Статті в журналах з теми "Dove Confident Me"

BackgroundIncreased rates of psychiatric disorder have previously been reported in those diagnosed with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), although the direction of causation in this relationship has not been established. We aimed to test the hypothesis that individuals with self-reported CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms.MethodA total of 5362 participants were prospectively followed with various measures of personality, psychiatric disorder and fatigue levels collected over the first 43 years of their life. CFS/ME was identified through self-report during a semi-structured interview at age 53 years.ResultsThirty-four (1.1%) of the 3035 subjects assessed at age 53 years reported a diagnosis of CFS/ME. CFS/ME was more common among females, but there was no association between CFS/ME and either social class, social mobility or educational level. Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.26–5.57, p=0.01]. Increased levels of psychiatric illness, in particular depression and anxiety, were present prior to the occurrence of fatigue symptoms. There was a dose–response relationship between the severity of psychiatric symptoms and the likelihood of later CFS/ME. Personality factors were not associated with a self-reported diagnosis of CFS/ME.ConclusionsThis temporal, dose–response relationship suggests that psychiatric disorders, or shared risk factors for psychiatric disorders, are likely to have an aetiological role in some cases of CFS/ME.

AbstractThe current state of the art in field experiments does not give me any confidence that we should be assuming that we have anything worth scaling, assuming we really care about the expected welfare of those about to receive the instant intervention. At the very least, we should be honest and explicit about the need for strong priors about the welfare effects of changes in averages of observables to warrant scaling. What we need is a healthy dose of theory and the implied econometrics.

BackgroundArthrocentesis is a procedure performed to aspirate synovial fluid from a joint cavity. It has both diagnostic and therapeutic utilization in outpatient and inpatient settings. While arthrocentesis is considered a minor surgical procedure, there is always potential to injure blood vessels, nerves, and tendons1. Although joint arthrocentesis is not an Accreditation Council for Graduate Medical Education procedural requirement for Internal Medicine (IM) residents in the United States, several studies have revealed that training on knee arthrocentesis and injection provided a solid foundation to medical residents toward increasing their confidence and refining motor skills2.ObjectivesTo evaluate the current Roger Williams Medical Center (RWMC) IM residents’ confidence level in performing intra-articular injection. Results from this study will inform the design of resident-orientated quality improvement arthrocentesis teaching series in RWMC.MethodsProject was incepted and designed by one rheumatology faculty, one fellow and five IM residents of RWMC. We selected the survey as a tool to elicit information from all current IM residents who filled out a 7-question survey regarding their residency experience and exposures to knee aspiration and injection. We used Survey Monkey as an anonymous survey tool (see Table 1). Data were collected between 1/14/22 until 1/27/22 and were verified by two members of the research team.Table 1.Survey from 39 total responsesQuestionResponses1.What post-graduate year are you?PGY1:41.03%PGY2: 35.90%PGY3: 9%2. Are you comfortable/confident with knee arthrocentesis/injection during residency?Not Comfortable/confident: 69.23%Somewhat comfortable/confident: 28.21%Quite comfortable/confident: 2.56%3. Do you think you have adequate exposure to knee procedures in residency?Strongly Agree: 0%Agree: 0%Undecided: 5.13%Disagree: 51.28%Strongly Disagree: 43.59%4. How many knee aspirations/injections have you done during residency?0: 73.68%1-4: 26.32%5-10: 0%>10: 0%5. Do you think our residency program is preparing you to do knee aspirations/injections?Strongly Agree: 0%Agree: 0%Undecided: 17.95%Disagree: 35.90%Strongly Disagree: 46.15%6. Would you be interested in doing more knee aspirations/injections?Yes: 94.87%No: 5.13%7. Having exposure to arthrocentesis is very important for me to have in my residency programStrongly Agree: 33.33%Agree: 35.90%Undecided: 23.08%Disagree: 5.13%Strongly Disagree: 2.56%ResultsA total of 47 IM residents within three classes in this community residency program were provided with the survey. The survey response rate was 82.9% (39 /47). 69.23% residents do not feel comfortable doing arthrocentesis. More than half of the resident population (51.28%) do not think they have adequate exposure to knee arthrocentesis. 73.68% respondents have never performed knee injections/arthrocentesis. According to the survey, 94.87% of the residents would be interested in learning to do knee procedures. Having exposure to knee arthrocentesis during residency was important to 36.84% and very important to 34.21% of the trainees.ConclusionThe survey results demonstrate that most of the IM residents had no prior exposure and are uncomfortable with knee arthrocentesis. However we proved that there is high interest in learning this procedure. Literature review shows that structured training sessions have a long-term effect in competency and confidence with similar procedures. This survey provides us data to set up a system to improve the quality of joint procedures teaching in RWMC.References[1]Akbarnia H, Saber AY, Zahn E. Knee arthrocentesis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470229/. Published September 5, 2021[2]Barilla-LaBarca M-L, Tsang JC, Goldsmith M, Furie R. Design, implementation, and outcome of a hands-on Arthrocentesis Workshop. J Clin Rheumatol. 2009;15(6):275-279.Disclosure of InterestsPamela Gonzalez: None declared, Ravinder Kaler: None declared, Neenu Sukumaran: None declared, Ahmed ElDib: None declared, Yana Turkowski: None declared, Zi Ying Li: None declared, Katarzyna Gilek-Seibert Speakers bureau: Abbvie, Consultant of: GSK

PURPOSE This pilot, open-label study evaluates the antiemetic efficacy and safety of a single 20-mg intravenous (IV) dose of dexamethasone combined with a single IV dose of ondansetron (32, 24, or 8 mg) in patients receiving highly emetogenic (HE), moderately high emetogenic (MHE), or moderately emetogenic (ME) chemotherapy, respectively. PATIENTS AND METHODS One hundred forty-six patients received a single 20-mg IV dose of dexamethasone over 15 minutes beginning 45 minutes before chemotherapy and either a single 32-, 24-, or 8-mg IV dose of ondansetron over 15 minutes beginning 30 minutes before chemotherapy. Patients were evaluated for emetic episodes, extent of nausea, and adverse events for 24 hours after chemotherapy. RESULTS Complete response (no emetic episodes) was noted in 72% (95% confidence interval [CI], 60% to 84%), 88% (95% CI, 79% to 97%), and 77% (95% CI, 63% to 92%) of patients in the HE, MHE, and ME categories, respectively. The proportion of patients who experienced no nausea on the posttreatment assessment was 51% (95% CI, 37% to 64%), 69% (95% CI, 56% to 81%), and 47% (95% CI, 29% to 65%), respectively. The antiemetic regimens were all well tolerated. The proportion of patients with any drug-related adverse events did not vary across the three study groups despite the range of ondansetron doses and variety of chemotherapy regimens. Mild headache was noted in 28% of patients. Other adverse events, all of which were noted in fewer than 10% of patients, included lightheadedness, fatigue, dizziness, and constipation. CONCLUSION A single IV dose of either 8, 24, or 32 mg of ondansetron combined with a single 20-mg IV dose of dexamethasone resulted in good control of acute emesis across a wide spectrum of chemotherapy regimens. Nausea control proved somewhat more difficult, with approximately 50% of patients in the HE and ME emetogenic categories experiencing some degree of nausea. The results of our pilot study suggest that adjusting the dose of ondansetron to the intrinsic emetogenicity of the chemotherapy regimen permits a more efficient use of ondansetron while maintaining good antiemetic control. Such an approach appears worthy of further investigation.

Ukraine finds itself in the countries of the Global North, which means that it adopts the formulation of its typical research questions like the current migration research landscape. Existing research are heavily skewed towards the Global North, where governments and international organizations increasingly fund them to inform policy development. Thus, migration provides the relevance of the study of discourses around the body of concepts on it. The article describes the subtexts of media characterising the perception of migration by migrants themselves and the perception of migrants by host side. With using the Mediateka tool, an automated sample of 39,000 reports on various groups of migrants was received in the TOP-15 of the Ukrainian media (print media, TV channels, informational online media) from 2015 to 2018. The sample consisted of 12,000 messages, every tenth of which was selected for further in-depth analysis. The research was based on qualitative content analysis and critical discourse analysis. The six steps were done: looking at the description of the migration as objective necessity, subjective aspiration and something meaningless, and looking at the description of migrants as decent people, indecent people and just people with some lifestyle. The latent meanings of the messages, where the leading Ukrainian media touched on the perception of migration and migrants, were divergent and contradictory; they could not become the basis for confidence in any permanent characteristics of the images of migrants. As one of the most interesting prospects for further research, it may be the test of whether those transmitted meanings, which are usually considered positive, can interfere with social integration, and vice versa – whether negative meanings can help it. This can be done on the basis of additional empirical research using quantitative methods, such as cluster analysis to check which groups media consumers might be divided into after receiving the information about migrants.

Rice fields, especially rice straw, is one part of the agricultural sector that contributes to global warming. It is estimated that about 1% of global warming comes from rice fields. One of the efforts that can be done in reducing the contribution of paddy fields is to utilize the remaining harvest in the form of rice straw as animal feed. However, the utilization of rice straw is constrained by its low nutritional value. Therefore it is necessary to carry out ammonia to improve its quality. This study was conducted to determine the potential of rice straw to produce methane gas and to improve its quality using ammonia technology as ruminant feed. This study used a completely randomized design with four urea levels (0, 2, 4, 6% w/w) and six replications. The variables measured were gas production, methane production, total volatile fatty acids (TVFA), metabolic energy (ME), dry matter digestibility (DMD), and organic matter digestibility (OMD). The data obtained were analyzed using analysis of variance, and differences between means using Duncan's multiple range test with a confidence level of P <0.05. The results of the calculation of the production of methane (CH4) and carbon dioxide (CO2) from rice straw in Jambi Province in 2021 reached 9,024 Gg CH4 per year and Carbon 3362,167 per year. The results of ammonium hay showed that urea level had a significant effect (P<0.05) on total gas production, gas production of CH4, DMD, OMD, TVFA, and ME. The ammoniated rice straw with urea level up to 4% was the best treatment for total gas production, CH4, TVFA, and ME production. The results of the study concluded that ammoniated rice straw with 4% urea content was the best treatment to improve the quality of rice straw as ruminant feed.

Objective. To assess the effectiveness of the low-dose air ozonation for disinfection of the air in the working room. Materials and methods. We investigated 90 air samples (3 samples were taken weekly before and after the production meeting using the automatic sampling device of biological aerosols of air PU-1B). The total bacterial contamination, the content of staphylococci and mold spores were determined. Ozonation of the room (83.3 m3) was carried out for 20 minutes by means of domestic ozonator. The accumulated dose of ozone was 133.3 mg (1.6 mg/m3). Statistical data processing was carried out using the MedStat licensed program. The median, median error (Me me), left and right 95 % confidence intervals (95 % CI) were calculated. Paired comparisons were made using Wilcoxon's T-test. Results. After the meeting, the total bacterial contamination of the air was 56.0 9.3 (47.078.0) CFU. The content of staphylococci and mold spores in the air was 85.5 12.5 (76.0100.0) and 44.5 6.5 (32.054.0) CFU, respectively. After ozonation, the total bacterial contamination of the air was 14.5 3.6 (10.021.0) CFU. The content of staphylococci and mold spores in the air after ozonation was 35.5 6.7 (25.052.0) and 26.0 5.0 (18.032.0) CFU, respectively. Ozonation of the room provided a significant decrease (p 0.001) in all three of the above indicators. The room ozonation carried out promoted a reliable decrease (p 0.001) in all the above mentioned parameters. Conclusions. The above data and analysis of the literature show the possibility of using low doses of ozone for the prevention of bacterial, fungal and viral infections including SARS-CoV-2. Further study and development of reasonable modes of ozone disinfection, including low doses of ozone, is needed, as well as determination of the efficiency degree of air disinfection with non-toxic gas concentrations.

OBJECTIVE The purpose of this study was to assess the effect of low-fidelity simulation on students' confidence, knowledge, and skills in pediatric physical assessments, and to compare students' interest ratings of topics and effectiveness of learning activities between students' who experienced simulation and those who did not. METHODS Within a pediatric elective, a vital signs and physical assessment activity was re-designed to incorporate a low-fidelity heart and breath sounds simulator. Students rated their confidence in completing 9 different physical assessment skills before and after the activity and assessment. Students' perspectives of the activity were also assessed. Course evaluation surveys were compared with prior course offerings (without simulation) to determine a change in students' interest ratings of the topic and effectiveness of learning activities. The Wilcoxon signed rank test, thematic analysis, and descriptive statistics were used to analyze outcomes. RESULTS All 106 second professional year students in the elective completed the pre- and post-simulation surveys and course evaluations for 3 offerings. Students' post-simulation average confidence scores increased statistically on all 9 skills compared with pre-simulation scores. All students agreed or strongly agreed “the lecture and simulation activity done in class helped me overcome challenges I had with learning the skill.” Students (98%) successfully demonstrated competency on the formal assessment. Compared with previous course offerings, students reported higher interest ratings in the topics and instruction effectiveness when simulation was incorporated into the activity. CONCLUSIONS Low-fidelity simulation is an effective teaching and learning approach to increase students' confidence, knowledge, and interest in pediatric vital signs and physical assessment.

Aim: MicroRNAs (miRNAs) are small noncoding RNAs that function as oncogene or tumor suppressors. The single nucleotide polymorphisms in miRNAs potentially can alter miRNA-binding sites on target genes as well as affecting miRNAs expression. The present study aimed to evaluate the impact of miR-608 rs4919510 C>G variant on breast cancer (BC) risk. Materials and Me thods: This case-control study conducted on 160 women with BC and 192 age-matched healthy women. Genotyping of miR608 rs4919510 was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: Our findings showed that GC genotype significantly decreased the risk of BC (odds ratio (OR) = 0.49, 95% confidence interval (CI) 0.28–0.88, p = 0.018) compared to CC genotype. Furthermore the G allele decreased the risk of BC (OR = 0.53, 95%CI 0.30–0.92, p = 0.024). No significant association was found between miR-609 genotypes and clinicopathological characteristics of BC patients (p > 0.05). Conclusion: Our findings indicate that miR-608 polymorphism might be associated with decreased risk of BC in an Iranian subpopulation. Further large-scale studies with different ethnicities are needed to verify our findings.

ABSTRACT If the question asked of the oil spill R&D community is, “What have you done for me lately?,” a solid answer is the Texas Automated Buoy System (TABS) and its contribution to the response effort in the 3000-barrel Buffalo Barge 292 oil spill. The TABS network consists of five automated buoys anchored off the Texas coast that report half-hourly current measurements every 6 hours under normal conditions and every 2 hours during spill events. Public access to TABS is provided via an easy-to-use Internet Web page. Because of TABS, trajectory modelers knew the offshore currents within minutes of the Buffalo Barge 292 spill and were able to continuously track the currents along the Texas coast over the next 24 days. TABS also provided the first indications of a critical current reversal during the spill that allowed planners and managers to confidently stand down response preparations (and their associated costs) in some areas while redirecting response resources to truly threatened sections of the coast. Industry partners to date include Aramco Services Company, the Marine Spill Response Corporation, and the Marine Industry Response Group. Industry involvement is critical to maintaining the operational focus of TABS.

BackgroundRheumatoid Arthritis is the most common form of inflammatory arthritis in older adults, with the mainstay of treatment being the conventional DMARDs (Tutuncu & Kavanaugh, 2007). These drugs are not without side effects, and as elderly people have higher rates of adverse drug reactions and less long-term benefits, the risk/benefit ratio is different compared to other age groups. This research sought to evaluate if the rheumatology department at Southend hospital was sufficiently acknowledging the changing circumstances of their elderly patients and de-escalating conventional DMARDs accordingly. As the average age of rheumatology patients is only likely to increase in the future, contextualising a patients treatment plan for their rheumatological disorder with their overall health status will become an increasingly important skill for clinicians and the observations from this study will be applicable to all who treat elderly patients with inflammatory disorders.Objectives1. Evaluate if major new diagnoses were acknowledged in the rheumatology clinic and if conventional DMARD treatment was reduced in response. 2. Record and compare the outcomes of when conventional DMARD was stopped abruptly vs when it was tapered down slowly.MethodsEvaluated 10 year’s worth of clinic letters from rheumatology and other specialities in 50 patients with a diagnosis of RA over the age of 89. Noted new diagnoses of dementia, cancer and frailty (multiple falls, care home admission or becoming newly house bound) as well as acute hospital admissions and declining renal function and evaluated if this was acknowledged in clinic letters and whether treatment was changed in response. Recorded all instances where conventional DMARDs were stopped or had a dose reduction and evaluated if these dose drops were successful (patient stayed at reduced dose with no flares in disease activity), semi-successful (patient had mild RA flare treated with short course corticosteroids, or stayed at reduced dose for at least a year before returning to original dose) or unsuccessful (patient suffered flare and went back to original dose within 1 year.)ResultsOf the 50 patients, 31 received methotrexate monotherapy, 12 methotrexate and other conventional DMARDs, and 5 DMARDs other than methotrexate. 36 out of 45 patients receiving methotrexate had some decrease in dose by the end of the 10 year period, with the median decrease being 5mg. Patients on multiple DMARDs saw a greater average decrease in methotrexate compared to those on monotherapy. 15 abrupt cessations in methotrexate were recorded, with acute hospital admission being the most common trigger. Of these 3 were successful, 5 were semi-successful and 7 were unsuccessful. 55 planned methotrexate dose reductions in the rheumatology clinic were recorded, with 38 being successful, 9 being semi-successful and 8 being unsuccessful (Figure 1.). Clinic letters did generally acknowledge both new physical diagnoses and changes in social circumstances, but some diagnoses were more likely to trigger a change in treatment, for example in 8 new cancer diagnoses, there were 5 changes to treatment, whereas in 12 dementia diagnoses there were 3 changes to treatment. 6 patients received more methotrexate than guidelines suggest for their level of CKD, with 3 of these having it acknowledged in clinic letters.ConclusionMost patients had a reduction in dose of methotrexate over a 10 year period. Planned de-escalations were mostly successful, whereas abrupt stops to treatment were generally less successful. Rheumatologists are good at acknowledging changes to health status but were more likely to change DMARD therapy in response to a cancer diagnosis than a dementia diagnosis or frailty. There is still some work to be done in acknowledging declining renal function and changing methotrexate in response. Overall, these results suggest de-escalation is mostly successful and clinicians can be confident in further expanding this into their day to day practice.References[1]Tutuncu, Z. and Kavanaugh, A., 2007. Treatment of elderly rheumatoid arthritis. Future Rheumatology, 2(3), pp.313-319.AcknowledgementsMany thanks to my supervisor Dr Fiona Hayes and the rest of the rheumatology team at Southend University Hospital for being so welcoming and allowing me to make full use of the tea supplies.Disclosure of InterestsNone declared

The process of build the character can be done by instilling moral values through messages that can be conveyed by parents through various literary media such as, songs, poems, or fairy tales. this study will describe the moral values of humans who relationship with God, self, and with others. This research will use descriptive qualitative method, it means procedure based on descriptive data in the form of oral or written words from research on subjects who have observed and has the characteristics, the data provided is the original data that have been changed by using systematically method and can be accounted for the truth. The data are used from ten English children's songs with the tittle (1) twinkle little star (2) baa baa black sheep (3) you are my sunshine (4) my daddy is the best (5) Please and thank you (6) sorry, excuse me (7) sick song (8) if you’re happy (9) Johny, Johny yes papa (10) Are we there yet? Moral value from human relationship with God, which is obtained from the lyrics of English children's songs relationship with God is a feeling of gratitude for God's power. The moral value of human relations with oneself, in the English children's songs lyrics conveys ways to cultivate self-confidence, joy, and sincere about what happens in this life. moral value that we can get from human Relations with others in English children's song lyrics teach how to behave well with others, respect, and love for others.

Tot hij in april 1916 in de buurt van Diks-muide gewond raakte, was de dichter August Van Cauwelaert als broer van de politicus Frans Van Cauwelaert de man die soldatenklachten aanhoorde en die de spanningen tussen Franstalige bevelhebbers en de Vlaamse manschappen registreerde. Maar door de informatie die hem tijdens zijn her-stel in het Zuid-Franse Cannes bereikte, stond Gust Van Cauwelaert gaandeweg dichter bij de Frontbeweging dan zijn broer Frans. Dat blijkt uit een drietal hekeldichten die hij tijdens en na de oorlog schreef aan het adres van de Belgisch regering in Le Havre en aan koning Albert.Gust achtte zijn broer te goedgelovig in zijn contacten met de Belgische regering en met koning Albert. Meermaals waarschuwde hij Frans dat hij op het punt stond zijn prestige te verspelen. Eind december 1916 schreef hij hem: “Het feit dat gij geloofd hebt in de beloften die van hogerhand gedaan werden aangaande onze zaak, en dat vertrouwen hebt meegedeeld, heeft u kwaad gedaan, geloof me”.De verdeeldheid binnen de Vlaamse beweging die Gust had voorspeld was een feit toen hij in augustus 1919 werd gedemobiliseerd.__________ ‘Volk is voogd en meester moede Until he was wounded in the vicinity of Diksmuide in April 1916, the poet August Van Cauwelaert, as the brother of the politician Frans Van Cauwelaert, was the man who listened to soldiers’ complaints and who kept a record of tensions between French-speaking commanders and Flemish enlisted men. But, due to the information that reached him during his recuperation in Cannes in the South of France, Gust Van Cauwelaert gradually moved closer to the Front Movement than his brother Frans. This can be seen in three satirical pieces that he wrote during and after the war, directed at the Belgian government in Le Havre and to King Albert.Gust considered his brother to be too credulous in his contacts with the Belgian government and King Albert. On several occasions he warned Frans that he was about to forfeit his prestige. In the end of December 1916 he wrote to him: “The fact that you have believed in the promises that were made from on high regarding our cause, and that you have made that confidence known out loud, has done you harm, believe me.”The division among the Flemish Movement that Gust had predicted was a fact by the time he was demobilized in August 1919.

ABSTRACTThe nephrotoxicity of polymyxins is a major dose-limiting factor for treatment of infections caused by multidrug-resistant Gram-negative pathogens. The mechanism(s) of polymyxin-induced nephrotoxicity is not clear. This study aimed to investigate polymyxin B-induced apoptosis in kidney proximal tubular cells. Polymyxin B-induced apoptosis in NRK-52E cells was examined by caspase activation, DNA breakage, and translocation of membrane phosphatidylserine using Red-VAD-FMK [Val-Ala-Asp(O-Me) fluoromethyl ketone] staining, a terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) assay, and double staining with annexin V-propidium iodide (PI). The concentration dependence (50% effective concentration [EC50]) and time course for polymyxin B-induced apoptosis were measured in NRK-52E and HK-2 cells by fluorescence-activated cell sorting (FACS) with annexin V and PI. Polymyxin B-induced apoptosis in NRK-52E cells was confirmed by positive labeling from Red-VAD-FMK staining, TUNEL assay, and annexin V-PI double staining. The EC50(95% confidence interval [CI]) of polymyxin B for the NRK-52E cells was 1.05 (0.91 to 1.22) mM and was 0.35 (0.29 to 0.42) mM for HK-2 cells. At lower concentrations of polymyxin B, minimal apoptosis was observed, followed by a sharp rise in the apoptotic index at higher concentrations in both cell lines. After treatment of NRK-52E cells with 2.0 mM polymyxin B, the percentage of apoptotic cells (mean ± standard deviation [SD]) was 10.9% ± 4.69% at 6 h and reached plateau (>80%) at 24 h, whereas treatment with 0.5 mM polymyxin B for 24 h led to 93.6% ± 5.57% of HK-2 cells in apoptosis. Understanding the mechanism of polymyxin B-induced apoptosis will provide important information for discovering less nephrotoxic polymyxin-like lipopeptides.

Although the variability and prediction of rainfall is an essential issue of the Santhal Pargana Division of the Jharkhand State but the issue is still far from its’ conclusive statement till date. Therefore, this study aimed to simulate the monthly rainfall from 1901 to 2020 using an eight-step procedure. After downloading the monthly rainfall for the Santhal Pargana Division from 1901 to 2020, the TBATS and Naive models were used to simulate the rainfall. The accuracy assessment of each model was done by using the MASE, MAE, RMSE, ME, and R. For the Naïve model, the Godda station was noticed with a comparatively high combined error. The lowest combined error was found for the Pakur station in case of Naïve models. Similar result was also obtained for the TBATS model. The TBATS was found with comparatively higher accuracy, as the combined error was less for the TBATS. The spatial assessment for the standardized rainfall varied from 84.419 mm. to 149.225 mm. For the Naïve predicted model, the rainfall was marked in between 8.133 mm. to 67.059 mm. For the TBATS fitted model, the rainfall fluctuated from the 37.127 mm. to 62.993 mm. Dumka station was noticed with comparatively low rainfall (i.e.,37.127 mm.). Deoghar and Jamtara stations were marked with a moderate rainfall. Remaining stations were marked with higher amount of rainfall for the TBATS fitted model. The Wilcoxon test proved that each model was significant at 95% confidence interval. The result produced in this research is fruitful enough to be utilized for agricultural planning in the Santhal Pargana Division of the Jharkhand state, India. Keywords : TBATS model; Naive model; simulation; accuracy Copyright (c) 2022 Geosfera Indonesia and Department of Geography Education, University of Jember This work is licensed under a Creative Commons Attribution-Share A like 4.0 International License

We have all grieved, been enraged and depressed about the death of Māori children at the hands of whānau . We can all name Māori children who have become terrible bywords for the failure of some Māori families to protect and nurture their children.Over the years the recurring response has been to call for Māori families to take greater responsibility for both their actions and their whānau with parenting courses promoted as one of the ‘across the board’ solutions. In light of this a brief survey was done in 2003 to see what parenting information was available to Māori parents from the main social service agencies and information providers in Dunedin. Early on it was obvious that there was very little information specifically for Māori families and so the search was widened to look at what was available generally in Dunedin. This was not intended to be a rigorous quantitative study, but the numbers do give an indication of what resources were easily available to parents.In all, 12 Dunedin information, health and social service providers were visited to see what was available to parents on parenting skills. Having been involved in health promotion, social work and a number of local community groups, I was confident that I had approached most of the likely organisations that would be expected to either provide, or have links to those providing parenting information to Dunedin parents.Four of the providers ran courses for parents and information was gathered on the topics covered. Plunket ran a six-week course for parents of toddlers that covered issues such as toileting, nutrition, positive parenting, play, development and safety. Barnardos ran two courses, one on family financial management, and a five week course entitled, ‘Parenting with less stress and more enjoyment’. Catholic social service ran three courses based on its ‘Parenting Positive Families’ formula for parents with children under five, primary school age children and teenagers. The Family Care Centre ran a course called ‘Caring with confidence’. No course was targeted specifically at Māori families.From the 12 agencies 21 pamphlets, posters, books and videos were available on parenting skills. In all there were only six resources on parenting skills that were aimed specifically at Māori families. Two were from the Children’s, Young Persons and their Families services and focused on positive things to do with children. The other four were focused on smacking and physical abuse. Three of these were from the Office of the Children’s Commissioner, the other, a video was from the Children and Young Persons Service. (This was a parallel video put out for Māori parents to the mainstream one on smacking. The mainstream video focused on real parents and how they dealt with discipline. The scene that stood out to me was a Pākehā father breaking down in tears admitting that he had smacked his child. The Māori version used actors where the woman in the story eventually beats her son to death.)In all there were 28 resources or programmes available to parents. Six were targeted specifically at Māori and 22 were targeted at the general public. Each resource was assessed to ascertain the general themes and fell into three broad categories: communication, child/adolescent development and discipline.

