives’ (a term that I am not wholly comfortable with). Here we see the emergence of ‘Chilout’: Children out of Detention. This was an organisation whose membership was described to me as ‘north shore professionals’, drew heavily on those who believed the forced incarceration of young refugee children was an affront to their values system. 4. Insurgent Citizenship – Empowered and Engaged The final space is the insurgent citizen: that is, the citizen who is both engaged and empowered. This is a term borrowed from South Africa and the USA (Holston 1) – and it should be seen as having two, almost diametrically opposed, sides: progressive and reactionary. This group may not have access to a great deal of financial resources, but has high social capital and both a willingness and ability to engage in political processes. Consequently, there is a sense of empowerment and engagement with civic institutions. There is also a strong push for self-sufficiency – but this is encased in a belief that civic institutions have a responsibility to provide services to the public, and that some services are naturally better provided by the public sector. Despite this, there is often an antagonistic relationship with such institutions. From the progressive perspective, we see ‘activists’ promoting social justice issues (including students, academics, unionists and so on). Organisations such as A Just Australia are strongly supported by various student organisations, unions and other social justice and activist groups. From a reactionary perspective, we see the emergence of groups that take an anti-immigration stance (such as ‘anti-immigration’ groups including Australia First that draw both activists and have an established political party). (Information regarding ‘anti-refugee activists’ can be found at http://ausfirst.alphalink.com.au/ while the official website for the Australia First political part is at http://www.australiafirstparty.com.au/cms/.) One way to understand the relationship between these groups is through the engagement/empowered typology below. While a detailed discussion of the limitations of typologies is beyond the scope of this paper, it is important to acknowledge that any typology is a simplification and generalisation of the arguments presented. Likewise, it is unlikely that any typology has the ability to cover all cases and situations. This typology can, however, be used to underscore the relational nature of citizenship. The purpose here is to highlight that there are relationships between the different citizenship spaces and individuals can move between groups and each cluster has significant internal variation. Key here is that this can frame future studies. Conclusion and Next Steps There is little doubt there is a relationship between attitudes to citizenship and the health of a democracy. In Australia, democracy is robust in some ways, but many feel disempowered, disengaged and some feel both – often believing they are remote from the workings of civic institutions. It would appear that for many, interest in the process of (formal) government is at an all-time low as reflected in declining membership of political parties (Jaensch et al. 58). Democracy is not a ‘once for ever’ achievement – it needs to be protected and promoted. To do this, we must ensure that there are avenues for representation for all. This point also highlights one of the fundamental flaws of the aforementioned citizenship test. According to the Department of Immigration and Citizenship, the test is designed to: help migrants integrate and maximise the opportunities available to them in Australia, and enable their full participation in the Australian community as citizens. (par. 4) Those designing the test have assumed that citizenship is both stable and, once achieved, automatically ensures representation. This paper directly challenges these assumptions and offers an alternative research agenda with the ultimate aim of promoting high levels of engagement and empowerment. References Anderson, A. “The Liberals Have Not Betrayed the Menzies Legacy.” Online Opinion 25 Oct. 2004. < http://www.onlineopinion.com.au/view.asp?article=2679 >. Arvanitakis, J. “Highly Affected, Rarely Considered: The International Youth Parliament Commission’s Report on the Impacts of Globalisation on Young People.” Sydney: Oxfam Australia, 2003. Baldassar, L., Z. Kamalkhani, and C. Lange. “Afghan Hazara Refugees in Australia: Constructing Australian Citizens.” Social Identities 13.1 (2007): 31-50. Burchell, D. “Dysfunctional Dumping Grounds.” The Australian 10 Feb. 2007. < http://www.theaustralian.news.com.au/story/0,20867,21199266-28737,00.html >. Burnley, I.H. The Impact of Immigration in Australia: A Demographic Approach. Melbourne: Oxford UP, 2001. Castells, M. “European Cities, the