Journal articles on the topic 'Electronic records Victoria'

Objectives. To describe a model that matches electronic patient care records within a given case to one or more patients within that case. Method. This retrospective study included data from all metropolitan Ambulance Victoria electronic patient care records (n = 445 576) for the time period 1 January 2009–31 May 2010. Data were captured via VACIS (Ambulance Victoria, Melbourne, Vic., Australia), an in-field electronic data capture system linked to an integrated data warehouse database. The case patient algorithm included ‘Jaro–Winkler’, ‘Soundex’ and ‘weight matching’ conditions. Results. The case patient matching algorithm has a sensitivity of 99.98%, a specificity of 99.91% and an overall accuracy of 99.98%. Conclusions. The case patient algorithm provides Ambulance Victoria with a sophisticated, efficient and highly accurate method of matching patient records within a given case. This method has applicability to other emergency services where unique identifiers are case based rather than patient based. What is known about the topic? Accurate pre-hospital data that can be linked to patient outcomes is widely accepted as critical to support pre-hospital patient care and system performance. What does this paper add? There is a paucity of literature describing electronic matching of patient care records at the patient level rather than the case level. Ambulance Victoria has developed a complex yet efficient and highly accurate method for electronically matching patient records, in the absence of a patient-specific unique identifier. Linkage of patient information from multiple patient care records to determine if the records are for the same individual defines the ‘case patient’. What are the implications for practitioners? This paper describes a model of record linkage where patients are matched within a given case at the patient level as opposed to the case level. This methodology is applicable to other emergency services where unique identifiers are case based.

Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital’s current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records. This causes inefficiencies in the recall of patient information and can potentially lead to incidences of adverse drug events. What does this paper add? This paper supports the concept of a shared medical record system using 200 audited patient records across five Victorian metropolitan hospitals, comparing the current information systems in place for healthcare practitioners to retrieve data. This research identifies the degree of concordance between these sources of information and in doing so, areas for improvement. What are the implications for practitioners? Implications of this research are the improvements in the quality, storage and accessibility of medical data in Australian healthcare systems. This is a relevant issue in the current Australian environment where no guidelines exist across the board in medical history documentation or in the distribution of discharge summaries to other healthcare providers (general practitioners, etc).

The objective of this study was to identify limitations to the use of electronic medical records (EMRs) in general practice and to identify consequent limitations to the value of EMRs as data sources for research or case finding. Patient demographic, diagnostic, therapeutic and administrative data pertaining to osteoporosis management during 2003 were extracted from the EMRs of participating general practitioners (GPs) in Bendigo, Victoria. Data quality was measured primarily by the absence of data from fields. Twenty-three of 60 eligible GPs participated; 29, 356 patient records were searched. Patient age or sex was missing from 1.2 per cent of records. For those with a diagnosis of osteoporosis on the record, reason for prescription was missing for 54 per cent of patients receiving osteoporosis medications, recording of Authority numbers was inconsistent and only 31 per cent of records noted fracture site in the prescription free-text detail field. The study concluded that missing data compromises the value of general practice EMRs as data sources. Researchers wishing to use EMR data will benefit from assisting GPs to appreciate and use EMR capabilities and to appreciate the value of maintaining accurate and complete datasets.

This paper reports on the social and business profiles of 39 landholders (in three groups) in north-east Victoria, participating in an Environmental Management Systems (EMS) project, and their motivations for participating in EMS. The level and type of record keeping, formal monitoring, use of electronic technology, and interest or capacity to monitor their environmental performance were also assessed because this is a crucial part of the EMS process and one that research has not reported on to date. Landholder participation in EMS was mostly for reasons of wanting to better account for sustainability issues in farm management. Most participants recorded rainfall, soil test results, production measures and chemical use (in total 69–97%); however, 31% kept no chemical records. Few kept records of remnant native vegetation, pasture management, weeds, pest animals or native fauna. Electronic record keeping systems were used by 26% of participants. Almost all owned a computer and over 70% used the internet and email. To assess interest and capacity to monitor environmental performance, participants were introduced to a water balance calculation tool (this being a locally relevant issue) and asked to calculate their own values. Most participants needed two to three visits to gain confidence to perform the calculations and most did not view the tools as being of much relevance. This was in strong contrast to previous work carried out in the southern Riverina of New South Wales. We conclude that environmental monitoring is more important for catchment management authorities (CMAs) and state agencies than for landholders. If CMAs are to assess how on-farm actions lead to improved environmental performance, there is a need to collect information remotely, invest in monitoring or provide incentives for farmers. There appears to be insufficient record keeping and monitoring by landholders to trace chemical residue problems. This, in addition to a lack of environmental monitoring, means that farmers in north-east Victoria cannot substantiate either ‘clean’ or ‘green’ claims. Future work should focus on awareness and education in natural resource management, as well as improved record keeping and monitoring. Some form of recognition will be needed if the majority of farmers are to participate in environmental programs. Introductory EMS training provides a means of improving business outcomes, documentation and improving environmental management.

IntroductionGeneral practice is integral to the Australian healthcare system. Outcome Health’s POpulation Level Analysis and Reporting (POLAR) database uses de-identified electronic health records to analyse general practice data in Australia. Previous studies using routinely collected health data for research have not consistently reported the codes and algorithms used to describe the population, exposures, interventions and outcomes in sufficient detail to allow replication. This paper reports a study protocol investigating patterns of care for people presenting with musculoskeletal conditions to general practice in Victoria, Australia. Its focus is on the systematic approach used to classify and select eligible records from the POLAR database to facilitate replication. This will be useful for other researchers using routinely collected health data for research.Methods and analysisThis is a retrospective cohort study. Patient-related data will be obtained through electronic health records from a subset of general practices across three primary health networks (PHN) in southeastern Victoria. Data for patients with a low back, neck, shoulder and/or knee condition and who received at least one general practitioner (GP) face-to-face consultation between 1 January 2014 and 31 December 2018 will be included. Data quality checks will be conducted to exclude patients with poor data recording and/or non-continuous follow-up. Relational data files with eligible and valid records will be merged to select the study cohort and the GP care received (consultations, imaging requests, prescriptions and referrals) between diagnosis and 31 December 2018. Number and characteristics of patients and GPs, and number, type and timing of imaging requests, prescriptions for pain relief and referrals to other health providers will be investigated.Ethics and disseminationEthics approval was obtained from the Cabrini and Monash University Human Research Ethics Committees (Reference Numbers 02-21-01-19 and 16975, respectively). Study findings will be reported to Outcome Health, participating PHNs, disseminated in academic journals and presented in conferences.

Background: Little information has been documented regarding interventions for mastitis by Australian physiotherapists. It is currently not known if physiotherapy interventions vary across Australian regions and types of healthcare facilities. Research aims: (1) To identify the interventions used by Australian physiotherapists treating mothers with mastitis and (2) to determine the variability in interventions used across regions and facilities. Methods: A retrospective observational design was used. A sample of case records of mothers with mastitis was identified ( N = 192). These case records documented physiotherapy interventions for mastitis in hospitals and private physiotherapy practices in Western Australia ( n = 77; 40.1%), Victoria ( n = 76; 39.6%), and New South Wales ( n = 39; 20.3%). An electronic data collection tool was designed to examine intervention variables. Results: The physiotherapy interventions received by mothers included therapeutic ultrasound (n=175; 91.1%), education and advice ( n = 160; 83.3%), and massage ( n = 103; 53.6%). Therapeutic ultrasound parameters varied across regions and types of healthcare facilities. Mean documented therapeutic ultrasound intensity was approximately twice as high in New South Wales and Victoria than in Western Australia. Conclusions: Regional and facility differences exist in physiotherapy interventions for mastitis in Australia. Healthcare professionals who refer to physiotherapists for mastitis should be aware that interventions received may differ across regions and facility types.

In Australia, compulsory microchipping legislation requires that animals are microchipped before sale or prior to 3 months in the Australian Capital Territory, New South Wales, Queensland and Victoria, and by 6 months in Western Australia and Tasmania. Describing the implementation of microchipping in animals allows the data guardians to identify individual animals presenting to differing veterinary practices over their lifetimes, and to evaluate compliance with legislation. VetCompass Australia (VCA) collates electronic patient records from primary care veterinary practices into a database for epidemiological studies. VCA is the largest companion animal clinical data repository of its kind in Australia, and is therefore the ideal resource to analyse microchip data as a permanent unique identifier of an animal. The current study examined the free-text ‘examination record’ field in the electronic patient records of 1000 randomly selected dogs and cats in the VCA database. This field may allow identification of the date of microchip implantation, enabling comparison with other date fields in the database, such as date of birth. The study revealed that the median age at implantation for dogs presented as individual patients, rather than among litters, was 74.4 days, significantly lower than for cats (127.0 days, p = 0.003). Further exploration into reasons for later microchipping in cats may be useful in aligning common practice with legislative requirements.

Research utilising de-identified patient health information extracted from electronic medical records (EMRs) from general practices has steadily grown in recent years in response to calls to increase use of health data for research and other secondary purposes in Australia. Little is known about the views of key primary care personnel on this issue, which are important, as they may influence whether practices agree to provide EMR data for research. This exploratory qualitative study investigated the attitudes and beliefs of general practitioners (GPs), practice managers (PMs) and practice nurses (PNs) around sharing de-identified EMR patient health information with researchers. Semi-structured interviews were conducted with 11 participants (6 GPs, 3 PMs and 2 PNs) recruited via purposive sampling from general practices in Victoria, Australia. Transcripts were coded and thematically analysed. Participants were generally enthusiastic about research utilising de-identified health information extracted from EMRs for altruistic reasons, including: positive effects on primary care research, clinical practice and population health outcomes. Concerns raised included patient privacy and data breaches, third-party use of extracted data and patient consent. These findings can provide guidance to researchers and policymakers in designing and implementing projects involving de-identified health information extracted from EMRs.

ObjectiveThis study aimed to explore how general practitioners (GPs) access and use both guidelines and electronic medical records (EMRs) to assist in clinical decision-making when prescribing antibiotics in Australia.DesignThis is an exploratory qualitative study with thematic analysis interpreted using the Theory of Planned Behaviour (TPB) framework.SettingThis study was conducted in general practice in Victoria, Australia.ParticipantsTwenty-six GPs from five general practices were recruited to participate in five focus groups between February and April 2018.ResultsGPs expressed that current EMR systems do not provide clinical decision support to assist with antibiotic prescribing. Access and use of guidelines were variable. GPs who had more clinical experience were less likely to access guidelines than younger and less experienced GPs. Guideline use and guideline-concordant prescribing was facilitated if there was a practice culture encouraging evidence-based practice. However, a lack of access to guidelines and perceived patients’ expectation and demand for antibiotics were barriers to guideline-concordant prescribing. Furthermore, guidelines that were easy to access and navigate, free, embedded within EMRs and fit into the clinical workflow were seen as likely to enhance guideline use.ConclusionsCurrent barriers to the use of antibiotic guidelines include GPs’ experience, patient factors, practice culture, and ease of access and cost of guidelines. To reduce inappropriate antibiotic prescribing and to promote more rational use of antibiotic in the community, guidelines should be made available, accessible and easy to use, with minimal cost to practicing GPs. Integration of evidence-based antibiotic guidelines within the EMR in the form of a clinical decision support tool could optimise guideline use and increase guideline-concordant prescribing.

IntroductionIn Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice. The aim of our quantitative observational study is to define how pathology tests are used in general practice and investigate how test ordering practices align with evidence-based pathology guidelines.Methods and analysisAccess to non-identifiable patient data will be obtained through electronic health records from general practices across three primary health networks in Victoria, Australia. Numbers and characteristics of patients, general practices, encounters, pathology tests and problems managed over time will be described. Overall rates of encounters and tests, alongside more detailed investigation between subcategories (encounter year, patient’s age, gender, and location and general practice size), will also be undertaken. To evaluate how general practitioner test ordering coincides with evidence-based guidelines, five key candidate indicators will be investigated: full blood counts for patients on clozapine medication; international normalised ratio measurements for patients on warfarin medication; glycated haemoglobin testing for monitoring patients with diabetes; vitamin D testing; and thyroid function testing.Ethics and disseminationEthics clearance to collect data from general practice facilities has been obtained by the data provider from the RACGP National Research and Evaluation Ethics Committee (NREEC 17–008). Approval for the research group to use these data has been obtained from Macquarie University (5201700872). This study is funded by the Australian Government Department of Health Quality Use of Pathology Program (Agreement ID: 4-2QFVW4M). Findings will be reported to the Department of Health and disseminated in peer-reviewed academic journals and presentations (national and international conferences, industry forums).

Introduction:The growing number of mass gathering events (MGEs) in Victoria has seen an increase in demand for event health services and the need for real-time reporting of medical incidents at these events.Aim:Since 2016, St. John Ambulance Victoria has introduced an electronic patient care record (ePCR) system with the aim of improving patient care and satisfaction. It appears that this ePCR system is the first of its kind to be trialed at MGEs by a volunteer organization.Methods:A qualitative study was conducted to determine strengths and limitations of the ePCR system by compiling results of surveys and interviews and through anonymous feedback from volunteers and patrons (event organizers, patients). This study is ongoing.Results:It was found that the use of ePCR: 1.Allowed for collection of relevant data to assist in future planning of MGEs2.Aids the overall coordination of first aid delivery at MGEs -faster relaying of patient information to event commanders-reduction of paperwork-improved ability to locate first aid crews using GPS tracking3.Received positive feedback from first aiders, event organizers, and patrons4.Was deemed easy-to-use (4/5), acceptable (4.3/5), and helpful (4.1/5) by our membersDiscussion:These experiences demonstrate that ePCR is well-received, easy to use, and leads to improved patient satisfaction and treatment outcomes at MGEs. Furthermore, the ability to collect and analyze real-time data such as GPS location tracking, incidence heat maps, and patient demographics facilitate future event planning and resource allocation at MGEs. It is acknowledged that this study is preliminary, and the trialed use of an ePCR system has been limited to metropolitan areas and MGEs with <1 million patrons. The intent is to continue this study and explore the use of ePCRs at larger MGEs and events in rural or regional areas.

Background Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted. Objective This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system. Methods This qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework. Results A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Conclusions Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.

Background:The lifetime prevalence of lower back pain is between 60% and 70%, with surgical treatments spared for those not responding to other options.Objectives:To investigate the age, gender and socio-economic status differences in back pain procedures in the UK between 2000, 2008 and 2016.Methods:Data was obtained from primary care electronic medical records (CPRD GOLD) linked to English hospital admissions data. Lower back procedures in patients aged 35+ were identified using OPCS-4 codes for Decompression (Dc), Fusion (F), Therapeutic injections (TI) and Denervation (Dn). Standardised incidence rates (IR) of each type of lower back procedures were calculated per 10,000 CPRD registered person years for each age group, gender, region and SES strata in 2000, 2008 and 2016. IR were also calculated for combinations of age and gender. Negative binomial regression calculated incidence rate ratios (IRR) and 95% confidence intervals.Results:The IR of lower back procedures was 21.5 [20.7, 22.3] per 10,000 person years in 2000. This doubled by 2008 (45.5 [44.5, 46.5]) and trebled by 2016 (62.5 [60.8, 64.2]). Number of events and incidence rates of each procedure type are shown in table 1 below. The incidence of Dn has increased 6-fold whilst Dc and F have doubled. Female (IR in 2016 of 73.99 [71.43, 76.61] vs 50.08 [47.90, 52.33] in men, IRR 1.50 [1.41, 1.59]) and age are associated with back procedure rates (figure 1). Large socio-economic differences were observed, with higher procedure rates seen in the most deprived areas. These differences did however narrow over time during the study period (figure 2).Table 1.Event numbers and incidence rates of different types of lower back procedure.FusionDecompressionTherapeutic InjectionDenervationEventsIR (95% CI)EventsIR (95% CI)EventsIR (95% CI)EventsIR (95% CI)20001090.86 (0.71, 1.04)4663.69 (3.36, 4.04)203516.11 (15.42, 16.82)910.72 (0.58, 0.88)20083331.77 (1.58, 1.97)11976.35 (6.00, 6.72)628333.35 (32.53, 34.18)5963.16 (2.91, 3.43)20161591.93 (1.65, 2.26)5256.39 (5.85, 6.96)386547.03 (45.56, 48.54)4875.93 (5.41, 6.48)Figure 1.Age and Gender stratified incidence rate ratios of all back procedures in 2000, 2008 and 2016Figure 2.Deprivation status incidence rate ratios by yearConclusion:The incidence of lower back procedures has more than trebled since 2000. Women are more likely to have lower back procedures than men, with patients aged 65-74 the most likely to have a procedure. Procedures in those aged 75+ have become more common over time, potentially increasing the risk of post-operative complications. Socio-economic differences in the incidence of low back procedures are probably related to the known higher prevalence of back pain in deprived areas. Whether the observed narrowing in socio-economic variation over time is explained by a reduced need or by lowered provision needs further research.Disclosure of Interests:Danielle E Robinson: None declared, Jennifer Lane: None declared, Richard Craig: None declared, Andrew Judge: None declared, James Bailey: None declared, Dahai Yu: None declared, Kelvin Jordan: None declared, George Peat: None declared, Ross Wilkie: None declared, Alan Silman: None declared, Victoria Y Strauss: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen

Purpose The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a setting of devolved governance. Design/methodology/approach This qualitative study used thematic analysis of interviews with public hospital medical directors. For additional context, findings were framed by themes from a review of hospital safety and quality in the same jurisdiction. Findings Varying approaches and levels of complexity were described about what and how performance data are reviewed, prioritised, and quality improvements implemented. Although no consistent narrative emerged, facilitators of improvement were suggested relating to organisational culture, governance, resources, education, and technologies. These hospital-level perspectives articulate with and expand on the system-level themes in a state-wide review of hospital safety and quality. Research limitations/implications The findings are not generalisable, but point to an underlying absence of system-wide agreement on how to perceive, retrieve, analyse, prioritise and action hospital performance data. Practical implications Lack of electronic medical records and an inefficient incident reporting system limits the extent to which performance and incident data can be analysed, linked and shared, thus limiting hospital performance improvement, oversight and learning. Social implications Variable approaches to quality and safety, standards of care, and hospital record keeping and reporting, mean that healthcare consumers might expect inconsistency across Victorian hospitals. Originality/value The views of medical directors have been little researched. This work uses their voice to better understand contextual factors that situate and impact on hospital quality and safety towards understanding the mixed effectiveness of hospital quality improvement strategies.