BackgroundRheumatoid arthritis (RA) is associated with reduced physical performance capacity, leisure activities and self-service [1]. These changes are the results of the destruction of the joints, as well as the decrease in muscle strength, which is known as sarcopenia. However, patients with RA beset with a rheumatoid cachexia (RC), a specific form of sarcopenia, characterized with a decrease in fat-free mass index and an increase in fat mass index [2]. RC leads to a dramatic decrease in the life quality and increase in mortality rate [3].ObjectivesTo study the clinical and laboratory factors associated with the RC.Methods110 patients (102 females and 8 males) were enrolled in our study. All patients fulfilled the 2010 ACR/EULAR classification criteria for RA. Standard clinical, laboratory and instrumental examinations were performed. Additionally, hsCRP, ACPA, CTX-1, P1NP and 25(OH)D were defined. Dual-energy X-ray absorptiometry with Total Body program was performed. The diagnosis of RC was based on the next criteria: fat-free mass index less than 10th percentiles with fat mass index above 25th percentiles [2]. Statistical analysis was performed using a software package “Statistica 12.0”. Parametric parameters are presented as M±std.dev. (95% CI), non-parametrics as Me (Q1-Q3). Intragroup analysis of quantitative indicators was carried out using Student’s or Mann-Whitney test. The multiple logistic regression analysis was performed with a stepwise direct search procedure. Results are presented as odds ratio (OR) and 95% confidence interval (95% CI). ROC curve was plotted to assess the diagnostic significance of quantitative signs in predicting rheumatoid cachexia.ResultsMean patients age was 53,7±12,07 (10,8-13,7) years. More than 85% had severe of terminal progression of the RA. Most patients were RF (77,3%) and ACPA (67,3%) positive, had moderate disease activity (3,79 [2,89-4,40]), cartilage erosions (79%) and II (56,4%) functional class. RC was diagnosed in 25 patients. Prevalence of RC was lower in RF-negative patients (OR 0,11 (95% CI 0,01-0,83). Also, prevalence of RA was associated with the duration of RA (1,06 (1,01-1,11)). Mean cumulative dose of glucocorticoids (GCs) was higher in patients with RC (8,5 g [6,2-17,5 g]), than without (5,8 g [3,6-13,7 g]) (Z=-1,98; p=0,047). Mean daily dose of GCs was lower in patients with RC (5 mg [4-8 mg] and 8 mg [5-10 mg] (Z=2,58; p=0,01)). The median duration of RA was higher among patients with RC (14,0 years [9,0-22,0] vs 8,0 years [3,0-16,0] (Z=-2,18; p=0,029)).ROC-curve was employed to assess the significance of the RF-negativity and RA duration in the diagnosis of RC. Results are presented in Figure 1.Figure 1.ROC-curve for the RC based on the duration of RA and the presence of RF.The optimum cut-off point of 9,5 years of RA was defined using Youden’s J, with a sensitivity of 88% and specificity of 53%.ConclusionRC is associated with the duration of RA, positivity for RF, higher cumulative dose of GCs and lower daily dose of GCs. Due to clinical practice, higher doses of GCs are usually prescribed as a “bridge-therapy” at the start of the treatment or while switching the therapy. On the other side, patients with low daily dose of GCs are more often hormone dependent, with high total cumulative dose. With the sensitivity of 88% patients with the duration of RA 9,5 years and more have RC.References[1]Metsios GS, Kitas GD. Physical activity, exercise and rheumatoid arthritis: effectiveness, mechanisms and implementation. Best Practice & Research Clinical Rheumatology. 2018; 32(5):669-682.[2]Coin A, Sergi G, Minicuci N, Giannini S, Barbiero E, Manzato E, et al. Fat-free mass and fat mass reference values by dual-energy X-ray absorptiometry (DEXA) in a 20-80 year-old Italian population. Clinical Nutrition. 2008; 27(1): 87-94.[3]Roubenoff R. Rheumatoid cachexia: a complication of rheumatoid arthritis moves into the 21st century. Arthritis Research & Therapy. 2009; 11(2): 108.Disclosure of InterestsNone declared

I’ve been both fascinated and distressed by the arguments raging over how best to respond to the covid-19 pandemic. In particular, I’ve been struck by the way people claim scientific authority for their confident assurances of what needs to be done. And I’m especially intrigued by the scorn they often lavish on those who hold differing views on what science is telling us. The heat generated by the resulting debates is strikingly similar to the heat generated by debates over the science connected with human-caused climate change. And in both cases, the disputants too often presuppose indefensibly naïve views about scientific authority and certitude, apparently unaware that even the allegedly most obvious logical truths lack the certainty attributed to scientific authority in these debates. As a rule, I dislike re-circulating my Editorials, but I think it’s time to resurrect one (modestly tweaked) from a few years ago, addressing precisely this issue (Vol. 31, No. 3, pp. 379–386, 2017). …………………………………… “Man is a rational animal who always loses his temper when he is called upon to act in accordance with the dictates of reason.” --Oscar Wilde I’ve often noticed how debates within the SSE community sometimes parallel debates in the political arena, perhaps especially with respect to the passion they elicit and the intolerance and condescension sometimes lavished on members of the “opposition.” Occasionally, of course, the debates in the SSE are nearly indistinguishable from those in the political arena—say, over the evidence for human-caused climate change. But what I find most striking is how the passion, intolerance, etc.—perhaps most often displayed by those defending whatever the “received” view happens to be—betrays either a surprising ignorance or else a seemingly convenient lapse of memory, one that probably wouldn’t appear in less emotionally-charged contexts. What impassioned partisans tend to ignore or forget concerns (a) the tentative nature of both scientific pronouncements and knowledge claims generally (including matters ostensibly much more secure than those under debate), as well as (b) the extensive network of assumptions on which every knowledge claim rests. So I’d like to offer what I hope will be a perspective-enhancer, concerning how even our allegedly most secure and fundamental pieces of a priori knowledge are themselves open to reasonable debate. A widespread, but naïve, view of logic is that no rational person could doubt its elementary laws. But that bit of popular “wisdom” is demonstrably false. And if that’s the case, then so much the worse for the degree of certitude we can expect in more controversial arenas. Let me illustrate with a few examples.[1] [1] I’m indebted to Aune, 1970 for much of what follows.

Abstract. Muslim lifestyle in the city which one of the causes is the development of mass me-dia, especially in religious nuances magazines. By analyzing 13rd – 18th volume of SCARF Maga-zine Cover this research is done to find out how the Scarf magazine constructs hijaber in their cover magazine version. The method used in this study is a qualitative method with Peirce semiot-ics analysis and data collection techniques in this study is by Interview, Observation, and Library Studies. From the results of this study found that there are ten symbols on the cover of Scarf maga-zine that has a meaning in accordance with the criteria of muslimah urban Scarf magazine. The ten symbols are models are public figure, entrepreneur models symbol, a gesture tilting his head, a gesture raising one foot, hand closing gesture, a fashion symbol, a hijab headscarf, a symbol of wearing a headscarf, a symbol of different makeup styles - different, and SCARF text symbols. Where the meaning is to construct hijabers in version of Scarf magazine cover. The conclusion of this research is that the symbols have a meaning that construct a muslimah in magazine cover of Scarf magazine not only through fashion but also from other symbols that fit with the characteris-tics of Muslim according to the magazine that is smart, active, independent, confident, dynamic, and commit to spirituality value. From this research SCARF should more consider about spiritual-ity value and other symbol that shown through the cover magazine according to the vison of this magazine. Abstrak. perkembangan hijab bagi muslimah di kota besar salah satunya diakibatkan perkembangan media massa khususnya majalah bernuansa agama termasuk majalah SCARF. Dengan menganalisis Cover majalah SCARF volume 13-18 penelitian ini bertujuan untuk menge-tahui bagaimana majalah SCARF mengkonstruksi perempuan berhijab versi cover majalahnya. Metode yang digunakan yaitu metode penelitian kualitatif dengan analisis semiotika Charles Sand-ers Peirce dan teknik pengumpulan data Wawancara, Observasi, dan Studi Pustaka. Dari hasil penelitian didapatkan bahwa terdapat sepuluh simbol pada cover majalah Scarf yang memiliki makna sesuai dengan kriteria muslimah urban mengkonstruksi perempuan berhijab versi cover majalah Scarf. Sepuluh simbol tersebut yaitu simbol model seorang public figure, simbol model seorang entrepreneur, simbol gesture mendongakkan kepala, simbol gesture meninggikan satu ka-ki, simbol gesture tangan menutup, simbol gaya busana, simbol jilbab tidak menutup dada, simbol penggunaan jilbab, simbol gaya riasan yang berbeda-beda, dan simbol teks SCARF. Simpulan dari penelitian ini simbol-simbol tersebut memiliki makna yang mengkonstruksi perempuan berhijab versi cover majalah Scarf tidak hanya melalui fashion tapi juga dari simbol lain yang sesuai dengan karakteristik muslimah menurut majalah tersebut yaitu smart, active, independent, confi-dent, dynamic, dan commit to spirituality value. Pada penelitian ini peneliti menyarankan agar majalah SCARF lebih mempertimbangkan simbol-simbol termasuk nilai-nilai spiritual yang di-tunjukkan melalui covernya agar lebih sesuai dengan tujuan majalah.

The goal of psoriatic arthritis (PsA) therapy is to achieve remission or minimal disease activity (MDA). According to the EULAR guidelines, synthetic disease-modifying antirheumatic drugs (sDMARDs), methotrexate (MTX) in particular, are first-line therapy for PsA.Objective: to study the rate of MDA achievement after initiation of sDMARD therapy in patients with early- and late-stage PsA and the efficacy of oral and parenteral MTX.Patients and methods. The investigation enrolled 253 patients (93 men and 160 women) diagnosed with PsA who met the appropriate 2006 CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria and were recorded in the All-Russian PsA Registry. The median (Me) age was 47 (Min 20 – Max 82) years. All the patients took sDMARDs: MTX (n=211) that was received orally (as tablets) (n=102) and parenterally (n=109); leflunomide (n=7); sulfasalazine (n=24); apremilast (n=10); and tofacitinib (n=1). According to the disease duration at sDMARD treatment initiation, the patients were divided into two groups. Group 1 included 165 patients with an early PsA duration of less than 2 years and Group 2 consisted of 88 patients with a disease duration of >2 years. The efficiency of oral and parenteral MTX was evaluated in 182 patients (68 men and 114 women). Every 6 months, the patients underwent a standard rheumatology examination that included PsA activity assessment. The efficiency of MTX therapy was evaluated from MDA achievement (5 out of the 7 criteria) in the patients.Results and discussion. After sDMARD prescription, MDA was achieved in 39 (24%) of the 165 patients with early PsA and in 4 (5%) of the 88 long-term patients. The patients who started sDMARD at an early stage of the disease were significantly more likely to achieve MDA than those with late-stage PsA (odds ratio (OR) 6.5; 95% confidence interval (CI) 2.2–18.9). At 11 years after sDMARD therapy initiation, the cumulative MDA achievement rate in the patients with late-stage disease was 5% (p<0.05). MDA was achieved by 16.5% of the 182 patients receiving oral or subcutaneous MTX. MDA was observed in 25 (31%) patients who received parenteral MTX and in only 5 (5%) patients who took oral MTX. The patients who received parenteral MTX were significantly more likely to achieve MDA than those who took oral MTX as tablets (OR 8.8; 95% CI 3.2–24.3). Following 27-month parenteral MTX therapy, the cumulative rate of MDA achievement was 48%, whereas after oral MTX treatment, that was 7% (p<0.05). In the patients who achieved MDA, the mean dose of parenteral MTX was 17 mg/week, and in those who failed, that was 15 mg/week. The mean dose of oral MTX was 15 mg/week, regardless of MDA achievement.Conclusion. The administration of sDMARD at an early stage of PsA lasting less than 2 years allows MDA to be achieved significantly more often and faster than at later stages of the disease. Among sDMARDs, preference is mostly given to the use of MTX in real clinical practice; the treatment with the latter enables 16.5% of patients to achieve MDA. Parenteral MTX significantly enhances the efficiency of therapy and can achieve MDA in almost one third (31%) of patients.

BackgroundSB5, an adalimumab (ADL) biosimilar, was developed in a low-concentration (40 mg/0.8 mL, SB5-LC) aligned with the reference ADL product. Pharmacokinetics (PK) equivalence of SB5 and reference ADL was demonstrated in a Phase I study conducted in healthy subjects1. Equivalent efficacy and comparable safety between 40 mg/0.8 mL SB5 and 40 mg/0.8 mL reference ADL were demonstrated in a Phase III study conducted in patients with rheumatoid arthritis2. High-concentration, low-volume, citrate-free SB5 (40 mg/0.4 mL, SB5-HC) has been developed as a part of life cycle management in line with the reference ADL formulation.ObjectivesTo compare the PK, safety, and tolerability of the newly developed SB5-HC (40 mg/0.4 mL) to prior SB5-LC (40 mg/0.8 mL) in healthy male subjects.MethodsThis study was a randomised, single-blind, two-arm, parallel group, single-dose study in healthy male subjects. Subjects were randomised in a ratio of 1:1 to receive a single dose of either SB5-HC or SB5-LC by subcutaneous injection on Day 1 and then observed for 57 days during which the PK, safety, and immunogenicity were evaluated. The serum concentration of ADL was measured using an enzyme-linked immunosorbent assay. The primary PK parameters were area under the concentration-time curve from time zero to infinity (AUCinf) and maximum serum concentration (Cmax). Equivalence for the primary PK parameters was to be concluded if the 90% confidence intervals (CIs) for the ratio of geometric least squares means (LSMeans) of the treatment groups compared were completely contained within the pre-defined equivalence margin of 0.80 to 1.25 using an analysis of variance.ResultsOf 188 randomised subjects, 187 subjects were analysed as PK Analysis Set (PKS) (n=93 in SB5-HC and n=94 in SB5-LC). One subject was excluded from the PKS in SB5-HC group (major protocol deviation for not being withdrawn in the event of confirmed COVID-19). The geometric LSMeans ratios for the comparison of SB5-HC and SB5-LC for AUCinf and Cmax were 0.920 and 0.984, respectively, and the corresponding 90% CIs were within the pre-defined equivalence margin of 0.80 to 1.25 (Table 1), indicating the two treatment groups are bioequivalent. There were no deaths, serious adverse events or discontinuation of the study due to treatment-emergent adverse events (TEAEs) during the study. The proportions of subjects who experienced TEAEs were comparable between the two treatment groups (44.7% in SB5-HC vs 51.1% in SB5-LC). The most frequent TEAEs were headache (10.6% in SB5-HC vs 12.8% in SB5-LC).Table 1.Comparison of Primary PK Parameters between the TreatmentsPK ParameterTreatmentGeometric LSMeanRatio90% CIAUCinf (h·μg/mL)SB5-HC2616.10.9200.8262; 1.0239SB5-LC2844.3Cmax (μg/mL)SB5-HC4.10.9840.9126; 1.0604SB5-LC4.1ConclusionThis study demonstrated PK equivalence between SB5-HC and SB5-LC in healthy subjects. Both SB5-HC and SB5-LC were generally well tolerated with similar safety profiles.References[1]Shin D et al. J Clin Pharm Ther. 2017 Dec;42(6):672-678.[2]Weinblatt ME et al. Arthritis Rheumatol. 2018 Jun;70(6):832-840.Disclosure of InterestsNone declared

Dear Editor, I was exposed to a COVID-19 positive cardiologist last March 1. I had ENT clinics until March 11, treating mostly patients with complaints of cough and fever (sinusitis and bronchitis). I felt that my facial mask, hooded magnifier lens, and gloves gave me enough protection. I was wrong. They were not sufficient. I had a temperature of 38°C on March 13 and went home immediately to self-isolate. By March 15, I was coughing unremittingly and persistently as if a feather was stuck in my throat. I had no phlegm. I had no running nose, nor respiratory difficulty. But my rib muscles ached continuously - an intense, miserable pain not relieved by any position. I felt a severe point tenderness over both lower back ribs that even soft pillows could not diminish. I lacked sleep. I felt weaker as days went by. My taste was flat as I swallowed soups and arroz caldo but I still had my sense of smell. On March 16, I took Clarithromycin 500 mg and N-Acetylcysteine 600 mg, both twice daily to treat what I diagnosed as acute pharyngitis. Two more days of severe coughing, fever and sore throat made me worry about COVID-19. How come I was not getting better? In fact, I was getting BITTER over this uncertainty of COVID-19 and the treatment I had prescribed myself. I had been religiously taking probiotics to imbue me with immunity for infections like these.1 I believed that lactobacillus acidophilus, the friendly gut bacteria, stimulates the Gut Associated Lymphoid Tissue (GALT) to produce antibodies against virus and bacteria shedding into small intestines and against bacteria abnormally multiplying in the large intestine.2 I was assured by the research of Russian Dr. Elie Metchnikoff on the potent lactobacillus in yogurt (which comprised almost 50% of the Bulgarian diet and made them strong and healthy). Dr. Metchnikoff (who had won the 1908 Nobel Prize in Physiology and Medicine) honored Bulgaria by naming his friendly bacteria lactobacillus bulgaricus.3,4 Dr. Metchnikoff was later honored as the “father of natural immunity.”5 Then came the Spanish flu of 1918-1919 that killed more than 2.5 million Europeans, mostly Italians and British.6 Yet the number of those killed in Bulgaria was as close to that in Switzerland, which was the lowest. Now, the COVID-19 pandemic marched into 2020 killing 4,633 patients out of 82,918 COVID+ in Wuhan, China; 31,855 out of 219,183 COVID+ in Great Britain; 30,560 out of 219,070 COVID+ in Italy; and 80,787 out of 1,367,638 COVID+ in the USA. Ninety-one died of COVID out of 1,965 positive for COVID-19 in Bulgaria.7 I was confident that the lactobacillus acidophilus 20 billion Colony Forming Units (CFU) were stimulating production of the IgG and IgM (from GALT which produces 70% of the body’s immune globulins) needed to neutralize viruses or bacteria.8 The acidophilus produces Vitamin B specially Vit B129 which I believe made for my stronger body. I had prepared myself as I prepared my patients for the flu by consuming Vit C and Zinc. Zinc stimulates the thymus to increase immune responses to viruses.10,11 I was fortified with 2 Colostrum pills daily, preformed sources of IgG and IgA.12 I followed my regimen for acute rhinitis (though there was no nasal obstruction) which meant doing nasal SALINE washing or sprays thrice a day. I knew that the flu virus (or even the SARS-COV2) hides EARLY in the nose and sinuses and is able to produce toxins which inflame the whole body. Worse for SARS-COV2 because these drop into the tonsils and into the lungs. The nasal sprays were meant to reduce the virus numbers (viral load) in the nose and sinuses so there were less shedding. Saline washes decongest the nose to improve breathing. The 60 seconds antiseptic mouthwash followed a regimen of brushing the teeth then the palate and the tonsils and to the base of the tongue. This was to extinguish any virus lurking to go down into the lungs or GIT. This regimen was routine at 3x a day. The fever dropped slowly. Coughing diminished though the muscles constantly ached after 3 days of Clarithromycin. I was determined to have the COVID tests and a high resolution CT scan of the chest. On March 20 at the hospital ER, I explained I was a patient requesting a CBC, a COVID test, and a chest CT scan and that I will wait for my turn since the ER was full (took me 3 hours). After the interview with the ER physician, I was led to a seat one meter apart from others. Elderly patients with cough all quizzically looked at me in my white doctor’s gown wondering if I was sick. I changed to the gown, mask, and gloves I was provided with when the nurse escorted me to cubicle one. First came the CBC. Next were Rt-PCR swabs of the nose and nasopharynx and of the throat. Finally after the staff sterilized the CT scan room, my scan was completed in a few minutes. The chest scan showed ground glass appearance consistent with Bilateral Basal Pneumonia. I was told that the PCR results would be ready within 7 days. I was advised urgently by my classmate, a pulmonary specialist from another hospital, for admission for oxygen inhalation and treatment. She went out of her way to look for a pulmonologist but none was available due to quarantine. She looked for an Infectious Disease Specialist who was now in isolation. I requested her that since I was not in respiratory distress and because of my weakened state, I was worried about getting a hospital acquired infection and that I be committed to strict home isolation with treatment prescribed by her. She reluctantly acceded with the admonition that I proceed immediately back to hospital if respiratory difficulties occur. I started the Oseltamivir (Tamiflu) at 2x a day for 5 days and Azithromycin once daily for 7 days plus a mucolytic N- Acetylcysteine 600 mg 2x a day. There was another dimension beyond my physical stress. I was in MENTAL stress, the pervasive fear of not surviving this that engulfed me. Knowing my close colleagues died from COVID-19 pneumonia after a short battle in ICU with intubation, I realized THIS certainty of death and THAT uncertainty of recovery. I asked for a lifeline from my UP Med ‘76 classmates. (The lifeline in the family was unconditionally given though from a distance). My pulmonologist classmate closely monitored my condition daily. Some offered their listening ears to my echoing worries. Most prayed to God with their unconditional love for me to recover. Another classmate had extraordinary pranic sessions for my healing, my relaxation and my energy. I reflected on my dad’s advice that in a righteous fight (like against this pneumonia), “you use all means and all ways to win.” I started deep breathing into the nose and slowly out through the mouth knowing full well that the nitric oxide I absorbed through the roof of the nose dilated my coronaries for better heart function and my pulmonary arteries for better oxygen exchange. The deep breathing provided nitric oxide to the bronchus and bronchioles to dilate them for more airflow. Moreover, I was taking in lots of calamansi juices (or lemon or oranges) for its citrulline which has been researched to prolong the effects of nitric oxide.13 These breathing sessions were the MOST IMPORTANT activities if I were to survive and were continuous morning, noon and evening. Fortunately, I was isolated in 3rd floor Music Room with access to the roof deck garden and fresh air from Laguna de Bay (about 1.5 km from the house in Taguig) and of course, LPs of the Beatles, Aiza and Sharon, and Mozart. I did chest thumping or percussion as far as I could reach my back to loosen the phlegm in my lungs. This self ‘physical therapy’ was 3x a day. I started to spit scanty whitish, thick phlegm. I made sure that Oseltamivir (Tamiflu) was taken mornings and evenings and the Azithromycin was taken at lunch so there were no drug interactions. The 2 Colostrum tabs were swallowed on waking up. The probiotics were taken after breakfast and after dinner. The Zinc was taken after lunch. Soft stools were present but that was my GIT reacting to the medications. Adding to the controversy was the new regimen US President Donald Trump was trumpeting on Fox News and CNN. A hospitalist physician treating COVID-19 pneumonias in San Francisco was giving us the new protocols for Chloroquine and Azithromycin, with promising results. He was the classmate of my daughter in UP Med. I went to pharmacies in Taguig and Greenhills for Chloroquine. It was not available. My pulmonologist classmate was firm; “No!” when I suggested the shift. “You will need confinement and an ECG because these combination drugs prolong QTc on electrocardiogram.” This meant Chloroquine and Azithromycin combination may initially precipitate bradycardia (lower heart rate) then ventricular tachycardia (heightened heart rate), and finally, cardiac arrest for senior patients (68 years old) like me with a history of hypertension. This discussion stopped all controversies in treatment. Moreover, I was getting better. My temperature decreased to 37.8 °C. The muscle pain diminished. The severe point tenderness over the lower ribs persisted. I was deep-breathing which I could not hold for more than 10 seconds. That was not normal! I listened to my lungs for the CRACKLING sounds of pneumonia with my stethoscope. The maze of gurgling and churning sounds from the stomach and intestines seemed to mask the sounds I was listening for. Or was I in denial? I decided to go back to ER on the 3rd day for a chest X ray. The objective was to see if my pneumonia was progressing. The chest X ray still showed basal pneumonia. I had mixed feelings-- good that pneumonia did not progress to middle lung fields and --- bad that pneumonia was festering. I completed the 5-day regimen of Oseltamivir (Tamiflu) and was continuing the 8th day of Azithromycin and N-Acetylcysteine when my COVID test finally arrived through email-- I was COVID positive #1906 . By this time, I was recovering physically and mentally. I had no fever (37.2 °C average), no cough, no sore throat. Breathing was full. I had my appetite back. My outlook was as OPTIMISTIC as the blooming flowers I nurtured during this trial. This timing was fortunate because even with confirmed COVID-19 positive, I knew I had beaten COVID-19 pneumonia at home. Isolation was completed 2 weeks from my recovery which necessitated another COVID test and rapid test April 10, 2020. This test was still positive. A third PCR done on April 20 was negative for SARSCoV-2. The new DOH protocol was to isolate up to May 5 which I have followed. I am practicing social distancing and wearing a mask.

EDITORIAL Tenho imenso prazer em apresentar a Edição Especial da Revista Prociências, intitulada “Capacitação em competência digital: uma resposta para o fortalecimento das instituições públicas nos países da América Latina e do Caribe”, que objetiva divulgar resultados iniciais do Programa de treinamento virtual para formadores em habilidades digitais, desenvolvido junto a países das citadas regiões.Nesse contexto, é necessário agradecer a confiança depositada na Revista Prociências pelas instituições que organizam e fomentam o referido Programa, ao escolher a nossa Revista como veículo para divulgação de resultados da execução das intervenções no âmbito dessas atividades. Notadamente, agradecer à Organização de Estados Ibero-americanos (OEI), à Agência Espanhola de Cooperação Internacional para o Desenvolvimento (AECID), ao Convênio Andrés Bello (CAB), e à Universidade Nacional de Educação a Distância (UNED) da Espanha, pela confiança depositada em nossa Revista.Desejo parabenizar os autores e autoras dos artigos que compõem esta Edição Especial, oriundos de diversos países da América Latina e do Caribe, como Argentina, Cuba, El Salvador, Peru, Uruguay y Venezuela, por socializar os resultados de seus projetos de pesquisa com os leitores da Revista Prociências.Expressar, também, meu reconhecimento ao trabalho realizado pelas Coordenadoras desta Edição da Revista, professoras Ana María Martín Cuadrado, Lourdes Pérez Sánchez, e Mabel Álvarez, que desde Argentina e Espanha foram determinantes na organização dos trabalhos, para oferecer aos leitores do nosso periódico científico um conjunto seleto de artigos que refletem resultados significativos do Programa em tela.Resta mencionar que a Revista Prociências continua à disposição da comunidade científica internacional para publicação de outras Edições Especiais, no formato Dossiê ou Edição Temática; e que a Revista recebe contribuições em fluxo contínuo, ação que contempla a submissão, recebimento e avaliação de artigos durante o ano todo.Aguardo, portanto, o recebimento de propostas de novas Edições Especiais da Revista, assim com trabalhos inéditos para as próximas edições regulares do nosso periódico.Para finalizar, desejo a todos uma profícua leitura desta Edição Especial da Revista Prociências, e me despeço, até a próxima edição da Revista! Walter R. Iriondo OteroEditor EDITORIAL I am very pleased to present the Special Issue of Prociências Journal, entitled "Training in Digital Competence: a response to strengthen public institutions in Latin American and Caribbean countries", which aims to publicize initial results of the Program of virtual training for trainers in digital skills that is developed with countries in these regions.In this context, it is crucial to recognize the institutions that organize and promote the Program for the confidence they have placed in Prociências Journal. I am grateful to them by choosing our journal to publish the results from their investigations.I would like to specially thank the Organization of American States (OAS), the Spanish Agency for International Development Cooperation (AECID), the Andrés Bello Agreement (CAB) and the National University for Distance Education (UNED) from Spain, for the trust placed in our journal.I would like to congratulate the authors of this Special Issue, who are from Argentina, Cuba, El Salvador, Peru, Uruguay, and Venezuela, for socializing the results of their research projects with the readers of Prociências Journal.I would also like to express my appreciation for the work done by the professors Ana María Martín Cuadrado, Lourdes Pérez Sánchez and Mabel Álvarez, who are the coordinators of this issue. From Argentina and Spain, they have been effective in organizing the work to offer the readers a high-quality set of articles that reflect significant results of our program.It is also worth mentioning that the Prociências Journal is still available to the international scientific community for the publication of other Special Issues in Dossier or Thematic Issue format. The Journal receives contributions on a continuous flow, an action that contemplates the submission, receipt, and evaluation of articles throughout the year.I look forward, therefore, to receive proposals for new Special Issues and unpublished works for the next regular issues of our journal.To conclude, I wish everyone a successful reading of our Special Issue. Walter R. Iriondo OteroEditor EDITORIAL Me da mucho gusto presentar la Edición Especial de la Revista Prociencias, titulada “Capacitación en competencia digital: una respuesta al fortalecimiento de las instituciones públicas en los países de América Latina y el Caribe”, que tiene como objetivo difundir los resultados iniciales del Programa de capacitación virtual de formadores en competencias digitales, desarrollado en países de las regiones antes mencionadas.En este contexto, es necesario agradecer la confianza depositada en la Revista Prociências por las instituciones que organizan y promueven el mencionado Programa, al elegir nuestra Revista como vehículo de difusión de los resultados de la ejecución de intervenciones en el ámbito de estas actividades. En particular, quisiera agradecer a la Organización de Estados Iberoamericanos (OEI), a la Agencia Española de Cooperación Internacional para el Desarrollo (AECID), al Convenio Andrés Bello (CAB), y a la Universidad Nacional de Educación a Distancia (UNED) de España, por la confianza depositada en nuestra Revista.Deseo felicitar a los autores y autoras de los artículos que componen esta Edición Especial, provenientes de diferentes países de América Latina y el Caribe, como Argentina, Cuba, El Salvador, Perú, Uruguay y Venezuela, por compartir los resultados de sus proyectos de investigación con los lectores de la Revista Prociências.También quisiera expresar mi reconocimiento a la labor desarrollada por las Coordinadoras de esta Edición de la Revista, las profesoras Ana María Martín Cuadrado, Lourdes Pérez Sánchez y Mabel Álvarez, quienes desde Argentina y España fueron fundamentales en la organización de los trabajos, para ofrecer a los lectores de nuestra revista científica un selecto conjunto de artículos que reflejan resultados significativos del Programa en cuestión.Cabe mencionar que la Revista Prociências continúa a la disposición de la comunidad científica internacional para la publicación de otras Ediciones Especiales, en formato de Dossier o de Edición Temática; y que la Revista recibe contribuciones en un flujo continuo, acción que incluye el envío, recepción y evaluación de artículos a lo largo de todo el año.Por lo tanto, espero recibir propuestas para nuevos números especiales de Prociências, así como trabajos inéditos para los próximos números regulares de nuestra Revista.Finalmente, les deseo a todos una fructífera lectura de esta Edición Especial de la Revista Prociências, y me despido ¡hasta la próxima edición de la Revista! Walter R. Iriondo OteroEditor