Informational Society, and the Global Economy.” New Left Review I/204 (March-April 1994): 46-57. Chamberlain, C., and D. Mackenzie. Homeless Careers: Pathways in and out of Homelessness. Melbourne: RMIT University, 2002. Chari, R., J. Hogan, and G. Murphy. “Regulating Lobbyists: A Comparative Analysis of the United States, Canada, Germany and the European Union.” The Political Quarterly 78.3 (2007): 423-438. Collins, J. “Chinese Entrepreneurs: The Chinese Diaspora in Australia.” International Journal of Entrepreneurial Behaviour & Research 8.1/2 (2002): 113-133. Dee, M. “Young People, Citizenship and Public Space.” International Sociological Association Conference Paper, Brisbane, 2002. Della Porta, D. “Globalisations and Democracy.” Democratizations 12.5 (2005): 668-685. Fagan, B., R. Dowling, and J. Longdale. “Suburbs in the ‘Global City’: Sydney since the Mid 1990s.” State of Australian cities conference. Parramatta, 2003. Frew, W. “And the Most Polarised City Is…” Sydney Morning Herald 16-17 Feb. 2008: 7. Gleeson, B. Australian Heartlands: Making Space for Hope in the Suburbs. Crows Nest: Allen and Unwin, 2006. Gleeson, B. “What’s Driving Suburban Australia?” Australian Policy Online 15 Jan. 2004. < http://www.apo.org.au/webboard/results.chtml?filename_num=00558 >. Gow, G. “Rubbing Shoulders in the Global City: Refugees, Citizenship and Multicultural Alliances in Fairfield, Sydney.” Ethnicities 5.3 (2005): 386-405. Hahn, C. L. “Citizenship Education: An Empirical Study of Policy, Practices and Outcomes.” Oxford Review of Education 25.1/2 (1999): 231-250. Hawley, S. “Sir Donald Bradman Likely to Be Dumped from Citizenship Test.” ABC Local Radio Online. 29 Jan. 2008. < http://www.abc.net.au/am/content/2007/s2148383.htm >. Hoare, D. “Bradman’s Spot in Citizenship Test under Scrutiny.” ABC Local Radio online. 29 Jan. 2008. < http://www.abc.net.au/pm/content/2008/s2149325.htm >. Holston, J. Insurgent Citizenship: Disjunctions of Democracy and Modernity in Brazil. California: Cloth, 2007. Jaensch, D., P. Brent, and B. Bowden. “Australian Political Parties in the Spotlight.” Democratic Audit of Australia Report 4. Australian National University, 2004. Mackay, H. “Sleepers Awoke from Slumber of Indifference.” Sydney Morning Herald 27 Nov. 2007: 13. NSWPD – New South Wales Parliamentary Debates. “South Western Sydney Banking Services.” Legislative Assembly Hansard, 52nd NSW Parliament, 19 Sep. 2001. Portney, K.E., and L. O’Leary. Civic and Political Engagement of America’s Youth: National Survey of Civic and Political Engagement of Young People. Medford, MA: Tisch College, Tufts University, 2007. Price, S. “Stress and Debt Make Sydney a Violent City.” Sydney Morning Herald 13 Jan. 2008: 16. Pusey, M. The Experience of Middle Australia: The Dark Side of Economic Reform. Cambridge: Cambridge UP, 2003. White, R. “Swarming and the Social Dynamics of Group Violence.” Trends and Issues in Crime and Criminal Justice 326 (Oct. 2006). < http://www.aic.gov.au/publications/tandi2/tandi326t.html >. Wolfe, P. “Race and Citizenship.” Magazine of History 18.5 (2004): 66-72.

Introduction One of the first challenges faced by new Australian Prime Minister, Kevin Rudd, was what to do with the former government’s controversial citizenship test. While a quick evaluation of the test shows that 93 percent of those who have sat it ‘passed’ (Hoare), most media controversy has focussed less on the validity of such a test than whether questions relating to Australian cricketing legend, Don Bradman, are appropriate (Hawley). While the citizenship test seems nothing more that a crude and populist measure imposed by the former Howard government in its ongoing nationalistic agenda, which included paying schools to raise the Australian flag (“PM Unfurls Flag”), its imposition seems a timely reminder of the challenge of understanding citizenship today. For as the demographic structures around us continue to change, so must our understandings of ‘citizenship’. More importantly, this fluid understanding of citizenship is not limited to academics, and policy-makers, but new technologies, the processes of globalisation including a globalised media, changing demographic patterns including migration, as well as environmental challenges that place pressure on limited resources is altering the citizens understanding of their own role as well as those around them. This paper aims to sketch out a proposed new research agenda that seeks to investigate this fluid and heterogenous nature of citizenship. The focus of the research has so far been Sydney and is enveloped by a broader aim of promoting an increased level of citizen engagement both within formal and informal political structures. I begin by sketching the complex nature of Sydney before presenting some initial research findings. Sydney – A Complex City The so-called ‘emerald city’ of Sydney has been described in many ways: from a ‘global’ city (Fagan, Dowling and Longdale 1) to an ‘angry’ city (Price 16). Sarah Price’s investigative article included research from the University of Western Sydney’s Centre of Culture Research, the Bureau of Crime Statistics and interviews with Tony Grabs, the director of trauma at St Vincent’s Hospital in inner city Darlinghurst. Price found that both injuries from alcohol and drug-related violence had risen dramatically over the last few years and seemed to be driven by increasing frustrations of a city that is perceived to be lacking appropriate infrastructure and rising levels of personal and household debt. Sydney’s famous harbour and postcard landmarks are surrounded by places of controversy and poverty, with residents of very backgrounds living in close proximity: often harmoniously and sometimes less so. According to recent research by Griffith University’s Urban Research Program, the city is becoming increasingly polarised, with the wealthiest enjoying high levels of access to amenities while other sections of the population experiencing increasing deprivation (Frew 7). Sydney, is often segmented into different regions: the growth corridors of the western suburbs which include the ‘Aspirational class’; the affluent eastern suburb; the southern beachside suburbs surrounding Cronulla affectionately known by local residents as ‘the Shire’, and so on. This, however, hides that fact that these areas are themselves complex and heterogenous in character (Frew 7). As a result, the many clichés associated with such segments lead to an over simplification of regional characteristics. The ‘growth corridors’ of Western Sydney, for example, have, in recent times, become a focal point of political and social commentary. From the rise of the ‘Aspirational’ voter (Anderson), seen to be a key ‘powerbroker’ in federal and state politics, to growing levels of disenfranchised young people, this region is multifaceted and should not be simplified. These areas often see large-scale, private housing estates; what Brendan Gleeson describes as ‘privatopias’, situated next to rising levels of homelessness (“What’s Driving”): a powerful and concerning image that should not escape our attention. (Chamberlain and Mackenzie pay due attention to the issue in Homeless Careers.) It is also home to a growing immigrant population who often arrive as business migrants and as well as a rising refugee population traumatised by war and displacement (Collins 1). These growth corridors then, seem to simultaneously capture both the ambitions and the fears of Sydney. That is, they are seen as both areas of potential economic boom as well as social stress and potential conflict (Gleeson 89). One way to comprehend the complexity associated with such diversity and change is to reflect on the proximity of the twin suburbs of Macquarie Links and Macquarie Fields situated in Sydney’s south-western suburbs. Separated by the clichéd ‘railway tracks’, one is home to the growing Aspirational class while the other continues to be plagued by the stigma of being, what David Burchell describes as, a ‘dysfunctional dumping ground’ whose plight became national headlines during the riots in 2005. The riots were sparked after a police chase involving a stolen car led to a crash and the death of a 17 year-old and 19 year-old passengers. Residents blamed police for the deaths and the subsequent riots lasted for four nights – involving 150 teenagers clashing with New South Wales Police. The dysfunction, Burchell notes is seen in crime statistics that include 114 stolen cars, 227 burglaries, 457 cases of property damage and 279 assaults – all in 2005 alone. Interestingly, both these populations are surrounded by exclusionary boundaries: one because of the financial demands to enter the ‘Links’ estate, and the other because of the self-imposed exclusion. Such disparities not only provide challenges for policy makers generally, but also have important implications on the attitudes that citizens’ experience towards their relationship with each other as well as the civic institutions that are meant to represent them. This is particular the case if civic institutions are seen to either neglect or favour certain groups. This, in part, has given rise to what I describe here as a ‘citizenship surplus’ as well as a ‘citizenship deficit’. Research Agenda: Investigating Citizenship Surpluses and Deficits This changing city has meant that there has also been a change in the way that different groups interact with, and perceive, civic bodies. As noted, my initial research shows that this has led to the emergence of both citizenship surpluses and deficits. Though the concept of a ‘citizen deficits and