40 Background: Chemotherapy scheduling and determining associated nursing resources are complex multiobjective decision problems. Management of DRs are thought to take additional chair and nurse time and should be accounted for in appointment scheduling in order to having an efficiently running clinic. BC Cancer – Victoria is a tertiary care regional site of BC Cancer in Victoria, British Columbia, Canada and currently schedules patients using a regimen-based resource intensity model (Greene et al, 2012). Methods: DRs were tracked in real time over 3 months, where BC Cancer ID, reaction, protocol, agent, cycle number and time of reaction were recorded. Our electronic medical record was interrogated to determine start and end of chair time. We then compared the actual chair time required to manage patients with a DR to scheduled chair time. Results: Thirty reactions occurred, including DRs to paclitaxel (43%), rituximab (13%), docetaxel (10%), nivolumab (7%), oxaliplatin (7%), pertuzumab (7%), bendmustine (3%), and daratumumab (3%). The reactions most commonly occurred with cycles 1 or 2. The averages for total chair time during DR, time from arrival to reaction, and time from reaction to discharge were 281 min (+79.5), 106 min (+ 55), and 171 min (+ 94), respectively. An average of 449 min/month extra were required for DR management above scheduled chair time. Conclusions: The agents precipitating DRs were common and predictable. An average of 7 hours and 29 minutes per month above scheduled chair time was required to manage DRs. This information could be used to more efficiently schedule chair and nursing time. This also highlights the need to minimize the number of DRs as management is resource intensive.[Table: see text]

Abstract Background: Whole breast irradiation (WBI) after a positive sentinel lymph node biopsy (SNB) is recommended to be treated in the supine position to facilitate inclusion of the low axilla with “high tangents” when regional nodal irradiation is not planned. Treatment in the prone position has several advantages over supine positioning including minimizing heart and lung doses for many and decreased skin toxicity for larger breasted women. We hypothesized that, using three dimensional conformal radiation therapy (3DCRT), the low axilla can be safely and adequately treated in the prone position with minimal toxicity and good outcomes. Methods: We identified patients who underwent post lumpectomy whole breast and low axilla irradiation in the prone position using 3DCRT from 2014 to 2020. Standard 3DCRT treatment planning included delineation of surgical cavity, breast and low axillary clinical target volumes (CTV) with 5 mm expansion to planning target volumes (PTV). The “low axilla” CTV was generally defined as the level I axilla according to the RTOG Breast Cancer Atlas. Dosimetric data for both targets and organs at risk (OARs) was extracted from approved treatment plans’ dose-volume histograms (DVHs). Toxicity and cancer outcomes were collected from the electronic medical records. Descriptive statistical analysis was performed. Results: Seventy patients were identified. Median age was 61 years (range 34-87), median body mass index (BMI) was 30.4 kg/m2 (range 22.1-49.1), and 88.6% (N=62) had hormone sensitive, HER2 negative breast cancer. The median tumor size was 1.35 cm (range 0.07-4.5cm). For 56 patients (80.0%), a SNB was done with median of 2 (range 1-7) sentinel nodes removed - 19 (34%) with macro-metastasis (median size 4 mm, range 2.2-13mm), 21 (37.5%) with micrometastasis, and 16 (28.6%) with isolated tumor cells. Three patients had an additional node with isolated tumor cells. Thirteen (18.6%) were Nx (no nodal evaluation) and 1 had an unsuccessful SLNB with no lymph nodes obtained. Hypofractionation was used in 97.1% (N=68): 4256 cGy in 16 fractions (N=44, 62.8%) or 4000 cGy in 15 fractions (N=24, 34.3%). All targets were covered adequately. The median V95/V90 of the PTVbreast_eval, PTVlump_eval, and PTVAx were 96%/98.3% (range 76.2/91.9% - 99.6/101.4%), 100.1%/101.2% (range 87.6/94.9%-102.8/103.3%), and 95.3%/97.5% (range 82.4/91.6%-100.4/101.7%) respectively. The mean heart dose for all patients was 83.5 cGy; 82.7 cGy for right-sided tumors and 83.8 cGy for left-sided tumors. The median V16 of the ipsilateral lung was 4.25% (range 0.2 - 11.3%). Overall, toxicity was low with no grade 3 or higher events. For acute toxicity, most patients (N=54, 77.1%) reported grade 1 fatigue and had either grade 1 (N=52, 74.2%) or grade 2 (N=15, 21.4%) dermatitis. For late toxicity, 14 patients (20%) were referred to physical therapy after radiation, 7 (10%) for range of motion, 5 (7%) for arm lymphedema evaluation and 4 (6%) for other reasons. With a median follow-up of 18.5 months (range 0-63 months), 1 patient recurred both locally and regionally (1.4%) and one other patient recurred distantly. Conclusions: Patients with a positive SNB or are Nx who are recommended to have post-lumpectomy whole breast and low axilla irradiation can be safely and adequately treated in the prone position using 3DCRT with minimal toxicity and good outcomes. Citation Format: Victoria Doss, Erin Healy, Sasha Beyer, Sachin R. Jhawar, Jose G. Bazan, Julia White. Radiation of the low axilla in the prone position [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-19-17.

Abstract Background: Patient (pt) QoL is a key factor in the treatment (tx) of ABC. There are gaps in real-world evidence of how QoL is assessed in clinical practice. We examined the importance of QoL, its influence on tx decisions, and how it is discussed in a clinical setting from pts’ and healthcare professionals’ (HCPs) perspectives. Methods: The survey was designed by a steering committee of medical oncologists and patients and ethically approved to survey HCPs and patients. Data were collected from July 2020 to May 2021 via a cross-sectional online survey of HCPs (oncologists [Onc] and oncology nurses [OncNu]) and pts with HR+/HER2- ABC in Australia, Brazil, Egypt, Germany, Italy, South Korea, and USA. HCPs were recruited via a 3rd party and surveyed on the management of ABC including the importance of QoL and its assessment in clinical practice. Pts were recruited via HCPs and advocacy groups and surveyed on the importance of QoL, how tx impacts QoL, daily activities, and work, and the frequency of QoL discussions with HCPs. All observations were assessed using a 4-point Likert scale; data were analysed descriptively. Results: 277 Onc, 225 OncNu, and 467 pts with ABC took part in the survey. 221 pts had stage III advanced (locoregionally recurrent not amenable to curative therapy) and 229 had stage IV metastatic disease. 142 pts were receiving first line (1L), 116 second line (2L), and 209 third or later line (3L+) tx. Most HCPs, 88% of Onc and 96% of OncNu, reported asking about QoL at follow-up appointments, where fewer pts report being asked about QoL by Onc (64%) and OncNu (43%). Pts at later line of therapy (LoT) less frequently reported QoL discussions with Onc; 43% of pts at 1L (n=140) reported they were always asked about QoL at follow-up appointments vs 21% at 2L (n=113) and 16% at 3L+ (n=206). Among Onc, importance of QoL for tx decisions increased with LoT; 48% reported that QoL was very important at 1L, 57% at 2L, 79% at 3L, and 85% at 4th line. In contrast, importance of QoL among pts decreased with LoT; while only 39% were comfortable discussing QoL with Onc, 73% at 1L agreed that QoL was important vs 45% at 2L and 40% at 3L+. Among pts who experienced a side effect (SE) that was not discussed with their HCP (n=96), 40% agreed this was because HCPs did not ask about it, and 28% at least moderately agreed they do not report SE as they do not want their Onc to change their tx. 81% of HCPs did not completely agree with the statement “I have enough time to discuss QoL with my pts”. Among those who reported asking pts about their QoL, 93% of HCPs (n=481) reported using questions of their own, while 11% of Onc and 30% of OncNu reported using QoL questionnaires. Only 11% of HCPs agreed that available QoL tools were specific enough to customise for their pts, and only 12% agreed they had access to QoL tools that were integrated with electronic health record systems. Among HCPs (n=341) who were familiar with QoL tools used in clinical trials for ABC, only 10% agreed that these tools were able to accurately reflect QoL, and only 11% agreed that the tools were able to capture improvements in QoL when tx delayed disease progression. Conclusion: We found disconnects between pts with ABC and HCPs around the importance of discussions around QoL; pts report a lower frequency of these discussions in later LoT than HCPs. QoL assessment tools were infrequently used by HCPs, as those currently available were not considered adequate for ABC. QoL should be formally assessed regularly using an ABC-specific QoL assessment tool. This would allow HCPs to address pt issues around QoL through focused discussions to help inform tx decisions. To ensure clinical value, a tool should be quick and easy to use, be able to be completed outside of an appointment setting, yield results that are easy to interpret and compare, and be integrated into medical records. Citation Format: Fatima Cardoso, Julie Rihani, Dawn Aubel, Adam Moore, Victoria Harmer, Nadia Harbeck, Ana Casas, Sina Haftchenary, Purnima Pathak, Eva Schumacher-Wulf. Assessment of quality of life (QoL) in patients with metastatic breast cancer (MBC) in clinical practice: A real-world multi-country survey [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-03.

Purpose Expanding networks of data portals and repositories linked to electronic patient record systems, along with advances in information technology, have created both new opportunities in improving public health and new challenges in protecting patient privacy. The purpose of this paper is to review stakeholder perspectives and provide a framework for promoting implementation of current privacy protection improvement recommendations. Design/methodology/approach This paper summarizes a workshop session discussion stemming from the 2017 Information Technology and Communication in Health (ITCH) biennial international conference in Victoria, British Columbia, Canada. The perspectives within health service research, journalism, informatics and privacy protection were represented. Findings Problems underlying gaps in privacy protection in the USA and Canada, along with then-current changes recommended by public health leaders as well as Information and Privacy Commissioners, were identified in a session of the 2015 ITCH conference. During the 2017 conference, a workshop outlined the current situation, identifying ongoing challenges and a lack of significant progress. This paper summarizes that 2017 discussion identifying political climate as the major impediment to progress on this issue. It concludes with a framework to guide the path forward. Originality/value This paper provides an international perspective to problems, resources and solution pathways with links useful to readers in all countries.

Background Distal radius (wrist) fractures are the second most common fracture admitted to hospital. The anatomical pattern of these types of injuries is diverse, with variation in clinical management, guidelines for management remain inconclusive, and the uptake of findings from clinical trials into routine practice limited. Robust predictive modelling, which considers both the characteristics of the fracture and patient, provides the best opportunity to reduce variation in care and improve patient outcomes. This type of data is housed in unstructured data sources with no particular format or schema. The “Predicting fracture outcomes from clinical Registry data using Artificial Intelligence (AI) Supplemented models for Evidence-informed treatment (PRAISE)” study aims to use AI methods on unstructured data to describe the fracture characteristics and test if using this information improves identification of key fracture characteristics and prediction of patient-reported outcome measures and clinical outcomes following wrist fractures compared to prediction models based on standard registry data. Methods and design Adult (16+ years) patients presenting to the emergency department, treated in a short stay unit, or admitted to hospital for >24h for management of a wrist fracture in four Victorian hospitals will be included in this study. The study will use routine registry data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), and electronic medical record (EMR) information (e.g. X-rays, surgical reports, radiology reports, images). A multimodal deep learning fracture reasoning system (DLFRS) will be developed that reasons on EMR information. Machine learning prediction models will test the performance with/without output from the DLFRS. Discussion The PRAISE study will establish the use of AI techniques to provide enhanced information about fracture characteristics in people with wrist fractures. Prediction models using AI derived characteristics are expected to provide better prediction of clinical and patient-reported outcomes following distal radius fracture.

ObjectivesTo evaluate the capacity of general practice (GP) electronic medical record (EMR) data to assess risk factor detection, disease diagnostic testing, diagnosis, monitoring and pharmacotherapy for the interrelated chronic vascular diseases—chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease.DesignCross-sectional analysis of data extracted on a single date for each practice between 12 April 2017 and 18 April 2017 incorporating data from any time on or before data extraction, using baseline data from the Chronic Disease early detection and Improved Management in PrimAry Care ProjecT. Deidentified data were extracted from GP EMRs using the Pen Computer Systems Clinical Audit Tool and descriptive statistics used to describe the study population.SettingEight GPs in Victoria, Australia.ParticipantsPatients were ≥18 years and attended GP ≥3 times within 24 months. 37 946 patients were included.ResultsRisk factor and disease testing/monitoring/treatment were assessed as per Australian guidelines (or US guidelines if none available), with guidelines simplified due to limitations in data availability where required. Risk factor assessment in those requiring it: 30% of patients had body mass index and 46% blood pressure within guideline recommended timeframes. Diagnostic testing in at-risk population: 17% had diagnostic testing as per recommendations for CKD and 37% for T2D. Possible undiagnosed disease: Pathology tests indicating possible disease with no diagnosis already coded were present in 6.7% for CKD, 1.6% for T2D and 0.33% familial hypercholesterolaemia. Overall prevalence: Coded diagnoses were recorded in 3.8% for CKD, 6.6% for T2D, 4.2% for ischaemic heart disease, 1% for heart failure, 1.7% for ischaemic stroke, 0.46% for peripheral vascular disease, 0.06% for familial hypercholesterolaemia and 2% for atrial fibrillation. Pharmaceutical prescriptions: the proportion of patients prescribed guideline-recommended medications ranged from 44% (beta blockers for patients with ischaemic heart disease) to 78% (antiplatelets or anticoagulants for patients with ischaemic stroke).ConclusionsUsing GP EMR data, this study identified recorded diagnoses of chronic vascular diseases generally similar to, or higher than, reported national prevalence. It suggested low levels of extractable documented risk factor assessments, diagnostic testing in those at risk and prescription of guideline-recommended pharmacotherapy for some conditions. These baseline data highlight the utility of GP EMR data for potential use in epidemiological studies and by individual practices to guide targeted quality improvement. It also highlighted some of the challenges of using GP EMR data.

Abstract Background Reattachment of the distal Achilles tendon to the posterior calcaneus following distal Achilles tendon tears/avulsions or after excision of large posterior heel spurs is a challenging task for the orthopaedic surgeon. Patients/Material and Methods Between 2005 and the end of 2015, 22 patients who underwent repair/reconstruction of a lesion of the distal Achilles tendon were identified from our electronic records. Calcaneal reinsertions were performed following distal Achilles tendon tears/avulsions (n = 15) or following excision of a large symptomatic posterior heel spur (n = 7). The respective outcome was evaluated comparatively using the VISA-A – G (Victorian Institute of Sports Assessment-Achilles tendon, German version) questionnaire (100 = maximum). Data were collected preoperatively (n = 11/22), and prospectively at three, six, and 12 months postoperatively (n = 5 – 11/22). Two further retrospective follow-ups were performed 12 – 114 and 21 – 149 months postoperatively (n = 17/22 and 22/22, respectively). All data were analysed retrospectively. Complications were searched from the electronic files. Results Transosseous sutures and different anchor techniques (Panalok®, Corkscrew®, SpeedBridge®) were generally performed. Preoperatively, the VISA-A – G score was 27.3 ± 13.5 (6 – 45) following distal Achilles tendon reinsertions for avulsions and 45.3 ± 49.0 (0 – 100) when reattachment was performed after resection of a large posterior heel spur (p = 0.831). At the final follow-up, VISA-A – G values were 89.4 ± 13.9 (54 – 100) following distal Achilles tendon tear/avulsion and 82.5 ± 24.5 (51 – 100), when Achilles tendons were reattached after posterior heel spur excisions (p = 0.969). There were no complications in the “heel spur group”. In the Achilles tendon tear/avulsion group, four out of seven patients with Panalok® repairs developed a fistula. One patient suffered a thromboembolism. None of these complications affected the long-term outcome. Conclusions This study demonstrates good long-term outcomes after distal Achilles tendon reinsertion. Knotless double row anchor repair provides a greater area of compression, simplifies and standardises the repair/reconstruction, and provides safety against fistula. These implants are therefore recommended for safe and effective reattachment of the distal Achilles tendon.