The hospitality industry is under intense pressure. COVID-19 restrictions and limited trading opportunities have forced restaurateurs to consider their pricing structures. Reflecting those concerns, Richard Corney, MD of the Inigo Coffee Group, proposed that the retail price of a cup of coffee needed to rise to between $6.50 and $7.00 to “take into account all the other cost increases hospitality establishments have experienced in the last decade, not to mention the challenges of the pandemic in the last two years” [1]. Alongside these revenue issues, the industry also needs to move away from a tradition of low pay and low value [2], and perhaps towards the concept of a ‘hospitable wage’ [3]. However, laudable as these goals might be, upward price movement may be resisted by many customers. So how can restaurateurs and hoteliers ‘sell’ revised-price-products to their customers? Clearly, increased revenue can be achieved through both marginal price increases and up-selling to increase average customer spend. We propose that both of these goals can be achieved if employers embrace the concept of hospitality as an experience [4, 5], where the performance of staff is central [6], and where the experience is delivered with ‘hospitality personality’. Much has been written about the personality of hospitality staff. Most of that work can be traced back to the early work of Erving Goffman [7] who proposed that hospitality employees were playing roles, and acting out, by using their emotional intelligence. Goffman likened such workers to actors who literally ‘take on’ a character. The characteristics of the hospitality personality have been explored by many authors [8–10] and include, agreeableness, extroversion, openness to experience, conscientiousness, and emotional stability; although some research also reveals that neuroticism is also a hospitality characteristic in hotel receptionists. Alongside this research, other studies have identified the role of mood and personality in positive guest experiences, specifically service quality perception and customer satisfaction [11]. This supports our suggestion that the performance of staff can have a direct impact on customer experience and potentially revenue, and that Corney’s price recommendation could be a realistic option for many businesses struggling economically. But there’s a ‘fly in the ointment’: the Tall Poppy Syndrome. Tall poppy syndrome originated around 500BC in ancient Rome, when King Tarquinius Superbus demonstrated how the nation should deal with its enemies. In an active display he lopped off the heads of the tallest poppies in his garden with a stick [12]. Today, tall poppies are conspicuously successful people, who may attract envy, resentment or hostility, and the Tall Poppy Syndrome (TPS) is the habit of others to diminish those who have attained excellence in a field – to cut them down to size [13]. While TPS is commonly associated with Australia and New Zealand, it is also part of other cultures. Within Scandinavian cultures, janteloven1 promotes humility and conformity paralleling TPS [15]; in Japanese culture, ‘the nail that sticks up gets pounded down’ [16]; and within Filipino culture a crab mentality exists whereby crabs in a bucket tend to pull back any adventurous crabs trying to escape [17]. TPS is often described as being ingrained in New Zealand culture [18] and has been identified as a phenomenon in New Zealand entrepreneurship and business [19]. While TPS encourages conformist cultures, our research provides a valuable insight into how employers can spot potential employees who actively resist notions of TPS’s conformity and are more likely to perform to the highest levels. Using Instagram, we interviewed 1000 young self-identifying New Zealanders to explore their qualitative experiences of TPS. They identified as 68% female and 32% male. Their age ranges were: 58% aged 18–24; 27% aged 25–34; 7% aged 35–44; 3% aged 45–54; and 2% aged 55 or above. Three percent of the respondents were excluded from our final sample because they were aged 17 or younger. The respondents’ feelings, victimhood, self-esteem, and knowledge about TPS provided our research with the largest amount of data. Of our 1000 participants, 50% knew what TPS was, while 50% did not. Similarly, 45% of our respondents claimed to be victims of TPS. Contrastingly, 55% had no experiences of TPS. Within those considerations, the data revealed clearly that TPS was perceived by participants as ‘something done to them’ and not as ‘something they do to other people’. Yet, and despite that difference, the pervasive nature of TPS within Kiwi socio-culture was noted by participants. Several participants recounted the cost of TPS; for example, “Definitely held me back. It can knock your confidence so much” and “Made me want to hide/play down my talents/my life.” Other participants perceived TPS “put-downs” (belittling or humiliating remarks) as a challenge or motivating force. They commented, “Uncomfortable but it pushed me harder to be even more successful” and “It motivated me. I realized people saw something in me and strived to continue improving.” For the 45% of our participants directly experiencing TPS, those experiences were grounded within two base reactions. Reflecting that, more than half of our participants adopted conformist behaviours, succumbing to the bullying pressures of others. However, 45% recognised TPS and its bullying as a motivator to create further behaviours and actions of excellence. The role of social media in TPS was significant. Participants directly linked TPS to social media with 89% of respondents recognising the role of social media in TPS. Key to their views was the realisation that social media not only provided distance between people but also that people used social media to manipulate the image they projected to others. In those ways, social media was a mediating factor. As participants observed, “Easier to be mean and cut someone down through a comment than to their face” and “Social media has made it easier to abuse and put down those that stand out.” Given the attributes of the hospitality personality, and Richard Corney’s proposed pricing restructures in hospitality, the key is for employers to consider the resilience of their staff to TPS and conformity. They should consider whether they can recruit and retain the 45% of staff that use TPS as inspiration to succeed – the staff who will rise the challenge of delivering exceptional customer experiences through their own performance of the ‘hospitality personality’. It is within the unique characteristics of these staff that hospitality businesses can generate that extra point of difference and experience that customers will be happy to pay a little more to enjoy; and perhaps hospitality businesses might go a step further by also considering the concept of the ‘hospitable wage’. Corresponding author Lindsay Neill can be contacted at: lindsay.neill@aut.ac.nz Note “Janteloven (the law of Jante) at its simplest describes the way that all Norwegians (and in fact, other Scandinavians too) behave: putting society ahead of the individual, not boasting about individual accomplishments, and not being jealous of others” [14]. References (1) Wilkes, M. We Need to Pay $7 for a Flat White if Cafes are Going to Survive, Says Coffee Boss, 2021. https://www.stuff.co.nz/life-style/food-drink/drinks/127196374/we-need-to-pay-7-for-a-flat-white-if-cafes-are-going-to-survive-says-coffee-boss (accessed Dec 12, 2021). (2) Te Ora, N. Does Hospitality Have a Low Wages Problem? Workers Say Yes. Some Restaurant Owners Say No, 2021. https://www.stuff.co.nz/business/industries/125301113/does-hospitality-have-a-low-wages-problem-workers-say-yes-some-restaurant-owners-say-no (accessed Dec 10, 2021). (3) Douglas, J.; Williamson, D.; Harris, C. Dirty Deeds Done Dirt Cheap: Creating “Hospitable Wages” through the Living Wage Movement. Hospitality & Society 2020, 10 (1), 3–22. (4) Hemmington, N. From Service to Experience: Understanding and Defining the Hospitality Business. The Service Industries Journal 2007, 27 (6), 747–755. (5) Lugosi, P. Hospitality Spaces, Hospitable Moments: Consumer Encounters and Affective Experiences in Commercial Settings. Journal of Foodservice 2008, 19 (2), 139–149. (6) Morgan, M.; Watson, P.; Hemmington, N. Drama in the Dining Room: Theatrical Perspectives on the Foodservice Encounter. Journal of Foodservice 2008, 19 (2), 111–118. (7) Goffman, E. The Presentation of Self in Everyday Life; Doubleday: Garden City, New York, 1959. (8) Köşker, H.; Unur, K.; Gursoy, D. The Effect of Basic Personality Traits on Service Orientation and Tendency to Work in the Hospitality and Tourism Industry. Journal of Teaching in Travel & Tourism 2019, 19 (2), 140–162. (9) Grobelna, A. Extraversion and its Importance in the Hospitality Workplace. Scientific Journal, No. 876, Economic Problems of Tourism 2015, 3 (31), 89–96. (10) Gonzalez-Gonzalez, T.; García-Almeida, D. J. Frontline Employee-Driven Change in Hospitality Firms: An Analysis of Receptionists’ Personality on Implemented Suggestions. International Journal of Contemporary Hospitality Management 2021, 33 (12), 4439–4459. (11) Kocabulut, Ö.; Albayrak, T. The Effects of Mood and Personality Type on Service Quality Perception and Customer Satisfaction. International Journal of Culture, Tourism, and Hospitality Research 2019, 13 (1), 98–112. (12) Felton, D. Advice to Tyrants: The Motif of “Enigmatic Counsel” in Greek and Roman Texts. Phoenix 1998, 52 (1–2), 42–54. (13) Feather, N. T. Attitudes towards the High Achiever: The Fall of the Tall Poppy. Australian Journal of Psychology 1989, 41 (3), 239–267. (14) Nikel, D. What Exactly Is Janteloven? Life in Norway, 2015. https://www.lifeinnorway.net/what-exactly-is-janteloven/ (accessed Dec 10, 2021). (15) Ahlness A. Janteloven and Social Conformity in Thorbørn Egner’s Literature, 2014. http://ncurproceedings.org/ojs/index.php/NCUR2014/article/view/738 (accessed Oct 8, 2019). (16) Matsumoto, D. Culture and Self: An Empirical Assessment of Markus and Kitayama’s Theory of Independent and Interdependent Self-Construals. Asian Journal of Social Psychology 1999, 2, 289–310. (17) Licuanan, P. A Moral Recovery Program: Building a People – Building a Nation. In: Dy, M. B. (ed) Values in Philippine Culture and Education: Philippine Philosophical Studies, 1; The Council for Research in Values and Philosophy: Washington, DC, 1994, pp. 35–54. (18) Ockhuysen, S. It's Time to Do Better and Cut Tall Poppy Syndrome out of Our Culture. Stuff, Feb 20, 2020. https://www.stuff.co.nz/taranaki-daily-news/news/119627156/its-time-to-do-better-and-cut-tall-poppy-syndrome-out-of-our-culture (accessed Dec 11, 2021) (19) Kirkwood, J. Tall Poppy Syndrome: Implications for Entrepreneurship in New Zealand. Journal of Management & Organization 2007, 13 (4), 366–382.

Purpose This paper aims to develop an instrument that helps in managing liquidity. Liquidity is one of the most critical issues to be considered by the financial management of the business firms to meet its financial obligations. It is more vital for banks because of the liquid nature of its assets and liabilities, along with the fact that the confidence in the bank and degree of risk depends heavily on liquidity as an indicator of its wellbeing. Islamic banks (IBs) look at the liquidity issue from the same side as the traditional banks. IBs – the most apparent Islamic financial institution – suffered from the problem of not benefiting from the lender of last resort that Central Banks (CBs) offer to traditional banks because IBs cannot borrow from the CBs at interest. The experience of Institution(s) offering Islamic Financial Services[1] (IIFS) regarding the establishment of Islamic money markets did not show a tangible success instead of the early studies done by some scholars. In spite of the rich experience of some countries in creating new money market instruments or configuration of the interest-based ones according to Islamic - Sharī’ah[2], the designs of these instruments have many limitations in terms of their tradability and flexibility, restricting their use for open-market operations by CBs. Design/methodology/approach The purpose of calculating the time weighted debt units (TWDUs) is to find the equivalent amount of money that the supplier can borrow to the lender in the future for a maturity that differs from the first credit contract. It is a swap between an amount of credit for a particular period of time and another amount for another period. The scheme are called traditionally as reciprocal (mutual) loans, reciprocal (mutual) deposits, swapped conditional loans and “I lend you, provided you lend me” (Hammad, 2010). It is also well known in Pakistan as time multiple counter loan (TMCL), and known within some Arabic IBs as specks (Nomar = numbers) system. This contract will be called the reciprocal loans in the current paper. Findings The current paper represents a blue print of suggested money market instrument (scheme) that is based on the idea of Al Qardh El Hasan (interest-free loan) – called TWDUs. This instrument does not promise any revenue for the supplier and no charge for the lender. Research limitations/implications The suggested model is known in traditional and contemporary writings of Islamic economists and - Sharī’ah scholars. It is accepted by many - Sharī’ah Boards in IBs (Merah, 2011) and was accepted by the Council of Islamic Ideology in Pakistan in 1980 through the TMCL. Despite that, it is still not discussed in depth by international - Sharī’ah boards as the International Islamic Fiqh Academy – in addition to the wide spread of opponent viewpoint that considers this contract as a kind of riba. Originality/value TWDUs is presumed to help IBs and other IIFS to add more flexibility in liquidity management in the side of risk management[3] (represented by the potential loss to IIFS arising from their inability either to meet their obligations or to fund increases in assets as they fall due without incurring unacceptable costs or losses) in addition to avoiding the case of hoarding surplus funds in the short term. Also, the suggested instrument will not be exclusive to IBs or IIFS; it can be developed to be used at a later stage by them as a mean of overdraft between IBs and their clients. Moreover, beside its viability to help in liquidity management for other firms in business sector (non-financial) or government agencies in liquidity management, TWDUs look for Islamic financial theory as an alternative to the traditional financial theory that is based on interest. Moreover, TWDUs is expected to play an important role in monetary policy in a totally Islamic financial system or even in a mixed one (Islamic and capitalistic).

Abstract Introduction HIV is now a long-term condition, presenting new challenges for primary care providers. Hospital-based specialists have traditionally provided medicine-related support to people living with HIV (PLWH) within secondary care clinics,1 but with an aging population and rising polypharmacy2 other forms of support will be needed. Although community pharmacists (CPs) are already involved in sexual and reproductive health service delivery to varying magnitudes,3 it is unknown whether PLWH want them to be involved in their HIV treatment and medicine support. Aim To understand the pReferences and perceptions of PLWH towards CP involvement in their care. Methods An online survey, promoted to UK HIV charities and activists via social media (November 2021–July 2022), asked about pReferences for medicine-related support and the involvement of CPs in PLWH’s care. Questions explored factors that would influence use of CPs for all services. Views on sharing HIV diagnoses with CPs during medicine-related consultations were also obtained. Descriptive analysis was used. Institutional ethics approval was obtained. Results Approximately half (73/144) of those who accessed the survey fully completed it: 57.5% male; age 22-80 years. Of those who provided demographic data: 88.9%(n=48/54) were white; gay/lesbian (64.8%, n=35); University-level education (57.4%, n=31) and employed (55.6%, n=30). CPs were rated among the least helpful health professionals in terms of medicine support (2.7%, n=2) compared to general practitioners (13.7%, n=10), HIV clinic-based nurses (35.6%, n=26), specialist pharmacists (42.5%, n=31) or consultants (56.2%, n=41). Over half (56.1%, n=41) were unsure or did not want their CP to be involved in their HIV care. Patient autonomy/self-efficacy, mistrust, concerns around stigma and privacy/confidentiality of information shared in community pharmacy settings, and perceived lack of HIV-related knowledge among CPs influenced participants’ pReferences: “they don’t need to know or don’t have the understanding of HIV and HIV meds to correctly use this information. I check drug and treatment interactions or complications before procedures myself.” Many participants wanted more information on HIV-related drug interactions and less judgemental attitudes: "if they could be less racist and homophobic and normalise conversations about HIV.” Some participants wanted holistic supply of all their antiretroviral and non-HIV medicines from their community pharmacies. There was equal resistance from other participants: “I certainly wouldn’t want my HIV care to be done by a chemist...” Expectedly, more participants were willing to share information about their HIV status and antiretroviral drug history during private (39.7%, n= 29) compared to over-the-counter consultations (28.8%, n= 21). Reasons for sharing information with CPs were positive: “so that they fully understand my medical circumstances and help me accordingly” and “in case of interactions”. Discussion/Conclusion Whereas some PLWH want more involvement of CPs in their care, others are sceptical of their role in HIV, similar to other primary care providers.1 This study was limited to online respondents. Future research is needed to explore how to build confidence of PLWH in CPs with regards to their changing medicine support needs. Understanding training needs of CPs and promoting HIV-friendly community pharmacies will be key in supporting medicine needs of PLWH. References 1. Rai T et al. Experience of primary care for people with HIV: a mixed-method analysis. BJGP Open, 2019;3(4):1-14 2. Baylis A et al. The future of HIV services in England -shaping the response to changing needs. Kings Fund Report. 2017;1-100 3. Public Health England (The UK Health Security Agency). The pharmacy offer for sexual health, reproductive health and HIV - a resource for commissioners and providers, 2019;1-25

Every game theorist knows of Mertens and Zamir (1985)'s universal beliefs space, which gives deep foundations to Harsanyi's model of Bayesian games, and Kohlberg and Mertens (1986)'s strategic stability, which is the first stone of a complete, axiomatic theory of selection among Nash equilibria. Some French mathematicians refer to the “Mertens–Zamir operator” when using techniques that Mertens and Zamir (1971) introduced to solve a class of repeated games with incomplete information. Readers of Macroeconomic Dynamics may instead have seen Mertens and Rubinchik's 2012 article “Intergenerational Equity and the Discount Rate for Policy Analysis.”The previous examples give just a slight idea of the scope of Jean-François Mertens's contributions, which also deal with general equilibrium, stochastic games, nonatomic cooperative games, and the strategic foundations of microeconomic theory. In his 2005 MD interview, Robert Aumann says, “A [. . .] person at CORE who has had a tremendous influence on game theory [. . .] is Jean-François Mertens. Mertens has done some of the deepest work in the discipline, some of it in collaboration with Israelis like my students Kohlberg, Neyman, and Zamir; he established a Belgian school of mathematical game theory that is marked by its beauty, depth, and sophistication.” The short interview that follows will definitely not account for the variety and the relevance of Jean-François's research achievements, but is typical of the way in which he talked about his work.Jean-François asked me to interview him for MD during the spring of 2010. We discussed by e-mail the topics that would be covered and on July 6, 2010, I came to Louvain-la-Neuve with a tape recorder. After lunch, Jean-François suggested that we have coffee on a terrace near the golf course and there, he patiently answered my questions, sometimes in French, sometimes in English, for about two hours. We planned to go on for at least another round but kept postponing the project. . . . When I saw Jean-François for the last time, in February 2012, I gave him the transcript of the July 2010 interview, but he hardly commented on it. He rather told me about an ongoing research article, “A Random Partitions Approach to the Value,” to be presented (by Abraham Neyman) as a “von Neumann lecture” at the World Congress of Game Theory in Istanbul in July 2012. At the same time, he was also completing, with Anna Rubinchik, the revision of a companion paper to the MD article referred to previously (“Equilibria in an Overlapping Generations Model with Transfer Policies and Exogenous Growth,” forthcoming in Economic Theory).Even if Jean-François did not proofread the transcript that follows, I cannot keep this material for myself. I am confident that those who have known Jean-François will take the interview, even incomplete, as an opportunity to remember his enthusiasm and his patience when he was talking about research. He would often start by identifying holes in obvious or well-known solutions to basic problems, and after a few audacious but illuminating shortcuts, would describe the most surprising achievements in everyday words. I hope that the interview will give an idea of Jean-François's approach to those who did not know him.Quite naturally, because MD was the planned outlet of the interview, we started by talking about the paper on the discount rate for policy analysis, which was already mentioned in the preceding. Jean-François made a number of informal comments, which usefully complement the MD article. He also explained how this paper led him and his coauthor to undertake a thorough analysis of overlapping generations economies in continuous time. This made a perfect transition to Jean-François's views on general equilibrium theory, his own work in this area, and his early career.The next step would be Jean-François's meeting with Bob Aumann, who introduced him to game theory. Jean-François pursued Aumann and Maschler's seminal work on infinitely repeated games with incomplete information, mostly with Shmuel Zamir. He went on with the existence of a value in stochastic games, another model of infinitely long games, which was introduced by Shapley in 1953. This research was undertaken with Abraham Neyman at the Institute of Advanced Studies in Jerusalem in 1980. Soon after, Mertens and Zamir started to review and complete all available results on repeated games in order to prepare a reference book on this topic. The material kept growing. Sylvain Sorin joined the team in the nineties and a draft appeared as a 1994 CORE discussion paper. However, in 2010, the book was still unpublished. . . the interview ends up with Jean-François's feelings about the project.As shown by the list of publications at the end, many important contributions of Jean-François Mertens to game theory and microeconomics are not even mentioned in the interview. During his stay at the Institute of Advanced Studies in Jerusalem in 1980, Jean-François not only worked with Abraham Neyman on stochastic games, but also had his first discussions with Elon Kohlberg on refinements of Nash equilibria. These would be followed by many others, at CORE and Harvard, until the famous Econometrica paper appeared in 1986. For the next 15 years or so, Jean-François further developed the theory of strategic stability, by himself and with his students.During the same period, Jean-François was also making progress on a completely different problem, the extension of the Shapley value to nonatomic cooperative games. Aumann and Shapley (1974) had made the first steps by proposing a value for smooth games. Jean-François proposed a complete answer to the problem in the eighties and, as already pointed out above, kept working on related topics until the very end.Even without entering into details, a description of Jean-François's more recent contributions would be beyond the scope of this short introduction. As the interview makes clear, Jean-François became more and more interested in the foundations of microeconomic theory. A typical example is his “limit price mechanism,” which can be loosely described as a double auction with several goods or as an extension of Shapley and Shubik's strategic market games. Another example is “relative utilitarianism,” which, as Jean-François explains in the interview, plays a crucial role in the determination of an appropriate social discount rate for the evaluation of long-term economic policies. Let us listen to him.