surpluses’ have not emerged within the broader literature, there is a wide range of literature that discusses how some sections of the population lack of access to democratic processes. There are three broad areas of research that have emerged relevant here: citizenship and young people (see Arvanitakis; Dee); citizenship and globalisation (see Della Porta; Pusey); and citizenship and immigration (see Baldassar et al.; Gow). While a discussion of each of these research areas is beyond the scope of this paper, a regular theme is the emergence of a ‘democratic deficit’ (Chari et al. 422). Dee, for example, looks at how there exist unequal relationships between local and central governments, young people, communities and property developers in relation to space. Dee argues that this shapes social policy in a range of settings and contexts including their relationship with broader civic institutions and understandings of citizenship. Dee finds that claims for land use that involve young people rarely succeed and there is limited, if any, recourse to civic institutions. As such, we see a democratic deficit emerge because the various civic institutions involved fail in meeting their obligations to citizens. In addition, a great deal of work has emerged that investigates attempts to re-engage citizens through mechanisms to promote citizenship education and a more active citizenship which has also been accompanied by government programs with the same goals (See for example the Western Australian government’s ‘Citizenscape’ program ). For example Hahn (231) undertakes a comparative study of civic education in six countries (including Australia) and the policies and practices with respect to citizenship education and how to promote citizen activism. The results are positive, though the research was undertaken before the tumultuous events of the terrorist attacks in New York, the emergence of the ‘war on terror’ and the rise of ‘Muslim-phobia’. A gap rises, however, within the Australian literature when we consider both the fluid and heterogenous nature of citizenship. That is, how do we understand the relationship between these diverse groups living within such proximity to each other overlayed by changing migration patterns, ongoing globalised processes and changing political environments as well as their relations to civic institutions? Further, how does this influence the way individuals perceive their rights, expectations and responsibilities to the state? Given this, I believe that there is a need to understand citizenship as a fluid and heterogenous phenomenon that can be in surplus, deficit, progressive and reactionary. When discussing citizenship I am interested in how people perceive both their rights and responsibilities to civic institutions as well as to the residents around them. A second, obviously related, area of interest is ‘civic engagement’: that is, “the activities of people in the various organisations and associations that make up what scholars call ‘civil society’” (Portney and Leary 4). Before describing these categories in more detail, I would like to briefly outline the methodological processes employed thus far. Much of the research to this point is based on a combination of established literature, my informal discussions with citizen groups and my observations as ‘an activist.’ That is, over the last few years I have worked with a broad cross section of community-based organisations as well as specific individuals that have attempted to confront perceived injustices. I have undertaken this work as both an activist – with organisations such as Aid/Watch and Oxfam Australia – as well as an academic invited to share my research. This work has involved designing and implementing policy and advocacy strategies including media and public education programs. All interactions begin with a detailed discussion of the aims, resources, abilities and knowledge of the groups involved, followed by workshopping campaigning strategies. This has led to the publication of an ‘activist handbook’ titled ‘From Sitting on the Couch to Changing the World’, which is used to both draft the campaign aims as well as design a systematic strategy. (The booklet, which is currently being re-drafted, is published by Oxfam Australia and registered under a creative commons licence. For those interested, copies are available by emailing j.arvanitakis (at) uws.edu.au.) Much research is also sourced from direct feedback given by participants in reviewing the workshops and strategies The aim of tis paper then, is to sketch out the initial findings as well as an agenda for more formalised research. The initial findings have identified the heterogenous nature of citizenship that I have separated into four ‘citizenship spaces.’ The term space is used because these are not stable groupings as many quickly move between the areas identified as both the structures and personal situations change. 1. Marginalisation and Citizenship Deficit The first category is a citizenship deficit brought on by a sense of marginalisation. This is determined by a belief that it is pointless to interact with civic institutions, as the result is always the same: people’s opinions and needs will be ignored. Or in the case of residents from areas such as Macquarie Fields, the relationship with civic institutions, including police, is antagonistic and best avoided (White par. 21). This means that there is no connection between the population and the civic institutions around them – there is no loyalty or belief that efforts to be involved in political and civic processes will be rewarded. Here groups sense that they do not have access to political avenues to be heard, represented or demand change. This is leading to an experience of disconnection from political processes. The result is both a sense of disengagement and disempowerment. One example here emerged in discussions with protesters around the proposed development of the former Australian Defence Industry (ADI) site in St Marys, an outer-western suburb of Sydney. The development, which was largely approved, was for a large-scale housing estate proposed on sensitive bushlands in a locality that resident’s note is under-serviced in terms of public space. (For details of these discussions, see http://www.adisite.org/.) Residents often took the attitude that whatever the desire of the local community, the development would go ahead regardless. Those who worked at information booths during the resident protests informed me that the attitude was one best summarised by: “Why bother, we always get stuffed around any way.” This was confirmed by my own discussions with local residents – even those who joined the resident action group. 2. Privatisation and Citizenship Deficit This citizenship deficit not only applies to the marginalised, however, for there are also much wealthier populations who also appear to experience a deficit that results from a lack of access to civic institutions. This tends to leads to a privatisation of decision-making and withdrawal from the public arena as well as democratic processes. Consequently, the residents in the pockets of wealth may not be acting as citizens but more like consumers – asserting themselves in terms of Castells’s ‘collective consumption’ (par. 25). This citizenship deficit is brought on by ongoing privatisation. That is, there is a belief that civic institutions (including government bodies) are unable or at least unwilling to service the local community. As a result there is a tendency to turn to private suppliers and believe that individualisation is the best way to manage the community. The result is that citizens feel no connection to the civic institutions around them, not because there is no desire, but there are no services. This group of citizens has often been described as the ‘Aspirationals’ and are most often found in the growth corridors of Sydney. There is no reason to believe that this group is this way because of choice – but rather a failure by government authorities to service their needs. This is confirmed by research undertaken as early as 1990 which found that the residents now labelled Aspirational, were demanding access to public infrastructure services including public schools, but have been neglected by different levels of government. (This was clearly stated by NSW Labor MP for Liverpool, Paul Lynch, who argued for such services as a way to ensure a functioning community particularly for Western Sydney; NSWPD 2001.) As a result there is a reliance on private schools, neighbourhoods, transport and so on. Any ‘why bother’ attitude is thus driven by a lack of evidence that civic institutions can or are not willing to meet their needs. There is a strong sense of local community – but this localisation limited to others in the same geographical location and similar lifestyle. 3. Citizenship Surplus – Empowered Not Engaged The third space of citizenship is based on a ‘surplus’ even if there is limited or no political engagement. This group has quite a lot in common with the ‘Aspirationals’ but may come from areas that are higher serviced by civic institutions: the choice not to engage is therefore voluntary. There is a strong push for self-sufficiency – believing that their social capital, wealth and status mean that they do not require the services of civic institutions. While not antagonistic towards such institutions, there is often a belief is that the services provided by the private sector are ultimately superior to public ones. Consequently, they feel empowered through their social background but are not