One of the key risks identified for the Vertebrate Zoology (VZ) Collections at Museums Victoria has been data error, loss and dissociation. These risks are highest during the stages involved in preparing the specimen for lodgement in the collection (from collecting and accession of the specimen, to preparation, labelling and so on). The VZ Collections data are managed through an electronic collection information system (EMu) but the process of data transferral and input can be time-consuming and error-prone at many steps along the way. The two main methods of specimen acquisition in the Mammalogy, Ornithology and Herpetology collections in recent years have been internal field programs and external stakeholder donations. Prior to 2012, most specimen data from both of these methods of acquisition were handwritten and transcribed one or more times by multiple people before a specimen ended up in the primary database. An assortment of other identifying numbers or codes were used prior to a collection number being assigned, and sometimes these have been difficult to match up or reconcile. The amount of time needed to enter this information manually also increased the risk of data dissociation and specimen misplacement, as it could significantly delay getting specimens lodged correctly in the collection. Since 2012, a number of steps have been taken by the VZ Collection staff to reduce these risks and streamline data processing. For internal field programs in Mammalogy and Ornithology, a field data-collecting tool has been developed using FileMaker Pro. This enables direct input of specimen and field data into our FileMaker field database using the FileMaker Go app on iPad that is then exportable to an Excel spreadsheet for upload to EMu. Specimens are given field numbers initially, and a collection number once at the museum. Data processing is simplified as most specimens undergo full preparation in the field. We have also developed an upload spreadsheet in Excel that can be used by internal or external researchers who are lodging bulk lots of specimens. Thus we receive the mandatory data we require, and it is already in a format we can easily upload to EMu. For external stakeholder donations, preparation is completed at the museum so all data available upon donation are entered directly into EMu. A collection registration number is applied as soon as a specimen is accessioned so there is only one number required to track it during and after preparation. All specimen-related data generated during preparation are still handwritten and then transcribed direct to the electronic catalogue record by collection managers. These procedures continue to be refined, but have significantly enhanced specimen and associated data management. Accidental data loss through technical issues, for example possible iPad data-loss before backup, human error at data input stage such as overwriting a record, or incorrectly assigning field number, have been minimal. Also, we will continue to decrease the need for data transcription by encouraging internal and external researchers to use our data-upload spreadsheet, and training preparation staff to enter specimen data directly into the specimen catalogue record in EMu.

Abstract Background Immunocompromised (IC) patients (pts) can have prolonged SARS-CoV-2 PCR positivity, even after resolution of COVID-19 symptoms. This study aimed to determine if viable virus could be detected in samples collected &gt; 21 days after an initial positive (pos) SARS-CoV-2 PCR in IC pts. Methods We obtained 20 remnant SARS-CoV-2 PCR pos nasopharyngeal swabs from IC pts (bone marrow or solid organ transplant, high dose steroids, immunosuppressive medications) with a pos repeat PCR within the previous 30 days. The repeat specimens were cultured on Vero-hACE2-TMPRSS2 cells and incubated for 96 hours to assess viral viability. Viable RNA and infectious virus in the cultured cells were measured by qPCR and infectious plaque assays. RNA sequencing was performed on a HiSeq platform (Illumina). Samples also underwent SARS-CoV-2 antigen (Ag) testing (BD Veritor). Clinical data were extracted from the electronic health record by chart review. Results Pt characteristics are in Table 1. Viral cultures from the repeat specimen were negative (neg) for 18 pts and pos for 2 (Table 2). Pt 1 is a 60M treated with obinatuzumab 19 days prior to his first pos PCR test, with repeat specimen collected 21 days later (cycle threshold (Ct) not available). Pt 1 had a low viral titer (27 PFU/mL) & a D614G mutation on sequencing. Pt 2 is a 75M treated with rituximab 10 days prior to his first pos PCR test, with repeat specimen collected 23 days later (Ct 27.56/27.74). Pt 2 had a high viral titer (2e6 PFU/mL) and D614G, S98F, and S813I mutations. Demographics of Study Population (N=20) Characteristics of patients with a positive SARS-CoV-2 viral culture Conclusion 90% of specimens collected &gt; 21 days after an initial pos SARS-CoV-2 PCR did not have viable virus detected on their repeat specimen. The 2 pts with pos viral cultures had active hematologic malignancies treated with an anti-CD20 mAb at the time of COVID-19 diagnosis. One pt had a high concentration of active, viable virus. No known variants of concern were noted in this cohort, collected in Q2 2020, though prolonged replication is a risk for variant development. Further data are needed about risk factors for persistent viable viral shedding & methods to prevent transmission of viable virus from IC hosts. Disclosures Victoria J. Fraser, MD, CDC Epicenters (Grant/Research Support)Cigna/Express Scripts (Other Financial or Material Support, Spouse is Chief Clinical Officer)Doris Duke Fund to Retain Clinical Scientists (Grant/Research Support, Research Grant or Support)Foundation for Barnes-Jewish Hospital (Grant/Research Support, Research Grant or Support)NIH (Grant/Research Support, Research Grant or Support) Victoria J. Fraser, MD, Centers for Disease Control and Prevention (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support; Cigna/Express Scripts (Individual(s) Involved: Spouse/Partner): Employee; Doris Duke Charitable Foundation (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support; National Institutes of Health (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support; The Foundation for Barnes-Jewish Hospital (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support Michael S. Diamond, MD, PhD, Carnival Corporation (Consultant)Emergent BioSolutions (Grant/Research Support)Fortress Biotech (Consultant)Immunome (Advisor or Review Panel member)Inbios (Consultant)Moderna (Grant/Research Support, Advisor or Review Panel member)Vir Biotechnology (Consultant, Grant/Research Support) Carey-Ann Burnham, PhD, BioFire (Grant/Research Support, Other Financial or Material Support)bioMerieux (Grant/Research Support)Cepheid (Consultant, Grant/Research Support)Luminex (Grant/Research Support)Roche (Other Financial or Material Support) Carey-Ann Burnham, PhD, BioFire (Individual(s) Involved: Self): Grant/Research Support; bioMerieux (Individual(s) Involved: Self): Grant/Research Support, Scientific Research Study Investigator, Speakers’ bureau; Cepheid (Individual(s) Involved: Self): Consultant, Grant/Research Support, Scientific Research Study Investigator; Luminex (Individual(s) Involved: Self): Scientific Research Study Investigator Hilary Babcock, MD, MPH, FIDSA, FSHEA, Nothing to disclose

Background:Spondyloarthritis (SpA) is a group of heterogeneous diseases that includes axial SpA (axSpA), such as ankylosing spondylitis and axial non-radiographic SpA, and Psoriatic Arthritis (PsA) with peripheral and/or axial involvement (axPsA). Currently, it is not well known if the characteristics and burden of the disease in patients with axPsA are similar to that of patients with axSpA.Objectives:To compare the demographic, clinical and structural features between patients with axSpA and axPsA.Methods:Data from an observational prospective cohort including all patients with SpA initiating biological therapy because of predominant axial manifestations from 2002-2019 in a university hospital were analyzed. AxSpA and axPsA were defined in clinical practice according to the prescribing rheumatologist, based on clinical features and complementary examinations. Demographic information, laboratory tests, disease presentation, sacroiliitis according to modified New York criteria in the pelvis X-ray, disease activity indexes (ASDAS and BASDAI) and concomitant treatment before starting biological drug were collected from the electronic medical record and biologic database. In the statistical analysis, chi square or the exact Fisher’s test was used for categorical and t-student or U-Mann Whitney for continuous variables, according to the distribution of the data. Then, the association between demographic and clinical features and each disease was analysed using univariable and multivariable logistic regression models.Results:Out of 352 included patients, 287 (81.5%) had axSpA, and 65 had axPsA (18.5%). Baseline characteristics are shown in Table 1. Mean baseline ASDAS was 3.3±0.9 and 3.1±1.0 for axSpA and axPsA, respectively. Biological therapies initiated can be seen in Figure 1. No significant differences at baseline were observed between axSpA and axPsA for most of the characteristics including: gender, age at diagnosis, age at starting biologic, disease duration before biologic, smoking habit, CRP, disease activity, enthesitis, dactylitis, inflammatory bowel disease (IBD), patient global assessment and sulfasalazine use. However, there were differences between diseases in some relevant characteristics. AxSpA patients had less peripheral involvement (41.5 vs. 78.5 %, p=0.004), more uveitis (15.3 vs. 3.1 %, p=0.03) and were more frequently HLA-B*27 positive (72.3 vs 34.1 %, p<0.001), in comparison to axPsA patients. They also had better physician global assessments (PhGA) (37.4 vs 44.4, p=0.02), and a higher grade of radiographic sacroiilitis. AxSpA patients used less global baseline concomitant therapy (p=0.001), methotrexate (p<0.001) and prednisone (p<0.01), whereas they used more sulfasalazine (p=0.003) than axPsA patients in our cohort. After running multivariate analyses, the absence of peripheral manifestations (OR=4.7; p<0.001) and the positivity of HLA-B27 (OR=5.4; p<0.001) were independently associated with axSpA.Table 1. Baseline stratified characteristics. Results are shown as absolute numbers (percentages) or mean ± standard deviation.Conclusion:Despite being spondyloartrithis with many common traits, axSpA and axPsA present some differences in clinical practice. Whereas axSpA patients are more frequently HLA-B27 positive, axPsA have more peripheral involvement. These differences in clinical presentation between both diseases may contribute to variances in therapeutic management, such as increased use of baseline concomitant therapy in axPsA patients who initiate biological therapy.Figure 1.Biological therapies initiated in axSpA and axPsADisclosure of Interests:Diego Benavent: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Chamaida Plasencia: None declared, Diana Peiteado: None declared, Alejandro Villalva: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz

Pressure injuries (PIs) substantively impact quality of care during hospital stays, although only when they are severe or acquired as a result of the hospital stay are they reported as quality indicators. Globally, researchers have repeatedly highlighted the need to invest more in quality improvement, risk assessment, prevention, early detection, and care for PI to avoid the higher costs associated with treatment of PI. Coders' perspectives on quality assurance of the clinical coded PI data have never been investigated. This study aimed to explore challenges that hospital coders face in accurately coding and reporting PI data and subsequently, explore reasons why data sources may vary in their reporting of PI data. This article is based upon data collected as part of a multi-phase collaborative project to build capacity for optimizing PI prevention across Monash Partners health services. We have conducted 16 semi-structured phone interviews with clinical coders recruited from four participating health services located in Melbourne, Australia. One of the main findings was that hospital coders often lacked vital information in clinicians' records needed to code PI and report quality indicators accurately and highlighted the need for quality improvement processes for PI clinical documentation. Nursing documentation improvement is a vital component of the complex capacity building programs on PI prevention in acute care services and is relied on by coders. Coders reported the benefit of inter-professional collaborative workshops, where nurses and coders shared their perspectives. Collaborative workshops had the potential to improve coders' knowledge of PI classification and clinicians' understanding of what information should be included when documenting PI in the medical notes. Our findings identified three methods of quality assurance were important to coders to ensure accuracy of PI reporting: (1) training prior to initiation of coding activity and (2) continued education, and (3) audit and feedback communication about how to handle specific complex cases and complex documentation. From a behavioral perspective, most of the coders reported confidence in their own abilities and were open to changes in coding standards. Transitioning from paper-based to electronic records highlighted the need to improve training of both clinicians and coders.

BackgroundTreatment of multi-drug resistant tuberculosis (MDR-TB) for a prolonged period with comparatively less effective and more toxic second-line anti-TB drugs is associated with greater incidence of adverse events.Study aimThis study aimed to evaluate the frequency and factors associated with occurrence of adverse events among patients with MDR-TB attending the Bahawal Victoria Hospital, Bahawalpur, Pakistan.Study designThis retrospective study included all patients with MDR-TB who were registered and treated at the study site between June 2014 and December 2016 and had their treatment outcomes available at the time of data collection (i.e., November 2018).Measures and outcomesThe Electronic Nominal Record System (ERNS) records, medical charts of patients, and laboratory reports were reviewed to obtain the data. Adverse events were reported as per the standard criteria recommended by the WHO. Multivariate binary logistic regression was used to find the independent factors associated with the occurrence of adverse events.ResultsA total of 179 patients with MDR-TB were included in the final analysis. Out of these, 114 (63.7%) patients experienced at least one adverse event during the course of their treatment. Depression was the most common adverse events (33%), followed by nausea and vomiting (27.4%) and arthralgia (27.4%). The factors associated with the occurrence of adverse events included presence of comorbidity (adjusted odds ratio [AOR] 2.951; 95% CI 1.423, 6.118) and being employed (AOR 3.445; 95% CI 1.188, 9.993).ConclusionAdverse events were prevalent in this cohort, however, resolved with the effective management approaches. Patients with identified factors for occurrence of adverse events need special attention and enhanced clinical management.

Introduction Elimination of hepatitis C virus stands as an unresolved World Health Organization target, and is associated with complications including cirrhosis and hepatocellular carcinoma. Hepatitis C virus management has been revolutionised following the widespread availability of direct-acting antiviral agents in Australia since 2016; however, large proportions of the population remain untreated. Telehealth-based service delivery is an accessible and effective alternative, and we aimed to assess qualitative and clinical outcomes in a clinical nurse consultant-led regional telehealth model. Methods A prospective cohort analysis of all patients referred to a Victorian regional hospital’s hepatitis C virus telehealth clinic between 1 April 2017 and 10 June 2020 was conducted. Data were collated from outpatient and electronic medical records. Results Fifty-five out of 71 referred patients were booked, with 44 patients (80%) attending at least one appointment. A history of alcohol use disorder and psychiatric comorbidity was seen in 25 (54%) and 24 (52%) patients, respectively. Twenty-one out of 24 (88%) eligible patients had direct-acting antiviral agent treatment and 14 out of 21 (67%) successfully completed the treatment. An average of 46.5 km, 54.6 min and $AUD30.70 was saved per patient for each visit. Observed benefits included: increased medical engagement, adherence to and completion of HCV treatment and cirrhosis monitoring. Telehealth-driven hepatocellular carcinoma surveillance was successful in the cirrhotic subgroup. Conclusion Clinical nurse consultant-led hepatitis C virus management via telehealth allows access to marginalised regional populations. Clinical outcomes were comparable to other cohorts with additional cost-benefit, efficiency gains and carbon footprint reduction amongst a previously unreported regional Victorian hepatitis C virus population.

Abstract Background Aortic dissection is a common differential in patients presenting with chest pain. In Northern Ireland, there is one hospital with a cardiac surgical unit. Therefore, patients are diagnosed in district general hospitals and then transferred for intervention. Over the past number of years it has been noted that there can be delays in the diagnosis and transfer of patients with aortic dissection to the cardiac surgery service. This study aims to identify any common reasons for this and develop a way to improve. Methods Patients operated on for aortic dissection from 2014-2019 in the Royal Victoria Hospital Belfast were included. Their notes and electronic care records were analysed, looking at time of initial presentation, time of diagnosis, and time of arrival to theatre. Results 61 cases were analysed. Among those with delays in diagnosis, many were initially admitted medically or to cardiology wards for work up of their chest pain. When a medical cause was not found, scans were performed demonstrating aortic dissection. Some patients were discharged from ED after initial presentation and the diagnosis was found on re-presentation. There were delays in reports of some scans. Delay in diagnosis was a more common feature than delay in transfer. Implications Delay in diagnosis or transfer of these patients affects their prognosis. As a result of this study a pathway has been developed regarding diagnosis, initial medical management, and transfer of these patients and it is hoped this will be implemented in hospital departments in Northern Ireland in the future.

Introduction Our earlier analysis during the COVID-19 surges in 2020 showed a reduction in general practitioner (GP) in-person visits to residential aged care facilities (RACFs) and increased use of telehealth. This study assessed how sociodemographic characteristics affected telehealth utilisation. Methods This retrospective cohort consists of 27,980 RACF residents aged 65 years and over, identified from general practice electronic health records in Victoria and New South Wales during March 2020-August 2021. Residents’ demographic characteristics, including age, sex, region, and pension status, were analysed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the associations with telehealth utilisation (telephone/video vs. in-person consultations) and with video versus telephone consultations, in mixed-effects multiple level regression models. Results Of 32,330 median monthly GP consultations among 21,987 residents identified in 2020, telehealth visits accounted for 17% of GP consultations, of which 93% were telephone consults. In 2021, of 32,229 median monthly GP consultations among 22,712 residents, telehealth visits accounted for 11% of GP consultations (97% by telephone). Pension holders (OR: 1.14; 95% CI: 1.10, 1.17) and those residing in rural areas (OR: 1.72; 95% CI: 1.57, 1.90) were more likely to use telehealth. However, residents in rural areas were less likely to use video than telephone in GP consultations (OR: 0.41; 95% CI: 0.29, 0.57). Results were similar in separate analyses for each COVID surge. Discussion Telephone was primarily used in telehealth consultations among pension holders and rural residents in RACFs. Along with the limited use of video in virtual care in rural RACFs, the digital divide may imply potential healthcare disparities in socially disadvantaged patients.

Background: Health information governance (IG) in Australian hospitals was hitherto unexplored. Objectives: To determine hospitals’ health IG status and maturity in Victoria, Australia, identify drivers and barriers affecting IG adoption, examine electronic health data breach response plan usage and assess employees’ electronic data breach awareness. Method: Mixed-methods descriptive study utilising an online survey of directors – clinical/health information services and chief health information managers (HIMs) in Victorian hospitals, ≥50 beds. Results: Response rate: 42.9% ( n = 36). Fifty percent ( n = 17) of respondent-hospitals had an IG program. IG equally supported decision-making and risk identification and prevention. The greatest potential organisational damages from system disruption or failure were information loss (66.7%) and clinical risks (63.9%). HIMs in 15 (55.6%) hospitals had knowledge to monitor and detect electronic data breaches. Staff in 19 (70.4%) hospitals knew who to inform about a suspected breach. Most hospitals had mature health information-related IG practices, most (88.9%, n = 24) provided IG-related education, 77.8% ( n = 21) regularly reviewed data breach response plans. The strongest IG drivers were privacy-security compliance and changes to data capture or documentation practices (82.8%, n = 24); the greatest barriers were implementation complexity (57.1%, n = 16) and cost (55.6%, n = 15). Conclusion: These baseline Australian data show 50% of respondent-hospitals had no formal health IG program. Privacy-security compliance, and audits, needed improvement; however, most hospitals had well-developed medical record/health information IG-relevant schedules, policies and practices. HIMs, the professionals most engaged in IG, required upskilling in electronic data breach detection.