Dr. Akira Mizuta Lippit, author of Electric Animal: Toward a Rhetoric of Wildlife, explores, in the context of the development of cinema, how the concept of “the animal” has become central to modern understandings of human subjectivity. Lippit considers the disappearance of real animals and their concurrent appearance in various conceptual and material uses, particularly noting the ways in which the conjoined notions of humanity and animality figure into and through cinema. The animal, he argues, haunts the foundation of western logical systems. Yet, despite the fact that humans and animals suffer under the discursive weight of the signifier, Lippit is careful to note the increasing instability of the human-animal boundary and what might be done to realize more just relationships among both humans and other animals. On February 12, 2008, Lauren Corman spoke with Lippit as part of the “Animal Voices” radio program, a weekly show dedicated to animal advocacy and cultural critique. They discussed how Lippit developed his thesis and the ramifications of his theoretical work. Electric Animal: Toward a Rhetoric of Wildlife was published in 2000 by the University of Minnesota Press. “Animal Voices” can be heard weekly on CIUT 89.5 FM in Toronto, or online at animalvoices.ca.Full TextLauren Corman: How have questions regarding animals and animality figured into your film scholarship? When did you bring these themes into your work, and why? Akira Mizuta Lippit: That is its own story in a way. The book that you refer to, Electric Animal, was written initially as my doctoral dissertation, and at the time, I was thinking in particular about the moment at which cinema appeared in the late 19th century. There are all kinds of phantasmatic and imaginary birthdays of cinema, but generally people agree that 1895, or thereabouts, was when cinema appeared as a set of technological, aesthetic, and cultural features, and as an economic mode of exchange. People sold and bought tickets and attended screenings. And I was thinking about what it must have felt like at that moment to experience this uncanny medium. There are various reports of early film performances and screenings, some of them apocryphal and inventive and embellished and so forth, but I think the fascination, the kind of wonder that cinema evoked among many early viewers had to do with this uncanny reproduction of life, of living movement, and the strange tension that it created between this new technology (and we are in the middle of the industrial revolution and seeing the advent of all sorts of technologies and devices and apparatuses), and its proximity to, in a simple way, life: the movements of bodies. And I began to think that the principle of animation, here was critical. To make something move, and in thinking about the term animation and all of its roots, to make something breathe, to make something live. What struck me, in this Frankensteinian moment was the sense that something had come to life, and the key seemed to be about how people understood, conceived of, and practiced this notion of animating life through a technology. I started to hear a resonance between animals and animation. I started to think about the way in which animals also played a role, not only in early cinema and in animation and the practice of the genre but leading up to it in the famous photographs of Edward Muybridge and Étienne-Jules Marey, the moving images of animals that were produced serially, as well as the “chronophotographs” that rendered animal motion. And it occurred to me that there was a reason to pause and think about what role animals were playing at that moment in history. As I began to read, and as I began to collect materials and to think through this question of the status and function of the animal, what animality meant, it took on its own set of values, and essentially Electric Animal ended up being a kind of preamble, or an introduction to a book that I haven’t yet written, because I only reach at the end of the book, and in a very perfunctory manner, the advent of cinema. So in a sense, this book, and this question, about what an animal meant for generations before, at that moment and in successive generations, became its own subject, one I still think is critically linked to the question of cinema, and the arrival of cinema, and the force of cinema throughout the 20th century. LC: Let’s return to that piece that you mentioned about life, and that cinema could show or play this Frankensteinian role; of course, a parallel stream is around death, and some of the work that I have read about early cinema shows that people were quite afraid, initially, of what it meant. Could you comment on that theme of death and the animal in cinema? AML: This emerged as a major issue during the course of my study. The discourse on death and the uncanny, the idea that something appears to be there, in the form of a ghost or a phantom, already existed in discussions of photography throughout the 19th century. The sense that photography forges a material connection to the object, that the photograph establishes a material connection to the photographed object, and as such when you look at a photograph you are not simply looking at a rendering, like an artist’s interpretation in a painting or sculpture, but you are actually looking at, experiencing a kind of carnal, physical contact with the persons themselves, or with an object, reappears frequently in the discourses on photography. This creates a real excitement, and also fear. I think that effect, the photographic effect of somehow being in the presence of the thing itself, is enhanced by the addition of movement, because with movement you have the feeling that this being is not just there, looking at you perhaps, but also moving in its element, in its time, whether (and this is very important to the discussions of photography) that person is still alive or not. I think that gap is produced at the moment of any photograph and perhaps in any film: the person who appears before you, who appears to be alive, who at that moment is alive, may or may not still be alive. So it produces, among those who have thought in this way, a sense of uncanniness, something is there and isn’t there at once. Where I think that this is particularly important in this discussion of “the animal,” and as I began to discover in doing the reading (I should add that I am not a philosopher, I don’t teach philosophy, but I am a reader of philosophy; I read it sporadically, I read here and there wherever my interests are) is that with very few but important exceptions, there is a line of western philosophy that says animals are incapable of dying. On the most intuitive level this seems nonsensical. Of course animals die. We know that animals die. We kill animals; we kill them andwe see them die. No question that animals die. But the philosophical axiom here—which begins with Epicurus, but is repeated over and over, by Descartes perhaps most forcefully, and in the 20th century by Martin Heidegger—is that death is not simply a perishing, the end of life, but it is a experience that one has within life, a relationship with one’s own end. The claim that is made over and over again, which has been disputed by many people – and it is certainly not my claim – but the claim that one finds repeatedly in philosophy is that animals don’t die – they don’t have death in the way human beings have, and carry with them, death. Animals know fear, they know things like instinctual preservation, they seek to survive, but they don’t have death as an experience. Heidegger will say in the most callous way, they simply perish. It struck me that this problem was not a problem of animals, but rather a problem for human beings. If human beings don’t concede the capacity of animals to die, then what does it mean that animals are disappearing at this very moment, in the various developments of industry, in human population, in urbanization, environmental destruction, that animals are increasingly disappearing from the material and everyday world? And where do they go, if we don’t, as human beings, concede or allow them death? (Of course this is only in a very specific, and one might argue, very small, discursive space in western philosophy. Many people have pointed out that this is not the case in religious discourses, in a variety of cultural practices, and in various ethnic and cultural communities. This is a certain kind of western ideology that has been produced through a long history of western philosophy.) So the question of death, the particular form of suspended death that photography and cinema introduced appeared in response to perhaps a crisis in western critical and philosophical discourse that denied to the animal, to animals, the same kind of death that human beings experience. You have this convergence of two death-related, life-anddeath related, problems at a time when I think that these issues were particularly important. LC: So from there, the question that comes to mind is what purpose does it serve and the word that is coming to mind is identity, and the idea of human identity and subjectivity. There must be some reason that western thought keeps going back to this denial of animal death. You tie it in, as others have, to language. AML: Two key features of human subjectivity, in the tradition of western philosophy, have been language and death, and the relationship between language and death. This goes back to Plato, to Socrates, and before. The point at which I was writing Electric Animal, at the end of the 20th century, gave me the ability to look back at developments in critical theory, philosophy, and the history of ideas throughout the 20th century, and it became clear with the significant interventions of the late 1960s that from at least one century earlier, the question of human subjectivity, its stability, its absoluteness, had already been in question. This question is slowly working its way toward a radical re-evaluation of the status of, the value of, and ultimately the confidence that human beings place in their own subjectivity, and there are many, many influences: around questions of gender and sexuality, questions of race and identity, and in crimes like genocide, for example, during World War II, but before and after as well. All of these developments contribute to this reevaluation, but one could argue that at this moment, in the late 19th century already, there was a certain sense that what had been insisted upon as absolutely unique, as an absolute form in itself – the human subject – required a whole series of constant exclusions and negations for it to survive. One such exclusion is to claim as properly human, language; what makes the human being human, is the capacity for language, and through this capacity, the capacity for death. As many philosophers argue, only human beings can name death as such, because language gives us the capacity to names those things, not just objects around us, but to name those things that do not appear before us, and these would be the traditional philosophical objects: love, death, fear, life, forgiveness, friendship, and so on. And it will be assumed that animals have communication, they communicate various things within their own groups and between groups, they signal of course, but that animals don’t have language as such, which means they can’t name those things that are not before them or around them. And it is very clear that there is an effort among human beings to maintain the survival of this precious concept of human subjectivity, as absolutely distinct and absolutely unique. So you find in those long discourses on human subjectivity, this return to questions of language and death. I would suggest that at this time, with the appearance of Charles Darwin and his theory of evolution, and with other disruptive thinkers like Sigmund Freud and the advent of psychoanalysis, there is a great sense of uncertainty regarding these edifices of human subjectivity, language and death. In Electric Animal this moment is particularly rich with such shifts and instabilities, and the sense that language is not exclusive to human beings, as many people thought, but also that language is not as self-assured in human beings as people thought. Here psychoanalysis plays an important role in indicating, at least speculatively, that we are not as in control of the language that we use to the extent that we would like to believe. LC: What are the consequences of this process in western thought, where the subject is conceived through an exclusion or a negation of the animal? What are the implications for humans, and also what are the implications for animals? I know that is a huge question. AML: It is a huge question; It is a very important question. One could argue that the consequences of a certain practice, let’s say, of the politics of the subject have been disastrous, certainly for animals, but also for human beings. If you take one of the places where the form of the human subject is created, it would be Descartes’ Discourse on Method, his attempt to figure out what, when everything that can be doubted and has been doubted, is left to form the core. And this is his famous quote: “Je pense donc je suis”, I think therefore I am, I am thinking therefore I am. If you read the Discourse on Method, this is a process of exclusion: I exclude everything that I am not to arrive at the central core of what I am. The process he follows leads him to believe that it is his consciousness, it is his presence, his selfpresence with his own consciousness that establishes for him, beyond any doubt, his existence. This is somewhat heretical, it is a break from theological discourses of the soul; it represents a form of self-creation through one’s consciousness. But consciousness is a very complicated thing, a very deceptive thing, because what I believe, what I feel, is not always exactly the way things are. Looking at a series of important shifts that have taken place during what we might call generally the modern period, which extends further back than the recent past, one finds a number of assaults on the primacy of consciousness. Freud names one as the Copernican revolution, which suggested that the earth was not the centre of the universe and that human beings were not at the centre of the universe; the Darwinian revolution, which suggested that humans beings were not created apart from other forms, all other forms of organic life, and that human beings shared with other animate beings, organic beings a common history, a pre-history. And Freud (he names himself as the third of these revolutionaries), is the one who suggested that consciousness itself is not a given at any moment, or available at any moment, to us as human beings. What constitutes our sense of self, our consciousness, is drawn from experiences that we no longer have access to—interactions with others, the desires of others, the kinds of influences and wishes that were passed into us through others, our parents, other influential figures early in our life— and that what we believe to be our conscious state, our wishes, desires, dreams and so forth, are not always known to us, and in fact can’t be known because they might be devastating and horrifying, in some cases. They will tell us things about ourselves that we couldn’t properly accept or continue to live with. I think that what is happening, certainly by the time that we enter the 20th century, around this discourse of the subject is that it is no longer holding, it is no longer serving its original purpose; it is generating more anxiety than comfort. Key historical events, World War I, for example, are producing enormous blows to the idea of western progress, humanism, and Enlightenment values, to the cultural achievements of the West— Hegel, for example, a 19th century philosopher, is very explicit about this—to those values that helped to shape the world, and ultimately were supposed to have created a better world for human beings: the Enlightenment, the pursuit of knowledge, science, medicine, religion and so forth. And yet, by the mid-twentieth century many of these beliefs were exposed as illusions, especially after the advent of death camps, camps created for the sole purpose of producing, as Heidegger himself says, producing corpses, a factory for corpses. It’s not a place where people happen to die. This is an entire apparatus designed in order to expeditiously, efficiently, and economically, create corpses out of living human beings. Similarly, with the first use of the atomic bomb, on Hiroshima and Nagasaki in 1945, on human beings. This was a machine, a science, a technology, a weapon devised for maximizing, efficiently and economically, the destruction of human beings. I think what this created for many thinkers, philosophers, writers, artists, activists, citizens around the world was a sense that in fact what had helped to create this situation and these catastrophic results was not a matter of totalitarian regimes and bad politics, but something more fundamental: a certain belief that I have the right to destroy or take life from others. And how is that achieved? By first denying that those others are like me. So the discourse on Jews practiced throughout Nazi Germany is in fact even more extreme than that of the discourse on animals; in fact, as many people have pointed out, that many Nazis were famous for their love of animal, some were practicing vegetarians; they outlawed animal experimentation. In a sense animals were more like Aryan Germans, than Jews were. You have a series here of rhetorics that allow you to cast the enemy, the Other, at a distance from your own subjectivity, and in order to achieve this you have to deny them any form of subjectivity. Not just that they are just culturally different, or that they engage in different practices: They are radically and absolutely unlike me. And I believe that as many people began to think about this condition (Adorno has a very famous passage in which he talks about this), it became clear that one of the sources of this, is in fact the very ideology of the subject, which insists on an absolute autonomy, singularity, and distinct mode of existence from that which is not the subject, not any subject, the Other. Adorno, in a passage he wrote in a book titled Minima Moralia, which is a collection of aphorisms and observations he wrote during and after World War II, offers an observation I quote in Electric Animal. He titles it “People are looking at you”, and he says there is a moment in a typical scene of hunting where a wounded animal looks into the eyes of the hunter, or the killer as it dies. It produces at that moment, an effect that is undeniable: This thing, that is alive, that I have wounded and which is now dying, is looking at me. How can I deny that it is alive, that it is there, that it exists in the world, with its own consciousness, its own life, its own dreams, and desires? Adorno says the way you shake this off is you say to yourself, “It’s only an animal.” He will then link that gesture to the history of racism, and what he calls the pogrom, or genocide, against other human beings. You transfer this logic. So the ability to say to an animal, toward an animal that you have killed, whose death you’ve brought about, “It’s only an animal”, becomes the same logic you apply to other human beings when you harm or kill them. It’s a very profound observation because it suggests that in fact there is no line that separates the killing of animals from the killing of human beings. And in fact already at the moment when we kill an animal, we recognize something immediately that we have to erase from our consciousness with this phrase, “It’s only an animal.” LC: It seems to me then, too, that it’s this kind of perpetual haunting, because in that erasure, in that statement, “It’s only an animal,” there’s the animal itself that you had to assert yourself against and its living beingness. Do you think in that moment that he’s talking about—because it seems like kind of a struggle, or a narrative that you have to tell yourself—do you think that is also a moment potentially of agency, or resistance, in terms of an assertion of an animal subjectivity, or umwelt, or however you want to describe it? AML: Absolutely, and I think that Adorno’s phrase and that passage in which he is writing about this scene, an arbitrary, perhaps imaginary but typical scene of the hunt written shortly after the end of World War II, as well as all of Adorno’s pessimistic observations about the state of human culture, are written in a state of deep anguish. As he says in this very brief aphorism, we never believe this, even of the animal. When we tell ourselves, “It’s only an animal”, we in fact never believe it. Why? Because we are there and we see in the presence of an Other, a life that is there. For him it is important that the gaze, as he says, of the wounded animal, falls on the person who has perpetrated the crime. You seek to exclude it, to erase it, to dismiss it by saying that it is only an animal, but it allows you to transfer that very logic into the destruction of other human beings. Your phrase “haunting” is really important because I think that it suggests that a phantom animal becomes the crucial site not only for an animal rights, but for human ethics as well. The ability to kill another, is something in fact we—we, human beings—never properly achieve; we never truly believe this, “It’s only an animal” at that moment, Adorno says. We tell ourselves this, we insist upon it, try to protect ourselves through this mantric repetition of a phrase, “It’s only an animal,” “It’s only an animal,” yet we never believe it. And as such, we are haunted by it. I think the crisis in human subjectivity, in discourses on the human subject that arrive in the late 1950s, has everything to do with this kind of haunted presence. Human subjectivity is now a haunted subjectivity, haunted by animals, by everyone that has been excluded, by women, by people of different races, different ethnicities, different sexual preferences. And in fact the convergence of civil rights, critical theory, animal rights, feminism, the gay and lesbian movements, all of these things really shape—to use Foucault’s term—the episteme in which the primary political focus for many philosophers and theorists erupts in a critique of the subject. LC: Without getting you to offer something prescriptive [both laugh] about where to go from here, I do, I guess, want to ask about where to go from here. Because our audience is sort of the average person, turning on their car radio, or the animal rights activist, what does this mean then for… It just seems like a huge juggernaut, this huge weight, of Western history for people who want to shift, or people talk about blurring the boundaries between humans and animals (and this, of course, is very anxiety-provoking considering the legacy of Western thought), where is the turn now? Or where do you think there are potentials for (I think your phrase is) “remembering animals”? Is that the best can we can do? AML: Again, it’s an important question in so many ways. There are so many things I would like to speak to in response to that question. I would say that I don’t know if I am, by nature, an optimist or a pessimist. I do think, however, that a lot of things have been turning away from this condition, let’s say, or a certain kind of assumption, about the longevity of the human subject. I think that human subjectivity practiced honestly and ethically will continue to re-evaluate the terms of its own existence in relationship to Others, defined in the modern sense. And I do think that a certain ability to exist with an Other—an Other that may not share the same language that I speak, but certainly exists in a world that is as valuable, authentic, legitimate, as my own—will be the goal. I’ll introduce a phrase by Jacques Derrida. Somebody asked him, what does justice mean? What would justice be? He says justice is speaking to the Other in the language of the Other. I find this to be a very beautiful and very optimistic expression. It is not my task to exclude from my world those that I don’t understand; but it is my responsibility, or it is the practice or task of justice, to learn the Other’s language, which is to give the Other that capacity for language, to assume that there is in the Other, language. Language is, according to that earlier part of our conversation, language is that which is traditionally denied to the Other. “I don’t know what you mean when you speak”;, “women speak emotionally”; “ animals don’t have any language”; “the language that less developed cultures speak is not as articulate or precise as the language that I speak”, and so on and so forth. I think this pursuit of justice, defined as Derrida does, is very important. The other thing I will add is that the development of a field that some have called, perhaps temporarily, provisionally “Animal Studies”, is absolutely critical. I think there was a time when Animal Studies would have meant zoology, or in a very focused and direct manner, the pursuit of animal rights. What has been really been exciting for me to observe in this field of animal studies— and it’s not merely a community of scholars and academics; they are artists and performers, who engage in expressive and creative actions, activists who are committed politically, activists who are engaged in their daily lives and daily practices, and also a wide range of scholars in a variety of fields (feminists, literary scholars, historians, historians of ideas, philosophers, and so forth)—there is a certain understanding that “the question of the animal”, as it’s been called, or “of animals” or “of animality”, is not something that is restricted in the end just to the well-being of animals: it affects everybody in fact in ways that are obvious and perhaps less obvious. I think this kind of realization and this kind of community, let’s say, ex-community of people, who are in the field but also outside of their fields but in contact with one another is another way in which, much of what has been established can being critiqued, rethought, unthought, reformulated, toward a viable existence for all forms of life on this earth, and elsewhere. LC: It seems to me that it’s a difficult but important place to be, working in Animal Studies, in these divergent fields. My own experience was coming from Women’s Studies. It’s interesting how you point to these different groups, marginalized groups, and I think that one of the saddest things for me has been also that there’s this incredible moment of optimism, and potential to be thinking about “the animal” in different ways, (and thus us in different ways) but also in those moments of marginalization there has been a scrambling, a push towards a reinforcement of that human subject to say, “Ah, we are just like that, though. We are not like animals.” I think that this is very classic, in terms of an older feminism: liberation is about inclusion into a human culture that is necessarily exclusionary of animals. I think that’s still happening, that while there’s a kind of opening up of what this question means, “the question of the animal”, there’s also a concern, my concern anyway, that a simultaneous reinforcement as marginalized groups fight, using language, using the discourse of rights, etc., to become a part of what they were always excluded from. AML: That’s right. That’s a very difficult situation that traditionally marginalized groups have had to address. When you have been denied very basic civil rights, for example, one of the immediate and legitimate goals of any movement is to make sure that one secures those rights for one’s constituencies, for one’s members, and at the same time to make sure that the pursuit or achievement of that right does not reproduce the exclusion of others that one was fighting against initially. That’s why I think the role of animal rights is so important, because the animal is perhaps the place where life as such has been most excluded in the history of human cultures. And as such it is the place, perhaps, where this rethinking has to begin. There will be all sorts of differences, and all sorts of different objectives and agendas, but when this discussion is practiced rigorously and in good faith, I think ultimately it will be productive. Remember that most of those whom we now think of as the great thinkers were often marginalized in their time; many endured this marginalization, ridicule, hostility. It’s part of the task, and I think one of the comforts we can draw in these situations is that the process is ongoing and one makes a contribution where one can, one engages where one can, and it continues forward hopefully toward some better formulation of life for all beings. LC: Thank you very much. I hope you can join us again on the program sometime. It was really a great honour, and a great pleasure, to speak with you today. AML: It was a great pleasure for me today. And I really appreciate the work you’re doing. The questions were just fantastic. I enjoyed every moment of it. LC: Thank you so much. Today we’ve been speaking with Dr. Akira Mizuta Lippit.

BackgroundPatients with eosinophilic granulomatosis with polyangiitis (EGPA) can present with vasculitic or eosinophilic phenotypes.1 The Phase III MIRRA study demonstrated that patients with EGPA spent more time in remission and had reduced oral corticosteroid (OCS) use with mepolizumab versus placebo.2ObjectivesTo evaluate the efficacy of mepolizumab in patients with a vasculitic EGPA phenotype enrolled in the MIRRA study.MethodsMIRRA was a Phase III, multicentre, double-blind, parallel-group trial in adult patients with relapsing/refractory EGPA and ≥4 weeks stable OCS treatment. Patients were randomised to receive standard of care plus mepolizumab (300 mg subcutaneously every 4 weeks) or placebo for 52 weeks. Primary endpoints were: accrued weeks of remission (defined as Birmingham Vasculitis Activity Score [BVAS] of 0 and OCS dose ≤4 mg/day prednisolone or equivalent) over the 52-week study period categorised in weeks (0, >0 to <12, 12 to <24, 24 to <36 and ≥36 weeks), and the proportion of patients in remission at both Weeks 36 and 48. This post hoc analysis used data from the MIRRA study to evaluate these endpoints according to patients’ antineutrophil cytoplasmic antibody (ANCA) history (current or previous positive test for myeloperoxidase[MPO]/proteinase 3[PR3]-ANCA at study baseline versus no history of a positive MPO/PR3-ANCA test at baseline), baseline BVAS (=0 vs >0) and Vasculitis Damage Index (VDI) score (<5 vs ≥5). Types of disease relapse (vasculitis [BVAS >0], asthma [active asthma symptoms and/or signs with a worsening in Asthma Control Questionnaire-6 score] and sinonasal [active nasal and/or sinus disease with a worsening in ≥1 sinonasal symptom questions]) reported during the treatment period were also described. EGPA disease characteristics focusing on vasculitic components were assessed in patients who did and did not achieve remission at any point during the study.ResultsOf the 136 patients in the study, 26 (19%) had a history of a positive ANCA test at study baseline and 110 (81%) did not. In addition, 51 (38%) had a BVAS =0 at baseline while 85 (63%) had a BVAS >0; 74 (54%) had a VDI <5 at baseline and 62 (46%) had a VDI ≥5. Accrued remission duration was greater with mepolizumab versus placebo, irrespective of ANCA positive status, baseline BVAS or baseline VDI score (Figure 1). Across all the subgroups, a larger proportion of patients achieved remission at both Weeks 36 and 48 with mepolizumab versus placebo (Figure 1). Among patients receiving mepolizumab, the numbers (proportion) of patients achieving remission at both Weeks 36 and 48 were: 7 (54%) for patients with a history of an ANCA-positive test and 15 (27%) for patients without a history of an ANCA-positive test; 14 (45%) in the BVAS =0 and 8 (22%) in the BVAS >0 groups; 11 (29%) in the VDI score <5 and 11 (37%) in the VDI score ≥5 groups. Mepolizumab reduced all types of disease relapse assessed during the treatment period, including vasculitis, asthma and sinonasal relapses, compared with placebo. Vasculitic characteristics including neuropathy, glomerulonephritis, alveolar haemorrhage, palpable purpura and ANCA positivity were generally similar among patients who did and did not achieve remission during the study.Figure 1.Mepolizumab efficacy by patient baseline characteristicsANCA, antineutrophil cytoplasmic antibody; BVAS, Birmingham Vasculitis Activity Score; CI, confidence interval; NA, data not available – estimate could not be calculated owing to a lack of patients in the placebo group achieving remission at Weeks 36 and 48; VDI, Vasculitis Damage Index.ConclusionMepolizumab is associated with clinical benefits in patients with EGPA, including those with and without a vasculitic phenotype.References[1]Latorre M et al. Eur Respir J. 2013;42(Suppl 57):1797.[2]Wechsler ME et al. N Engl J Med. 2017;376(20):1921–32.AcknowledgementsFunding: GSK (MEA115921; NCT02020889); the Division of Intramural Research, NIAID, NIH funded in part time spent on this abstract by one of the authors (PK).Disclosure of InterestsBenjamin Terrier Consultant of: Roche, Chugai, GSK, AstraZeneca, Bristol Myers Squibb, Terumo BCT, Sanofi, LFB and Grifols, David Jayne Speakers bureau: Amgen Vifor, Consultant of: AstraZeneca, Aurinia, BMS, Boehringer Ingelheim, ChemoCentryx, GSK, Janssen, Novartis, Roche/Genentech, Takeda and Vifor, Grant/research support from: AstraZeneca, Aurinia, BMS, Boehringer Ingelheim, ChemoCentryx, GSK, Janssen, Novartis, Roche/Genentech, Takeda and Vifor, Bernhard Hellmich Speakers bureau: AbbVie, BMS, Boehringer Ingelheim, Chugai, GSK, InflaRx, Novartis, Pfizer, Roche and Vifor Pharma, Consultant of: AbbVie, BMS, Boehringer Ingelheim, Chugai, GSK, InflaRx, Novartis, Pfizer, Roche and Vifor Pharma, Grant/research support from: Ab2Bio, AbbVie, AstraZeneca, Bristol Myers Squibb, ChemoCentryx, GSK, InflaRx, Kiniksa, Nippon Kayaku, Novartis, Roche, and Sanofi (my institution received payments for participation in multicentre clinical trials and the institution or myself did not receive money for any other kind of research projects), Jane H. Bentley Shareholder of: GSK, Employee of: GSK, Jonathan Steinfeld Shareholder of: GSK, Employee of: GSK, Steven W Yancey Shareholder of: GSK, Employee of: GSK, Namhee Kwon Shareholder of: GSK, Employee of: GSK, Praveen Akuthota Paid instructor for: AstraZeneca, Consultant of: AstraZeneca, GSK, Sanofi, Grant/research support from: GSK, AstraZeneca and Regeneron, Paneez Khoury: None declared, Lee Baylis Shareholder of: GSK, Employee of: GSK, Michael Wechsler Consultant of: GSK, Genentech, Sanofi, Regeneron, AstraZeneca, Teva, Novartis, Boehringer Ingelheim, Sentien, and Equillium, Grant/research support from: National Institute of Allergy and Infectious Diseases and the National Heart, Lung, and Blood Institute

We’ll have trouble now!The Archaeological Society of Jutland was founded on Sunday, 11 March 1951. As with most projects with which P.V Glob was involved, this did not pass off without drama. Museum people and amateur archaeologists in large numbers appeared at the Museum of Natural History in Aarhus, which had placed rooms at our disposal. The notable dentist Holger Friis, the uncrowned king of Hjørring, was present, as was Dr Balslev from Aidt, Mr and Mrs Overgaard from Holstebro Museum, and the temperamental leader of Aalborg Historical Museum, Peter Riismøller, with a number of his disciples. The staff of the newly-founded Prehistoric Museum functioned as the hosts, except that one of them was missing: the instigator of the whole enterprise, Mr Glob. As the time for the meeting approached, a cold sweat broke out on the foreheads of the people present. Finally, just one minute before the meeting was to start, he arrived and mounted the platform. Everything then went as expected. An executive committee was elected after some discussion, laws were passed, and then suddenly Glob vanished again, only to materialise later in the museum, where he confided to us that his family, which included four children, had been enlarged by a daughter.That’s how the society was founded, and there is not much to add about this. However, a few words concerning the background of the society and its place in a larger context may be appropriate. A small piece of museum history is about to be unfolded.The story begins at the National Museum in the years immediately after World War II, at a time when the German occupation and its incidents were still terribly fresh in everyone’s memory. Therkel Mathiassen was managing what was then called the First Department, which covered the prehistoric periods.Although not sparkling with humour, he was a reliable and benevolent person. Number two in the order of precedence was Hans Christian Broholm, a more colourful personality – awesome as he walked down the corridors, with his massive proportions and a voice that sounded like thunder when nothing seemed to be going his way, as quite often seemed to be the case. Glob, a relatively new museum keeper, was also quite loud at times – his hot-blooded artist’s nature manifested itself in peculiar ways, but his straight forward appearance made him popular with both the older and the younger generations. His somewhat younger colleague C.J. Becker was a scholar to his fingertips, and he sometimes acted as a welcome counterbalance to Glob. At the bottom of the hierarchy was the student group, to which I belonged. The older students handled various tasks, including periodic excavations. This was paid work, and although the salary was by no means princely, it did keep us alive. Student grants were non-existent at the time. Four of us made up a team: Olfert Voss, Mogens Ørsnes, Georg Kunwald and myself. Like young people in general, we were highly discontented with the way our profession was being run by its ”ruling” members, and we were full of ideas for improvement, some of which have later been – or are being – introduced.At the top of our wish list was a central register, of which Voss was the strongest advocate. During the well over one hundred years that archaeology had existed as a professional discipline, the number of artefacts had grown to enormous amounts. The picture was even worse if the collections of the provincial museums were taken into consideration. We imagined how it all could be registered in a card index and categorised according to groups to facilitate access to references in any particular situation. Electronic data processing was still unheard of in those days, but since the introduction of computers, such a comprehensive record has become more feasible.We were also sceptical of the excavation techniques used at the time – they were basically adequate, but they badly needed tightening up. As I mentioned before, we were often working in the field, and not just doing minor jobs but also more important tasks, so we had every opportunity to try out our ideas. Kunwald was the driving force in this respect, working with details, using sections – then a novelty – and proceeding as he did with a thoroughness that even his fellow students found a bit exaggerated at times, although we agreed with his principles. Therkel Mathiassen moaned that we youngsters were too expensive, but he put up with our excesses and so must have found us somewhat valuable. Very valuable indeed to everyon e was Ejnar Dyggve’s excavation of the Jelling mounds in the early 1940s. From a Danish point of view, it was way ahead of its time.Therkel Mathiassen justly complained about the economic situation of the National Museum. Following the German occupation, the country was impoverished and very little money was available for archaeological research: the total sum available for the year 1949 was 20,000 DKK, which corresponded to the annual income of a wealthy man, and was of course absolutely inadequate. Of course our small debating society wanted this sum to be increased, and for once we didn’t leave it at the theoretical level.Voss was lucky enough to know a member of the Folketing (parliament), and a party leader at that. He was brought into the picture, and between us we came up with a plan. An article was written – ”Preserve your heritage” (a quotation from Johannes V. Jensen’s Denmark Song) – which was sent to the newspaper Information. It was published, and with a little help on our part the rest of the media, including radio, picked up the story.We informed our superiors only at the last minute, when everything was arranged. They were taken by surprise but played their parts well, as expected, and everything went according to plan. The result was a considerable increase in excavation funds the following year.It should be added that our reform plans included the conduct of exhibitions. We found the traditional way of presenting the artefacts lined up in rows and series dull and outdated. However, we were not able to experiment within this field.Our visions expressed the natural collision with the established ways that comes with every new generation – almost as a law of nature, but most strongly when the time is ripe. And this was just after the war, when communication with foreign colleagues, having been discontinued for some years, was slowly picking up again. The Archaeological Society of Jutland was also a part of all this, so let us turn to what Hans Christian Andersen somewhat provocatively calls the ”main country”.Until 1949, only the University of Copenhagen provided a degree in prehistoric archaeology. However, in this year, the University of Aarhus founded a chair of archaeology, mainly at the instigation of the Lord Mayor, Svend Unmack Larsen, who was very in terested in archaeology. Glob applied for the position and obtained it, which encompassed responsibility for the old Aarhus Museum or, as it was to be renamed, the Prehistoric Museum (now Moesgaard Museum).These were landmark events to Glob – and to me, as it turned out. We had been working together for a number of years on the excavation of Galgebakken (”Callows Hill”) near Slots Bjergby, Glob as the excavation leader, and I as his assistant. He now offered me the job of museum curator at his new institution. This was somewhat surprising as I had not yet finished my education. The idea was that I was to finish my studies in remote Jutland – a plan that had to be given up rather quickly, though, for reasons which I will describe in the following. At the same time, Gunner Lange-Kornbak – also hand-picked from the National Museum – took up his office as a conservation officer.The three of us made up the permanent museum staff, quickly supplemented by Geoffrey Bibby, who turned out to be an invaluable colleague. He was English and had been stationed in the Faeroe Islands during the war, where he learned to speak Danish. After 1945 he worked for some years for an oil company in the Gulf of Persia, but after marrying Vibeke, he settled in her home town of Aarhus. As his academic background had involved prehistoric cultures he wanted to collaborate with the museum, which Glob readily permitted.This small initial flock governed by Glob was not permitted to indulge inidleness. Glob was a dynamic character, full of good and not so good ideas, but also possessing a good grasp of what was actually practicable. The boring but necessary daily work on the home front was not very interesting to him, so he willingly handed it over to others. He hardly noticed the lack of administrative machinery, a prerequisite for any scholarly museum. It was not easy to follow him on his flights of fancy and still build up the necessary support base. However, the fact that he in no way spared himself had an appeasing effect.Provincial museums at that time were of a mixed nature. A few had trained management, and the rest were run by interested locals. This was often excellently done, as in Esbjerg, where the master joiner Niels Thomsen and a staff of volunteers carried out excavations that were as good as professional investigations, and published them in well-written articles. Regrettably, there were also examples of the opposite. A museum curator in Jutland informed me that his predecessor had been an eager excavator but very rarely left any written documentation of his actions. The excavated items were left without labels in the museum store, often wrapped in newspapers. However, these gave a clue as to the time of unearthing, and with a bit of luck a look in the newspaper archive would then reveal where the excavation had taken place. Although somewhat exceptional, this is not the only such case.The Museum of Aarhus definitely belonged among the better ones in this respect. Founded in 1861, it was at first located at the then town hall, together with the local art collection. The rooms here soon became too cramped, and both collections were moved to a new building in the ”Mølleparken” park. There were skilful people here working as managers and assistants, such as Vilhelm Boye, who had received his archaeological training at the National Museum, and later the partners A. Reeh, a barrister, and G.V. Smith, a captain, who shared the honour of a number of skilfully performed excavations. Glob’s predecessor as curator was the librarian Ejler Haugsted, also a competent man of fine achievements. We did not, thus, take over a museum on its last legs. On the other hand, it did not meet the requirements of a modern scholarly museum. We were given the task of turning it into such a museum, as implied by the name change.The goal was to create a museum similar to the National Museum, but without the faults and shortcomings that that museum had developed over a period of time. In this respect our nightly conversations during our years in Copenhagen turned out to be useful, as our talk had focused on these imperfections and how to eradicate them.We now had the opportunity to put our theories into practice. We may not have succeeded in doing so, but two areas were essentially improved:The numerous independent numbering systems, which were familiar to us from the National Museum, were permeating archaeological excavation s not only in the field but also during later work at the museum. As far as possible this was boiled down to a single system, and a new type of report was born. (In this context, a ”report” is the paper following a field investigation, comprising drawings, photos etc. and describing the progress of the work and the observations made.) The instructions then followed by the National Museum staff regarding the conduct of excavations and report writing went back to a 19th-century protocol by the employee G.V. Blom. Although clear and rational – and a vast improvement at the time – this had become outdated. For instance, the excavation of a burial mound now involved not only the middle of the mound, containing the central grave and its surrounding artefacts, but the complete structure. A large number of details that no one had previously paid attention to thus had to be included in the report. It had become a comprehensive and time-consuming work to sum up the desultory notebook records in a clear and understandable description.The instructions resulting from the new approach determined a special records system that made it possible to transcribe the notebook almost directly into a report following the excavation. The transcription thus contained all the relevant information concerning the in vestigation, and included both relics and soil layers, the excavation method and practical matters, although in a random order. The report proper could then bereduced to a short account containing references to the numbers in the transcribed notebook, which gave more detailed information.As can be imagined, the work of reform was not a continuous process. On the contrary, it had to be done in our spare hours, which were few and far between with an employer like Glob. The assignments crowded in, and the large Jutland map that we had purchased was as studded with pins as a hedge hog’s spines. Each pin represented an inuninent survey, and many of these grew into small or large excavations. Glob himself had his lecture duties to perform, and although he by no means exaggerated his concern for the students, he rarely made it further than to the surveys. Bibby and I had to deal with the hard fieldwork. And the society, once it was established, did not make our lives any easier. Kuml demanded articles written at lightning speed. A perusal of my then diary has given me a vivid recollection of this hectic period, in which I had to make use of the evening and night hours, when the museum was quiet and I had a chance to collect my thoughts. Sometimes our faithful supporter, the Lord Mayor, popped in after an evening meeting. He was extremely interested in our problems, which were then solved according to our abilities over a cup of instant coffee.A large archaeological association already existed in Denmark. How ever, Glob found it necessary to establish another one which would be less oppressed by tradition. Det kongelige nordiske Oldsskriftselskab had been funded in 1825 and was still influenced by different peculiarities from back then. Membership was not open to everyone, as applications were subject to recommendation from two existing members and approval by a vote at one of the monthly lecture meetings. Most candidates were of course accepted, but unpopular persons were sometimes rejected. In addition, only men were admitted – women were banned – but after the war a proposal was brought forward to change this absurdity. It was rejected at first, so there was a considerable excitement at the January meeting in 1951, when the proposal was once again placed on the agenda. The poor lecturer (myself) did his best, although he was aware of the fact that just this once it was the present and not the past which was the focus of attention. The result of the voting was not very courteous as there were still many opponents, but the ladies were allowed in, even if they didn’t get the warmest welcome.In Glob’s society there were no such restrictions – everyone was welcome regardless of sex or age. If there was a model for the society, it was the younger and more progressive Norwegian Archaeological Society rather than the Danish one. The main purpose of both societies was to produce an annual publication, and from the start Glob’s Kuml had a closer resemblance to the Norwegian Viking than to the Danish Aarbøger for nordisk Oldkyndighed og Historie. The name of the publication caused careful consideration. For a long time I kept a slip of paper with different proposals, one of which was Kuml, which won after having been approved by the linguist Peter Skautrup.The name alone, however, was not enough, so now the task became to find so mething to fill Kuml with. To this end the finds came in handy, and as for those, Glob must have allied him self with the higher powers, since fortune smiled at him to a considerable extent. Just after entering upon his duties in Aarhus, an archaeological sensation landed at his feet. This happened in May 1950 when I was still living in the capital. A few of us had planned a trip to Aarhus, partly to look at the relics of th e past, and partly to visit our friend, the professor. He greeted us warmly and told us the exciting news that ten iron swords had been found during drainage work in the valley of lllerup Aadal north of the nearby town of Skanderborg. We took the news calmly as Glob rarely understated his affairs, but our scepticism was misplaced. When we visited the meadow the following day and carefully examined the dug-up soil, another sword appeared, as well as several spear and lance heads, and other iron artefacts. What the drainage trench diggers had found was nothing less than a place of sacrifice for war booty, like the four large finds from the 1800s. When I took up my post in Aarhus in September of that year I was granted responsibility for the lllerup excavation, which I worked on during the autumn and the following six summers. Some of my best memories are associated with this job – an interesting and happy time, with cheerful comradeship with a mixed bunch of helpers, who were mainly archaeology students. When we finished in 1956, it was not because the site had been fully investigated, but because the new owner of the bog plot had an aversion to archaeologists and their activities. Nineteen years later, in 1975, the work was resumed, this time under the leadership of Jørgen Ilkjær, and a large amount of weaponry was uncovered. The report from the find is presently being published.At short intervals, the year 1952 brought two finds of great importance: in Februar y the huge vessel from Braa near Horsens, and in April the Grauballe Man. The large Celtic bronze bowl with the bulls’ heads was found disassembled, buried in a hill and covered by a couple of large stones. Thanks to the finder, the farmer Søren Paaske, work was stopped early enough to leave areas untouched for the subsequent examination.The saga of the Grauballe Man, or the part of it that we know, began as a rumour on the 26th of April: a skeleton had been found in a bog near Silkeborg. On the following day, which happened to be a Sunday, Glob went off to have a look at the find. I had other business, but I arrived at the museum in the evening with an acquaintance. In my diary I wrote: ”When we came in we had a slight shock. On the floor was a peat block with a corpse – a proper, well-preserved bog body. Glob brought it. ”We’ll be in trouble now.” And so we were, and Glob was in high spirits. The find created a sensation, which was also thanks to the quick presentation that we mounted. I had purchased a tape recorder, which cost me a packet – not a small handy one like the ones you get nowadays, but a large monstrosity with a steel tape (it was, after all, early days for this device) – and assisted by several experts, we taped a number of short lectures for the benefit of the visitors. People flocked in; the queue meandered from the exhibition room, through the museum halls, and a long way down the street. It took a long wait to get there, but the visitors seemed to enjoy the experience. The bog man lay in his hastily – procured exhibition case, which people circled around while the talking machine repeatedly expressed its words of wisdom – unfortunately with quite a few interruptions as the tape broke and had to be assembled by hand. Luckily, the tape recorders now often used for exhibitions are more dependable than mine.When the waves had died down and the exhibition ended, the experts examined the bog man. He was x-rayed at several points, cut open, given a tooth inspection, even had his fingerprints taken. During the autopsy there was a small mishap, which we kept to ourselves. However, after almost fifty years I must be able to reveal it: Among the organs removed for investigation was the liver, which was supposedly suitable for a C-14 dating – which at the time was a new dating method, introduced to Denmark after the war. The liver was sent to the laboratory in Copenhagen, and from here we received a telephone call a few days later. What had been sent in for examination was not the liver, but the stomach. The unfortunate (and in all other respects highly competent) Aarhus doctor who had performed the dissection was cal1ed in again. During another visit to the bogman’s inner parts he brought out what he believed to be the real liver. None of us were capable of deciding th is question. It was sent to Copenhagen at great speed, and a while later the dating arrived: Roman Iron Age. This result was later revised as the dating method was improved. The Grauballe Man is now thought to have lived before the birth of Christ.The preservation of the Grauballe Man was to be conservation officer Kornbak’s masterpiece. There were no earlier cases available for reference, so he invented a new method, which was very successful. In the first volumes of Kuml, society members read about the exiting history of the bog body and of the glimpses of prehistoric sacrificial customs that this find gave. They also read about the Bahrain expeditions, which Glob initiated and which became the apple of his eye. Bibby played a central role in this, as it was he who – at an evening gathering at Glob’s and Harriet’s home in Risskov – described his stay on the Persian Gulf island and the numerous burial mounds there. Glob made a quick decision (one of his special abilities was to see possibilities that noone else did, and to carry them out successfully to everyone’s surprise) and in December 1952 he and Bibby left for the Gulf, unaware of the fact that they were thereby beginning a series of expeditions which would continue for decades. Again it was Glob’s special genius that was the decisive factor. He very quickly got on friendly terms with the rulers of the small sheikhdoms and interested them in their past. As everyone knows, oil is flowing plentifully in those parts. The rulers were thus financially powerful and some of this wealth was quickly diverted to the expeditions, which probably would not have survived for so long without this assistance. To those of us who took part in them from time to time, the Gulf expeditions were an unforgettable experience, not just because of the interesting work, but even more because of the contact with the local population, which gave us an insight into local manners and customs that helped to explain parts of our own country’s past which might otherwise be difficult to understand. For Glob and the rest of us did not just get close to the elite: in spite of language problems, our Arab workers became our good friends. Things livened up when we occasionally turned up in their palm huts.Still, co-operating with Glob was not always an easy task – the sparks sometimes flew. His talent of initiating things is of course undisputed, as are the lasting results. He was, however, most attractive when he was in luck. Attention normally focused on this magnificent person whose anecdotes were not taken too seriously, but if something went wrong or failed to work out, he could be grossly unreasonable and a little too willing to abdicate responsibility, even when it was in fact his. This might lead to violent arguments, but peace was always restored. In 1954, another museum curator was attached to the museum: Poul Kjærum, who was immediately given the important task of investigating the dolmen settlement near Tustrup on Northern Djursland. This gave important results, such as the discovery of a cult house, which was a new and hitherto unknown Stone Age feature.A task which had long been on our mind s was finally carried out in 1955: constructing a new display of the museum collections. The old exhibitio n type consisted of numerous artefacts lined up in cases, accompaied ony by a brief note of the place where it was found and the type – which was the standard then. This type of exhibition did not give much idea of life in prehistoric times.We wanted to allow the finds to speak for themselves via the way that they were arranged, and with the aid of models, photos and drawings. We couldn’t do without texts, but these could be short, as people would understand more by just looking at the exhibits. Glob was in the Gulf at the time, so Kjærum and I performed the task with little money but with competent practical help from conservator Kornbak. We shared the work, but in fairness I must add that my part, which included the new lllerup find, was more suitable for an untraditional display. In order to illustrate the confusion of the sacrificial site, the numerous bent swords and other weapons were scattered a.long the back wall of the exhibition hall, above a bog land scape painted by Emil Gregersen. A peat column with inlaid slides illustrated the gradual change from prehistoric lake to bog, while a free-standing exhibition case held a horse’s skeleton with a broken skull, accompanied by sacrificial offerings. A model of the Nydam boat with all its oars sticking out hung from the ceiling, as did the fine copy of the Gundestrup vessel, as the Braa vessel had not yet been preserved. The rich pictorial decoration of the vessel’s inner plates was exhibited in its own case underneath. This was an exhibition form that differed considerably from all other Danish exhibitions of the time, and it quickly set a fashion. We awaited Glob’s homecoming with anticipation – if it wasn’t his exhibition it was still made in his spirit. We hoped that he would be surprised – and he was.The museum was thus taking shape. Its few employees included Jytte Ræbild, who held a key position as a secretary, and a growing number of archaeology students who took part in the work in various ways during these first years. Later, the number of employees grew to include the aforementioned excavation pioneer Georg Kunwald, and Hellmuth Andersen and Hans Jørgen Madsen, whose research into the past of Aarhus, and later into Danevirke is known to many, and also the ethnographer Klaus Ferdinand. And now Moesgaard appeared on the horizon. It was of course Glob’s idea to move everything to a manor near Aarhus – he had been fantasising about this from his first Aarhus days, and no one had raised any objections. Now there was a chance of fulfilling the dream, although the actual realisation was still a difficult task.During all this, the Jutland Archaeological Society thrived and attracted more members than expected. Local branches were founded in several towns, summer trips were arranged and a ”Worsaae Medal” was occasionally donated to persons who had deserved it from an archaeological perspective. Kuml came out regularly with contributions from museum people and the like-minded. The publication had a form that appealed to an inner circle of people interested in archaeology. This was the intention, and this is how it should be. But in my opinion this was not quite enough. We also needed a publication that would cater to a wider public and that followed the same basic ideas as the new exhibition.I imagined a booklet, which – without over-popularsing – would address not only the professional and amateur archaeologist but also anyone else interested in the past. The result was Skalk, which (being a branch of the society) published its fir t issue in the spring of 1957. It was a somewhat daring venture, as the financial base was weak and I had no knowledge of how to run a magazine. However, both finances and experience grew with the number of subscribers – and faster than expected, too. Skalk must have met an unsatisfied need, and this we exploited to the best of our ability with various cheap advertisements. The original idea was to deal only with prehistoric and medieval archaeology, but the historians also wanted to contribute, and not just the digging kind. They were given permission, and so the topic of the magazine ended up being Denmark’s past from the time of its first inhabitant s until the times remembered by the oldest of us – with the odd sideways leap to other subjects. It would be impossible to claim that Skalk was at the top of Glob’s wish list, but he liked it and supported the idea in every way. The keeper of national antiquities, Johannes Brøndsted, did the same, and no doubt his unreserved approval of the magazine contributed to its quick growth. Not all authors found it easy to give up technical language and express themselves in everyday Danish, but the new style was quickly accepted. Ofcourse the obligations of the magazine work were also sometimes annoying. One example from the diary: ”S. had promised to write an article, but it was overdue. We agreed to a final deadline and when that was overdue I phoned again and was told that the author had gone to Switzerland. My hair turned grey overnight.” These things happened, but in this particular case there was a happy ending. Another academic promised me three pages about an excavation, but delivered ten. As it happened, I only shortened his production by a third.The 1960s brought great changes. After careful consideration, Glob left us to become the keeper of national antiquities. One important reason for his hesitation was of course Moesgaard, which he missed out on – the transfer was almost settled. This was a great loss to the Aarhus museum and perhaps to Glob, too, as life granted him much greater opportunities for development.” I am not the type to regret things,” he later stated, and hopefully this was true. And I had to choose between the museum and Skalk – the work with the magazine had become too timeconsuming for the two jobs to be combined. Skalk won, and I can truthfully say that I have never looked back. The magazine grew quickly, and happy years followed. My resignation from the museum also meant that Skalk was disengaged from the Jutland Archaeological Society, but a close connection remained with both the museum and the society.What has been described here all happened when the museum world was at the parting of the ways. It was a time of innovation, and it is my opinion that we at the Prehistoric Museum contributed to that change in various ways.The new Museum Act of 1958 gave impetus to the study of the past. The number of archaeology students in creased tremendously, and new techniques brought new possibilities that the discussion club of the 1940s had not even dreamt of, but which have helped to make some of the visions from back then come true. Public in terest in archaeology and history is still avid, although to my regret, the ahistorical 1960s and 1970s did put a damper on it.Glob is greatly missed; not many of his kind are born nowadays. He had, so to say, great virtues and great fault s, but could we have done without either? It is due to him that we have the Jutland Archaeological Society, which has no w existed for half a century. Congr tulat ion s to the Society, from your offspring Skalk.Harald AndersenSkalk MagazineTranslated by Annette Lerche Trolle