engaged with civic institutions or the political process. Despite this, my initial research findings show that this group has a strong connection to decision-makers – both politicians and bureaucrats. This lack of engagement changes if there is a perceived injustice to their quality of life or their values system – and hence should not be dismissed as NIMBYs (not in my backyard). They believe they have the resources to mobilise and demand change. I believe that we see this group materialise in mobilisations around proposed developments that threaten the perceived quality of life of the local environment. One example brought to my attention was the rapid response of local residents to the proposed White City development near Sydney’s eastern suburbs that was to see tennis courts and public space replaced by residential and commercial buildings (Nicholls). As one resident informed me, she had never seen any political engagement by local residents previously – an engagement that was accompanied by a belief that the development would be stopped as well as a mobilisation of some impressive resources. Such mobilisations also occur when there is a perceived injustice. Examples of this group can be found in what Hugh Mackay (13) describes as ‘doctor’s wives’ (a term that I am not wholly comfortable with). Here we see the emergence of ‘Chilout’: Children out of Detention. This was an organisation whose membership was described to me as ‘north shore professionals’, drew heavily on those who believed the forced incarceration of young refugee children was an affront to their values system. 4. Insurgent Citizenship – Empowered and Engaged The final space is the insurgent citizen: that is, the citizen who is both engaged and empowered. This is a term borrowed from South Africa and the USA (Holston 1) – and it should be seen as having two, almost diametrically opposed, sides: progressive and reactionary. This group may not have access to a great deal of financial resources, but has high social capital and both a willingness and ability to engage in political processes. Consequently, there is a sense of empowerment and engagement with civic institutions. There is also a strong push for self-sufficiency – but this is encased in a belief that civic institutions have a responsibility to provide services to the public, and that some services are naturally better provided by the public sector. Despite this, there is often an antagonistic relationship with such institutions. From the progressive perspective, we see ‘activists’ promoting social justice issues (including students, academics, unionists and so on). Organisations such as A Just Australia are strongly supported by various student organisations, unions and other social justice and activist groups. From a reactionary perspective, we see the emergence of groups that take an anti-immigration stance (such as ‘anti-immigration’ groups including Australia First that draw both activists and have an established political party). (Information regarding ‘anti-refugee activists’ can be found at http://ausfirst.alphalink.com.au/ while the official website for the Australia First political part is at http://www.australiafirstparty.com.au/cms/.) One way to understand the relationship between these groups is through the engagement/empowered typology below. While a detailed discussion of the limitations of typologies is beyond the scope of this paper, it is important to acknowledge that any typology is a simplification and generalisation of the arguments presented. Likewise, it is unlikely that any typology has the ability to cover all cases and situations. This typology can, however, be used to underscore the relational nature of citizenship. The purpose here is to highlight that there are relationships between the different citizenship spaces and individuals can move between groups and each cluster has significant internal variation. Key here is that this can frame future studies. Conclusion and Next Steps There is little doubt there is a relationship between attitudes to citizenship and the health of a democracy. In Australia, democracy is robust in some ways, but many feel disempowered, disengaged and some feel both – often believing they are remote from the workings of civic institutions. It would appear that for many, interest in the process of (formal) government is at an all-time low as reflected in declining membership of political parties (Jaensch et al. 58). Democracy is not a ‘once for ever’ achievement – it needs to be protected and promoted. To do this, we must ensure that there are avenues for representation for all. This point also highlights one of the fundamental flaws of the aforementioned citizenship test. According to the Department of Immigration and Citizenship, the test is designed to: help