Abstract Background Takotsubo Cardiomyopathy represents an acute transient decline in left ventricular (LV) function occurring in the absence of obstructive coronary artery disease or acute plaque rupture. Therapeutic strategies vary due to a paucity of evidence-based guidelines. Purpose To evaluate clinical and biochemical characteristics, management approach and outcomes in a contemporary cohort of patients with Takotsubo Cardiomyopathy across two tertiary centres in Victoria, Australia. Neurohormonal associations were explored by characterising the prevalence of pre-existing endocrinopathies and malignancy. Methods We conducted a retrospective study of 240 patients with Takotsubo Cardiomyopathy diagnosed between 2008–2018, utilising data from electronic medical records. Results Patients were predominantly female (91.3%, mean age 66±12 years), smokers (48.3%), and hypertensive (55.0%). A small proportion (16.7%) had pre-existing malignancy (breast 30%, gastrointestinal 23%, genitourinary 19%, lung 9%, other 19%) or endocrine disease (12.5%), largely driven by thyroid disease (94%). Troponin rise was common (94.6%; peak troponin 6.4±13μg/L), though few presented with ST-elevation (21.7%). Psychosocial stress was prevalent (44.6%) compared with physical illness (39.2%) or an unidentified precipitant (16.7%). Management was heterogeneous. Many were discharged on aspirin (37.7%), dual antiplatelet therapy (34%) or statins (35.9%) in the absence of obstructive coronary disease or other clinical indication and were frequently continued beyond 1 year. ACE inhibitors or angiotensin receptor blockers were prescribed in 83.7%, beta blockers in 84.9% or both in 74.9% (continuing beyond 1 year in 60.4%). LV dysfunction occurred in 81.7% at diagnosis (mean LV ejection fraction (LVEF) 45±11%), recovering in 91.3% (mean LVEF 62±8%; 17.2% increase, p<0.001) on repeat echocardiography (mean 107±154 days). Follow up occurred in 81.4%, though most patients with normalised LV function continued heart failure therapy (83.6%). 12-month mortality was rare (7%) as was recurrence (5.1%). Conclusions Management of Takotsubo Cardiomyopathy remains challenging due to phenotypic diversity, variable therapeutic approach and unclear treatment duration. Pre-existing illness, including malignancy and endocrinopathy, may provide a substrate for the development of Takotsubo Cardiomyopathy or amplify cardiac adrenoreceptor sensitivity. Enhanced understanding of possible neurohormonal and cellular mechanisms may facilitate targeted management and preventive strategies. The role of antiplatelets or lipid lowering therapy is not supported in existing literature, however, as this study highlights, they continue to feature heavily in the Takotsubo treatment armamentarium. Further studies are needed to enhance understanding of underlying mechanisms and establish a standardised treatment approach with targeted therapy to promote LV recovery and prevent recurrence. Acknowledgement/Funding None

ObjectivesElectronic Health Record (EHR) data have created unique opportunities for research. However, these data are: not curated, siloed and poorly integrated. We describe linkage of EHR data from an entire health service with government datasets to establish a linked geographic cohort within the Australian National Centre for Healthy Ageing (NCHA). ApproachResearch suitable EHR items were identified from Peninsula Health (NCHA partner) data systems based on: published research, availability and quality. Items underwent end-user Delphi processes to identify core research items (consensus=70%). Approvals were obtained from the Australian Institute of Health and Welfare (AIHW) for linkage with: Medicare, medication dispensings, Aged Care and death registry data through the AIHW spine, created using identifiers from the Medicare Consumer Directory (MCD); and from the Centre for Victorian Data Linkage for linkage to state-wide hospital data. Identifiers for local residents aged ≥60 years who attended Peninsula Health were submitted for probabilistic data linkage. ResultsDelphi participants included 10 researchers from 8 fields/departments and 13 clinicians from 11 clinical areas. To date 7 of the 11 datasets have been reviewed. N=107 potentially suitable data items were identified and 96 gained consensus for inclusion in the core dataset. Of the 49,767 Health Service users (episodes: Jan 2010-Dec May 2021) submitted for linkage, 98.4% were successfully linked to the MCD (Median age 72.2 years, 52.2% female, 1.8% regional residence). An additional 172,290 individuals living within the geographic region but not contained within the EHR dataset were identified in the MCD for linkage to the government datasets. Linkage accuracy was impacted by inaccurate/incomplete address fields (~30%) and lack of adherence to naming conventions within the EHR data. ConclusionLinking with EHR data is complex. Having an established EHR research dataset will improve the feasibility of data linkage and potential for future expansion of linkages within the NCHA. Once merged, the data will be used to underpin a range of research activities related to ageing and dementia.

IntroductionSharing aggregated electronic health records (EHRs) for integrated health care and public health studies is increasingly demanded. Patient privacy demands that anonymisation procedures are in place for data sharing. ObjectiveTraditional methods such as k-anonymity and its derivations are often overgeneralising resulting in lower data accuracy. To tackle this issue, we proposed the Semantic Linkage K-Anonymity (SLKA) approach to balance the privacy and utility preservation through detecting risky combinations hidden in the record linkage releases. ApproachK-anonymity processing quasi-identifiers of data may lead to ‘over generalisation’ when dealing with linkage data sets. As most linkage cases do not include all local patients and thus not all modifying data for privacy-preserving purposes needs to be used, we proposed the linkage k-anonymity (LKA) by which only obfuscated individuals in a released linkage set are required to be indistinguishable from at least k-1 other individuals in the local dataset. Considering the inference disclosure issue, we further designed the semantic-based linkage k-anonymity (SLKA) method through extending with a semantic-rule base for automatic detection of (and ruling out) risky associations from previous linked data releases. Specially, associations identified from the “previous releases” of the linkage dataset can become the input of semantic reasoning for the “next release”. ResultsThe approach is evaluated based on a linkage scenario where researchers apply to link data from an Australia-wide national type-1 diabetes platform with survey results from 25,000+ Victorians about their health and wellbeing. In comparing the information loss of three methods, we find that extra cost can be incurred in SLKA for dealing with risky individuals, e.g., 13.7% vs 5.9% (LKA, k=4) however it performs much better than k-anonymity, which can cause 24% information loss (k=4). Besides, the k values can affect the level of distortion in SLKA, such as 11.5% (k=2) vs 12.9% (k=3). ConclusionThe SLKA framework provides dynamic protection for repeated linkage releases while preserving data utility by avoiding unnecessary generalisation as typified by k-anonymity.

Abstract Background The emergency department has been a major focus for the implementation of Australia’s national electronic health record, known as My Health Record. However, the association between use of My Health Record in the emergency department setting and patient care is largely unknown. The aim of this study was to explore the perspectives of emergency department clinicians regarding My Health Record use frequency, the benefits of My Health Record use (with a focus on patient care) and the barriers to use. Methods All 393 nursing, pharmacy, physician and allied health staff employed within the emergency department at a tertiary metropolitan public hospital in Melbourne were invited to participate in a web-based survey, between 1 May 2021 and 1 December 2021, during the height of the Delta and Omicron Covid-19 outbreaks in Victoria, Australia. Results Overall, the survey response rate was 18% (70/393). Approximately half of the sample indicated My Health Record use in the emergency department (n = 39, 56%, confidence interval [CI] 43–68%). The results showed that users typically only engaged with My Health Record less than once per shift (n = 15, 39%, CI 23–55%). Just over half (n = 19/39, 54%, CI 32–65%) of all participants who use My Health Record agreed they could remember a time when My Health Record had been critical to the care of a patient. Overall, clinicians indicated the biggest barrier preventing their use of My Health Record is that they forget to utilise the system. Conclusion The results suggest that My Health Record has not been adopted as routine practice in the emergency department, by the majority of participants. Close to half of self-identified users of My Health Record do not associate use as being critical to patient care. Instead, My Health Record may only be used in scenarios that clinicians perceive will yield the greatest benefit—which clinicians in this paper suggest is patients with chronic and complex conditions. Further research that explores the predictors to use and consumers most likely to benefit from use is recommended—and strategies to socialise this knowledge and educate clinicians is desperately required.

Objectives: In the new era of voluntary assisted dying (VAD) legislation in Australia, this study aimed to explore (1) underlying reasons for desire to die statements (DTDSs), (2) clinician responses to DTDSs and (3) whether DTDSs were a true request for VAD. Methods: Clinical audit using an existing prospectively collected quality assurance database, supplemented by electronic medical records. Patients known to a consultation-liaison palliative care service who expressed a DTDS between October 2019 and September 2020 were included. Results: Forty-one patients were included; 29 (71%) were male, 29 (71%) had a malignancy and 31 (76%) expressed a DTDS more than once. Uncontrolled psychological symptoms were present more often than physical (n = 30 vs 19 [73% vs 46%]), yet physical symptoms were addressed more frequently than psychological (80% vs 63% of the time). Based on available data, the VAD assessment process was commenced by 7 patients, and death by VAD occurred for 2 patients. Conclusions: In our study, DTDSs were complex, multi-layered requests that more commonly reflected psychological rather than physical suffering. Though VAD is now legally possible, a DTDS was not always synonymous with a request for VAD. Key to responding to these requests are high levels of clinician confidence and communication skills. Training in this area remains critical for the experience of both patients and clinicians.

Abstract Focus and outcomes for participants “Children are our future” - the wellbeing of our future adults will influence the future of the world. However, this generation of children and mid-life adults face increasing rates of complex health and development problems, and many of them are preventable. Traditional research approaches are not keeping pace with need. Discovery and testing of solutions is blocked by the lack of fast, cheap, large-scale, low burden and effective ways to conduct research for the population and its many subgroups. Innovation in epidemiological methods is required to deliver large scale studies of unprecedented scale and scope. These will support research that enables better prevention, prediction and treatment – all of which are needed to solve today’s pressing child and adult health problems. This 90-minute symposium will draw on the forthcoming Generation Victoria (GenV) to illustrate innovative epidemiological methods established in its foundation phase to enable large-scale studies. GenV is designed to address physical, mental and social issues experienced during childhood and mid-adulthood, as well as the antecedents of a wide range of diseases of ageing. Parents of all newborns (estimated. 170,000) in the state of Victoria (population 6.5 million), Australia, will be approached from 2021 for two full years. Following consent, GenV proposes to bank biosamples collected during routine care, link to administrative and clinical data, and directly collect parent and child data using interactive electronic interfaces with the potential for face-to-face assessment during the school years. Encompassing clinical trials, registries, health services and geospatial as well as discovery research, GenV’s initial focus will be on pregnancy and newborns, reaching into regional and rural communities and traditionally hard-to-reach groups in sizeable numbers. Permission will be sought to link trials, registries, and health services research with existing pre- and post-birth administrative and electronic health record datasets, and also to bank biospecimens collected during routine care. We will discuss why innovation is essential to the next wave of large-scale studies such as GenV, and share practical examples of method innovations being developed within GenV. We will forecast the opportunities and challenges of large-scale studies for improving wellbeing and reducing the disease burden with children and adults. Focus: Outcomes: Rationale for the symposium, including for its inclusion in the Congress The future wellbeing and productivity of our societies depend on wellbeing and good health of our children and adults. However, today’s children and mid-life adults are facing both old and new challenges. Traditional research approaches have largely failed to deliver progress towards solving these challenges. For example, most existing cohorts only allow for observational follow up, and children are greatly under-represented in gold-standard clinical trials, which leads to less evidence to children’s treatment and prevention. Multi-purpose, low burden, high up-take innovative large studies are required to address these gaps. GenV seeks to generate translatable evidence (prediction, prevention, treatments, and services) to improve future wellbeing and reduce the future disease burden of children and adults. It will allow researchers, clinicians and policy makers to better understand the issues affecting Victorian children and their families with greater speed and precision, and therefore outcomes be translated more quickly into practice. Also it will help facilitate an environment where researchers, clinicians, policy makers, and other organisations can come together to enact change for future generations’ wellbeing. With this symposium, we intend to share our reflections on how the scale of cohort studies is changing, and showcase new trends in research design. The GenV team will then show how we practically achieve innovation in large-study methodology and design, with the aim of encouraging others to think ambitiously at large-scale. We will share our intentions and rationale for these innovations as well as the challenges. The symposium is designed to spark a discussion with the audience, seeking their reflections and suggestions on shaping our innovations. Finally, we aim to encourage researchers (especially early career researchers) to exchange their vision and views on innovations and methods for cohort studies. Presentation program (90 minutes) Names of presenters Prof Melissa Wake, Dr Susan Clifford, Dr Yanhong Jessika Hu, A/Prof Jo Said, Dr Joan Leong, Dr Suzanne Mavoa.

Background The Australian hospital-acquired complication (HAC) policy was introduced to facilitate negative funding adjustments in Australian hospitals using ICD-10-AM codes. Objective The aim of this study was to determine the positive predictive value (PPV) of the ICD-10-AM codes in the HAC framework to detect hospital-acquired pneumonia in patients with cancer and to describe any change in PPV before and after implementation of an electronic medical record (EMR) at our centre. Method A retrospective case review of all coded pneumonia episodes at the Peter MacCallum Cancer Centre in Melbourne, Australia spanning two time periods (01 July 2015 to 30 June 2017 [pre-EMR period] and 01 September 2020 to 28 February 2021 [EMR period]) was performed to determine the proportion of events satisfying standardised surveillance definitions. Results HAC-coded pneumonia occurred in 3.66% ( n = 151) of 41,260 separations during the study period. Of the 151 coded pneumonia separations, 27 satisfied consensus surveillance criteria, corresponding to an overall PPV of 0.18 (95% CI: 0.12, 0.25). The PPV was approximately three times higher following EMR implementation (0.34 [95% CI: 0.19, 0.53] versus 0.13 [95% CI: 0.08, 0.21]; p = .013). Conclusion The current HAC definition is a poor-to-moderate classifier for hospital-acquired pneumonia in patients with cancer and, therefore, may not accurately reflect hospital-level quality improvement. Implementation of an EMR did enhance case detection, and future refinements to administratively coded data in support of robust monitoring frameworks should focus on EMR systems. Implications Although ICD-10-AM data are readily available in Australian healthcare settings, these data are not sufficient for monitoring and reporting of hospital-acquired pneumonia in haematology-oncology patients.

IntroductionIt is well recognised that mental illness causes significant morbidity and mortality, and has been identified as a national health priority. Despite this, there is a paucity of research about paramedic student perceptions and attitudes toward those experiencing mental health presentations. The objective of this study was to explore the mental health perceptions of a final year cohort of paramedic students from a regional Victorian university.MethodsFinal year undergraduate paramedicine students enrolled in the core subject Advanced Mental Health Practice were invited to participate in both pre- and post-subject surveys and record their perceptions of mental health using electronic questionnaires. The questionnaires used nine 5-point Likert scale questions and three multiple option questions using declarative statements.ResultsOf the 25 eligible students, 16 completed the pre-subject questionnaire and 12 completed both the pre- and post-subject questionnaires. The results indicated that this cohort held common myths and misconceptions relating to mental health combined with a lack of general knowledge about mental illness and its paramedic management. These perceptions altered following the introduction of the mental health subject.ConclusionThe results suggest that the implementation of a mental health subject into paramedicine undergraduate curriculum has the ability to positively alter perceptions of mental health. This may lead to students acquiring the knowledge and attitudes required to manage mental health presentations.

Abstract Background Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently, only 44% of Australians aged 50–74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice. Methods We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narrative messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with a two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to the control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to 12 months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit. Discussion This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620001020976. Registered on 17 October 2020.