ALL THINGS WISE AND WONDERFUL: A Christian Understanding of How and Why Things Happen, in Light of COVID-19 by E. Janet Warren. Eugene, OR: Wipf & Stock, 2021. 208 pages + index. Paperback; $27.00. ISBN: 9781725292031. *In All Things Wise and Wonderful, E. Janet Warren develops a multidisciplinary, Christian understanding of causation with the hope that it will help us "to respond with integrity and compassion for those who suffer" (p. 182). Warren is not short on familiar examples of uncompassionate responses to suffering that are worth critiquing: "God caused the pandemic to teach us to be kind" (p. 127), "Everything happens for a reason" (p. 180), and "This tragedy happened to grow your faith" (p. 22). Warren argues that these symptoms point toward a common diagnosis: a false, "omni-causal" view of God, according to which God "causes everything that happens, including pandemics" (p. 31). *Chapter 1: Introduction lays the groundwork for the rest of the book in two ways: first, by giving a complex taxonomy of philosophical distinctions bearing on causation; second, by introducing (as Warren argues) the problematic practice of too easily explaining an event as the result of God's direct causal intervention (e.g., God provided a parking spot!) when mundane explanations suffice. The tension between the complexity of causation and the human tendency to gravitate toward simplistic (divine) explanations becomes the book's recurring theme. In chapter 2, Warren surveys biblical claims about causation, concluding that the Bible "does not give a simple account of causation," (p. 45) and encouraging the reader to "accept ambiguity and complexity" (p. 36) in the text rather than demanding a coherent biblical theory. *The third chapter, "What Does Christian Theology Say about Causation?" is the clear standout and would make a provocative discussion-piece for an undergraduate class on divine providence in a science and religion course. Warren contrasts two pictures of God, one in which God is an omni-causal, omni-controlling dictator of a deterministic world (pp. 57, 77) and another in which God is a servant king who relinquishes the option to utilize God's power in order to preserve space for indeterministic, creaturely freedom (pp. 53, 58). The strokes are intentionally broad, nudging the reader to see the potential ethical pitfalls of positing an omni-causal God. In particular, Warren worries that an omni-causal God would not be capable of being lovingly responsive to creaturely agents (p. 57). *In Warren's preferred picture, God builds a world that can host longstanding causal patterns without repeated divine intervention; once created, the world is, in some sense "self-causing" (p. 35) and does not require any special act of divine conservation. Although God does act in the world, God refrains from fully exercising his power to control in order to respect "the freedom he has granted to humans and the created order" (p. 60). *The contrasting portraits, however vivid, also preempt discussion of various middle views--one might distinguish between an omni-causing and omni-controlling God, for instance. Warren is also stronger on critique than on the details of her own positive proposal--perhaps by design. "The language of metaphor and analogies is more accessible," Warren writes, "than the language of philosophy or science" (p. 68). This is faithful to her refrain that real-world causal networks are messy and not easily wrapped in neat theological packaging, but it may prove frustrating to those readers eager to engage the details of a constructive project. *In chapter 4, Warren gives the reader a crash course in statistical concepts that are useful for understanding causation, quickly covering (for instance) base rates, regression to the mean, and the law of large numbers. Genuine chance is not incompatible with a kind of sovereignty, Warren argues; rather, God "created randomness" (p. 90) and is capable of guiding overarching events through it while fostering the vulnerability, excitement, and intellectual humility that comes with real chanciness. Chapter 5 asks what science says about causation. Notable--both for the audience it will attract and exclude--is Warren's commitment to take divine healings, demonic activity, and parapsychology seriously while also summarizing key concepts from quantum theory and medicinal practice. *In chapter 6, Warren turns to psychological explanations of why we jump to simple causal explanations. Drawing liberally from Kahneman,1 Warren introduces dual processing theory, distinguishing between our quick, automatic system 1 judgments and our reflective, deliberate system 2 judgments. Citing Barrett's hypersensitive agency detection device2 and Taleb's narrative fallacy,3 among other mechanisms, Warren suggests that causal explanations that invoke a narrative about God's intentions are often psychologically easy for us to jump to (via system 1). A reflective Christian should, Warren argues, be aware of this tendency and moderate our confidence in unreflective judgments about divine intervention in ordinary events. *Chapter 7 and the conclusion that follows take a pastoral turn and will be of special interest to church study groups. Alongside giving practical recommendations for exercising discernment, Warren concludes that "by better understanding the nature of causation and the nature of God's interaction with our wise and wonderful world, we can better evaluate how and why things happen, without glibly assuming God causes everything" (p. 177). *Warren's book could profitably be read by undergraduates in a science and religion course at a confessional college, with special attention given to the third chapter, which has points of contact with Polkinghorne,4 Bartholomew,5 Boyd,6 and Oord.7 But the book may be even more at home in study groups at (broadly) evangelical churches, where the writing's therapeutic lens can shine. Warren's easy prose is accessible as she hops without hesitation from the Bible to Polkinghorne to Aristotle to Bruce Almighty. *While the breadth of Warren's book is impressive, any interdisciplinary book is liable to engage more fully with some disciplines than others. It is no surprise that Warren's book is strongest when drawing on her expertise in medicine and theology and less so when discussing philosophy. *One philosophical concern for Warren's argument against an omni-causal God is the possibility of causation from nonaction. Some philosophers think that absences cause: My not watering the plant causes it to die; my not calling on his birthday causes Dad to be sad. In each of these cases, there is something I could have easily done that would have prevented the effect. But if absences cause, then there is a serious challenge for Warren's view. A powerful and wise (even if not classically omniscient) God can easily prevent most events from happening. God could easily have prevented me from getting that last parking spot or my friend from being infected with a virus. Perhaps, then, God's not preventing these events should number among their causes (or at least their explanations). *This need not be a criticism of the overall theological picture Warren develops--one in which God does not intend or directly intervene to prevent the normal operation of the world except (usually) for explicitly theological reasons. Rather, I suggest that how much leverage can be gained by critiquing the concept of an omni-causal God depends on substantive philosophical commitments about the nature of causation and how causation relates to other philosophical concepts such as explanation and responsibility. Perhaps a God as powerful and involved as traditional Christian theology posits can't help but be in close causal contact with the world--a God whose interventions, however sparingly placed, ripple far throughout the created world, either by preventing or by failing to prevent events that are well within God's power to stop. If so, then "God didn't cause that" may not often be strictly true. Even if God didn't specially intervene with the purpose of bringing the event about, saying "God didn't intend that," "God didn't plan that," or "God didn't want that" may be more honest. Retaining God's action or inaction as causes of mundane events--while complicating the story about divine intent and providence--may also allow us to vindicate the biblical practice of prayerful complaint against God's (in)action (with Job and the psalmist) as a therapeutically important and theologically understandable response to suffering while simultaneously allowing us to join Warren's critique of "comforting" clichés about God's specific purposes for particular harms. *But these are concerns about tactics within the context of a shared goal to enrich and complexify Christian understandings of causation. At its best, Warren's work therapeutically nudges the reader toward a healthy skepticism of over-easy ascriptions of God's direct causal intervention in the world. And this amidst an ambitious, interdisciplinary conceptual toolkit that weaves accessibly through theology, philosophy, statistics, psychology, and the sciences more broadly. *Notes *1Daniel Kahneman, Thinking, Fast and Slow (Toronto, ON: Doubleday Canada, 2011). *2Justin L. Barrett, Born Believers: The Science of Children's Religious Belief (New York: Free Press, 2012). *3Nassim Nicholas Taleb, The Black Swan: The Impact of the Highly Improbable, 2nd ed. (New York: Random House, 2010). *4John C. Polkinghorne, Science and Providence: God's Interaction with the World, 2nd ed. (West Conshohocken, PA: Templeton Foundation, 2005). *5David J. Bartholomew, God, Chance and Purpose: Can God Have It Both Ways? (Cambridge, UK: Cambridge University Press, 2008). *6Gregory A. Boyd, "The Open-Theism View," in Divine Foreknowledge: Four Views, ed. James K. Beilby and Paul R. Eddy (Downers Grove, IL: InterVarsity, 2001), 13-47. *7Thomas Jay Oord, The Uncontrolling Love of God: An Open and Relational Account of Providence (Downers Grove, IL: InterVarsity Academic, 2015). *Reviewed by Christopher Willard-Kyle, Department of Philosophy, University of Glasgow, Glasgow, UK G12 8LP.

This updated issue of the professional publication Bulletin of the Slovenian Armed Forces is dedicated to the question of the Slovenian commitment to finding peaceful solutions to conflicts. As Commander­in­Chief of the Defence Forces of the Republic of Slovenia, I find this subject not only necessary but also entirely essential. There are many reasons for this. The historical experience of the Slovenian people has not always been pleasant regarding the preservation of national identity, manifested in the language as well as in the cultural and national tradition. Despite different repressive and denationalising measures taken by many foreign authorities, our ancestors managed to preserve the Slovenian nation through much wisdom, deep national awareness and political skill. The importance of consistent compliance with the provisions of international law in crisis situations, including wars, was seen in 1991. Slovenia won the war, not only in a military sense but also by complying with all legal norms, thus soon becoming recognised as a young European democratic country founded on high legal and moral principles. The lessons of war in 1991 increased the resolve of the Slovenian people for clear rejection of the use of force in finding solutions to any kind of conflict. For this reason, my pleasure at being invited to write about the topic of Slovenian people in the service of peace is that much greater, in part also due to the fact that I spent a large part of my professional life, from 1992 to 2005, working in the United Nations, first as the ambassador of the Republic of Slovenia, later as UN Assistant Secretary­General. In both functions I dealt with peacekeeping operations to a considerable extent. United Nations peacekeeping operations were in full swing at that time and underwent great development on the one hand, but also bitter disappointment and moments of deep doubt on the other. However, they continued to develop to the current extent. The topic of the Bulletin is presented in truly deep, scientific, theoretical and practical ways, from strategic and tactical levels, considering the evolutionary and transformational characteristics of peacekeeping operations, and deriving from historical experience. The most respected authors in the Slovenian professional field have thrown light upon important conceptual changes in the area of peacekeeping operations, which result from numerous factors, in particular from important geopolitical changes in the world. We must not disregard the increasing cooperation of regional organisations in the implementation of peacekeeping operations, which has indirectly brought about a different understanding of the term “peacekeeping operation” and opened technical discussions in the area of terminology as well as in the technical fulfilment of obligations, all the way to the question of the necessity of a preliminary UN mandate. These deficiencies can also be seen in Slovenia and point to the need for conducting a deep technical discussion as soon as possible and unifying the understanding of both the structure of the Slovenian Armed Forces and the broader defence and security system. The introductory and in particular the more theoretical parts of the Bulletin may be taken as important contributions in this regard. Some of the articles offer interesting historical insight into the cooperation of Slovenian men, and later women, in various endeavours for peace launched by individual great powers and international organisations. Although it is difficult to understand the military intervention of European forces on the island Crete in 1897 as a peacekeeping operation, the objective which is still in the forefront of contemporary efforts of the international community in this area was achieved for at least some time. This intervention ensured an armistice between the parties involved in the conflict and enabled a diplomatic solution on the island without unnecessary victims. The confidence that the highest political and military authorities in the Austro­Hungarian Empire had in the 2nd Battalion of the 87th Infantry Regiment from Celje was truly special. This was particularly the case because the military unit was mainly composed of Slovenes, and at the time of deployment in Crete its commander was a Slovene as well. However, we need to emphasise that such thinking is unconventional. By studying the literature on peacekeeping operations we see that such operations were first mentioned around 1919 in connection with peace conferences after the end of World War I and with managing various border issues in Europe, different plebiscites and other situations which, besides political and other diplomatic action, also required the protection of security and were followed by military operations intended for this particular purpose. History tells us much about peacekeeping operations intended to maintain truces. In these operations, coalition forces were deployed to an area in which a truce already existed and had to be maintained among well organised and disciplined armed forces. Today, the status of armed forces is quite different. We have to look at all of history and every aspect of international military engagement which is not armed combat by nature but a military presence with various aspects of employment of military force and the constant readiness and capability of peace forces to defend themselves effectively and be prepared to use weapons to fulfil their mandate. If today we see peacekeeping operations as valid in this respect, it is clear that we have to be familiar with history and evaluate what we can learn from past experience and how we are obliged to consider the present. Of course, we must consider the present. If we look at the status of peacekeeping operations today, we see how important this military activity is for the modern world. I will only dwell upon the United Nations, which from the standpoint of peacekeeping operations is the most important organisation operating today. Approximately 140,000 soldiers participate in peacekeeping operations under the auspices of the United Nations. No other military force has that number of uniformed personnel operating abroad. These people are assigned to eighteen currently active peacekeeping operations, each costing the organisation about seven billion dollars. This is the largest component of the budget of the United Nations. However, this expenditure is small in comparison to other kinds of military deployment outside the UN, to operations which are not peacekeeping operations by nature. Peacekeeping operations have become very multidimensional. The latest such operations, established in Africa (Darfur, Chad, Central African Republic), have been among the most demanding from the very beginning. We can thus conclude that peacekeeping operations are becoming increasingly more complex, which also results in a higher degree of risk. In 2007, 67 members of UN peacekeeping operations lost their lives. Looking at individual operations we see that six people died in Lebanon alone that year. Ever since peacekeeping operations have been in existence, Lebanon has been one of the most dangerous areas. Today, however, it is somewhat outside the sphere of interest. This may be due to the fact that there is a peacekeeping operation active in the area, on account of which a state of relative peace can be better maintained. Peacekeeping operations are both dangerous and multidimensional, multidimensional because they are no longer focused merely on keeping belligerent parties apart. Modern peacekeeping operations include both standard and supplemental functions. Providing a secure environment for political normalisation, humanitarian activity and development is a comprehensive task, requiring the engagement of peacekeeping forces in operations that are far from being common types of military deployment. This raises different questions about the training and competence of peacekeeping forces. We also have to ask ourselves how we can fully consider the lessons learned from previous peacekeeping operations and organise a system of command, particularly in organisations such as the United Nations, while at the same time making sure that national contingents do not lose their identity. There are thus two lines of communication, one through channels established by international organisations and the other through those established by national systems of armed forces. How to balance this and achieve efficient functioning? How to ensure the operation of different cultures, members and levels of competence in a way that facilitates the success of peacekeeping operations? These are always important questions to consider. In recent years the question of interest has pointed to the complexity of modern peacekeeping operations. Peacekeeping operations are frequently required to facilitate an environment in which elections can be conducted and assist in the establishment of a legal order and institutions to maintain that order. Both tasks are extremely demanding. The establishment of a safe environment for conducting elections in a country with poor communications, with no tradition of elections and with violence linked to every political event, is an extremely difficult task. The establishment of a legal order in areas with no such tradition or adequate infrastructure is even harder. There is often a need to include the civilian police, whose tasks in peacekeeping operations are very demanding. Civilian police have a number of other particularities besides problems connected to the aforementioned multidimensionality. It is necessary to adapt to the local environment in order to facilitate effective police performance. How to facilitate this in an environment such as Haiti, for example, with its difficult past? How to facilitate this in linguistically demanding environments such as East Timor until recently and in other difficult circumstances? These are all extremely demanding tasks. However, there is not much understanding with regard to all the details and problems arising from their implementation. The international political community is often satisfied merely by defining the mandate of a peacekeeping operation. For many people this signifies the solution to the problem, considering that the mandate is defined and that the deployment of forces will occur. However, this is where real problem solving only begins. Only then does it become obvious what little meaning general resolutions of the United Nations Security Council and other acts by which mandates are defined have in the context of actual situations. Therefore, I am of the opinion that we have to take a detailed look at experience from the distant past as well as the present. When speaking of the civilian police we also have to consider the fully human aspects that characterise every peacekeeping operation. Once I spoke to a very experienced leader of civilian police operations about the need to send additional police officers to the mission in Kosovo in the spring, when winter is over and people become more active, which also results in a higher crime rate. He explained that this is not only a problem in the area of this mission but elsewhere in Europe. In spring, the crime rate rises everywhere. Therefore it is difficult to find police officers during this time who are willing to leave their homeland, where they are most needed, and go to a mission area which is just then facing increased needs. I mention this to broaden understanding of the fact that the deployment of peacekeeping forces, both military and civilian police, is not only a matter of mandates and military organisation, but sometimes of the purely elementary questions that accompany social development. I have already mentioned that memory of the past is a very important component of considering present peacekeeping operations. I would like to conclude with another thought. I believe the manner of organising the knowledge of peacekeeping operations is of great importance to all countries, especially those that are new to cooperating in peacekeeping operations. This knowledge cannot be gained from books written at universities, but only from monitoring and carefully analysing the previous experiences of others. It is very important that this knowledge be carefully organised, that these experiences be carefully gathered and analysed, and that a doctrine be developed gradually. This doctrine is required for a country like Slovenia, which is new at conducting peacekeeping operations, to be able to manage well and define its role in international peacekeeping operations properly. To achieve this objective, a new country must cooperate with those countries which have been conducting peacekeeping operations for a long time and therefore have a richer experience. The neighbouring Austria is known to have one of the longest and most interesting systems of experience in peacekeeping operations within the United Nations. Ever since it joined the UN, Austria has been active in numerous activities linked to peacekeeping operations. Its soldiers and the civilian police have participated in a number of peacekeeping operations. Experience gained in this way is of great value, and using this experience is necessary for successful planning of and operating in future peacekeeping operations. The future will be complicated! At one time, when the members of peacekeeping operations numbered approximately 80,000, the United Nations thought that nothing more could be done, and a larger number of members was unthinkable. Today the number of members is significantly larger, development will most likely still continue and conditions will become even more demanding. I do not wish to forecast events which have not yet taken place. However, I would like to strongly emphasise that the history of peacekeeping operations is not over yet and that the future will be full of risks and challenges. I would also again like to stress the importance of this issue of the Bulletin of the Slovenian Armed Forces, which is entering a new decade, and express my pleasure at being able to note down a few thoughts. Let me particularly emphasise that as Commander­in­Chief of the Slovenian Defence Forces I will continue to devote special attention to achievements in the area of cooperation in peacekeeping operations in the future, having a special interest in these experiences. I thank the authors of the articles of this important issue of the Bulletin for their scientific and professional contributions – and I greatly respect those who have already done important work in the name of the Republic of Slovenia with the Slovenian flag on their shoulders, with the hope that they continue to fulfil their obligations in accordance with the rules.