migrants integrate and maximise the opportunities available to them in Australia, and enable their full participation in the Australian community as citizens. (par. 4) Those designing the test have assumed that citizenship is both stable and, once achieved, automatically ensures representation. This paper directly challenges these assumptions and offers an alternative research agenda with the ultimate aim of promoting high levels of engagement and empowerment. References Anderson, A. “The Liberals Have Not Betrayed the Menzies Legacy.” Online Opinion 25 Oct. 2004. http://www.onlineopinion.com.au/view.asp?article=2679>. Arvanitakis, J. “Highly Affected, Rarely Considered: The International Youth Parliament Commission’s Report on the Impacts of Globalisation on Young People.” Sydney: Oxfam Australia, 2003. Baldassar, L., Z. Kamalkhani, and C. Lange. “Afghan Hazara Refugees in Australia: Constructing Australian Citizens.” Social Identities 13.1 (2007): 31-50. Burchell, D. “Dysfunctional Dumping Grounds.” The Australian 10 Feb. 2007. http://www.theaustralian.news.com.au/story/0,20867,21199266-28737,00.html>. Burnley, I.H. The Impact of Immigration in Australia: A Demographic Approach. Melbourne: Oxford UP, 2001. Castells, M. “European Cities, the Informational Society, and the Global Economy.” New Left Review I/204 (March-April 1994): 46-57. Chamberlain, C., and D. Mackenzie. Homeless Careers: Pathways in and out of Homelessness. Melbourne: RMIT University, 2002. Chari, R., J. Hogan, and G. Murphy. “Regulating Lobbyists: A Comparative Analysis of the United States, Canada, Germany and the European Union.” The Political Quarterly 78.3 (2007): 423-438. Collins, J. “Chinese Entrepreneurs: The Chinese Diaspora in Australia.” International Journal of Entrepreneurial Behaviour & Research 8.1/2 (2002): 113-133. Dee, M. “Young People, Citizenship and Public Space.” International Sociological Association Conference Paper, Brisbane, 2002. Della Porta, D. “Globalisations and Democracy.” Democratizations 12.5 (2005): 668-685. Fagan, B., R. Dowling, and J. Longdale. “Suburbs in the ‘Global City’: Sydney since the Mid 1990s.” State of Australian cities conference. Parramatta, 2003. Frew, W. “And the Most Polarised City Is…” Sydney Morning Herald 16-17 Feb. 2008: 7. Gleeson, B. Australian Heartlands: Making Space for Hope in the Suburbs. Crows Nest: Allen and Unwin, 2006. Gleeson, B. “What’s Driving Suburban Australia?” Australian Policy Online 15 Jan. 2004. http://www.apo.org.au/webboard/results.chtml?filename_num=00558>. Gow, G. “Rubbing Shoulders in the Global City: Refugees, Citizenship and Multicultural Alliances in Fairfield, Sydney.” Ethnicities 5.3 (2005): 386-405. Hahn, C. L. “Citizenship Education: An Empirical Study of Policy, Practices and Outcomes.” Oxford Review of Education 25.1/2 (1999): 231-250. Hawley, S. “Sir Donald Bradman Likely to Be Dumped from Citizenship Test.” ABC Local Radio Online. 29 Jan. 2008. http://www.abc.net.au/am/content/2007/s2148383.htm>. Hoare, D. “Bradman’s Spot in Citizenship Test under Scrutiny.” ABC Local Radio online. 29 Jan. 2008. http://www.abc.net.au/pm/content/2008/s2149325.htm>. Holston, J. Insurgent Citizenship: Disjunctions of Democracy and Modernity in Brazil. California: Cloth, 2007. Jaensch, D., P. Brent, and B. Bowden. “Australian Political Parties in the Spotlight.” Democratic Audit of Australia Report 4. Australian National University, 2004. Mackay, H. “Sleepers Awoke from Slumber of Indifference.” Sydney Morning Herald 27 Nov. 2007: 13. NSWPD – New South Wales Parliamentary Debates. “South Western Sydney Banking Services.” Legislative Assembly Hansard, 52nd NSW Parliament, 19 Sep. 2001. Portney, K.E., and L. O’Leary. Civic and Political Engagement of America’s Youth: National Survey of Civic and Political Engagement of Young People. Medford, MA: Tisch College, Tufts University, 2007. Price, S. “Stress and Debt Make Sydney a Violent City.” Sydney Morning Herald 13 Jan. 2008: 16. Pusey, M. The Experience of Middle Australia: The Dark Side of Economic Reform. Cambridge: Cambridge UP, 2003. White, R. “Swarming and the Social Dynamics of Group Violence.” Trends and Issues in Crime and Criminal Justice 326 (Oct. 2006). http://www.aic.gov.au/publications/tandi2/tandi326t.html>. Wolfe, P. “Race and Citizenship.” Magazine of History 18.5 (2004): 66-72. Citation reference for this article MLA Style Arvanitakis, James. "The Heterogenous Citizen: How Many of Us Care about Don Bradman’s Average?." M/C Journal 10.6/11.1 (2008). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0804/07-arvanitakis.php>. APA Style Arvanitakis, J. (Apr. 2008) "The Heterogenous Citizen: How Many of Us Care about Don Bradman’s Average?," M/C Journal, 10(6)/11(1). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0804/07-arvanitakis.php>.