Special Care NoticeThis article discusses trauma and violence inflicted upon the Indigenous peoples of Tasmania through the processes of colonisation. Content within this article may be distressing to some readers. IntroductionThis article looks briefly at the collection, consultation, and digital sharing of stories essential to the histories of the First Nations peoples of Australia. Focusing on materials held in Sydney, New South Wales two case studies—the object known as the Proclamation Board and the George Augustus Robinson Papers—explore how materials can be shared with Aboriginal peoples of the region now known as Tasmania. Specifically, the authors of this article (a Palawa man and an Australian woman of European descent) ask how can the idea of the privileging of Indigenous voices, within Eurocentric cultural collections, be transformed from rhetoric to reality? Moreover, how can we navigate this complex work, that is made even more problematic by distance, through the utilisation of knowledge networks which are geographically isolated from the collections holding stories crucial to Indigenous communities? In seeking to answer these important questions, this article looks at how cultural, emotional, and intellectual ownership can be divested from the physical ownership of a collection in a way that repatriates—appropriately and sensitively—stories of Aboriginal Australia and of colonisation. Holding Stories, Not Always Our OwnCultural institutions, including libraries, have, in recent years, been drawn into discussions centred on the notion of digital disruption and “that transformative shift which has seen the ongoing realignment of business resources, relationships, knowledge, and value both facilitating the entry of previously impossible ideas and accelerating the competitive impact of those same impossible ideas” (Franks and Ensor n.p.). As Molly Brown has noted, librarians “are faced, on a daily basis, with rapidly changing technology and the ways in which our patrons access and use information. Thus, we need to look at disruptive technologies as opportunities” (n.p.). Some innovations, including the transition from card catalogues to online catalogues and the provision of a wide range of electronic resources, are now considered to be business as usual for most institutions. So, too, the digitisation of great swathes of materials to facilitate access to collections onsite and online, with digitising primary sources seen as an intermediary between the pillars of preserving these materials and facilitating access for those who cannot, for a variety of logistical and personal reasons, travel to a particular repository where a collection is held.The result has been the development of hybrid collections: that is, collections that can be accessed in both physical and digital formats. Yet, the digitisation processes conducted by memory institutions is often selective. Limited resources, even for large-scale digitisation projects usually only realise outcomes that focus on making visually rich, key, or canonical documents, or those documents that are considered high use and at risk, available online. Such materials are extracted from the larger full body of records while other lesser-known components are often omitted. Digitisation projects therefore tend to be devised for a broader audience where contextual questions are less central to the methodology in favour of presenting notable or famous documents online only. Documents can be profiled as an exhibition separate from their complete collection and, critically, their wider context. Libraries of course are not neutral spaces and this practice of (re)enforcing the canon through digitisation is a challenge that cultural institutions, in partnerships, need to address (Franks and Ensor n.p.). Indeed, our digital collections are as affected by power relationships and the ongoing impacts of colonisation as our physical collections. These power relationships can be seen through an organisation’s “processes that support acquisitions, as purchases and as the acceptance of artefacts offered as donations. Throughout such processes decisions are continually made (consciously and unconsciously) that affect what is presented and actively promoted as the official history” (Thorpe et al. 8). While it is important to acknowledge what we do collect, it is equally important to look, too, at what we do not collect and to consider how we continually privilege and exclude stories. Especially when these stories are not always our own, but are held, often as accidents of collecting. For example, an item comes in as part of a larger suite of materials while older, city-based institutions often pre-date regional repositories. An essential point here is that cultural institutions can often become comfortable in what they collect, building on existing holdings. This, in turn, can lead to comfortable digitisation. If we are to be truly disruptive, we need to embrace feeling uncomfortable in what we do, and we need to view digitisation as an intervention opportunity; a chance to challenge what we ‘know’ about our collections. This is especially relevant in any attempts to decolonise collections.Case Study One: The Proclamation BoardThe first case study looks at an example of re-digitisation. One of the seven Proclamation Boards known to survive in a public collection is held by the Mitchell Library, State Library of New South Wales, having been purchased from Tasmanian collector and photographer John Watt Beattie (1859–1930) in May 1919 for £30 (Morris 86). Why, with so much material to digitise—working in a program of limited funds and time—would the Library return to an object that has already been privileged? Unanswered questions and advances in digitisation technologies, created a unique opportunity. For the First Peoples of Van Diemen’s Land (now known as Tasmania), colonisation by the British in 1803 was “an emotionally, intellectually, physically, and spiritually confronting series of encounters” (Franks n.p.). Violent incidents became routine and were followed by a full-scale conflict, often referred to as the Black War (Clements 1), or more recently as the Tasmanian War, fought from the 1820s until 1832. Image 1: Governor Arthur’s Proclamation to the Aborigines, ca. 1828–1830. Image Credit: Mitchell Library, State Library of New South Wales, Call No.: SAFE / R 247.Behind the British combatants were various support staff, including administrators and propagandists. One of the efforts by the belligerents, behind the front line, to win the war and bring about peace was the production of approximately 100 Proclamation Boards. These four-strip pictograms were the result of a scheme introduced by Lieutenant Governor George Arthur (1784–1854), on the advice of Surveyor General George Frankland (1800–38), to communicate that all are equal under the rule of law (Arthur 1). Frankland wrote to Arthur in early 1829 to suggest these Proclamation Boards could be produced and nailed to trees (Morris 84), as a Eurocentric adaptation of a traditional method of communication used by Indigenous peoples who left images on the trunks of trees. The overtly stated purpose of the Boards was, like the printed proclamations exhorting peace, to assert, all people—black and white—were equal. That “British Justice would protect” everyone (Morris 84). The first strip on each of these pictogram Boards presents Indigenous peoples and colonists living peacefully together. The second strip shows “a conciliatory handshake between the British governor and an Aboriginal ‘chief’, highly reminiscent of images found in North America on treaty medals and anti-slavery tokens” (Darian-Smith and Edmonds 4). The third and fourth strips depict the repercussions for committing murder (or, indeed, any significant crime), with an Indigenous man hanged for spearing a colonist and a European man hanged for shooting an Aboriginal man. Both men executed in the presence of the Lieutenant Governor. The Boards, oil on Huon pine, were painted by “convict artists incarcerated in the island penal colony” (Carroll 73).The Board at the State Library of New South Wales was digitised quite early on in the Library’s digitisation program, it has been routinely exhibited (including for the Library’s centenary in 2010) and is written about regularly. Yet, many questions about this small piece of timber remain unanswered. For example, some Boards were outlined with sketches and some were outlined with pouncing, “a technique [of the Italian Renaissance] of pricking the contours of a drawing with a pin. Charcoal was then dusted on to the drawing” (Carroll 75–76). Could such a sketch or example of pouncing be seen beneath the surface layers of paint on this particular Board? What might be revealed by examining the Board more closely and looking at this object in different ways?An important, but unexpected, discovery was that while most of the pigments in the painting correlate with those commonly available to artists in the early nineteenth century there is one outstanding anomaly. X-ray analysis revealed cadmium yellow present in several places across the painting, including the dresses of the little girls in strip one, uniform details in strip two, and the trousers worn by the settler men in strips three and four (Kahabka 2). This is an extraordinary discovery, as cadmium yellows were available “commercially as an artist pigment in England by 1846” and were shown by “Winsor & Newton at the 1851 Exhibition held at the Crystal Palace, London” (Fiedler and Bayard 68). The availability of this particular type of yellow in the early 1850s could set a new marker for the earliest possible date for the manufacture of this Board, long-assumed to be 1828–30. Further, the early manufacture of cadmium yellow saw the pigment in short supply and a very expensive option when compared with other pigments such as chrome yellow (the darker yellow, seen in the grid lines that separate the scenes in the painting). This presents a clearly uncomfortable truth in relation to an object so heavily researched and so significant to a well-regarded collection that aims to document much of Australia’s colonial history. Is it possible, for example, the Board has been subjected to overpainting at a later date? Or, was this premium paint used to produce a display Board that was sent, by the Tasmanian Government, to the 1866 Intercolonial Exhibition in Melbourne? In seeking to see the finer details of the painting through re-digitisation, the results were much richer than anticipated. The sketch outlines are clearly visible in the new high-resolution files. There are, too, details unable to be seen clearly with the naked eye, including this warrior’s headdress and ceremonial scarring on his stomach, scars that tell stories “of pain, endurance, identity, status, beauty, courage, sorrow or grief” (Australian Museum n.p.). The image of this man has been duplicated and distributed since the 1830s, an anonymous figure deployed to tell a settler-centric story of the Black, or Tasmanian, War. This man can now be seen, for the first time nine decades later, to wear his own story. We do not know his name, but he is no longer completely anonymous. This image is now, in some ways, a portrait. The State Library of New South Wales acknowledges this object is part of an important chapter in the Tasmanian story and, though two Boards are in collections in Tasmania (the Tasmanian Museum and Art Gallery, Hobart and the Queen Victoria Museum and Art Gallery, Launceston), each Board is different. The Library holds an important piece of a large and complex puzzle and has a moral obligation to make this information available beyond its metropolitan location. Digitisation, in this case re-digitisation, is allowing for the disruption of this story in sparking new questions around provenance and for the relocating of a Palawa warrior to a more prominent, perhaps even equal role, within a colonial narrative. Image 2: Detail, Governor Arthur’s Proclamation to the Aborigines, ca. 1828–1830. Image Credit: Mitchell Library, State Library of New South Wales, Call No.: SAFE / R 247.Case Study Two: The George Augustus Robinson PapersThe second case study focuses on the work being led by the Indigenous Engagement Branch at the State Library of New South Wales on the George Augustus Robinson (1791–1866) Papers. In 1829, Robinson was granted a government post in Van Diemen’s Land to ‘conciliate’ with the Palawa peoples. More accurately, Robinson’s core task was dispossession and the systematic disconnection of the Palawa peoples from their Country, community, and culture. Robinson was a habitual diarist and notetaker documenting much of his own life as well as the lives of those around him, including First Nations peoples. His extensive suite of papers represents a familiar and peculiar kind of discomfort for Aboriginal Australians, one in which they are forced to learn about themselves through the eyes and words of their oppressors. For many First Nations peoples of Tasmania, Robinson remains a violent and terrible figure, but his observations of Palawa culture and language are as vital as they are problematic. Importantly, his papers include vibrant and utterly unique descriptions of people, place, flora and fauna, and language, as well as illustrations revealing insights into the routines of daily life (even as those routines were being systematically dismantled by colonial authorities). “Robinson’s records have informed much of the revitalisation of Tasmanian Aboriginal culture in the twentieth century and continue to provide the basis for investigations of identity and deep relationships to land by Aboriginal scholars” (Lehman n.p.). These observations and snippets of lived culture are of immense value to Palawa peoples today but the act of reading between Robinson’s assumptions and beyond his entrenched colonial views is difficult work.Image 3: George Augustus Robinson Papers, 1829–34. Image Credit: Mitchell Library, State Library of New South Wales, A 7023–A 7031.The canonical reference for Robinson’s archive is Friendly Mission: The Tasmanian Journals and Papers of George Augustus Robinson, 1829–1834, edited by N.J.B. Plomley. The volume of over 1,000 pages was first published in 1966. This large-scale project is recognised “as a monumental work of Tasmanian history” (Crane ix). Yet, this standard text (relied upon by Indigenous and non-Indigenous researchers) has clearly not reproduced a significant percentage of Robinson’s Tasmanian manuscripts. Through his presumptuous truncations Plomley has not simply edited Robinson’s work but has, quite literally, written many Palawa stories out of this colonial narrative. It is this lack of agency in determining what should be left out that is most troubling, and reflects an all-too-familiar approach which libraries, including the State Library of New South Wales, are now urgently trying to rectify. Plomley’s preface and introduction does not indicate large tranches of information are missing. Indeed, Plomley specifies “that in extenso [in full] reproduction was necessary” (4) and omissions “have been kept to a minimum” (8). A 32-page supplement was published in 1971. A new edition, including the supplement, some corrections made by Plomley, and some extra material was released in 2008. But much continues to be unknown outside of academic circles, and far too few Palawa Elders and language revival workers have had access to Robinson’s original unfiltered observations. Indeed, Plomley’s text is linear and neat when compared to the often-chaotic writings of Robinson. Digitisation cannot address matters of the materiality of the archive, but such projects do offer opportunities for access to information in its original form, unedited, and unmediated.Extensive consultation with communities in Tasmania is underpinning the digitisation and re-description of a collection which has long been assumed—through partial digitisation, microfilming, and Plomley’s text—to be readily available and wholly understood. Central to this project is not just challenging the canonical status of Plomley’s work but directly challenging the idea non-Aboriginal experts can truly understand the cultural or linguistic context of the information recorded in Robinson’s journals. One of the more exciting outcomes, so far, has been working with Palawa peoples to explore the possibility of Palawa-led transcriptions and translation, and not breaking up the tasks of this work and distributing them to consultants or to non-Indigenous student groups. In this way, people are being meaningfully reunited with their own histories and, crucially, given first right to contextualise and understand these histories. Again, digitisation and disruption can be seen here as allies with the facilitation of accessibility to an archive in ways that re-distribute the traditional power relations around interpreting and telling stories held within colonial-rich collections.Image 4: Detail, George Augustus Robinson Papers, 1829–34. Image Credit: Mitchell Library, State Library of New South Wales, A 7023–A 7031.As has been so brilliantly illustrated by Bruce Pascoe’s recent work Dark Emu (2014), when Aboriginal peoples are given the opportunity to interpret their own culture from the colonial records without interference, they are able to see strength and sophistication rather than victimhood. For, to “understand how the Europeans’ assumptions selectively filtered the information brought to them by the early explorers is to see how we came to have the history of the country we accept today” (4). Far from decrying these early colonial records Aboriginal peoples understand their vital importance in connecting to a culture which was dismantled and destroyed, but importantly it is known that far too much is lost in translation when Aboriginal Australians are not the ones undertaking the translating. ConclusionFor Aboriginal Australians, culture and knowledge is no longer always anchored to Country. These histories, once so firmly connected to communities through their ancestral lands and languages, have been dispersed across the continent and around the world. Many important stories—of family history, language, and ways of life—are held in cultural institutions and understanding the role of responsibly disseminating these collections through digitisation is paramount. In transitioning from physical collections to hybrid collections of the physical and digital, the digitisation processes conducted by memory institutions can be—and due to the size of some collections is inevitably—selective. Limited resources, even for large-scale and well-resourced digitisation projects usually realise outcomes that focus on making visually rich, key, or canonical documents, or those documents considered high use or at risk, available online. Such materials are extracted from a full body of records. Digitisation projects, as noted, tend to be devised for a broader audience where contextual questions are less central to the methodology in favour of presenting notable documents online, separate from their complete collection and, critically, their context. Our institutions carry the weight of past collecting strategies and, today, the pressure of digitisation strategies as well. Contemporary librarians should not be gatekeepers, but rather key holders. In collaborating across sectors and with communities we open doors for education, research, and the repatriation of culture and knowledge. We must, always, remember to open these doors wide: the call of Aboriginal Australians of ‘nothing about us without us’ is not an invitation to collaboration but an imperative. Libraries—as well as galleries, archives, and museums—cannot tell these stories alone. Also, these two case studies highlight what we believe to be one of the biggest mistakes that not just libraries but all cultural institutions are vulnerable to making, the assumption that just because a collection is open access it is also accessible. Digitisation projects are more valuable when communicated, contextualised and—essentially—the result of community consultation. Such work can, for some, be uncomfortable while for others it offers opportunities to embrace disruption and, by extension, opportunities to decolonise collections. For First Nations peoples this work can be more powerful than any simple measurement tool can record. Through examining our past collecting, deliberate efforts to consult, and through digital sharing projects across metropolitan and regional Australia, we can make meaningful differences to the ways in which Aboriginal Australians can, again, own their histories.Acknowledgements The authors acknowledge the Palawa peoples: the traditional custodians of the lands known today as Tasmania. The authors acknowledge, too, the Gadigal people upon whose lands this article was researched and written. We are indebted to Dana Kahabka (Conservator), Joy Lai (Imaging Specialist), Richard Neville (Mitchell Librarian), and Marika Duczynski (Project Officer) at the State Library of New South Wales. Sincere thanks are also given to Jason Ensor of Western Sydney University.ReferencesArthur, George. “Proclamation.” The Hobart Town Courier 19 Apr. 1828: 1.———. Proclamation to the Aborigines. Graphic Materials. Sydney: Mitchell Library, State Library of New South Wales, SAFE R / 247, ca. 1828–1830.Australian Museum. “Aboriginal Scarification.” 2018. 11 Jan. 2019 <https://australianmuseum.net.au/about/history/exhibitions/body-art/aboriginal-scarification/>.Brown, Molly. “Disruptive Technology: A Good Thing for Our Libraries?” International Librarians Network (2016). 26 Aug. 2018 <https://interlibnet.org/2016/11/25/disruptive-technology-a-good-thing-for-our-libraries/>.Carroll, Khadija von Zinnenburg. Art in the Time of Colony: Empires and the Making of the Modern World, 1650–2000. Farnham, UK: Ashgate Publishing, 2014.Clements, Nicholas. The Black War: Fear, Sex and Resistance in Tasmania. St Lucia, U of Queensland P, 2014.Crane, Ralph. “Introduction.” Friendly Mission: The Tasmanian Journals and Papers of George Augustus Robinson, 1829-1834. 2nd ed. Launceston and Hobart: Queen Victoria Museum and Art Gallery, and Quintus Publishing, 2008. ix.Darian-Smith, Kate, and Penelope Edmonds. “Conciliation on Colonial Frontiers.” Conciliation on Colonial Frontiers: Conflict, Performance and Commemoration in Australia and the Pacific Rim. Eds. Kate Darian-Smith and Penelope Edmonds. New York: Routledge, 2015. 1–14.Edmonds, Penelope. “‘Failing in Every Endeavour to Conciliate’: Governor Arthur’s Proclamation Boards to the Aborigines, Australian Conciliation Narratives and Their Transnational Connections.” Journal of Australian Studies 35.2 (2011): 201–18.Fiedler, Inge, and Michael A. Bayard. Artist Pigments, a Handbook of Their History and Characteristics. Ed. Robert L. Feller. Cambridge: Cambridge UP, 1986. 65–108. Franks, Rachel. “A True Crime Tale: Re-Imagining Governor Arthur’s Proclamation Board for the Tasmanian Aborigines.” M/C Journal 18.6 (2015). 1 Feb. 2019 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/1036>.Franks, Rachel, and Jason Ensor. “Challenging the Canon: Collaboration, Digitisation and Education.” ALIA Online: A Conference of the Australian Library and Information Association, 11–15 Feb. 2019, Sydney.Kahabka, Dana. Condition Assessment [Governor Arthur’s Proclamation to the Aborigines, ca. 1828–1830, SAFE / R247]. Sydney: State Library of New South Wales, 2017.Lehman, Greg. “Pleading Robinson: Reviews of Friendly Mission: The Tasmanian Journals and Papers of George Augustus Robinson (2008) and Reading Robinson: Companion Essays to Friendly Mission (2008).” Australian Humanities Review 49 (2010). 1 May 2019 <http://press-files.anu.edu.au/downloads/press/p41961/html/review-12.xhtml?referer=1294&page=15>. Morris, John. “Notes on A Message to the Tasmanian Aborigines in 1829, popularly called ‘Governor Davey’s Proclamation to the Aborigines, 1816’.” Australiana 10.3 (1988): 84–7.Pascoe, Bruce. Dark Emu. Broome: Magabala Books, 2014/2018.Plomley, N.J.B. Friendly Mission: The Tasmanian Journals and Papers of George Augustus Robinson, 1829–1834. Hobart: Tasmanian Historical Research Association, 1966.Robinson, George Augustus. Papers. Textual Records. Sydney: Mitchell Library, State Library of NSW, A 7023–A 7031, 1829–34. Thorpe, Kirsten, Monica Galassi, and Rachel Franks. “Discovering Indigenous Australian Culture: Building Trusted Engagement in Online Environments.” Journal of Web Librarianship 10.4 (2016): 343–63.