Supplemental Instruction (SI) has been a successful implementation into institutions worldwide. It serves as a means of reducing attrition and increasing the overall learning of course material. The City College of New York (CCNY) has recently implemented SI to General Chemistry I courses to examine whether or not SI would help students succeed in the course and understand and grasp the course material better. SI was made available several times a week during flexible times to students who are struggling in the course. Our method of data collection is a Likert-type and open-ended questionnaire that was distributed at the end of each of the semesters to SI participants in an anonymous fashion. Furthermore, we compared the grades and performance of students participating in SI with those who did not. The collected data enabled us to examine the impact of implementing Supplemental Instruction (SI) in General Chemistry I at CCNY. Our data show that SI was beneficial, contributed to improving students’ understanding of course material, and increased their success rate. About 80 percent of students who failed the first exam and participated in SI obtained a passing grade compared to 11 percent of those who did not.Keywords: supplemental instruction, chemistry education research, student learningINTRODUCTION Supplemental instruction is derived from the term developmental education and stems from a branch of Learning Assistance Centers or LACS [1]. To better understand the origins of Supplemental Instruction, we must first understand the framework that set up this type of education. Developmental education originates in the 1600s and focuses mainly on the assumption that each student has multifaceted talents that can be developed academically, opposed to focusing on the deficits of a student [1]. The main goal was to naturally adapt the students’ population to higher education through means of social and academic domains allowing the students to grow in multiple dimensions in their academic skills [1].Developmental education later paved the way for academic programs such as Learning Assistance Centers (LACs). It was viewed as an extension of the classroom and did not discriminate between faculty and students, and within the student population did not discriminate between students who performed to standard and those who performed below par. LACs were for everyone who wanted to be academically enriched [1]. As a new program, LACs had six main objectives: “higher course grades for participating students; central location for students to receive tutorial assistance; a referral source to other helping agencies; a comprehensive library of basic study aids; a training agency for paraprofessionals, peer counselors, and tutors; and a center for faculty development.” [1]. These goals made it very clear that this service was not to be mislabeled as remedial, which was a main topic of interest when it comes to implementing new services, like this one, in schools. LACs are essentially a tool used to attain higher education, not provide a remedial course. Another important reason as to why LACs were adopted into other higher education institutions is to increase student retention [1]. LACs jump-started improved learning across campuses not only in the United States but across the world.In the 1990’s developmental or remedial courses were not allowed to be offered at public four-year universities, thus making supplemental instruction a very attractive candidate to solving the issue with students’ academic integrity and attrition [1]. College faculty members were drawn to SI due to its minute fiscal commitment and that it strongly promoted individual self-learning for the students, this meant less time spent teaching for instructors [1].SI or supplemental instruction is as it states - supplemental instruction offered to the students enrolled in a course. SI gives the students the opportunity to work in a cooperative setting on problems and is supported by peer instructors [2]. SI works to increase academic performance and retention but utilizing both collaborative studying in addition to independent studying and analysis of study strategies. SI sessions are offered for traditionally difficult high risk course; ‘historically difficult’ courses are also identified by analyzing the grade distribution of courses throughout each academic division, “courses in which 30% or more of the students receive D or F grades or withdraw, become targets” [3]. One of the main factors that attribute to the individuality of SI programs is that it focuses on historically difficult courses [4] and large classes where students have little opportunity for interaction with the professor or other students [5]. Labeling a course as historically difficult allows you to categorize the class as challenging without placing blame on the professor or the students.SI sessions are scheduled on a weekly basis and all students enrolled in the course are encouraged to join. SI sessions act as a continuation of the lesson learned during in-class lecture with the instructor. Being that SI sessions are not tied down to class time, students can attend whenever and however many times they wish without the restriction of a required course preventing them. Constant feedback will be given based on the student’s grasp of the material taught in class, thus giving them ample time and motivation to alter their study methods to adapt, if need be. Research on SI suggests that problem-solving skills and study strategies learned in SI courses are transferable to other courses which leads to improved performance [6]. Supplemental instruction sessions are typically led by an SI leader, who would be a former student that succeeded in the same course, however it is not uncommon for a professor to join an SI session for a course. SI may improve students’ retention and graduation because it offers the students the opportunity to network socially which speeds up the acclimatization to the college experience [7].SI provides a way to combine “how do I teach myself this” with “what do I need to know”. While SI helps students gain a more thorough understanding of the material, it also helps students to condition themselves and alters their thinking to accommodate for the type of information they are processing. SI differs from a remedial tutoring course because it is created based on the course versus the students [1]. This potentially makes attending SI sessions more attractive to students who are afraid or shy to ask for help.SI is not a remedial course, it is considered a mediator connecting the gap between the new information presented to students and the students current knowledge and practices, “SI bridges the gap between the current knowledge base and the acquisition of new knowledge by focusing on the refinement of the learning skills indispensable for acquiring new knowledge” [8]. Successfully implemented SI programs were able to track those students who attended and the impact it made towards their grade, for data that was collected institutionally [9]. SI can be effectively used to develop study skills, increase motivation and improve performance in participants [10].According to Wolfe, “…there appear to be benefits of SI in courses where students are being newly introduced to chemical concepts and methods, but these benefits seem to drop off when students are more experienced with the material.” [5]. The results further go on to conclude that SI is most beneficial to entry level science courses such as, General Chemistry I and Organic Chemistry I. It seems as though SI is a great addition into institutions to overall help attrition rates and more generally help students improve within their courses. More research has been done to give us a wider range of knowledge on SI within Chemistry courses [9]. SI can be used to address the continuous decline of fundamental chemical knowledge noticed in recent college graduates [11].In large lecture classes, there is a disconnect between the lecturer and the student. Supplemental Instruction (SI) is often offered in a more intimate setting where the SI instructors can have one-on-one time with students to individually hone in on their specific problems, whether it is conceptual or problem-solving. As for learning environment, SI is usually held in a smaller more accommodating room where it is a less intimidating more inviting space. This setting provides a social interaction component in which usual Chemistry lectures don’t provide. In addition to the more personal tutoring time available, students are also encouraged to interact in a common social setting. This allows for an opportunity of collaborative learning and may help foster a sense of community [12].The attraction to SI in a college setting is due to its short and long-term effects. The short-term effects of SI sessions are to instill a deeper understanding of the coursework within students. Whereas the long-term goals are two-fold, the academic goal is to change the way students learn, study, and understand information so that the knowledge stays with them. Students who participate in SI earn higher grades not only the course but in subsequent semesters, which is due to improved study habits and is considered a long-term positive outcome of SI [13]. The second long-term goal is to develop better social interaction skills within these students.Many public institutions have implemented SI and thus have uncovered several significant findings. Findings that were previously mentioned pertaining to the outcomes of SI includes achieving higher percentages of passing grades [1, 14]. Some studies also found higher graduation rates among participants [1]. Despite their better performance, SI takers often score lower on academic success predictors such as the SAT and ACT exams [14]; increases in performance, therefore, appear to not occur because stronger students use SI. SI helps promote problem-solving skills because it involves the learner in the construction of knowledge and information processing based on their prior experiences which could contribute to cognitive development [15-16]. Furthermore, SI has been shown to improve motivation and enhance study habits and understanding difficult concepts [17]. Participants in SI have been found to have better control on their achievement, self-esteem, and confidence [18]. SI has also been found to higher academic self-efficacy and grades [19]. Studies have reported that students who participated in SI in introductory courses in Biology or Chemistry courses tended to continue onto upper level courses in the field; SI has a positive effect on students’ enrollment in upper level courses [20-21]. We should note that Rabitoy and co-authors reported that SI enhanced students’ achievement in STEM fields and this was greater for females and students of color [22]. METHODS While researching the topic of SI as a whole, we were able to uncover many studies that were in favor of this new implementation in institutions. Our research study is unique because it targets only at risk students and provides an added value to the curriculum. SI was implemented into The City College of New York (CCNY) as a test run in the Department of Chemistry and Biochemistry. The CCNY is an urban minority serving institute that offers a diverse selection of classes, which vary from the arts to the sciences and everything in between. We wanted to try implementing SI into the sciences to see if at risk science students can benefit from it. Grasping the S in stem, our main goal is to use the successful methods of SI to see what benefits it can bring to general science courses.Beginning during the Spring semester of 2018, SI was implemented at The CCNY’s General Chemistry I course which is composed of lecture, lab, and Peer-Led Team Learning (PLTL) workshop. PLTL is implemented as an integrated part of the course [23]. In the General Chemistry course, after exam one was distributed and grades were given back, an announcement was made introducing SI. The lecture professor would encourage students who received a failing grade, classified as a grade below a 65 out of 100 on exam one, to attend SI as means of improving in the course. This makes our study unique since we are only targeting students who are struggling the course and are not likely to earn a passing grade. It is noteworthy that PLTL offers a collaborative learning experience for all students. SI instructors targeted weaknesses in study habits, socialization, conceptual-understanding, and problem-solving skills.SI was made available for five days a week and on those days, SI was scheduled around classes times which makes it easier for students with busy schedules involving work and class to attend. During SI sessions there are instructors that have been hand-picked by instructors from a cohort of recitation leaders and who have successfully completed the course and have received a grade of A in the course. SI attendance was not mandatory.Throughout the first session available after the Supplemental Instruction announcement was made to the lecture class, those who chose to attend, because SI was not mandatory and it was strongly recommended for struggling students. Students brought their first exam with them to be discussed. This initial discussion is a one-on-one between the student and instructor, which serves as a more social component to learning whereas that isn’t available during class time. The first exam was then discussed so that the instructor can now sift through the student’s strengths and weaknesses to later target them in the weeks to come. The overall composition of our Supplementary Instruction sessions was influenced by the previous studies done and researched, hand-picking methods that seemed to work and leaving off ones that were less successful. SI sessions included cooperative learning activities, and addressed students’ misconceptions and difficulties, explored difficult concepts in depth, and enhanced problem-solving skills [24].Every week during Supplementary Instruction sessions students were encouraged to come back to further work through their weaknesses. During this trial specifically, it was noticed by the SI instructors that a lot of students actually struggle with basic problem-solving skills and reasoning. To help combat this, worksheets were made each week based on the lecture topics covered in class, based on problem-solving to help build their skills. Aside from doing the worksheets, students were encouraged to bring in topics or questions they have on the material so the SI instructors can further clarify and explain. Furthermore, students came to SI with questions that they were struggling with. Students provided questions for the SI instructor to explain which created a mutually beneficial relationship [11, 25].Our research question is: How does Supplemental Instruction in General Chemistry I impact students’ learning, conceptual understanding, retention, and attitudes?In order to properly assess how beneficial SI is to the way students learn Chemistry, data were collected at the end of the Spring and Fall of 2018 semesters, as well as Spring 2019. We used a combination Likert-type and open-ended questionnaire, as well as, grade comparisons. The Likert-type section included a five-point scale, where (1) Strongly Disagree, (2) Disagree, (3) Neutral, (4) Agree, (5) Strongly Agree. For each question, the average was taken which helps make sense of the data. For the open ended questions, questions 1 through 3, we created and used a rubric to score the questions on a scale from 1 to 5 similar to what was mentioned above. For question 4, we compiled the answers and created pie charts based on the type and number of responses.As previously stated, at the end of the semester surveys were printed and distributed to each SI session. Students that attended SI were all encouraged to participate in this survey. A total of 44 out of 60 students were available and willing to participate in the optional survey.RESULT AND DISCUSSION Graphical depictions of each Likert-type question along with average responses are shown in Figure 1. FIGURE 1. Averages for the answers for each of the Likert-type questionnaire. Our data clearly shows that students overall had a positive learning experience with SI. The students agree that SI improved their basic problem-solving skills, understanding of concepts covered, and attaining a better grade in the course. Furthermore, SI participation encouraged students to practice problems and tackle their weaknesses in the course. SI participants believe that the SI instructors targeted their weak areas and helped them improve. Finally, students felt that SI was worth the time and effort they put into it and that it was beneficial and contributed to improvements in grades.FIGURE 2. Averages of the short-answer responses were numerically scaled using a rubric.Figure 2 shows that students overall had a positive learning experience with SI and that it helped them better understand the concepts. Furthermore, the participants would enthusiastically would recommend SI to other Chemistry students.FIGURE 3. The pie chart above shows the beneficial components of SI to studentsFigure 3 shows the parts of SI that students found beneficial. Overall, there were many useful features of the SI program that facilitated students’ learning and succeeding in the course. The students appreciated the time spent on problem-solving, the flexibility of the offerings – refers to the times and days, the individualized learning experience, and the one-on-one support, guidance, and tutoring. From the Likert-type questions given in part one of the survey, responses were broken down for each given question in order to visualize the impact of SI for the students/participants. The average of the responses can be seen above and was about 4.8. The corresponding results can be viewed above as shown in Figure 1. To turn our attention to Figure 1 ‘SI has helped me to improve my basic problem solving skills’, upon meeting with the SI instructor team at The CCNY we were made aware that students have trouble with basic problem-solving which leads to the disconnect in understanding how to build upon this knowledge. When students lack this basic skill, it is difficult for them to move on and build upon this skill as the course progresses, which ultimately leads to their failure to meet the level of understanding for each lecture exam. From the responses, we can see that majority of the students feel as though their problem solving skills have developed as a result of participating in SI. Questions 6-8 deal with an overall belief about the experience of SI participation. Based on Figure 1, SI helped students better understand the course material, and had an overall positive response as 100% of students felt like they did have a better understanding of the course material after attending SI. Students overwhelmingly agree that SI is very beneficial to the way they learn Chemistry. Our data show that SI is well received by the participants which is consistent with other researchers [11]. Short answer questions 1-3 were made in order to have a more in-depth understanding of the student experience with SI this past semester. These questions were formed as short answer so students were more inclined to share their opinions of SI. The collected data shows that the students strongly agree that SI has been very beneficial for ways unique to each student. Some students enjoyed the SI instructors and their way of teaching and helping the students understand the material. While others enjoyed how personal the experience was. It wasn’t a ‘one size fits all’ experience but an experience that was personalized to each student’s needs, strengths, and weaknesses. Short answers for question 4 also had very personalized responses. Question 4 in particular – ‘What features of SI did you find to be most beneficial to you?’ was very helpful in understanding what students appreciate most about SI, and served as a standard to which should be upheld. Responses ranged from the flexible times SI was offered to the small class setting which is extremely different than the lecture, and more comfortable. Students also enjoyed and benefited from the one-on-one attention they received in SI session. For that reason, students would make time to attend the SI section of their ‘favorite instructor’. Furthermore, the individualized learning experience was appealing to SI participants. The overall goal is to get each student to understand complex concepts and if one instructor can better help someone to reach this goal; SI is a success. The overall responses show that SI is very beneficial and contributed a great deal to the way that students learn Chemistry. One main issue we have encountered during this initial phase of implementation is low number of students who self-select to participate in SI. Only about 10 percent of students who failed the first exam, participated in SI. One reason could be that students might not buy into the philosophy of SI. A second reason might be that students do not think that SI would help them better understand the content and succeed on the course. A third reason could be due to lack of motivation in these students. Another reason could be attributed to the lack of maturity in students who are taking General Chemistry I. We use the term ‘lack of maturity’ loosely in this sense to mean the lack of knowledge of how to conduct oneself in a college setting [26]. Most commonly, freshman students come straight from high school where they have not yet acquired good study techniques or methods which work best for them. These reasons combined with the hardship required to understand such complex concepts that they’re learning for the very first time can deter students. Our data show that students who participated in SI after failing the first exam achieved a success rate of about 80%. Students who failed the first exam and did not participate in SI had an 11% chance of passing the course. This data is consistent with several research in the field indicating that students who participate in SI have a higher chance of successfully completing the course with a passing grade [14, 27]. We feel these data make powerful statement for the added value of SI in General Chemistry courses and its impact on students learning and attitudes.CONCLUSION In conclusion, our research study on SI provided valuable data into students’ learning and conceptual understanding of content in General Chemistry. Furthermore, our findings provide insights into students’ attitudes about SI implementation and its benefits to the participants. Our research data supports the introduction of SI into General Chemistry courses and provides students with learning skills, socialization competencies, problem-solving skills, and the knowledge required to successfully complete the course. We believe that our data supports the notion that SI had a significantly affected the participants grades in a positive manner and it should be noted that that majority of SI participants earned a passing grade in the course. Our results and data on the implementation of SI in General Chemistry courses improved students’ attitudes towards the subject matter, learning, socialization, and study habits. We are confident we can reach a larger population and improve our recruitment so more students can experience SI and increase their chances of successful completion of the course. As an implication for curriculum, we would recommend supplemental instruction for all introductory courses STEM fields. ACKNOWLEDGMENT We also would like to thank the Department of Psychology at the CCNY and CUNY Coordinated Undergraduate Education (CUE) for funding our Supplemental Instruction program.

Abstract Background Due to the prevalence and associated adverse health consequences of negative body image among adolescents globally, there is a need to develop acceptable, effective, and scalable interventions. School-based body image interventions delivered by trained teachers show promise in reducing negative body image in adolescents. However, there is currently a lack of evidenced-based body image interventions for use in low- and middle-income countries (LMICs). This paper outlines a protocol for the development and evaluation of Dove Confident Me Indonesia: Single Session, a single-session, teacher-led body image intervention for Indonesian adolescents. Method The effectiveness of the intervention will be evaluated using a cluster randomised controlled trial design. Due to the COVID-19 pandemic, the trial will be conducted online. Trained teachers or school guidance counsellors will deliver the intervention. Self-report questionnaires will be collected at three time points: baseline, post-intervention, and two-month follow-up. The primary outcome is body esteem. Secondary outcomes are internalisation of appearance ideals, mood, engagement in life activities, tendency to engage in appearance comparisons, and skin shade satisfaction. A minimum of 1000 participants will provide 95% power to detect small-to-medium intervention effects. To account for attrition and potential internet issues, the sample will comprise of 2000 Indonesian adolescents in grades 7–9, attending state junior high schools in Surabaya, East Java. Quantitative and qualitative data on acceptability of the intervention will also be collected from teachers and students. Additionally, fidelity of lesson implementation will be assessed. This project received ethical approval from the Universitas Indonesia and the University of the West of England. The intervention will be disseminated in junior high schools throughout Indonesia via UNICEF’s Life Skills Education (LSE) programme, which will be freely available for teachers to download. Discussion This paper presents Dove Confident Me Indonesia: Single Session, a culturally adapted school-based intervention designed to improve Indonesian adolescents’ body image. It details the plan for evaluation, highlighting the strengths and limitations of the proposed study design. It will be informative for others aiming to adapt evidence-based school curricula to promote well-being among adolescents in LMICs. Trial registration NCT04665557. Registered 11th December 2020.

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An analytical observational study was conduct using a web-based questionnaire. Evidence-based practice is one of the most relevant concern of all health professions. This research has been done taking account of demographic information, attitudes and skills in reference to Evidence Based Practice (EBP) for application in the daily clinical practice. To describe beliefs and behaviors of physiotherapists from two Italian regions about EBP and its implementation in clinical practice, their knowledge in this field and the perception of its benefits and barrier in application in clinical practice. The participants completed a designed questionnaire, whose purpose was to determine beliefs, attitudes, knowledge, and behaviors regarding EBP, as well as demographic information about themselves and their practice settings. This survey was activated through the TSRM-PSTRP registers of Marche and Umbria regions that sent the questionnaire to all the registered physiotherapists. There was a response rate of 7.64% for Marche region, equal to a sample of 132 physiotherapists, and a response rate of 12.99% for Umbria region, equal to a sample of 110 physiotherapists, for a total sample of 242 physiotherapists. The questionnaire was filled out through an online Google platform called “Forms”. The responses were summarized for each item and the logistic regression analyses and the chi-square test were used to examine relationships among variables. The respondents agreed that the use of evidence in practice was necessary, that the literature was helpful in their practices and that the quality of patient care was better when evidence were used. For physiotherapists from Umbria, with more than 15 years of qualification, the following answers are statistically significant (p<0.05): “the application of EBP is necessary in the practice of physical therapy, EBP helps me making decisions about patient care and I actively seek practice guidelines pertaining to areas of my practice and EBP improves the quality of patient care”. For physiotherapists from Marche, with more than 15 years of qualification, the following answers are statistically significant (p<0.05): “EBP helps me making decisions about patient care, I actively seek practice guidelines pertaining to areas of my practice and I am confident in my ability to find relevant research to answer my clinical questions”. Training, familiarity with and confidence in search strategies, use of databases, and critical appraisal tended to be associated to younger therapists with fewer years of qualification. Physical therapists stated they have a positive attitude about EBP and they are interested in learning or improving the necessary skills to implement EBP. They noticed that they needed to increase the use of evidence in their daily practice.

Background: Minimally invasive surgery for intracerebral hemorrhage (ICH) has been evaluated in clinical trials. Although meta-analyses on this topic have been performed in the past, recent trials have added important information to the results of the comparison. However, little work has been done to compare the effect of MIS and conventional treatment on patient prognosis, especially mortality.Methods: PubMed, EMBASE, Web of Science, Ovid, China National Knowledge Infrastructure, and ClinicalTrials.gov were searched on May 1, 2021, for randomized controlled trials of MIS for spontaneous ICH. The primary outcome was defined as death at follow-up, while the secondary outcome was defined as death in different comparisons between MIS and craniotomy (CT) or medication (Me).Results: The initial search yielded 12 high-quality randomized controlled trials involving 2,100 patients. We analyzed the odds ratios (ORs) for MIS compared with conventional treatment, including Me and conventional CT. The OR and confidence intervals (CIs) of the primary and secondary outcomes were 0.62 (0.45–0.85) for MIS vs. conventional treatment. We also conducted subgroup analyses and found that the ORs and CIs for MIS compared with that of conventional treatment in the short-term follow-up were 0.58 (0.42–0.80), and, in the long-term follow-up, was 0.67 (0.46–0.98); and found that ORs were 0.68 (0.48–0.98) for MIS vs. CT and 0.57 (0.41–0.79) for MIS vs. Me.Conclusions: This meta-analysis demonstrates that certain patients with ICH benefit in short- and long-term follow-up from MIS over other treatments, including open surgery and conventional Me.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/.

ABSTRACTIncreasing antimicrobial resistance among uropathogens limits treatment options for patients with complicated urinary tract infection (cUTI). Plazomicin, a new aminoglycoside, hasin vitroactivity against multidrug-resistantEnterobacteriaceae, including isolates resistant to currently available aminoglycosides, as well as extended-spectrum β-lactamase-producing and carbapenem-resistantEnterobacteriaceae. We evaluated the efficacy and safety of plazomicin in a double-blind, comparator-controlled, phase 2 study in adults with cUTI or acute pyelonephritis. Patients were randomized 1:1:1 to receive intravenous plazomicin (10 or 15 mg/kg of body weight) or intravenous levofloxacin (750 mg) once daily for 5 days. Coprimary efficacy endpoints were microbiological eradication at the test of cure (TOC; 5 to 12 days after the last dose) in the modified intent-to-treat (MITT) and microbiologically evaluable (ME) populations. Overall, 145 patients were randomized to treatment. In the groups receiving plazomicin at 10 mg/kg, plazomicin at 15 mg/kg, and levofloxacin, microbiological eradication rates were, respectively, 50.0% (6 patients with microbiological eradication at TOC/12 patients treated [95% confidence interval {CI}, 21.1 to 78.9%]), 60.8% (31/51 [95% CI, 46.1 to 74.2%]), and 58.6% (17/29 [95% CI, 38.9 to 76.5%]) in the MITT population and 85.7% (6/7 [95% CI, 42.1 to 99.6%]), 88.6% (31/35 [95% CI, 73.3 to 96.8%]), and 81.0% (17/21 [95% CI, 58.1 to 94.6%]) in the ME population. In the MITT population, 66.7% (95% CI, 34.9 to 90.1%), 70.6% (95% CI, 56.2 to 82.5%), and 65.5% (95% CI, 45.7 to 82.1%) of the patients in the three groups, respectively, were assessed by the investigator to be clinically cured at TOC. Adverse events were reported in 31.8%, 35.1%, and 47.7% of the patients in the three groups, respectively. Serum creatinine values were generally stable over the course of the study. No plazomicin-treated patients with evaluable audiometry data had postbaseline sensorineural, conductive, or mixed hearing loss. In summary, plazomicin demonstrated microbiological and clinical success and an overall safety profile supportive of further clinical development. (This study has been registered at ClinicalTrials.gov under identifier NCT01096849.)

Background: We aimed to review relevant randomized controlled trials to assess the relative clinical effects of antibiotic treatment of patients with community-acquired pneumonia (CAP). Methods: In this meta-analysis, we identified relevant studies from PubMed, Cochrane, and Embase using appropriate keywords. Key pertinent sources in the literature were also reviewed and all articles published through Oct 2019 were considered for inclusion. For each study, we assessed the risk ratios (RRs) or mean difference combined with the 95% confidence interval (CI) to assess and synthesize outcomes. Results: Overall, 36 studies were consistent with the meta-analysis, involving 17,076 patients. There was no significant difference in the mortality after subgroup analysis: individualized treatment vs. standard treatment; β-lactams plus macrolides vs. β-lactam and/or fluoroquinolone; ceftaroline fosamil vs. ceftriaxone; combination therapy vs. monotherapy or high-dose vs. low-dose. The drug-related adverse event incidence was significantly higher in the ceftriaxone group than in the other drug groups (P<0.05) and also higher in the tigecyline group than in the levofloxacin group (P<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the test-of-cure (TOC) visit in the clinically evaluable population, modified intent-to-treat efficacy (MITTE) population, microbiologically evaluable (ME) population and the microbiological MITTE (mMITTE) population (all P<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the TOC visit in the mMITTE population of Gram positiveStreptococcus pneumoniae (P<0.05) and multidrug-resistant S. pneumoniae (P<0.05). Conclusion: There was a limited number of included studies in the subgroup analysis, but it will still be necessary to conduct more high-quality randomized controlled trials to confirm the clinical efficacy of different antibiotics used to treat CAP.

ABSTRACT Rapid detection of group A Streptococcus (GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100% and 91.3%, respectively, and BD Veritor had a sensitivity and a specificity of 76.2% and 93.6%, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100% ( n = 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement = 0.888 [95% confidence interval {CI}, 0.838 to 0.927]; kappa index = 0.689 [95% CI, 0.91 to 0.974]). We also found both the underutilization and the overutilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.

Research & Reviews: Journal of Ecology CURRENT ISSUE Atom logo RSS2 logo RSS1 logo Journal Help SUBSCRIPTION Login to verify subscription USER Username Password Remember me NOTIFICATIONS View Subscribe JOURNAL CONTENT Search Search Scope All Browse By Issue By Author By Title Other Journals FONT SIZE INFORMATION For Readers For Authors For Librarians HOME ABOUT LOGIN REGISTER SEARCH CURRENT ARCHIVES ANNOUNCEMENTS AUTHOR GUIDELINE REFERENCING PATTERN EDITORIAL BOARD PUBLICATION ETHICS& MALPRACTICE STATEMENT PUBLICATION ETHICS & MALPRACTICE STATEMENT Home > Vol 9, No 1 (2020) > Saha Open Access Open Access Restricted Access Subscription or Fee Access Evaluation on the Sensitivity of the Freshwater Tropical Worm, Branchiura sowerbyi (Beddard, 1892) to the Pyrethroid Pesticide, Bifenthrin Shubhajit Saha, Kishore Dhara, Nimai Chandra Saha Abstract In the present study, acute toxicity of the pyrethroid pesticide, bifenthrin, was evaluated under the experimental condition to the freshwater tropical oligochaete worm, Branchiura sowerbyi. The 96 h LC50 with 95% confidence limits of B. sowerbyi was 1.043(0.721-1.327) μg/l. None of the unexposed control test animal died during the experiment. Relation between each concentration and mortality rate during 24–96 h was found to be correlated. The mortality rate varied significantly (p<0.05) with the increasing concentration for the organisms at all the exposure concentrations except 3.50 μg/l, 4.50 μg/l and 5.00 μg/l (p>0.05) at all the exposure times. The relationship between rate of mortality and exposure times was also found to be significant (p<0.01). The effect of bifenthrin on the ethological changes of the oligochaete worm was directly proportional to the increasing dose of the toxicant.