IntroductionThey shall grow not old, as we that are left grow old; Age shall not weary them, nor the years condemn. At the going down of the sun and in the morning We will remember them.Recited at many Anzac and Remembrance Day services, ‘The Ode’, an excerpt from a poem by Laurence Binyon, speaks of a timelessness within the inexorable march of time. When we memorialise those for whom time no longer matters, time stands still. Whether those who died in service of their country have finally “beaten time” or been forced to acknowledge that “their time on earth was up”, depends on your preference for clichés. Time and death are natural bedfellows. War memorials, be they physical or digital, declare a commitment to “remember them”. This article will compare and contrast the purpose of, and community response to, virtual and physical war memorials. It will examine whether virtual war memorials are a sign of the times – a natural response to the internet era. If, as Marshall McLuhan says, the medium is the message, what experiences do we gain and lose through online war memorials?Physical War MemorialsDuring and immediately after the First World War, physical war memorials were built in almost every city, town and village of the Allied countries involved in the war. They served many purposes. One of the roles of physical war memorials was to keep the impact of war at the centre of a town’s consciousness. In a regional centre like Bathurst, in New South Wales, the town appears to be built around the memorial – the court, council chambers, library, churches and pubs gather around the war memorials.Similarly, in small towns such as Bega, Picton and Kiama, war memorial arches form a gateway to the town centre. It is an architectural signal that you are entering a community that has known pain, death and immense loss. Time has passed, but the names of the men and women who served remain etched in stone: “lest we forget”.The names are listed in a democratic fashion: usually in alphabetical order without their rank. However, including all those who offered their service to “God, King and Country” (not just those who died) also had a more sinister and divisive effect. It reminded communities of those “eligibles” in their midst whom some regarded as “shirkers”, even if they were conscientious objectors or needed to stay and continue vital industries, like farming (Inglis & Phillips 186).Ken Inglis (97) estimated that every second Australian family was in mourning after the Great War. Jay Winter (Sites 2) goes further arguing that “almost every family” in the British Commonwealth was grieving, either for a relative; or for a friend, work colleague, neighbour or lover. Nations were traumatised. Physical war memorials provided a focal point for that universal grief. They signalled, through their prominence in the landscape or dominance of a hilltop, that it was acceptable to grieve. Mourners were encouraged to gather around the memorial in a public place, particularly on Anzac Day and Remembrance Day each year. Grief was seen, observed, respected.Such was the industrial carnage of the Western Front, that about one third of Australia and New Zealand’s fatal casualties were not brought home. Families lost a family member, body and soul, in the Great War. For those people who subscribed to a Victorian view of death, who needed a body to grieve over, the war memorial took on the role of a gravesite and became a place where people would place a sprig of wattle, poke a poppy into the crevice beside a name, or simply touch the letters etched or embossed in the stone (Winter, Experience 206). As Ken Inglis states: “the statue on its pedestal does stand for each dead man whose body, identified or missing, intact or dispersed, had not been returned” to his home town (11).Physical war memorials were also a place where women could forge new identities over time. Women accepted, or claimed their status as war widows, grieving mothers or bereft fiancés, while at the same time coming to terms with their loss. As Joy Damousi writes: “mourning of wartime loss involved a process of sustaining both a continuity with, and a detachment from, a lost soldier” (1). Thus, physical war memorials were transitional, liminal spaces.Jay Winter (Sites 85) believes that physical war memorials were places to both honour and mourn the dead, wounded, missing and shell-shocked. These dual functions of both esteeming and grieving those who served was reinforced at ceremonies, such as Anzac or Remembrance Day.As Joy Damousi (156) and Ken Inglis (457, 463) point out, war memorials in Australia are rarely sites of protest, either for war widows or veterans campaigning for a better pension, or peace activists who opposed militarism. When they are used in this way, it makes headlines in the news (Legge). They are seldom used to highlight the tragedy, inhumanity or futility of war. The exception to this, were the protests against the Vietnam War.The physical war memorials which mushroomed in Australian country towns and cities after the First World War captured and claimed those cataclysmic four years for the families and communities who were devastated by the war. They provided a place to both honour and mourn those who served, not just once, but for as long as the memorial remained. They were also a place of pilgrimage, particularly for families who did not have a grave to visit and a focal point for the annual rituals of remembrance.However, over the past 100 years, some unmaintained physical war memorials are beginning to look like untended graves. They have become obstacles rather than sentinels in the landscape. Laurence Aberhart’s haunting photographs show that memorials in places like Dorrigo in rural New South Wales “go largely unnoticed year-round, encroached on by street signage and suburbia” (Lakin 49). Have physical war memorials largely fulfilled their purpose and are they becoming obsolete? Perhaps they have been supplanted by the gathering space of the 21st century: the Internet.Digital War MemorialsThe centenary of the Great War heralded a mushrooming of virtual war memorials. Online First World War memorials focus on collecting and amassing information that commemorates individuals. They are able to include far more information than will fit on a physical war memorial. They encourage users to search the digitised records that are available on the site and create profiles of people who served. While they deal in records from the past, they are very much about the present: the user experience and their connection to their ancestors who served.The Imperial War Museum’s website Lives of the First World War asks users to “help us build the permanent digital memorial to all who contributed during the First World War”. This request deserves scrutiny. Firstly, “permanent” – is this possible in the digital age? When the head of Google, Vint Cerf, disclosed in 2015 that software programming wizards were still grappling with how to create digital formats that can be accessed in 10, 100 or a 1000 years’ time; and recommended that we print out our precious digital data and store it in hard copy or risk losing it forever; then it appears that online permanency is a mirage.Secondly, “all who contributed” – the website administrators informed me that “all” currently includes people who served with Canada and Britain but the intention is to include other Commonwealth nations. It seems that the former British Empire “owns” the First World War – non-allied, non-Commonwealth nations that contributed to the First World War will not be included. One hundred years on, have we really made peace with Germany and Turkey? The armistice has not yet spread to the digital war memorial. The Lives of the First world War website missed an opportunity to be leaders in online trans-national memorialisation.Discovering Anzacs, a website built by the National Archives of Australia and Archives New Zealand, is a little more subdued and honest, as visitors are invited to “enhance a profile dedicated to the wartime journey of someone who served”.Physical and online war memorials can work in tandem. In 2015, the Supreme Court of Victoria created a website that provides background information on the military service of the 159 members of the legal profession who are named on their Memorial board. This is an excellent example of a digital medium expanding on and reinvigorating a physical memorial.It is noteworthy that all of these online memorial websites commemorate those who served in the First World War, and sometimes the Boer or South African War. There is no space for remembering those who served or died in more recent wars like Afghanistan or Iraq. James Brown and others discuss how the cult of Anzac is overshadowing the service and sacrifices of the men and women who have been to more recent wars. The proximity of their service mitigates against its recognition – it is too close for comfortable, detached remembrance.Complementary But Not ExclusiveA comparison of their functions indicates that online memorials which focus on the First World War complement, but will never replace the role of physical war memorials. As discussed, physical war memorials were sites for grieving, pilgrimage and collectively honouring the men and women who served and died. Online websites which allow users to upload scanned documents and photographs; transcribe diary entries or letters; post tribute poems, songs or video clips; and provide links to other relevant records online are neither places of pilgrimage nor sites for grieving. They are about remembrance, not memory (Scates, “Finding” 221).Ken Inglis describes physical war memorials as “bearers of collective memory” (7). In a sense, online war memorials are keepers of individual, user-enhanced archival records. It can be argued that online memorials to the First World War tap into the desire for hero-worship, the boom in family history research and what Scates calls the “cult of remembrance” (“Finding” 218). They provide a way for individuals, often two or three generations removed, to discover, understand and document the wartime experiences of individuals in their family. By allowing descendants to situate their family story within the larger, historically significant narrative of the First World War, online memorials encourage people to feel that the suffering and untimely death of their forbear wasn’t in vain – that it contributed to something worthwhile and worth remembering. At a collective level, this contributes to the ANZAC myth and former Australian Prime Minister John Howard’s attempt to use it as a foundational myth for Australia’s nationhood.Kylie Veale (9) argues that cyberspace has encouraged improvements on traditional memorial practices because online memorials can be created in a more timely fashion, they are more affordable and they are accessible and enable the sharing of grief and bereavement on a global scale. As evidence of this, an enterprising group in the USA has developed an android app which provides a template for creating an online memorial. They compete with Memorialsonline.com. Veale’s arguments remind us that the Internet is a hyper-democratic space where interactions and sites that are collaborative or contemplative exist alongside trolling and prejudice. Veale also contends that memorial websites facilitate digital immortality, which helps keep the memory of the deceased alive. However, given the impermanence of much of the content on the Internet, this final attribute is a bold claim.It is interesting to compare the way individual soldiers are remembered prior to and after the arrival of the Internet. Now that it is possible to create a tribute website, or Facebook page in memory of someone who served, do families do this instead of creating large physical scrapbooks or photo albums? Or do they do both? Garry Roberts created a ‘mourning diary’ as a record of his journey of agonising grief for his eldest son who died in 1918. His diary consists of 27 scrapbooks, weighing 10 kilograms in total. Pat Jalland (318) suggests this helped Roberts to create some sort of order out of his emotional turmoil. Similarly, building websites or digital tribute pages can help friends and relatives through the grieving process. They can also contribute the service person’s story to official websites such as those managed by the Australian Defence Forces. Do grieving family members look up a website or tribute page they’ve created in the same way that they might open up a scrapbook and remind themselves of their loved one? Kylie Veale’s research into online memorials created for anyone who has died, not necessarily those killed by war, suggests online memorials are used in this way (5).Do grieving relatives take comfort from the number of likes, tags or comments on a memorial or tribute website, in the same way that they might feel supported by the number of people who attend a memorial service or send a condolence card? Do they archive the comments? Garry Roberts kept copies of the letters of sympathy and condolence that he received from friends and relatives after his son’s tragic death and added them to his 27 scrapbooks.Both onsite and online memorials can suffer from lack of maintenance and relevance. Memorial websites can become moribund like untended headstones in a graveyard. Once they have passed their use as a focal point of grief, a place to post tributes; they can languish, un-updated and un-commented on.Memorials and PilgrimageOne thing that online memorials will never be, however, are sites of pilgrimage or ritual. One does not need to set out on a journey to visit an online memorial. It is as far away as your portable electronic device. Online memorials cannot provide the closure or sense of identity and community that comes from visiting a memorial or gravesite.This was evident in December 2014 when people felt the need to visit the Lindt Café in Sydney’s Martin Place after the terrorist siege and lay flowers and tributes. While there were also Facebook tribute pages set up for these victims of violence, mourners still felt the need to visit the sites. A permanent memorial to the victims of the siege has now opened in Martin Place.Do people gather around a memorial website for the annual rituals which take place on Anzac or Remembrance Day, or the anniversaries of significant battles? In 2013, the Australian War Memorial (AWM) saw a spike in people logging onto the Memorial’s Remembrance Day web page just prior to 11am. They left the site immediately after the minute’s silence. The AWM web team think they were looking for a live broadcast of the Remembrance Day service in Canberra. When that wasn’t available online, they chose to stay on the site until after the minute’s silence. Perhaps this helped them to focus on the reason for Remembrance Day. Perhaps, as Internet speeds get faster, it will be possible to conduct your own virtual ceremony in real time with friends and family in cyberspace.However, I cannot imagine a time when visiting dignitaries from other countries will post virtual wreaths to virtual war memorials. Ken Inglis argues that the tomb of the Unknown Soldier in the AWM has become the ritual centre of the Australian nation, “receiving obligatory wreaths from every visiting head of state” (459).Physical and Online Memorials to the War in AfghanistanThere are only eight physical war memorials to the Afghanistan conflict in Australia, even though this is the longest war Australia has been involved in to date (2001-2015). Does the lack of physical memorials to the war in Afghanistan mean that our communities no longer need them, and that people are memorialising online instead?One grieving father in far north Queensland certainly felt that an online memorial would never suffice. Gordon Chuck’s son, Private Benjamin Chuck, was killed in a Black Hawk helicopter crash in Afghanistan in 2010 when he was only 27 years old. Spurred by his son’s premature death, Gordon Chuck rallied family, community and government support, in the tiny hinterland town of Yungaburra, west of Cairns in Queensland, to establish an Avenue of Honour. He knocked on the doors of local businesses, the Returned Servicemen’s League (RSL), the Australian Defence Forces and every level of government to raise $300,000. His intention was to create a timeless memorial of world standard and national significance. On 21 June 2013, the third anniversary of his son’s death, the Chief of the Defence Force and the Prime Minister formally opened the Avenue of Honour in front of “thousands” of people (Nancarrow).Diggers from Afghanistan who have visited the Yungaburra Avenue of Honour speak of the closure and sense of healing it gave them (Nancarrow). The Avenue, built on the shores of Lake Tinaroo, features parallel rows of Illawarra flame trees, whose red blossoms are in full bloom around Remembrance Day and symbolise the blood and fire of war and the cycle of life. It commemorates all the Australian soldiers who have died in the Afghanistan war.The Avenue of Honour, and the memorial in Martin Place clearly demonstrate that physical war memorials are not redundant. They are needed and cherished as sites of grief, hope and commemoration. The rituals conducted there gather gravitas from the solemnity that falls when a sea of people is silent and they provide healing through the comfort of reverent strangers.ConclusionEven though we live in an era when most of us are online every day of our lives, it is unlikely that virtual war memorials will ever supplant their physical forebears. When it comes to commemorating the First World War or contemporary conflicts and those who fought or died in them, physical and virtual war memorials can be complementary but they fulfil fundamentally different roles. Because of their medium as virtual memorials, they will never fulfil the human need for a place of remembrance in the real world.ReferencesBinyon, Laurence. “For the Fallen.” The Times. 21 Sep. 1914. 7 Oct. 2019 <https://www.army.gov.au/our-history/traditions/for-the-fallen>.Brown, James. Anzac’s Long Shadow. Sydney: Black Inc., 2014.Damousi, Joy. The Labour of Loss. Great Britain: Cambridge UP, 1999.Hunter, Kathryn. “States of Mind: Remembering the Australian-New Zealand Relationship.” Journal of the Australian War Memorial 36 (2002). 7 Oct. 2019 <https://www.awm.gov.au/articles/journal/j36/nzmemorial>.Inglis, Ken. Sacred Places: War Memorials in the Australian Landscape. Melbourne: Melbourne UP, 1998.Inglis, Ken, and Jock Phillips. “War Memorials in Australia and New Zealand: A Comparative Survey.” Australian Historical Studies 24.96 (1991): 179-191.Jalland, Pat. Australian Ways of Death: A Social and Cultural History 1840-1918. London: Oxford University Press, 2002.Knapton, Sarah. “Print Out Digital Photos or Risk Losing Them, Google Boss Warns.” Telegraph 13 Feb. 2015. 7 Oct. 2019 <http://www.telegraph.co.uk/news/science/science-news/11410506/Print-out-digital-photos-or-risk-losing-them-Google-boss-warns.html>.Lakin, Shaune. “Laurence Aberhart ANZAC.” Artlink 35.1 (2015): 48-51.Legge, James. “Vandals Deface Two London War Memorials with ‘Islam’ Graffiti”. Independent 27 May 2013. 7 Oct. 2019 <https://www.independent.co.uk/news/uk/crime/vandals-deface-two-london-war-memorials-with-islam-graffiti-8633386.html>.Luckins, Tanya. The Gates of Memory. Fremantle, WA: Curtin University Books, 2004.McLuhan, Marshall. Understating Media: The Extensions of Man. New York: Mentor, 1964.McPhedran, Ian. “Families of Dead Soldiers Angered after Defence Chief David Hurley Donates Memorial Plinth to Avenue of Honour.” Cairns Post 7 June 2014. 7 Oct. 2019 <http://www.cairnspost.com.au/news/cairns/families-of-dead-soldiers-angered-after-defence-chief-david-hurley-donates-memorial-plinth-to-avenue-of-honour/story-fnjpusyw-1226946540125>.McPhedran, Ian. “Backflip over Donation of Memorial Stone from Afghanistan to Avenue of Honour at Yungaburra.” Cairns Post 11 June 2014. 7 Oct. 2019 <http://www.cairnspost.com.au/news/cairns/backflip-over-donation-of-memorial-stone-from-afghanistan-to-avenue-of-honour-at-yungaburra/story-fnkxmm0j-1226950508126>.Ministry for Culture and Heritage. “Interpreting First World War Memorials.” Updated 4 Sep. 2014. <http://www.nzhistory.net.nz/war/interpreting-first-world-war-memorials>.Nancarrow, Kirsty. “Thousands Attend Opening of Avenue of Honour, a Memorial to Diggers Killed in Afghanistan”. ABC News 7 Nov. 2014. 2 Oct. 2014 <http://www.abc.net.au/news/2013-06-22/avenue-of-honour-remembers-fallen-diggers/4773592>.Scates, Bruce. “Finding the Missing of Fromelles: When Soldiers Return.” Anzac Legacies: Australians and the Aftermath of War. Eds. Martin Crotty and Marina Larsson. Melbourne: Australian Scholarly Publishing, 2010. 212-231.Scates, Bruce. “Soldiers’ Journeys: Returning to the Battlefields of the Great War.” Journal of the Australian War Memorial 40 (2007): n.p.Scott, Ernest. Australia during the War: The Official History of Australia in the War of 1914–1918. Vol. XI. Sydney: Angus and Robertson, 1941.Stanley, Peter. “Ten Kilos of First World War Grief at the Melbourne Museum.” The Conversation 27 Aug. 2014. 10 Oct. 2019 <https://theconversation.com/ten-kilos-of-first-world-war-grief-at-the-melbourne-museum-30362>.Veale, Kylie. “Online Memorialisation: The Web as a Collective Memorial Landscape for Remembering the Dead.” Fibreculture Journal 3 (2004). 7 Oct. 2019 <http://three.fibreculturejournal.org/fcj-014-online-memorialisation-the-web-as-a-collective-memorial-landscape-for-remembering-the-dead/>.Winter, Jay. Sites of Memory, Sites of Mourning. Cambrigde: Cambridge UP, 1995.———. The Experience of World War I. London: Macmillan, 1988.

At one point in Victor Hugo’s novel, The Hunchback of Notre Dame, the archdeacon, Claude Frollo, looked up from a book on his table to the edifice of the gothic cathedral, visible from his canon’s cell in the cloister of Notre Dame: “Alas!” he said, “this will kill that” (146). Frollo’s lament, that the book would destroy the edifice, captures the medieval cleric’s anxiety about the way in which Gutenberg’s print technology would become the new universal means for recording and communicating humanity’s ideas and artistic expression, replacing the grand monuments of architecture, human engineering, and craftsmanship. For Hugo, architecture was “the great handwriting of humankind” (149). The cathedral as the material outcome of human technology was being replaced by the first great machine—the printing press. At this point in the third millennium, some people undoubtedly have similar anxieties to Frollo: is it now the book’s turn to be destroyed by yet another great machine? The inclusion of “post print” in our title is not intended to sound the death knell of the book. Rather, we contend that despite the enduring value of print, digital publishing is “present and active” and is changing the way in which research, particularly in the humanities, is being undertaken. Our approach has three related parts. First, we consider how digital technologies are changing the way in which content is constructed, customised, modified, disseminated, and accessed within a global, distributed network. This section argues that the transition from print to electronic or digital publishing means both losses and gains, particularly with respect to shifts in our approaches to textuality, information, and innovative publishing. Second, we discuss the Children’s Literature Digital Resources (CLDR) project, with which we are involved. This case study of a digitising initiative opens out the transformative possibilities and challenges of digital publishing and e-scholarship for research communities. Third, we reflect on technology’s capacity to bring about major changes in the light of the theoretical and practical issues that have arisen from our discussion. I. Digitising in a “post-print age” We are living in an era that is commonly referred to as “the late age of print” (see Kho) or the “post-print age” (see Gunkel). According to Aarseth, we have reached a point whereby nearly all of our public and personal media have become more or less digital (37). As Kho notes, web newspapers are not only becoming increasingly more popular, but they are also making rather than losing money, and paper-based newspapers are finding it difficult to recruit new readers from the younger generations (37). Not only can such online-only publications update format, content, and structure more economically than print-based publications, but their wide distribution network, speed, and flexibility attract advertising revenue. Hype and hyperbole aside, publishers are not so much discarding their legacy of print, but recognising the folly of not embracing innovative technologies that can add value by presenting information in ways that satisfy users’ needs for content to-go or for edutainment. As Kho notes: “no longer able to satisfy customer demand by producing print-only products, or even by enabling online access to semi-static content, established publishers are embracing new models for publishing, web-style” (42). Advocates of online publishing contend that the major benefits of online publishing over print technology are that it is faster, more economical, and more interactive. However, as Hovav and Gray caution, “e-publishing also involves risks, hidden costs, and trade-offs” (79). The specific focus for these authors is e-journal publishing and they contend that while cost reduction is in editing, production and distribution, if the journal is not open access, then costs relating to storage and bandwith will be transferred to the user. If we put economics aside for the moment, the transition from print to electronic text (e-text), especially with electronic literary works, brings additional considerations, particularly in their ability to make available different reading strategies to print, such as “animation, rollovers, screen design, navigation strategies, and so on” (Hayles 38). Transition from print to e-text In his book, Writing Space, David Bolter follows Victor Hugo’s lead, but does not ask if print technology will be destroyed. Rather, he argues that “the idea and ideal of the book will change: print will no longer define the organization and presentation of knowledge, as it has for the past five centuries” (2). As Hayles noted above, one significant indicator of this change, which is a consequence of the shift from analogue to digital, is the addition of graphical, audio, visual, sonic, and kinetic elements to the written word. A significant consequence of this transition is the reinvention of the book in a networked environment. Unlike the printed book, the networked book is not bound by space and time. Rather, it is an evolving entity within an ecology of readers, authors, and texts. The Web 2.0 platform has enabled more experimentation with blending of digital technology and traditional writing, particularly in the use of blogs, which have spawned blogwriting and the wikinovel. Siva Vaidhyanathan’s The Googlization of Everything: How One Company is Disrupting Culture, Commerce and Community … and Why We Should Worry is a wikinovel or blog book that was produced over a series of weeks with contributions from other bloggers (see: http://www.sivacracy.net/). Penguin Books, in collaboration with a media company, “Six Stories to Start,” have developed six stories—“We Tell Stories,” which involve different forms of interactivity from users through blog entries, Twitter text messages, an interactive google map, and other features. For example, the story titled “Fairy Tales” allows users to customise the story using their own choice of names for characters and descriptions of character traits. Each story is loosely based on a classic story and links take users to synopses of these original stories and their authors and to online purchase of the texts through the Penguin Books sales website. These examples of digital stories are a small part of the digital environment, which exploits computer and online technologies’ capacity to be interactive and immersive. As Janet Murray notes, the interactive qualities of digital environments are characterised by their procedural and participatory abilities, while their immersive qualities are characterised by their spatial and encyclopedic dimensions (71–89). These immersive and interactive qualities highlight different ways of reading texts, which entail different embodied and cognitive functions from those that reading print texts requires. As Hayles argues: the advent of electronic textuality presents us with an unparalleled opportunity to reformulate fundamental ideas about texts and, in the process, to see print as well as electronic texts with fresh eyes (89–90). The transition to e-text also highlights how digitality is changing all aspects of everyday life both inside and outside the academy. Online teaching and e-research Another aspect of the commercial arm of publishing that is impacting on academe and other organisations is the digitising and indexing of print content for niche distribution. Kho offers the example of the Mark Logic Corporation, which uses its XML content platform to repurpose content, create new content, and distribute this content through multiple portals. As the promotional website video for Mark Logic explains, academics can use this service to customise their own textbooks for students by including only articles and book chapters that are relevant to their subject. These are then organised, bound, and distributed by Mark Logic for sale to students at a cost that is generally cheaper than most textbooks. A further example of how print and digital materials can form an integrated, customised source for teachers and students is eFictions (Trimmer, Jennings, & Patterson). eFictions was one of the first print and online short story anthologies that teachers of literature could customise to their own needs. Produced as both a print text collection and a website, eFictions offers popular short stories in English by well-known traditional and contemporary writers from the US, Australia, New Zealand, UK, and Europe, with summaries, notes on literary features, author biographies, and, in one instance, a YouTube movie of the story. In using the eFictions website, teachers can build a customised anthology of traditional and innovative stories to suit their teaching preferences. These examples provide useful indicators of how content is constructed, customised, modified, disseminated, and accessed within a distributed network. However, the question remains as to how to measure their impact and outcomes within teaching and learning communities. As Harley suggests in her study on the use and users of digital resources in the humanities and social sciences, several factors warrant attention, such as personal teaching style, philosophy, and specific disciplinary requirements. However, in terms of understanding the benefits of digital resources for teaching and learning, Harley notes that few providers in her sample had developed any plans to evaluate use and users in a systematic way. In addition to the problems raised in Harley’s study, another relates to how researchers can be supported to take full advantage of digital technologies for e-research. The transformation brought about by information and communication technologies extends and broadens the impact of research, by making its outputs more discoverable and usable by other researchers, and its benefits more available to industry, governments, and the wider community. Traditional repositories of knowledge and information, such as libraries, are juggling the space demands of books and computer hardware alongside increasing reader demand for anywhere, anytime, anyplace access to information. Researchers’ expectations about online access to journals, eprints, bibliographic data, and the views of others through wikis, blogs, and associated social and information networking sites such as YouTube compete with the traditional expectations of the institutions that fund libraries for paper-based archives and book repositories. While university libraries are finding it increasingly difficult to purchase all hardcover books relevant to numerous and varied disciplines, a significant proportion of their budgets goes towards digital repositories (e.g., STORS), indexes, and other resources, such as full-text electronic specialised and multidisciplinary journal databases (e.g., Project Muse and Proquest); electronic serials; e-books; and specialised information sources through fast (online) document delivery services. An area that is becoming increasingly significant for those working in the humanities is the digitising of historical and cultural texts. II. Bringing back the dead: The CLDR project The CLDR project is led by researchers and librarians at the Queensland University of Technology, in collaboration with Deakin University, University of Sydney, and members of the AustLit team at The University of Queensland. The CLDR project is a “Research Community” of the electronic bibliographic database AustLit: The Australian Literature Resource, which is working towards the goal of providing a complete bibliographic record of the nation’s literature. AustLit offers users with a single entry point to enhanced scholarly resources on Australian writers, their works, and other aspects of Australian literary culture and activities. AustLit and its Research Communities are supported by grants from the Australian Research Council and financial and in-kind contributions from a consortium of Australian universities, and by other external funding sources such as the National Collaborative Research Infrastructure Strategy. Like other more extensive digitisation projects, such as Project Gutenberg and the Rosetta Project, the CLDR project aims to provide a centralised access point for digital surrogates of early published works of Australian children’s literature, with access pathways to existing resources. The first stage of the CLDR project is to provide access to digitised, full-text, out-of-copyright Australian children’s literature from European settlement to 1945, with selected digitised critical works relevant to the field. Texts comprise a range of genres, including poetry, drama, and narrative for young readers and picture books, songs, and rhymes for infants. Currently, a selection of 75 e-texts and digital scans of original texts from Project Gutenberg and Internet Archive have been linked to the Children’s Literature Research Community. By the end of 2009, the CLDR will have digitised approximately 1000 literary texts and a significant number of critical works. Stage II and subsequent development will involve digitisation of selected texts from 1945 onwards. A precursor to the CLDR project has been undertaken by Deakin University in collaboration with the State Library of Victoria, whereby a digital bibliographic index comprising Victorian School Readers has been completed with plans for full-text digital surrogates of a selection of these texts. These texts provide valuable insights into citizenship, identity, and values formation from the 1930s onwards. At the time of writing, the CLDR is at an early stage of development. An extensive survey of out-of-copyright texts has been completed and the digitisation of these resources is about to commence. The project plans to make rich content searchable, allowing scholars from children’s literature studies and education to benefit from the many advantages of online scholarship. What digital publishing and associated digital archives, electronic texts, hypermedia, and so forth foreground is the fact that writers, readers, publishers, programmers, designers, critics, booksellers, teachers, and copyright laws operate within a context that is highly mediated by technology. In his article on large-scale digitisation projects carried out by Cornell and University of Michigan with the Making of America collection of 19th-century American serials and monographs, Hirtle notes that when special collections’ materials are available via the Web, with appropriate metadata and software, then they can “increase use of the material, contribute to new forms of research, and attract new users to the material” (44). Furthermore, Hirtle contends that despite the poor ergonomics associated with most electronic displays and e-book readers, “people will, when given the opportunity, consult an electronic text over the print original” (46). If this preference is universally accurate, especially for researchers and students, then it follows that not only will the preference for electronic surrogates of original material increase, but preference for other kinds of electronic texts will also increase. It is with this preference for electronic resources in mind that we approached the field of children’s literature in Australia and asked questions about how future generations of researchers would prefer to work. If electronic texts become the reference of choice for primary as well as secondary sources, then it seems sensible to assume that researchers would prefer to sit at the end of the keyboard than to travel considerable distances at considerable cost to access paper-based print texts in distant libraries and archives. We considered the best means for providing access to digitised primary and secondary, full text material, and digital pathways to existing online resources, particularly an extensive indexing and bibliographic database. Prior to the commencement of the CLDR project, AustLit had already indexed an extensive number of children’s literature. Challenges and dilemmas The CLDR project, even in its early stages of development, has encountered a number of challenges and dilemmas that centre on access, copyright, economic capital, and practical aspects of digitisation, and sustainability. These issues have relevance for digital publishing and e-research. A decision is yet to be made as to whether the digital texts in CLDR will be available on open or closed/tolled access. The preference is for open access. As Hayles argues, copyright is more than a legal basis for intellectual property, as it also entails ideas about authorship, creativity, and the work as an “immaterial mental construct” that goes “beyond the paper, binding, or ink” (144). Seeking copyright permission is therefore only part of the issue. Determining how the item will be accessed is a further matter, particularly as future technologies may impact upon how a digital item is used. In the case of e-journals, the issue of copyright payment structures are evolving towards a collective licensing system, pay-per-view, and other combinations of print and electronic subscription (see Hovav and Gray). For research purposes, digitisation of items for CLDR is not simply a scan and deliver process. Rather it is one that needs to ensure that the best quality is provided and that the item is both accessible and usable by researchers, and sustainable for future researchers. Sustainability is an important consideration and provides a challenge for institutions that host projects such as CLDR. Therefore, items need to be scanned to a high quality and this requires an expensive scanner and personnel costs. Files need to be in a variety of formats for preservation purposes and so that they may be manipulated to be useable in different technologies (for example, Archival Tiff, Tiff, Jpeg, PDF, HTML). Hovav and Gray warn that when technology becomes obsolete, then content becomes unreadable unless backward integration is maintained. The CLDR items will be annotatable given AustLit’s NeAt funded project: Aus-e-Lit. The Aus-e-Lit project will extend and enhance the existing AustLit web portal with data integration and search services, empirical reporting services, collaborative annotation services, and compound object authoring, editing, and publishing services. For users to be able to get the most out of a digital item, it needs to be searchable, either through double keying or OCR (optimal character recognition). The value of CLDR’s contribution The value of the CLDR project lies in its goal to provide a comprehensive, searchable body of texts (fictional and critical) to researchers across the humanities and social sciences. Other projects seem to be intent on putting up as many items as possible to be considered as a first resort for online texts. CLDR is more specific and is not interested in simply generating a presence on the Web. Rather, it is research driven both in its design and implementation, and in its focussed outcomes of assisting academics and students primarily in their e-research endeavours. To this end, we have concentrated on the following: an extensive survey of appropriate texts; best models for file location, distribution, and use; and high standards of digitising protocols. These issues that relate to data storage, digitisation, collections, management, and end-users of data are aligned with the “Development of an Australian Research Data Strategy” outlined in An Australian e-Research Strategy and Implementation Framework (2006). CLDR is not designed to simply replicate resources, as it has a distinct focus, audience, and research potential. In addition, it looks at resources that may be forgotten or are no longer available in reproduction by current publishing companies. Thus, the aim of CLDR is to preserve both the time and a period of Australian history and literary culture. It will also provide users with an accessible repository of rare and early texts written for children. III. Future directions It is now commonplace to recognize that the Web’s role as information provider has changed over the past decade. New forms of “collective intelligence” or “distributed cognition” (Oblinger and Lombardi) are emerging within and outside formal research communities. Technology’s capacity to initiate major cultural, social, educational, economic, political and commercial shifts has conditioned us to expect the “next big thing.” We have learnt to adapt swiftly to the many challenges that online technologies have presented, and we have reaped the benefits. As the examples in this discussion have highlighted, the changes in online publishing and digitisation have provided many material, network, pedagogical, and research possibilities: we teach online units providing students with access to e-journals, e-books, and customized archives of digitised materials; we communicate via various online technologies; we attend virtual conferences; and we participate in e-research through a global, digital network. In other words, technology is deeply engrained in our everyday lives. In returning to Frollo’s concern that the book would destroy architecture, Umberto Eco offers a placatory note: “in the history of culture it has never happened that something has simply killed something else. Something has profoundly changed something else” (n. pag.). Eco’s point has relevance to our discussion of digital publishing. The transition from print to digital necessitates a profound change that impacts on the ways we read, write, and research. As we have illustrated with our case study of the CLDR project, the move to creating digitised texts of print literature needs to be considered within a dynamic network of multiple causalities, emergent technological processes, and complex negotiations through which digital texts are created, stored, disseminated, and used. Technological changes in just the past five years have, in many ways, created an expectation in the minds of people that the future is no longer some distant time from the present. Rather, as our title suggests, the future is both present and active. References Aarseth, Espen. “How we became Postdigital: From Cyberstudies to Game Studies.” Critical Cyber-culture Studies. Ed. David Silver and Adrienne Massanari. New York: New York UP, 2006. 37–46. An Australian e-Research Strategy and Implementation Framework: Final Report of the e-Research Coordinating Committee. Commonwealth of Australia, 2006. Bolter, Jay David. Writing Space: The Computer, Hypertext, and the History of Writing. Hillsdale, NJ: Erlbaum, 1991. Eco, Umberto. “The Future of the Book.” 1994. 3 June 2008 ‹http://www.themodernword.com/eco/eco_future_of_book.html>. Gunkel, David. J. “What's the Matter with Books?” Configurations 11.3 (2003): 277–303. Harley, Diane. “Use and Users of Digital Resources: A Focus on Undergraduate Education in the Humanities and Social Sciences.” Research and Occasional Papers Series. Berkeley: University of California. Centre for Studies in Higher Education. 12 June 2008 ‹http://www.themodernword.com/eco/eco_future_of_book.html>. Hayles, N. Katherine. My Mother was a Computer: Digital Subjects and Literary Texts. Chicago: U of Chicago P, 2005. Hirtle, Peter B. “The Impact of Digitization on Special Collections in Libraries.” Libraries & Culture 37.1 (2002): 42–52. Hovav, Anat and Paul Gray. “Managing Academic E-journals.” Communications of the ACM 47.4 (2004): 79–82. Hugo, Victor. The Hunchback of Notre Dame (Notre-Dame de Paris). Ware, Hertfordshire: Wordsworth editions, 1993. Kho, Nancy D. “The Medium Gets the Message: Post-Print Publishing Models.” EContent 30.6 (2007): 42–48. Oblinger, Diana and Marilyn Lombardi. “Common Knowledge: Openness in Higher Education.” Opening up Education: The Collective Advancement of Education Through Open Technology, Open Content and Open Knowledge. Ed. Toru Liyoshi and M. S. Vijay Kumar. Cambridge, MA: MIT Press, 2007. 389–400. Murray, Janet H. Hamlet on the Holodeck: The Future of Narrative in Cyberspace. Cambridge, MA: MIT Press, 2001. Trimmer, Joseph F., Wade Jennings, and Annette Patterson. eFictions. New York: Harcourt, 2001.