It seems clear that people who are deaf ... struggle continually against the meanings that others impose on their experience, and the way that this separates them from others. They struggle for acknowledgement of the way they see their lives and wish to live them, and aspire to connection?with other people, to share and belong. (David Moorhead. Knowing Who I Am. 1995. 85.) Nga Tapuwae and Before I am deaf but, before that part of my life started, I was hearing and worked for many years as a librarian in New Zealand. My first job was in a public library located within a secondary school Nga Tapuwae Secondary College in South Auckland. Its placement was a 1970’s social experiment to see if a public library could work within the grounds of a community college (and the answer was no, it could not). The experience was a great introduction for me to the Maori and Polynesian cultures that I had not previously encountered. Until then, I was wary of both groups, and so it was a revelation to realise that although there were many social problems in the area including low literacy, many of the children and teenagers were bright, talented individuals. They simply did not connect to the Anglo-Saxon reading materials we offered. Years later, my interest in the social dynamics of literacy led to my enrolment in a post-graduate literacy degree in Melbourne. This action may have saved my life because at the end of this course, a minor ailment resulted in a visit to the university doctor who diagnosed me with the life-threatening medical condition, Neurofibromatosis Type 2 (NF 2). NF2 is a late onset genetic condition in which one’s body grows tumours, always on both hearing nerves, sometimes elsewhere as well. The tumours usually cause deafness and can cause death. I was told I needed to have my tumours removed and would probably become fully deaf as a result. This is how my life as I knew it changed direction and I started the long journey towards becoming deaf. Diagnosis and Change Predictably, once diagnosed, friends and colleagues rallied to comfort me. I was told things probably weren’t as bad as they sounded. Helen Keller was mentioned several times as an example of someone who had succeeded despite being deaf and blind. ‘Really,’ my friends asked, ‘how bad can it be? ‘Inside myself however, it couldn’t have been worse. A day later the enormity of it all hit me and I became inconsolable. A friend drove me back to the doctor and she did two things that were to change my life. She referred me to the University’s counselling services where, happily, I was counselled by Elizabeth Hastings who later went on to become Australia’s first Disability Services Commissioner. Secondly, the doctor organised for me to visit the HEAR Service at the Victorian Deaf Society (VDS). Again by happy accident, my friend and I stumbled into the ‘wrong building’ where I ended up meeting John Lovett, who was Deaf and the CEO there, via an interpreter. When I met John Lovett I was distraught but, unlike other people, he made no attempt to stop me crying. He simply listened carefully until I realised he understood what I was saying and stopped crying myself. He said my fears that I could end up alone and lonely were valid and he suggested the best thing I could do for myself was to join the ‘Deaf community’; a community. I had never heard of. He explained it was made up of people like him who used Australian sign language (Auslan) to communicate. He was so engaging and supportive that this plan sounded fine to me. By the time we finished talking and he walked me over to the HEAR Service, I was so in his thrall that I had enrolled for a Deaf awareness workshop, an Auslan class, and had plans to join the Deaf community. Had I stayed on and learned Auslan, my life may well have followed a different path, but this was not to be at that time. Becoming Hearing Impaired (HI) Across at the HEAR service, an alternate view of my potential future was put to me. Instead of moving away from everything familiar and joining the Deaf community, I could learn to lip-read and hopefully use it to stay in the workforce and amongst my hearing friends. I had a cousin and aunt who were late deafened; my cousin in particular was doing well communicating with lip-reading. I discussed this with friends and the idea of staying with the people I already knew sounded far less confronting than joining the Deaf community and so I chose this path. My surgeon was also optimistic. He was confident he could save some of my hearing. Suddenly learning Auslan seemed superfluous. I phoned John Lovett to explain, and his response was that I should do what suited me, but he asked me to remember one thing: that it was me who decided to leave the Deaf Community, not that the Deaf community had not wanted me. He told me that, if I changed my mind, I could always go back because the door to the Deaf community would always be open and he would be still be there. It would be a decade before I decided that I wanted to go back through that door, and around that time this great man passed away, but I never forgot my promise to remember our conversation. It, and a few other exchanges I had with him in the following years, stayed at the back of my mind, especially as my residual hearing sank over the years, and the prospect of total deafness hung over me. When I had the surgery, my surgeon’s optimism proved unfounded. He could not save any hearing on my left side and my facial and balance nerves were damaged as well. The hospital then decided not to operate again, and would only attempt to remove the second tumour if it grew and threatened my health again. Consequently, for close to a decade, my life was on hold in many ways. I feared deafness—for me it signalled that my life as I knew it would end and I would be isolated. Every hearing test was a tense time for me as I watched my remaining hearing decline in a slow, relentless downward path on the graph. It was like watching the tide go out knowing it was never going to come in as fully again. My thinking started to change too. Within a week of my diagnosis I experienced discrimination for the first time. A library school that had offered me a place in its post graduate librarianship course the following year made it clear that they no longer wanted me. In the end it did not matter as I was accepted at another institution but it was my first experience of being treated less favourably in the community and it was a shock. After the surgery my life settled down again. I found work in public libraries again, rekindled an old relationship and in 1994 had a baby boy. However, living with a hearing loss is hard work. Everything seemed tiring, especially lip-reading. My ears rejected my hearing aid and became itchy and inflamed. I became aware that my continual hearing problems were sometimes seen as a nuisance in work situations. Socialising lost a lot of its appeal so my social world also contracted. Around this time something else started happening. Outside work, people started expressing admiration for me—words like ‘role model’ and ‘inspiring’ started entering the conversation. Any other time I might have enjoyed it but for me, struggling to adapt to my new situation, it felt odd. The whole thing reminded me of being encouraged to be like Helen Keller; as if there is a right way to behave when one is deaf in which you are an inspiration, and a wrong way in which one is seen as being in need of a role model. I discussed this with Elizabeth Hastings who had helped me prepare mentally for the surgery and afterwards. I explained I felt vulnerable and needy in my new situation and she gave me some useful advice. She thought feeling needy was a good thing as realising one needs people keeps one humble. She observed that, after years of intellectualising, educated people sometimes started believing they could use intellectualisation as a way to avoid painful emotions such as sadness. This behaviour then cut them off from support and from understanding that none of us can do it alone. She believed that, in always having to ask for help, people with disabilities are kept aware of the simple truth that all people depend on others to survive. She said I could regard becoming deaf as a disability, or I could choose to regard it as a privilege. Over the years the truth of her words became increasingly more evident to me as I waded through all the jargon and intellectualisation that surrounds discussion of both deafness and the disability arena, compared to the often raw emotion expressed by those on the receiving end of it. At a personal level I have found that talking about emotions helps especially in the face of the ubiquitous ‘positive thinking’ brigade who would have us all believe that successful people do not feel negative emotions regardless of what is happening. The Lie Elizabeth had initially sympathised with my sadness about my impending deafness. One day however she asked why, having expressed positive sentiments both about deaf people and people with disabilities, I was saying I would probably be better off dead than deaf? Up until that conversation I was unaware of the contradictions between what I felt and what I was saying. I came to realise I was living a lie because I did not believe what I was telling myself; namely, that deaf people and people with disabilities are as good as other people. Far from believing this, what I really thought was that being deaf, or having a disability, did lessen one’s worth. It was an uncomfortable admission, particularly sharing it with someone sitting in a wheelchair, and especially as up until then I had always seen myself as a liberal thinker. Now, faced with the reality of becoming deaf, I had been hoist by my own petard, as I could not come to terms with the idea of myself as a deaf person. The Christian idea of looking after the ‘less fortunate’ was one I had been exposed to, but I had not realised the flip side of it, which is that the ‘less fortunate’ are also perceived as a ‘burden’ for those looking after them. It reminded me of my initial experiences years earlier at Nga Tapuwae when I came face to face with cultures I thought I had understood but did not. In both cases it was only when I got to know people that I began to question my own attitudes and assumptions and broadened my thinking. Unfortunately for deaf people, and people with disabilities, I have not been the only person lying to myself. These days it is not common for people to express their fears about deaf people or people with disabilities. People just press on without fully communicating or understanding the other person’s attitude or perspectives. When things then do not work out, these failures reinforce the misconceptions and these attitudes persist. I believe it is one of the main reasons why true community inclusion for deaf and people with disabilities is moving so slowly. Paying for access is another manifestation of this. Everyone is supportive of access in principle but there is continuous complaint about paying for things such as interpreting. The never-ending discussions between deaf people and the wealthy movie industry about providing more than token access to captioned cinema demonstrate that the inclusion lie is alive and well. Until it can be effectively addressed through genuine dialogue, deaf people, hard of hearing people and people with disabilities will always be largely relegated to life outside the mainstream. Collectively we will also continue to have to endure this double message that we are of equal value to the community while simultaneously being considered a financial burden if we try to access it in ways that are meaningful to us. Becoming Deaf In 2002 however all this thinking still lay ahead of me. I still had some hearing and was back living in New Zealand to be close to my family. My relationship had ended and I was a solo mother. My workplace had approved leave of absence, and so I still had my job to go back to in Melbourne if I wanted it. However, I suspected that I would soon need the second tumour removed because I was getting shooting pains down my face. When my fears were confirmed I could not decide whether to move back to Melbourne or let the job go, and risk having trouble finding one if I went back later. I initially chose to stay longer as my father was sick but eventually I decided Melbourne was where I wanted to be especially if I was deaf. I returned, found temporary employment, and right up to the second surgery I was able to work as I could make good use of the small amount of hearing I still had. I thought that I would still be able to cope when I was made fully deaf as a result of the surgery. It was, after all, only one notch down on the audiogram and I was already ‘profoundly deaf’ and still working. When I woke up after the surgery completely deaf, it felt anti-climactic. The world seemed exactly the same, just silent. At home where I was surrounded by my close family and friends everything initially seemed possible. However, when my family left, it was just my seven-year-old son and myself again, and on venturing back into the community, it quickly became clear to me that at some level my status had changed. Without any cues, I struggled to follow speech and few people wanted to write things down. Although my son was only seven, people communicated with him in preference to me. I felt as if we had changed roles: I was now the child and he was the adult. Worse was soon to follow when I tried to re-enter the workforce. When I had the surgery, the hospital had installed a gadget called an auditory brainstem implant, (ABI) which they said would help me hear. An ABI is similar to a cochlear implant but it is attached to the brainstem instead of the cochlear nerve. My cochlear nerve was removed. I hoped my ABI would enable me to hear enough to find work but, aside from clinical conditions in which there was no background noise and the staff knew how to assist, it did not work. My most humiliating moment with it came when it broke down mid job interview and I spent half the time left trying to get it going again in full view of the embarrassed interview panel, and the other half trying to maintain my composure whilst trying to lip-read the questions. The most crushing blow came from the library where I had happily worked for seven years at middle management level. This library was collaborating with another institution to set up a new library and they needed new staff. I hopefully applied for a job at the same level I had worked at prior to becoming deaf but was unsuccessful. When I asked for feedback, I was told that I was not seen as having the skills to work at that level. My lowest point came when I was refused a job unpacking boxes of books. I was told I did not have experience in this area even though, as any librarian will attest, unpacking boxes is part of any librarian’s work. When I could not find unskilled work, it occurred to me that possibly I would never work again. While this was unfolding, my young son and I went from being comfortable financially to impoverished. My ex-partner also decided he would now make childcare arrangements directly with my son as he was annoyed at being expected to write things down for me. My relationship with him, some family members, and my friends were all under strain at that time. I was lost. It also became clear that my son was not coping. Although he knew the rudiments of Auslan, it was not enough for us to communicate sufficiently. His behaviour at school deteriorated and one night he became so frustrated trying to talk to me that he started to pull out his own hair. I calmed him and asked him to write down for me what he was feeling and he wrote down ‘It is like you died. It is like I don’t have a Mum now’. It was now clear to me that although I still had my friends, nobody including myself knew what to do. I realised I had to find someone who could understand my situation and I knew now it had to be a Deaf person. Fortunately, by this stage I was back learning Auslan again at La Trobe University. The week after the conversation with my son, I told my Auslan teacher what had happened. To my relief she understood my situation immediately. She told me to bring my son to class, at no cost, and she would teach him herself. I did and my life started to turn around. My son took to Auslan with such speed and application that he was able to not only converse with her in one month but immediately started using Auslan with me at home to get the things he wanted. We were able to re-establish the mother/son relationship that we both needed. I was also able to help my son talk through and deal with all the changes that me becoming deaf had foisted upon him. He still uses Auslan to talk to me and supplements it using speech, copious finger spelling, notes and diagrams. More than anything else, this relationship has kept me anchored to my long-term goal of becoming a clear signer. Encouraged by my son’s success, I put all my energy into learning Auslan and enrolled in a full time TAFE Auslan course. I also joined a chat group called ‘Here to Hear’ (H2H). The perspectives in the group ranged from strongly oral to strongly Deaf but for me, trying to find a place to fit in any of it, it was invaluable. Almost daily I chatted with the group, asking questions and invariably someone responded. The group acted as a safety net and sounding board for me as I worked out the practicalities of living life deaf. The day of my fateful interview and the ABI humiliation, I came home so shaken that I used the Irish remedy of a couple of swigs of whisky, and then went online and posted an account of it all. I can still remember the collective indignation of the group and, as I read the responses, beginning to see the funny side of it . . . something I could not have done alone. I also made use of easy access to Deaf teachers at TAFE and used that to listen to them and ask advice on situations. I found out for example, that if I instructed my son to stand behind me when people in shops insisted on addressing him, they had no alternative but to talk to me; it was a good clear message to all concerned that my son was the child in this relationship. About this time, I discovered the Disability Discrimination Act (DDA) that Elizabeth Hastings had worked so hard on, filed my first DDA complaint, and received my first apology at the mediation session that followed. My personal life also improved, relationship by relationship as everyone adjusted. Slowly the ice melted in most of my relationships; some relationships faded and were replaced with new ones with signing people, and eventually hearing people again. My life moved forward. Through a member of ‘Here to Hear’, I was invited to apply for my first post deaf job—covering holiday leave at a Deaf sports organisation. I practically finger-spelt my way through the interview but not only did they offer me the job, they were delighted to have me. I was able to buy a few things with the money I earned, and suddenly it felt as if everything was possible again. This acceptance of me by Deaf people had a profound impact on me. I mixed with people more, and it was not too long before I was able to use my basic signing skills to use Auslan interpreters and re-enter the workplace. I have discovered over time that living in silence also has advantages—no more noisy parties or rubbish trucks clanging at dawn and in its place a vastly heightened visual awareness that I enjoy. Before I was deaf I thought it would be lonely in the silence but in fact many of life’s best moments—watching rain hit and then run down a window, swimming in the sea, cooking and being with good friends—do not rely upon sound at all; they feel the same way they always did. Sometimes I have felt somewhat of an outsider in the Deaf community. I have sometimes been taken aback by people’s abruptness but I have learned over time that being succinct is valued in Auslan, and some people like to come straight to the point. At crisis points, such as when I asked for help at the Victorian Deaf Society and my Auslan class, it has been a huge relief to talk to Deaf people and know immediately that they understand just from reading their eyes. Having access to an additional world of deaf people has made my life more enjoyable. I feel privileged to be associated with the Deaf community. I can recall a couple of Christmases ago making dinner for some signing friends and suddenly realising that, without noticing, everything had become alright in my world again. Everyone was signing really fast – something I still struggle with; but every now and then someone would stop and summarise so I felt included. It was really relaxed and simply felt like old times, just old times without the sound thrown in. Le Page and Tabouret-Keller, two ethnographers, have this to say about why people communicate the ways they do: The individual ... creates for himself the patterns of his linguistic behaviour so as to resemble those of the group or groups with which from time to time he wishes to be identified, or so as to be unlike those from whom he wishes to be distinguished ... . We see speech acts as acts of projection; the speaker is projecting his inner universe, implicitly with the invitation to others to share it ... he is seeking to reinforce his models of the world, and hopes for solidarity from those with whom he wishes to identify. (181) This quote neatly sums up why I choose to communicate the ways I do. I use Auslan and speech in different situations because I am connected to people in both groups and I want them in my life. I do not feel hugely different from anyone these days. If it is accepted that I have as much to contribute to the community as anyone else, becoming deaf has also meant for me that I expect to see other people treated well and accepted. For me that means contributing my time and thoughts, and advocating. It also means expecting a good level of access to interpreters, to some thought provoking captioned movies in English, and affordable assistive technologies so I can participate. I see this right to participate and engage in genuine dialogue with the rest of the community as central to the aspirations and identity of us all, regardless of who we are or where others think we belong. References Le Page, R.B., and Andree Tabouret-Keller. Acts of Identity: Creole-Based Approaches to Language and Ethnicity. London: Cambridge University Press, 1985. Moorhead, D. “Knowing Who I Am.” In S. Gregory, ed., Deaf Futures Revisited. Block 3, Unit 10, D251 Issues in Deafness. Open University, 1995.

Despite numerous critics describing him as an auteur (i.e. a film-maker who ‘does’ everything and fulfils every production role [Bordwell and Thompson 37] and/or with a signature “world-view” detectable in his/her work [Caughie 10]), Rolf de Heer appears to have declined primary authorship of Dance Me to My Song (1997), his seventh in an oeuvre of twelve feature films. Indeed, the opening credits do not mention his name at all: it is only with the closing credits that the audience learns de Heer has directed the film. Rather, as the film commences, the viewer is informed by the titles that it is “A film by Heather Rose”, thus suggesting that the work is her singular creation. Direct and uncompromising, with its unflattering shots of the lead actor and writer (Heather Rose Slattery, a young woman born with cerebral palsy), the film may be read as a courageous self-portrait which finds the grace, humanity and humour trapped inside Rose’s twisted body. Alternatively, it may be read as yet another example of de Heer’s signature interest in foregrounding a world view which gives voice to marginalised characters such as the disabled or the disadvantaged. For example, the developmentally retarded eponyme of Bad Boy Bubby (1993) is eventually able to make art as a singer in a band and succeeds in creating a happy family with a wife and two kids. The ‘mute’ girl in The Quiet Room (1996) makes herself heard by her squabbling parents through her persistent activism. In Ten Canoes (2006) the Indigenous Australians cast themselves according to kinship ties, not according to the director’s choosing, and tell their story in their own uncolonised language. A cursory glance at the films of Rolf de Heer suggests he is overtly interested in conveying to the audience the often overlooked agency of his unlikely protagonists. In the ultra-competitive world of professional film-making it is rare to see primary authorship ceded by a director so generously. However, the allocation of authorship to a member of a marginalized population re-invigorates questions prompted by Andy Medhurst regarding a film’s “authorship test” (198) and its relationship to a subaltern community wherein he writes that “a biographical approach has more political justification if the project being undertaken is one concerned with the cultural history of a marginalized group” (202-3). Just as films by gay authors about gay characters may have greater credibility, as Medhurst posits, one might wonder would a film by a person with a disability about a character with the same disability be better received? Enabling authorship by an unknown, crippled woman such as Rose rather than a famous, able-bodied male such as de Heer may be cynically regarded as good (show) business in that it is politically correct. This essay therefore asks if the appellation “A film by Heather Rose” is appropriate for Dance Me to My Song. Whose agency in telling the story (or ‘doing’ the film-making), the able bodied Rolf de Heer or the disabled Heather Rose, is reflected in this cinematic production? In other words, whose voice is enabled when an audience receives this film? In attempting to answer these questions it is inevitable that Paul Darke’s concept of the “normality drama” (181) is referred to and questioned, as I argue that Dance Me to My Song makes groundbreaking departures from the conventions of the typical disability narrative. Heather Rose as Auteur Rose plays the film’s heroine, Julia, who like herself has cerebral palsy, a group of non-progressive, chronic disorders resulting from changes produced in the brain during the prenatal stages of life. Although severely affected physically, Rose suffered no intellectual impairment and had acted in Rolf de Heer’s cult hit Bad Boy Bubby five years before, a confidence-building experience that grew into an ongoing fascination with the filmmaking process. Subsequently, working with co-writer Frederick Stahl, she devised the scenario for this film, writing the lead role for herself and then proactively bringing it to de Heer’s attention. Rose wrote of de Heer’s deliberate lack of involvement in the script-writing process: “Rolf didn’t even want to read what we’d done so far, saying he didn’t want to interfere with our process” (de Heer, “Production Notes”). In 2002, aged 36, Rose died and Stahl reports in her obituary an excerpt from her diary: People see me as a person who has to be controlled. But let me tell you something, people. I am not! And I am going to make something real special of my life! I am going to go out there and grab life with both hands!!! I am going to make the most sexy and honest film about disability that has ever been made!! (Stahl, “Standing Room Only”) This proclamation of her ability and ambition in screen-writing is indicative of Rose’s desire to do. In a guest lecture Rose gave further insights into the active intent in writing Dance Me to My Song: I wanted to create a screenplay, but not just another soppy disability film, I wanted to make a hot sexy film, which showed the real world … The message I wanted to convey to an audience was “As people with disabilities, we have the same feelings and desires as others”. (Rose, “ISAAC 2000 Conference Presentation”) Rose went on to explain her strategy for winning over director de Heer: “Rolf was not sure about committing to the movie; I had to pester him really. I decided to invite him to my birthday party. It took a few drinks, but I got him to agree to be the director” (ibid) and with this revelation of her tactical approach her film-making agency is further evidenced. Rose’s proactive innovation is not just evident in her successfully approaching de Heer. Her screenplay serves as a radical exception to films featuring disabled persons, which, according to Paul Darke in 1998, typically involve the disabled protagonist struggling to triumph over the limitations imposed by their disability in their ‘admirable’ attempts to normalize. Such normality dramas are usually characterized by two generic themes: first, that the state of abnormality is nothing other than tragic because of its medical implications; and, second, that the struggle for normality, or some semblance of it in normalization – as represented in the film by the other characters – is unquestionably right owing to its axiomatic supremacy. (187) Darke argues that the so-called normality drama is “unambiguously a negation of ascribing any real social or individual value to the impaired or abnormal” (196), and that such dramas function to reinforce the able-bodied audience’s self image of normality and the notion of the disabled as the inferior Other. Able-bodied characters are typically portrayed positively in the normality drama: “A normality as represented in the decency and support of those characters who exist around, and for, the impaired central character. Thus many of the disabled characters in such narratives are bitter, frustrated and unfulfilled and either antisocial or asocial” (193). Darke then identifies The Elephant Man (David Lynch, 1980) and Born on the Fourth of July (Oliver Stone, 1989) as archetypal films of this genre. Even in films in which seemingly positive images of the disabled are featured, the protagonist is still to be regarded as the abnormal Other, because in comparison to the other characters within that narrative the impaired character is still a comparatively second-class citizen in the world of the film. My Left Foot is, as always, a prime example: Christy Brown may well be a writer, relatively wealthy and happy, but he is not seen as sexual in any way (194). However, Dance Me to My Song defies such generic restrictions: Julia’s temperament is upbeat and cheerful and her disability, rather than appearing tragic, is made to look healthy, not “second class”, in comparison with her physically attractive, able-bodied but deeply unhappy carer, Madelaine (Joey Kennedy). Within the first few minutes of the film we see Madelaine dissatisfied as she stands, inspecting her healthy, toned and naked body in the bathroom mirror, contrasted with vision of Julia’s twisted form, prostrate, pale and naked on the bed. Yet, in due course, it is the able-bodied girl who is shown to be insecure and lacking in character. Madelaine steals Julia’s money and calls her “spastic”. Foul-mouthed and short-tempered, Madelaine perversely positions Julia in her wheelchair to force her to watch as she has perfunctory sex with her latest boyfriend. Madelaine even masquerades as Julia, commandeering her voice synthesizer to give a fraudulently positive account of her on-the-job performance to the employment agency she works for. Madelaine’s “axiomatic supremacy” is thoroughly undermined and in the most striking contrast to the typical normality drama, Julia is unashamedly sexual: she is no Christy Brown. The affective juxtaposition of these two different personalities stems from the internal nature of Madelaine’s problems compared to the external nature of Julia’s problems. Madelaine has an emotional disability rather than a physical disability and several scenes in the film show her reduced to helpless tears. Then one day when Madelaine has left her to her own devices, Julia defiantly wheels herself outside and bumps into - almost literally - handsome, able-bodied Eddie (John Brumpton). Cheerfully determined, Julia wins him over and a lasting friendship is formed. Having seen the joy that sex brings to Madelaine, Julia also wants carnal fulfilment so she telephones Eddie and arranges a date. When Eddie arrives, he reads the text on her voice machine’s screen containing the title line to the film ‘Dance me to my song’ and they share a tender moment. Eddie’s gentleness as he dances Julia to her song (“Kizugu” written by Bernard Huber and John Laidler, as performed by Okapi Guitars) is simultaneously contrasted with the near-date-rapes Madelaine endures in her casual relationships. The conflict between Madeline and Julia is such that it prompts Albert Moran and Errol Vieth to categorize the film as “women’s melodrama”: Dance Me to My Song clearly belongs to the genre of the romance. However, it is also important to recognize it under the mantle of the women’s melodrama … because it has to do with a woman’s feelings and suffering, not so much because of the flow of circumstance but rather because of the wickedness and malevolence of another woman who is her enemy and rival. (198-9) Melodrama is a genre that frequently resorts to depicting disability in which a person condemned by society as disabled struggles to succeed in love: some prime examples include An Affair to Remember (Leo McCarey, 1957) involving a paraplegic woman, and The Piano (Jane Campion, 1993) in which a strong-spirited but mute woman achieves love. The more conventional Hollywood romances typically involve attractive, able-bodied characters. In Dance Me to My Song the melodramatic conflict between the two remarkably different women at first seems dominated by Madelaine, who states: “I know I’m good looking, good in bed ... better off than you, you poor thing” in a stream-of-consciousness delivery in which Julia is constructed as listener rather than converser. Julia is further reduced to the status of sub-human as Madelaine says: “I wish you could eat like a normal person instead of a bloody animal” and her erstwhile boyfriend Trevor says: “She looks like a fuckin’ insect.” Even the benevolent Eddie says: “I don’t like leaving you alone but I guess you’re used to it.” To this the defiant Julia replies; “Please don’t talk about me in front of me like I’m an animal or not there at all.” Eddie is suitably chastised and when he treats her to an over-priced ice-cream the shop assistant says “Poor little thing … She’ll enjoy this, won’t she?” Julia smiles, types the words “Fuck me!”, and promptly drops the ice-cream on the floor. Eddie laughs supportively. “I’ll just get her another one,” says the flustered shop assistant, “and then get her out of here, please!” With striking eloquence, Julia wheels herself out of the shop, her voice machine announcing “Fuck me, fuck me, fuck me, fuck me, fuck me”, as she departs exultantly. With this bold statement of independence and defiance in the face of patronising condescension, the audience sees Rose’s burgeoning strength of character and agency reflected in the onscreen character she has created. Dance Me to My Song and the films mentioned above are, however, rare exceptions in the many that dare represent disability on the screen at all, compliant as the majority are with Darke’s expectations of the normality drama. Significantly, the usual medical-model nexus in many normality films is ignored in Rose’s screenplay: no medication, hospitals or white laboratory coats are to be seen in Julia’s world. Finally, as I have described elsewhere, Julia is shown joyfully dancing in her wheelchair with Eddie while Madelaine proves her physical inferiority with a ‘dance’ of frustration around her broken-down car (see Starrs, "Dance"). In Rose’s authorial vision, audience’s expectations of yet another film of the normality drama genre are subverted as the disabled protagonist proves superior to her ‘normal’ adversary in their melodramatic rivalry for the sexual favours of an able-bodied love-interest. Rolf de Heer as Auteur De Heer does not like to dwell on the topic of auteurism: in an interview in 2007 he somewhat impatiently states: I don’t go in much for that sort of analysis that in the end is terminology. … Look, I write the damn things, and direct them, and I don’t completely produce them anymore – there are other people. If that makes me an auteur in other people’s terminologies, then fine. (Starrs, "Sounds" 20) De Heer has been described as a “remarkably non-egotistical filmmaker” (Davis “Working together”) which is possibly why he handed ownership of this film to Rose. Of the writer/actor who plied him with drink so he would agree to back her script, de Heer states: It is impossible to overstate the courage of the performance that you see on the screen. … Heather somehow found the means to respond on cue, to maintain the concentration, to move in the desired direction, all the myriad of acting fundamentals that we take for granted as normal things to do in our normal lives. (“Production NHotes”) De Heer’s willingness to shift authorship from director to writer/actor is representative of this film’s groundbreaking promotion of the potential for agency within disability. Rather than being passive and suffering, Rose is able to ‘do.’ As the lead actor she is central to the narrative. As the principle writer she is central to the film’s production. And she does both. But in conflict with this auteurial intent is the temptation to describe Dance Me to My Song as an autobiographical documentary, since it is Rose herself, with her unique and obvious physical handicap, playing the film’s heroine, Julia. In interview, however, De Heer apparently disagrees with this interpretation: Rolf de Heer is quick to point out, though, that the film is not a biography.“Not at all; only in the sense that writers use material from their own lives.Madelaine is merely the collection of the worst qualities of the worst carers Heather’s ever had.” Dance Me to My Song could be seen as a dramatised documentary, since it is Rose herself playing Julia, and her physical or surface life is so intense and she is so obviously handicapped. While he understands that response, de Heer draws a comparison with the first films that used black actors instead of white actors in blackface. “I don’t know how it felt emotionally to an audience, I wasn’t there, but I think that is the equivalent”. (Urban) An example of an actor wearing “black-face” to portray a cerebral palsy victim might well be Gus Trikonis’s 1980 film Touched By Love. In this, the disabled girl is unconvincingly played by the pretty, able-bodied actress Diane Lane. The true nature of the character’s disability is hidden and cosmeticized to Hollywood expectations. Compared to that inauthentic film, Rose’s screenwriting and performance in Dance Me to My Song is a self-penned fiction couched in unmediated reality and certainly warrants authorial recognition. Despite his unselfish credit-giving, de Heer’s direction of this remarkable film is nevertheless detectable. His auteur signature is especially evident in his technological employment of sound as I have argued elsewhere (see Starrs, "Awoval"). The first distinctly de Heer influence is the use of a binaural recording device - similar to that used in Bad Boy Bubby (1993) - to convey to the audience the laboured nature of Julia’s breathing and to subjectively align the audience with her point of view. This apparatus provides a disturbing sound bed that is part wheezing, part grunting. There is no escaping Julia’s physically unusual life, from her reliance on others for food, toilet and showering, to the half-strangled sounds emanating from her ineffectual larynx. But de Heer insists that Julia does speak, like Stephen Hawkings, via her Epson RealVoice computerized voice synthesizer, and thus Julia manages to retain her dignity. De Heer has her play this machine like a musical instrument, its neatly modulated feminine tones immediately prompting empathy. Rose Capp notes de Heer’s preoccupation with finding a voice for those minority groups within the population who struggle to be heard, stating: de Heer has been equally consistent in exploring the communicative difficulties underpinning troubled relationships. From the mute young protagonist of The Quiet Room to the aphasic heroine of Dance Me to My Song, De Heer’s films are frequently preoccupied with the profound inadequacy or outright failure of language as a means of communication (21). Certainly, the importance to Julia of her only means of communication, her voice synthesizer, is stressed by de Heer throughout the film. Everybody around her has, to varying degrees, problems in hearing correctly or understanding both what and how Julia communicates with her alien mode of conversing, and she is frequently asked to repeat herself. Even the well-meaning Eddie says: “I don’t know what the machine is trying to say”. But it is ultimately via her voice synthesizer that Julia expresses her indomitable character. When first she meets Eddie, she types: “Please put my voice machine on my chair, STUPID.” She proudly declares ownership of a condom found in the bathroom with “It’s mine!” The callous Madelaine soon realizes Julia’s strength is in her voice machine and withholds access to the device as punishment for if she takes it away then Julia is less demanding for the self-centred carer. Indeed, the film which starts off portraying the physical superiority of Madelaine soon shows us that the carer’s life, for all her able-bodied, free-love ways, is far more miserable than Julia’s. As de Heer has done in many of his other films, a voice has been given to those who might otherwise not be heard through significant decision making in direction. In Rose’s case, this is achieved most obviously via her electric voice synthesizer. I have also suggested elsewhere (see Starrs, "Dance") that de Heer has helped find a second voice for Rose via the language of dance, and in doing so has expanded the audience’s understandings of quality of life for the disabled, as per Mike Oliver’s social model of disability, rather than the more usual medical model of disability. Empowered by her act of courage with Eddie, Julia sacks her uncaring ‘carer’ and the film ends optimistically with Julia and her new man dancing on the front porch. By picturing the couple in long shot and from above, Julia’s joyous dance of triumph is depicted as ordinary, normal and not deserving of close examination. This happy ending is intercut with a shot of Madeline and her broken down car, performing her own frustrated dance and this further emphasizes that she was unable to ‘dance’ (i.e. communicate and compete) with Julia. The disabled performer such as Rose, whether deliberately appropriating a role or passively accepting it, usually struggles to placate two contrasting realities: (s)he is at once invisible in the public world of interhuman relations and simultaneously hyper-visible due to physical Otherness and subsequent instantaneous typecasting. But by the end of Dance Me to My Song, Rose and de Heer have subverted this notion of the disabled performer grappling with the dual roles of invisible victim and hyper-visible victim by depicting Julia as socially and physically adept. She ‘wins the guy’ and dances her victory as de Heer’s inspirational camera looks down at her success like an omniscient and pleased god. Film academic Vivian Sobchack writes of the phenomenology of dance choreography for the disabled and her own experience of waltzing with the maker of her prosthetic leg, Steve, with the comment: “for the moment I did displace focus on my bodily immanence to the transcendent ensemble of our movement and I really began to waltz” (65). It is easy to imagine Rose’s own, similar feeling of bodily transcendence in the closing shot of Dance Me to My Song as she shows she can ‘dance’ better than her able-bodied rival, content as she is with her self-identity. Conclusion: Validation of the Auteurial OtherRolf de Heer was a well-known film-maker by the time he directed Dance Me to My Song. His films Bad Boy Bubby (1993) and The Quiet Room (1996) had both screened at the Cannes International Film Festival. He was rapidly developing a reputation for non-mainstream representations of marginalised, subaltern populations, a cinematic trajectory that was to be further consolidated by later films privileging the voice of Indigenous Peoples in The Tracker (2002) and Ten Canoes (2006), the latter winning the Special Jury prize at Cannes. His films often feature unlikely protagonists or as Liz Ferrier writes, are “characterised by vulnerable bodies … feminised … none of whom embody hegemonic masculinity” (65): they are the opposite of Hollywood’s hyper-masculine, hard-bodied, controlling heroes. With a nascent politically correct worldview proving popular, de Heer may have considered the assigning of authorship to Rose a marketable idea, her being representative of a marginalized group, which as Andy Medhurst might argue, may be more politically justifiable, as it apparently is with films of gay authorship. However, it must be emphasized that there is no evidence that de Heer’s reticence about claiming authorship of Dance Me to My Song is motivated by pecuniary interests, nor does he seem to have been trying to distance himself from the project through embarrassment or dissatisfaction with the film or its relatively unknown writer/actor. Rather, he seems to be giving credit for authorship where credit is due, for as a result of Rose’s tenacity and agency this film is, in two ways, her creative success. Firstly, it is a rare exception to the disability film genre defined by Paul Darke as the “normality drama” because in the film’s diegesis, Julia is shown triumphing not simply over the limitations of her disability, but over her able-bodied rival in love as well: she ‘dances’ better than the ‘normal’ Madelaine. Secondly, in her gaining possession of the primary credits, and the mantle of the film’s primary author, Rose is shown triumphing over other aspiring able-bodied film-makers in the notoriously competitive film-making industry. Despite being an unpublished and unknown author, the label “A film by Heather Rose” is, I believe, a deserved coup for the woman who set out to make “the most sexy and honest film about disability ever made”. As with de Heer’s other films in which marginalised peoples are given voice, he demonstrates a desire not to subjugate the Other, but to validate and empower him/her. He both acknowledges their authorial voices and credits them as essential beings, and in enabling such subaltern populations to be heard, willingly cedes his privileged position as a successful, white, male, able-bodied film-maker. In the credits of this film he seems to be saying ‘I may be an auteur, but Heather Rose is a no less able auteur’. References Bordwell, David and Kristin Thompson. Film Art: An Introduction, 4th ed. New York: McGraw-Hill, 1993. Capp, Rose. “Alexandra and the de Heer Project.” RealTime + Onscreen 56 (Aug.-Sep. 2003): 21. 6 June 2008 ‹http://www.realtimearts.net/article/issue56/7153›. Caughie, John. “Introduction”. Theories of Authorship. Ed. John Caughie. London: Routledge and Kegan Paul, 1981. 9-16. Darke, Paul. “Cinematic Representations of Disability.” The Disability Reader. Ed. Tom Shakespeare. London and New York: Cassell, 1988. 181-198. Davis, Therese. “Working Together: Two Cultures, One Film, Many Canoes.” Senses of Cinema 2006. 6 June 2008 ‹http://www.sensesofcinema.com/contents/06/41/ten-canoes.html›. De Heer, Rolf. “Production Notes.” Vertigo Productions. Undated. 6 June 2008 ‹http://www.vertigoproductions.com.au/information.php?film_id=10&display=notes›. Ferrier, Liz. “Vulnerable Bodies: Creative Disabilities in Contemporary Australian Film.” Australian Cinema in the 1990s. Ed. Ian Craven. London and Portland: Frank Cass and Co., 2001. 57-78. Medhurst, Andy. “That Special Thrill: Brief Encounter, Homosexuality and Authorship.” Screen 32.2 (1991): 197-208. Moran, Albert, and Errol Veith. Film in Australia: An Introduction. Melbourne: Cambridge UP, 2006. Oliver, Mike. Social Work with Disabled People. Basingstoke: MacMillan, 1983. Rose Slattery, Heather. “ISAAC 2000 Conference Presentation.” Words+ n.d. 6 June 2008 ‹http://www.words-plus.com/website/stories/isaac2000.htm›. Sobchack, Vivian. “‘Choreography for One, Two, and Three Legs’ (A Phenomenological Meditation in Movements).” Topoi 24.1 (2005): 55-66. Stahl, Frederick. “Standing Room Only for a Thunderbolt in a Wheelchair,” Sydney Morning Herald 31 Oct. 2002. 6 June 2008 ‹http://www.smh.com.au/articles/2002/10/30/1035683471529.html›. Starrs, D. Bruno. “Sounds of Silence: An Interview with Rolf de Heer.” Metro 152 (2007): 18-21. ———. “An avowal of male lack: Sound in Rolf de Heer’s The Old Man Who Read Love Stories (2003).” Metro 156 (2008): 148-153. ———. “Dance Me to My Song (Rolf de Heer 1997): The Story of a Disabled Dancer.” Proceedings Scopic Bodies Dance Studies Research Seminar Series 2007. Ed. Mark Harvey. University of Auckland, 2008 (in press). Urban, Andrew L. “Dance Me to My Song, Rolf de Heer, Australia.” Film Festivals 1988. 6 June 2008. ‹http://www.filmfestivals.com/cannes98/selofus9.htm›.

Horvath, Polly. One Year in Coal Harbour. Toronto: Groundwood Books, 2012. Print. In this sequel to the multiple award winning, Everything on a Waffle, Horvath’s signature quirky humour and insights into human nature emerge once more as we follow 12-year-old Primrose Squarp’s attempts at matchmaking, at finding a best friend, and at generally trying to make life turn out right. The lovable Evie and Bert, who took Primrose in when her parents were lost at sea, sensible Uncle Jack, the entrepreneur who returned to Coal Harbour to look after Primrose, and fiercely independent Miss Bowzer, Primrose’s confidant and owner of The Girl on the Red Swing where everything is served on a waffle, return from the first book to help Primrose navigate life as a ‘tween’ in Coal Harbour. In one year, Primrose learns about defending what she cares about, letting people make their own choices, and accepting the flaws in herself as well as others. Primrose faces some hard lessons but readers will be glad to know that everything turns out, if not perfectly, then as it should, in the end. Horvath broaches issues related to foster children, unfit parents, environmental protests, relationships, and grieving, with honesty and empathy, showing real respect for her young readers’ ability to understand the nuances of these situations. Her characters embody the quirkiness and wisdom of small town life, making them even more believable. Each chapter begins with “What Happened...” or “What Didn’t Happen...” leading the reader along through the traumatic events of Primrose’s year in Coal Harbour, and ends with a recipe Primrose collects for the local cookbook she is writing bringing the tale back to the comfort zone of mundane details. With this marvelous glimpse of the world from the eyes of a 12-year-old girl, peppered with high hopes, frustration, insight and humour, Horvath has done it again. She has left me wanting more. Highly recommended: 4 out of 4 stars Reviewer: Kathy Inglis Kathy Inglis is a teacher-librarian and kindergarten teacher at South Park Family School in Victoria, BC and a Masters student in the Teacher-Librarianship through Distance Learning Program at the University of Alberta. Her favourite part of the job is seeing the excited look on the faces of students who have found that perfect book.

There are days when having a child with Down syndrome can mean losing all hope of being an ordinary mother: a mother with run of the mill concerns, a mother with run of the mill routines. I know. I’ve had such days. I’ve also found that sharing these feelings with other mothers, even those who have a child with a disability, isn’t always easy. Or straightforward. In part I believe my difficulty sharing my experience with other mothers is because the motherhood issues surrounding the birth of a child with Down syndrome are qualitatively different to those experienced by mothers who give birth to children with other disabilities. Disabilities such as autism or cerebral palsy. The mother who has a child with autism or cerebral palsy is usually viewed as a victim - as having had no choice – of life having dealt her a cruel blow. There are after all no prenatal tests that can currently pick up these defects. That she may not see herself as a victim or her child as a victim often goes unreported, instead in the eyes of the popular media to give birth to a child with a disability is seen as a personal tragedy – a story of suffering and endurance. In other words disability is to be avoided if at all possible and women are expected to take advantage of the advances in reproductive medicine – to choose a genetically correct pregnancy – thus improving their lives and the lives of their offspring. Within this context it is not surprising then that the mother of a child with Down syndrome is likely to be seen as having brought the suffering on herself – of having had choices – tests such as amniocentesis and CVS – but of having failed to take control, failed to prevent the suffering of her child. But how informative are tests such as pre-implantation diagnosis, CVS or amniocentesis? How meaningful? More importantly, how safe is it to assume lives are being improved? Could it be, for example, that some lives are now harder rather than easier? As one mother who has grappled with the issues surrounding prenatal testing and disability I would like to share with you our family’s experience and hopefully illuminate some of the more complex and troubling issues these technological advances have the capacity to create. Fraser’s Pregnancy I fell pregnant with Fraser in 1995 at the age of thirty-seven. I was already the mother of a fifteen-month old and just as I had during his pregnancy – I took the routine maternal serum alpha-fetoprotein blood screen for chromosomal abnormalities at sixteen weeks. It showed I was at high risk of having a child with Down syndrome. However as I’d had a similarly high-risk reading in my first pregnancy I wasn’t particularly worried. The risk with Fraser appeared slightly higher, but other than knowing we would have to find time to see the genetic counsellor again, I didn’t dwell on it. As it happened Christopher and I sat in the same office with the same counsellor and once again listened to the risks. A normal foetus, as you both know, has 46 chromosomes in each cell. But given your high AFP reading Fiona, there is a significant risk that instead of 46 there could be 47 chromosomes in each cell. Each cell could be carrying an extra copy of chromosome 21. And as you both know, she continued her voice deepening; Trisomy 21 is associated with mild to severe intellectual disability. It also increases the risk of childhood leukaemia; certain cardiac disorders and is associated with other genetic disorders such as Hirschsprung’s disease. We listened and just as we’d done the first time – decided to have a coffee in the hospital café. This time for some reason the tone was different, this time we could feel the high-octane spiel, feel the pressure pound through our bodies, pulsate through our veins – we should take the test, we should take the test, we should take the test. We were, were we not, intelligent, well-educated and responsible human beings? Surely we could understand the need to invade, the need to extract a sample of amniotic fluid? Surely there were no ifs and buts this time? Surely we realised we had been very lucky with our first pregnancy; surely we understood the need for certainty; for reliable and accurate information this time? We did and we didn’t. We knew for example, that even if we ruled out the possibility of Down syndrome there was no guarantee our baby would be normal. We’d done our research. We knew that of all the children born with an intellectual disability only twenty five percent have a parentally detectable chromosomal disorder such as Down syndrome. In other words, the majority of mothers who give birth to a child with an intellectual disability will have received perfectly normal, utterly reassuring amniocentesis results. They will have put themselves at risk and will have been rewarded with good results. They will have been expecting a baby they could cherish, a baby they could feel proud of – a baby they could love. Our Decision Should we relent this time? Should we accept the professional advice? We talked and we talked. We knew if we agreed to the amniocentesis it would only rule out Down syndrome – or a less common chromosomal disorder such as Trisomy 18 or Trisomy 13. But little else. Four thousand other known birth defects would still remain. Defects such as attention deficit disorder, cleft lip, cleft palate, clubfoot, congenital cardiac disorder, cystic fibrosis, epilepsy, ... would not magically disappear by agreeing to the test. Neither would the possibility of giving birth to a child with autism or cerebral palsy. Or a child with vision, hearing or speech impairment. Neurological problems, skin problems or behavioural difficulties... We were however strongly aware the drive to have a normal child was expected of us. That we were making our decision at a time when social and economic imperatives dictated that we should want the best. The best partner, the best career, the best house ... the best baby. I had already agreed to a blood test and an ultrasound, so why not an amniocentesis? Why stop now? Why not proceed with a test most women over the age of thirty-five consider essential? What was wrong with me? Put simply, the test didn’t engage me. It seemed too specific. Too focused. Plus there was also a far larger obstacle. I knew if I agreed to the test and the words chromosomal disorder were to appear – a certain set of assumptions, an as yet unspoken trajectory would swiftly emerge. And I wasn’t sure I would be able to follow its course. Beyond the Test I knew if the test results came back positive I would be expected to terminate immediately. To abort my affected foetus. The fact I could find it difficult to fall pregnant again after the termination or that any future foetus may also be affected by a birth defect would make little difference. Out the four thousand known birth defects it would be considered imperative not to proceed with this particular one. And following on from that logic it would be assumed that the how – the business of termination – would be of little importance to me given the perceived gravity of the situation. I would want to solve the problem by removing it. No matter what. Before the procedure (as it would be referred to) the staff would want to reassure me, would want to comfort me – and in soothing voices tell me that yes; yes of course this procedure is in your best interests. You and your baby shouldn’t be made to suffer, not now or ever. You’re doing the right thing, they would reassure me, you are. But what would be left as unsaid would be the unavoidable realities of termination. On the elected day, during what would be the twenty-second week of my pregnancy, I would have to consent to the induction of labour. Simultaneously, I would also be expected to consent to a foetal intra-cardiac injection of potassium chloride to ensure the delivery of a dead baby. I would be advised to give birth to a dead baby because it would be considered better if I didn’t hear the baby cry. Better if I didn’t see the tiny creature breathe. Or try to breathe. The staff would also prefer I consent, would prefer I minimised everyone else’s distress. Then after the event I would be left alone. Left alone to my own devices. Left alone with no baby. I would be promised a tiny set of foot and handprints as a memento of my once vibrant pregnancy. And expected to be grateful, to be thankful, for the successful elimination of a pending disaster. But while I knew the staff would mean well, would believe they were doing the right thing for me, I knew it wasn’t the road for me. That I just couldn’t do it. We spent considerably longer in the hospital café the second time. And even though we tried to keep things light, we were both subdued. Both tense. My risk of having a baby with Down syndrome had come back as 1:120. Yes it was slightly higher than my first pregnancy (1:150), but did it mean anything? Our conversation was full of bumps and long winding trails. My Sister’s Experience of Disability Perhaps the prospect of having a child with Down syndrome didn’t terrify me because my sister had a disability. Not that we ever really referred to it as such, it was only ever Alison’s epilepsy. And although it was uncontrollable for most of her childhood, my mother tried to make her life as normal as possible. She was allowed to ride a bike, climb trees and swim. But it wasn’t easy for my mother because even though she wanted my sister to live a normal life there were no support services. Only a somewhat pessimistic neurologist. No one made the link between my sister’s declining school performance and her epilepsy. That she would lose the thread of a conversation because of a brief petit mal, a brief moment when she wouldn’t know what was going on. Or that repeated grand mal seizures took away her capacity for abstract thought and made her more and more concrete in her thinking. But despite the lack of support my mother worked long and hard to bring up a daughter who could hold down a full time job and live independently. She refused to let her use her epilepsy as an excuse. So much so that even today I still find it difficult to say my sister had a disability. I didn’t grow up with the word and my sister herself rarely used it to describe herself. Not surprisingly she went into the field herself working at first as a residential worker in a special school for disabled children and later as a rehabilitation counsellor for the Royal Blind Society. Premature Babies I couldn’t understand why a baby with Down syndrome was something to be avoided at all costs while a baby who was born prematurely and likely to emerge from the labour-intensive incubator process with severe life-long disabilities was cherished, welcomed and saved no matter what the expense. Other than being normal to begin with – where was the difference? Perhaps it was the possibility the premature baby might emerge unscathed. That hope remained. That there was a real possibility the intense and expensive process of saving the baby might not cause any damage. Whereas with Down syndrome the damage was done. The damage was known. I don’t know. Perhaps even with Down syndrome I felt there could be hope. Hope that the child might only be mildly intellectually disabled. Might not experience any of the serious medical complications. And that new and innovative treatments would be discovered in their lifetime. I just couldn’t accept the conventional wisdom. Couldn’t accept the need to test. And after approaching the decision from this angle, that angle and every other angle we could think of we both felt there was little more to say. And returned to our genetic counsellor. The Pressure to Conform Welcome back, she smiled. I’d like to introduce you to Dr M. I nodded politely in the doctor’s direction while immediately trying to discern if Christopher felt as caught off guard as I did. You’ll be pleased to know Dr M can perform the test today, she informed us. Dr M nodded and reached out to shake my hand. It’s a bit of a squeeze, she told me, but I can fit you in at around four. And don’t worry; she reassured me, that’s what we’re here for. I was shocked the heavy artillery had been called in. The pressure to conform, the pressure to say yes had been dramatically heightened by the presence of a doctor in the room. I could also sense the two women wanted to talk to me alone. That they wanted to talk woman to woman, that they thought if they could get me on my own I would agree, I would understand. That it must be the male who was the stumbling block. The problem. But I could also tell they were unsure; Christopher was after all a doctor, a member of the medical profession, one of them. Surely, they reasoned, surely he must understand why I must take the test. I didn’t want to talk to them alone. In part, because I felt the decision was as much Christopher’s as it was mine. Perhaps a little more mine, but one I wanted to make together. And much to their dismay I declined both the talk and the amniocentesis. Well, if you change your mind we’re here the counsellor reassured me. I nodded and as I left I made a point of looking each woman in the eye while shaking her hand firmly. Thank you, but no thank you, I reassured them. I wanted the baby I’d felt kick. I wanted him or her no matter what. After that day the whole issue pretty much faded, in part because soon after I developed a heart problem, a tachycardia and was fairly restricted in what I could do. I worried about the baby but more because of the medication I had to take rather than any genetic issue to do with its well being. The Birth Despite my heart condition the birth went well. And I was able to labour naturally with little intervention. I knew however, that all was not right. My first glimmer of recognition happened as I was giving birth to Fraser. He didn't push against me, he didn't thrust apart the walls of my birth canal, didn’t cause me to feel as though I was about to splinter. He was soft and floppy. Yet while I can tell you I knew something was wrong, knew instinctively – at another level I didn't have a clue. So I waited. Waited for his Apgar score. Waited to hear what the standard assessment of newborn viability would reveal. How the individual scores for activity (muscle tone), pulse (heart rate), grimace (reflex response), appearance (colour) and respiration (breathing) would add up. I knew the purpose of the Apgar test was to determine quickly whether or not Fraser needed immediate medical care – with scores below 3 generally regarded as critically low, 4 to 6 fairly low, and over 7 generally normal. Fraser scored 8 immediately after birth and 9 five minutes later. His markers of viability were fine. However all was not fine and within minutes he received a tentative diagnosis – whispers and murmurs placing a virtual sticker on his forehead. Whispers and murmurs immediately setting him apart from the normal neonate. Whispers and murmurs of concern. He was not a baby they wanted anything to do with – an experience they wanted anything to do with. In a very matter of fact voice the midwife asked me if I had had an amniocentesis. I said no, and thankfully because I was still feeling the effects of the gas, the bluntness and insensitivity of her question didn't hit me. To tell the truth it didn't hit me until years later. At the time it registered as a negative and intrusive question – certainly not the sort you want to be answering moments after giving birth – in the midst of a time that should be about the celebration of a new life. And while I can remember how much I disliked the tenor of her voice, disliked the objectifying of my son, I too had already begun a process of defining, of recognising. I had already noted he was floppy and too red. But I guess the real moment of recognition came when he was handed to me and as a way of making conversation I suggested to Christopher our baby had downsy little eyes. At the time Christopher didn’t respond. And I remember feeling slightly miffed. But it wasn’t until years later that I realised his silence had been not because he hadn’t wanted to chat but because at that moment he’d let his dread, fear and sadness of what I was suggesting go straight over my head. Unconsciously though – even then – I knew my son had Down syndrome, but I couldn't take it in, couldn't feel my way there, I needed time. But time is rarely an option in hospital and the paediatrician (who we knew from the birth of our first son) was paged immediately. Disability and the Medical Paradigm From the perspective of the medical staff I was holding a neonate who was displaying some of the 50 signs and symptoms suggestive of Trisomy 21. Of Down syndrome. I too could see them as I remembered bits and pieces from my 1970s nursing text Whaley and Wong. Remembered a list that now seems so de-personalised, so harsh and objectifying. Flat faceSmall headFlat bridge of the noseSmaller than normal, low-set noseSmall mouth, causing the tongue to stick out and look unusually largeUpward slanting eyesExtra folds of skin at the inside corner of each eyeRounded cheeksSmall, misshapened earsSmall, wide handsA deep crease across the center of each palmA malformed fifth fingerA wide space between the big and second toesUnusual creases on the soles of the feetOverly-flexible joints (as in people who are double-jointed)Shorter than normal height Christopher and I awaited the arrival of the paediatrician without the benefits of privacy, only able to guess at what the other was thinking. We only had the briefest of moments alone when they transferred me to my room and Christopher was able to tell me that the staff thought our son had what I had blurted out. I remember being totally devastated and searching his face, trying to gauge how he felt. But there was no time for us to talk because as soon as he had uttered the words Down syndrome the paediatrician entered the room and it was immediately apparent he perceived our birth outcome a disaster. You’re both professionals he said, you both know what we are thinking. But he couldn’t bring himself to say the words, say Down syndrome, and instead went on about the need for chromosomal testing and the likelihood of a positive result. The gist, the message about our son was that while he would walk, might even talk, he would never cook, never understand danger and never live independently, never, never, never... Fraser was only an hour or so old and he’d already been judged, already been found wanting. Creating Fraser’s Cultural Identity The staff wanted me to accept his diagnosis and prognosis. I on the other hand wanted to de-medicalise the way in which his existence was being shaped. I didn’t want to know right then and there about the disability services to which I would be entitled, the possible medical complications I might face. And in a small attempt to create a different kind of space, a social space that could afford my son an identity that wasn’t focused on his genetic make-up, I requested it not be assumed by the staff that he had Down syndrome until the results of the blood tests were known – knowing full well they wouldn’t be available until after I’d left hospital. Over the next few days Fraser had to spend some time in the neonatal intensive care unit because of an unrelated medical problem. His initial redness turning out to be a symptom of polycythemia (too many red blood cells). And in many ways this helped me to become his mother – to concentrate on looking after him in the same way you would any sick baby. Yet while I was deeply confident I was also deeply ashamed. Deeply ashamed I had given birth to a baby with a flaw, a defect. And processing the emotions was made doubly difficult because I felt many people thought I should have had prenatal testing – that it was my choice to have Fraser and therefore my fault, my problem. Fortunately however these feelings of dejection were equally matched by a passionate belief he belonged in our family, and that if he could belong and be included in our lives then there was no reason why he couldn’t be included in the lives of others. How Prenatal Testing Shapes Our Lives It is now twelve years since I gave birth to Fraser yet even today talking about our lives can still mean having to talk about the test – having to explain why I didn’t agree to an amniocentesis. Usually this is fairly straightforward, and fairly painless, but not always. Women have and still do openly challenge my decision. Why didn’t I take control? Aren’t I a feminist? What sort of a message do I think I am sending to younger women? Initially, I wasn’t able to fathom how anyone could perceive the issue as being so simple – take test, no Down syndrome. And it wasn’t until I saw the film Gattaca in 1997 that I began to understand how it could seem such a straightforward issue. Gattaca explores a world in which genetic discrimination has been taken to its logical conclusion – a world in which babies are screened at birth and labeled as either valids or in-valids according to their DNA status. Valids have every opportunity open to them while in-valids can only do menial work. It is a culture in which pre-implantation screening and prenatal testing are considered givens. Essential. And to challenge such discrimination foolish – however in the film the main character Vincent does just that and despite his in-valid status and its inherent obstacles he achieves his dream of becoming an astronaut. The film is essentially a thriller – Vincent at all times at risk of his true DNA status being revealed. The fear and loathing of imperfection is palpable. For me the tone of the film was a revelation and for the first time I could see my decision through the eyes of others. Feel the shock and horror of what must appear an irrational and irresponsible decision. Understand how if I am not either religious or anti-abortion – my objection must seem all the more strange. The film made it clear to me that if you don’t question the genes as destiny paradigm, the disability as suffering paradigm then you probably won’t think to question the prenatal tests are routine and essential paradigm. That you will simply accept the conventional medical wisdom – that certain genetic configurations are not only avoidable, but best avoided. Paradoxically, this understanding has made mothering Fraser, including Fraser easier and more enjoyable. Because I understand the grounds on which he was to have been excluded and how out of tune I am with the conventional thinking surrounding pregnancy and disability – I am so much freer to mother and to feel proud of my son. I Would Like to Share with You What Fraser Can Do He canget dressed (as long as the clothes are already turned the right side out and have no buttons!) understand most of what mum and dad sayplay with his brothers on the computermake a cup of coffee for mumfasten his own seatbeltwait in the car line with his brothersswim in the surf and catch waves on his boogie boardcompete in the school swimming carnivaldraw for hours at a time (you can see his art if you click here) Heis the first child with Down syndrome to attend his schoolloves the Simpsons, Futurama and Star Wars begs mum or dad to take him to the DVD store on the weekendsloves sausages, Coke and salmon rissottoenjoys life is always in the now Having fun with Photo Booth His brothers Aidan and Harrison Brotherly Love – a photo taken by Persia (right) and exhibited in Local Eyes. It also appeared in The Fitz Files (Sun-Herald 30 Mar. 2008) What Excites Me Today as a Mother I love that there is now hope. That there is not just hope of a new test, a reliable non-invasive prenatal test, but hope regarding novel treatments – of medications that may assist children with Down syndrome with speech and memory. And an increasingly vocal minority who want to talk about how including children in mainstream schools enhances their development, how children with Down syndrome can, can, can … like Persia and Tyler for example. That perhaps in the not too distant future there will be a change in the way Down syndrome is perceived – that if Fraser can, if our family can – then perhaps mothering a child with Down syndrome will be considered culturally acceptable. That the nexus between genetics and destiny will be weakened in the sense of needing to choose one foetus over another, but strengthened by using genetic understandings to enhance and assist the lives of all individuals no matter what their genetic make-up. And perhaps one day Down syndrome will be considered a condition with which you can conceive. Can imagine. Can live. And not an experience to be avoided at all costs.

Being att Whitehall from whence one sence my coming thither I have troubled you, and this is like to prove another, I professe the only reason why I am not this way more often vissetting you. And peradventure my cautiousnesse may be accounted neglect, but having a clear mark of affection to you, I can by that give my selfe a great deale of quiett. I desire to abandon all thought of unkindnesse and I am certaine it must be high provocation that shall raise such a spiritt in me. As nature hath linked us soe near, soe shall the grace of God tye our affections with cords of true love that cannot be broken. I ought not to robb you of your pretious time, nor should I have gone any further, much lesse troubled you with any new matter, but that I am through the exceeding civility of my countryman, Mr Reynolds,1 prest in my disposition to answer the obligation of his kindnesse by recommending to your intrested power in the councell of Ireland the consideration of his bussinesse that it may have a speedy dispatch and effectually to answer the expectations which are very much raised even to confidence, for that his Highness hath written on his behalfe. That which is aimed att is that his lands may be sett oute. I need not ofer many arguments, there being a justnesse in it that it should be done and a just disposition in you to see those juste rights speedily and rightly placed; it being a carrecter upon you, hath prouved great reputation; never did private spiritt doe anything that was worthy of living praisse. I desire God to continew such a spiritt to you as may be publique, it being comprehensive you are certaine by its learge cercumference to take in all sorts of people, and soe consequently the people of God; you making noe difference but when the seale is upon a saint and the marke of the beaste upon an enimy to Jesus Christ, yet it preserving property to all sorts and ranks of men. I am ashamed of my tediousnesse to you, and therefore I shall desire your excuse and the presenting my unfeined respects and service to my dear sister and your self, I take leave and rest, deare brother,