On 19 January 1975, Australia’s first youth station 2JJ (Double Jay) launched itself onto the nation’s airwaves with a NASA-style countdown and You Only Like Me ‘Cause I’m Good in Bed by Australian band Skyhooks. Refused airtime by the commercial stations because of its explicit sexual content, this song was a clear signifier of the new station’s intent—to occupy a more radical territory on Australian radio. Indeed, Double Jay’s musical entrée into the highly restrictive local broadcasting environment of the time has gone on to symbolise both the station’s role in its early days as an enfant terrible of radio (Inglis 376), and its near 40 years as a voice for youth culture in Australia (Milesago, Double Jay). In this paper we explore the proposition that Double Jay functioned as an outlet for youth counterculture in Australia, and that it achieved this even with (and arguably because of) its credentials as a state-generated entity. This proposition is considered via brief analysis of the political and musical context leading to the establishment of Double Jay. We intend to demonstrate that although the station was deeply embedded in “the system” in material and cultural terms, it simultaneously existed in an “uneasy symbiosis” (Martin and Siehl 54) with this system because it consciously railed against the mainstream cultures from which it drew, providing a public and active vehicle for youth counterculture in Australia. The origins of Double Jay thus provide one example of the complicated relationship between culture and counterculture, and the multiple ways in which the two are inextricably linked. As a publicly-funded broadcasting station Double Jay was liberated from the industrial imperatives of Australia’s commercial stations which arguably drove their predisposition for formula. The absence of profit motive gave Double Jay’s organisers greater room to experiment with format and content, and thus the potential to create a genuine alternative in Australia broadcasting. As a youth station Double Jay was created to provide a minority with its own outlet. The Labor government committed to wrenching airspace from the very restrictive Australian broadcasting “system” (Wiltshire and Stokes 2) to provide minority voices with room to speak and to be heard. Youth was identified by the government as one such minority. The Australian Broadcasting Commission (ABC) contributed to this process by enabling young staffers to establish the semi-independent Contemporary Radio Unit (CRU) (Webb) and within this a youth station. Not only did this provide a focal point around which a youth collective could coalesce, but the distinct place and identity of Double Jay within the ABC offered its organisers the opportunity to ignore or indeed subvert some of the perceived strictures of the “mothership” that was the ABC, whether in organisational, content and/or stylistic terms. For these and other reasons Double Jay was arguably well positioned to counter the broadcasting cultures that existed alongside this station. It did so stylistically, and also in more fundamental ways, At the same time, however, it “pillaged the host body at random” (Webb) co-opting certain aspects of these cultures (people, scheduling, content, administration) which in turn implicated Double Jay in the material and cultural practices of those mainstream cultures against which it railed. Counterculture on the Airwaves: Space for Youth to Play? Before exploring these themes further, we should make clear that Double Jay’s legitimacy as a “counterculture” organisation is observably tenuous against the more extreme renderings of the concept. Theodore Roszak, for example, requires of counterculture something “so radically disaffiliated from the mainstream assumptions of our society that it scarcely looks to many as a culture at all” (5). Double Jay was a brainchild of the state: an outcome of the Whitlam Government’s efforts to open up the nation’s airwaves (Davis, Government; McClelland). Further, the supervision of this station was given to the publicly funded Australian national broadcaster, the ABC (Inglis). Any claim Double Jay has to counterculture status then is arguably located in less radical invocations of the term. Some definitions, for example, hold that counterculture contains value systems that run counter to culture, but these values are relational rather than divorced from each other. Kenneth Leech, for example, states that counterculture is "a way of life and philosophy which at central points is in conflict with the mainstream society” (Desmond et al. 245, our emphasis); E.D. Batzell defines counterculture as "a minority culture marked by a set of values, norms and behaviour patterns which contradict those of the dominant society" (116, our emphasis). Both definitions imply that counterculture requires the mainstream to make sense of what it is doing and why. In simple terms then, counterculture as the ‘other’ does not exist without its mainstream counterpoint. The particular values with which counterculture is in conflict are generated by “the system” (Heath and Potter 6)—a system that imbues “manufactured needs and mass-produced desires” (Frank 15) in the masses to encourage order, conformity and consumption. Counterculture seeks to challenge this “system” via individualist, expression-oriented values such as difference, diversity, change, egalitarianism, and spontaneity (Davis On Youth; Leary; Thompson and Coskuner‐Balli). It is these kinds of counterculture values that we demonstrate were embedded in the content, style and management practices within Double Jay. The Whitlam Years and the Birth of Double Jay Double Jay was borne of the Whitlam government’s brief but impactful period in office from 1972 to 1975, after 23 years of conservative government in Australia. Key to the Labor Party’s election platform was the principle of participatory democracy, the purpose of which was “breaking down apathy and maximising active citizen engagement” (Cunningham 123). Within this framework, the Labor Party committed to opening the airwaves, and reconfiguring the rhetoric of communication and media as a space of and for the people (Department of the Media 3). Labor planned to honour this commitment via sweeping reforms that would counter the heavily concentrated Australian media landscape through “the encouragement of diversification of ownership of commercial radio and television”—and in doing so enable “the expression of a plurality of viewpoints and cultures throughout the media” (Department of the Media 3). Minority groups in particular were to be privileged, while some in the Party even argued for voices that would actively agitate. Senator Jim McClelland, for one, declared, “We say that somewhere in the system there must be broadcasting which not only must not be afraid to be controversial but has a duty to be controversial” (Senate Standing Committee 4). One clear voice of controversy to emerge in the 1960s and resonate throughout the 1970s was the voice of youth (Gerster and Bassett; Langley). Indeed, counterculture is considered by some as synonymous with a particular strain of youth culture during this time (Roszak; Leech). The Labor Government acknowledged this hitherto unrecognised voice in its 1972 platform, with Minister for the Media Senator Doug McClelland claiming that his party would encourage the “whetting of the appetite” for “life and experimentation” of Australia’s youth – in particular through support for the arts (160). McClelland secured licenses for two “experimental-type” stations under the auspices of the ABC, with the youth station destined for Sydney via the ABC’s standby transmitter in Gore Hill (ABCB, 2). Just as the political context in early 1970s Australia provided the necessary conditions for the appearance of Double Jay, so too did the cultural context. Counterculture emerged in the UK, USA and Europe as a clear and potent force in the late 1960s (Roszak; Leech; Frank; Braunstein and Doyle). In Australia this manifested in the 1960s and 1970s in various ways, including political protest (Langley; Horne); battles for the liberalisation of censorship (Hope and Dickerson, Liberalisation; Chipp and Larkin); sex and drugs (Dawson); and the art film scene (Hope and Dickerson, Happiness; Thoms). Of particular interest here is the “lifestyle” aspect of counterculture, within which the value-expressions against the dominant culture manifest in cultural products and practices (Bloodworth 304; Leary ix), and more specifically, music. Many authors have suggested that music was pivotal to counterculture (Bloodworth 309; Leech 8), a key “social force” through which the values of counterculture were articulated (Whiteley 1). The youth music broadcasting scene in Australia was extremely narrow prior to Double Jay, monopolised by a handful of media proprietors who maintained a stranglehold over the youth music scene from the mid-50s. This dominance was in part fuelled by the rising profitability of pop music, driven by “the dreamy teenage market”, whose spending was purely discretionary (Doherty 52) and whose underdeveloped tastes made them “immune to any sophisticated disdain of run-of-the-mill” cultural products (Doherty 230-231). Over the course of the 1950s the commercial stations pursued this market by “skewing” their programs toward the youth demographic (Griffen-Foley 264). The growing popularity of pop music saw radio shift from a “multidimensional” to “mono-dimensional” medium according to rock journalist Bruce Elder, in which the “lowest-common-denominator formula of pop song-chat-commercial-pop-song” dominated the commercial music stations (12). Emblematic of this mono-dimensionalism was the appearance of the Top 40 Playlist in 1958 (Griffin-Foley 265), which might see as few as 10–15 songs in rotation in peak shifts. Elder claims that this trend became more pronounced over the course of the 1960s and peaked in 1970, with playlists that were controlled with almost mechanical precision [and] compiled according to American-devised market research methods which tended to reinforce repetition and familiarity at the expense of novelty and diversity. (12) Colin Vercoe, whose job was to sell the music catalogues of Festival Records to stations like 2UE, 2SER and SUW, says it was “an incredibly frustrating affair” to market new releases because of the rigid attachment by commercials to the “Top 40 of endless repeats” (Vercoe). While some air time was given to youth music beyond the Top 40, this happened mostly in non-peak shifts and on weekends. Bill Drake at 2SM (who was poached by Double Jay and allowed to reclaim his real name, Holger Brockmann) played non-Top 40 music in his Sunday afternoon programme The Album Show (Brockmann). A more notable exception was Chris Winter’s Room to Move on the ABC, considered by many as the predecessor of Double Jay. Introduced in 1971, Room to Move played all forms of contemporary music not represented by the commercial broadcasters, including whole albums and B sides. Rock music’s isolation to the fringes was exacerbated by the lack of musical sales outlets for rock and other forms of non-pop music, with much music sourced through catalogues, music magazines and word of mouth (Winter; Walker). In this context a small number of independent record stores, like Anthem Records in Sydney and Archie and Jugheads in Melbourne, appear in the early 1970s. Vercoe claims that the commercial record companies relentlessly pursued the closure of these independents on the grounds they were illegal entities: The record companies hated them and they did everything they could do close them down. When (the companies) bought the catalogue to overseas music, they bought the rights. And they thought these record stores were impinging on their rights. It was clear that a niche market existed for rock and alternative forms of music. Keith Glass and David Pepperell from Archie and Jugheads realised this when stock sold out in the first week of trade. Pepperell notes, “We had some feeling we were doing something new relating to people our own age but little idea of the forces we were about to unleash”. Challenging the “System” from the Inside At the same time as interested individuals clamoured to buy from independent record stores, the nation’s first youth radio station was being instituted within the ABC. In October 1974, three young staffers—Marius Webb, Ron Moss and Chris Winter— with the requisite youth credentials were briefed by ABC executives to build a youth-style station for launch in January 1975. According to Winter “All they said was 'We want you to set up a station for young people' and that was it!”, leaving the three with a conceptual carte blanche–although assumedly within the working parameters of the ABC (Webb). A Contemporary Radio Unit (CRU) was formed in order to meet the requirements of the ABC while also creating a clear distinction between the youth station and the ABC. According to Webb “the CRU gave us a lot of latitude […] we didn’t have to go to other ABC Departments to do things”. The CRU was conscious from the outset of positioning itself against the mainstream practices of both the commercial stations and the ABC. The publicly funded status of Double Jay freed it from the shackles of profit motive that enslaved the commercial stations, in turn liberating its turntables from baser capitalist imperatives. The two coordinators Ron Moss and Marius Webb also bypassed the conventions of typecasting the announcer line-up (as was practice in both commercial and ABC radio), seeking instead people with charisma, individual style and youth appeal. Webb told the Sydney Morning Herald that Double Jay’s announcers were “not required to have a frontal lobotomy before they go on air.” In line with the individual- and expression-oriented character of the counterculture lifestyle, it was made clear that “real people” with “individuality and personality” would fill the airwaves of Double Jay (Nicklin 9). The only formula to which the station held was to avoid (almost) all formula – a mantra enhanced by the purchase in the station’s early days of thousands of albums and singles from 10 or so years of back catalogues (Robinson). This library provided presenters with the capacity to circumvent any need for repetition. According to Winter the DJs “just played whatever we wanted”, from B sides to whole albums of music, most of which had never made it onto Australian radio. The station also adapted the ABC tradition of recording live classical music, but instead recorded open-air rock concerts and pub gigs. A recording van built from second-hand ABC equipment captured the grit of Sydney’s live music scene for Double Jay, and in so doing undercut the polished sounds of its commercial counterparts (Walker). Double Jay’s counterculture tendencies further extended to its management style. The station’s more political agitators, led by Webb, sought to subvert the traditional top-down organisational model in favour of a more egalitarian one, including a battle with the ABC to remove the bureaucratic distinction between technical staff and presenters and replace this with the single category “producer/presenter” (Cheney, Webb, Davis 41). The coordinators also actively subverted their own positions as coordinators by holding leaderless meetings open to all Double Jay employees – meetings that were infamously long and fraught, but also remembered as symbolic of the station’s vibe at that time (Frolows, Matchett). While Double Jay assumed the ABC’s focus on music, news and comedy, at times it politicised the content contra to the ABC’s non-partisan policy, ignored ABC policy and practice, and more frequently pushed its contents over the edges of what was considered propriety and taste. These trends were already present in pockets of the ABC prior to Double Jay: in current affairs programmes like This Day Tonight and Four Corners (Harding 49); and in overtly leftist figures like Alan Ashbolt (Bowman), who it should be noted had a profound influence over Webb and other Double Jay staff (Webb). However, such an approach to radio still remained on the edges of the ABC. As one example of Double Jay’s singularity, Webb made clear that the ABC’s “gentleman’s agreement” with the Federation of Australian Commercial Broadcasters to ban certain content from airplay would not apply to Double Jay because the station would not “impose any censorship on our people” – a fact demonstrated by the station’s launch song (Nicklin 9). The station’s “people” in turn made the most of this freedom with the production of programmes like Gayle Austin’s Horny Radio Porn Show, the Naked Vicar Show, the adventures of Colonel Chuck Chunder of the Space Patrol, and the Sunday afternoon comic improvisations of Nude Radio from the team that made Aunty Jack. This openness also made its way into the news team, most famously in its second month on air with the production of The Ins and Outs of Love, a candid documentary of the sexual proclivities and encounters of Sydney’s youth. Conservative ABC staffer Clement Semmler described the programme as containing such “disgustingly explicit accounts of the sexual behaviour of young teenagers” that it “aroused almost universal obloquy from listeners and the press” (35). The playlist, announcers, comedy sketches, news reporting and management style of Double Jay represented direct challenges to the entrenched media culture of Australia in the mid 1970s. The Australian National Commission for UNESCO noted at the time that Double Jay was “variously described as political, subversive, offensive, pornographic, radical, revolutionary and obscene” (7). While these terms were understandable given the station’s commitment to experiment and innovation, the “vital point” about Double Jay was that it “transmitted an electronic reflection of change”: What the station did was to zero in on the kind of questioning of traditional values now inherent in a significant section of the under 30s population. It played their music, talked in their jargon, pandered to their whims, tastes, prejudices and societal conflicts both intrinsic and extrinsic. (48) Conclusion From the outset, Double Jay was locked in an “uneasy symbiosis” with mainstream culture. On the one hand, the station was established by federal government and its infrastructure was provided by state funds. It also drew on elements of mainstream broadcasting in multiple ways. However, at the same time, it was a voice for and active agent of counterculture, representing through its content, form and style those values that were considered to challenge the ‘system,’ in turn creating an outlet for the expression of hitherto un-broadcast “ways of thinking and being” (Leary). As Henry Rosenbloom, press secretary to then Labor Minister Dr Moss Cass wrote, Double Jay had the potential to free its audience “from an automatic acceptance of the artificial rhythms of urban and suburban life. In a very real sense, JJ [was] a deconditioning agent” (Inglis 375-6). While Double Jay drew deeply from mainstream culture, its skilful and playful manipulation of this culture enabled it to both reflect and incite youth-based counterculture in Australia in the 1970s. References Australian Broadcasting Control Board. Development of National Broadcasting and Television Services. ABCB: Sydney, 1976. Batzell, E.D. “Counter-Culture.” Blackwell Dictionary of Twentieth-Century Social Thought. Eds. Williams Outhwaite and Tom Bottomore. Oxford: Blackwell, 1994. 116-119. Bloodworth, John David. “Communication in the Youth Counterculture: Music as Expression.” Central States Speech Journal 26.4 (1975): 304-309. Bowman, David. “Radical Giant of Australian Broadcasting: Allan Ashbolt, Lion of the ABC, 1921-2005.” Sydney Morning Herald 15 June 2005. 15 Sep. 2013 ‹http://www.smh.com.au/news/Obituaries/Radical-giant-of-Australian-broadcasting/2005/06/14/1118645805607.html›. Braunstein, Peter, and Michael William Doyle. Eds. Imagine Nation: The American Counterculture of the 1960s and '70s New York: Taylor and Francis, 2002. Brockman, Holger. Personal interview. 8 December 2013. Cheney, Roz. Personal interview. 10 July 2013. Chipp, Don, and John Larkin. Don Chipp: The Third Man. Adelaide: Rigby, 2008. Cunningham, Frank. Theories of Democracy: A Critical Introduction. London: Routledge, 2002. Davis, Fred. On Youth Subcultures: The Hippie Variant. New York: General Learning Press, 1971. Davis, Glyn. "Government Decision‐Making and the ABC: The 2JJ Case." Politics 19.2 (1984): 34-42. Dawson, Jonathan. "JJJ: Radical Radio?." Continuum: Journal of Media & Cultural Studies 6.1 (1992): 37-44. Department of the Media. Submission by the Department of the Media to the Independent Inquiry into Frequency Modulation Broadcasting. Sydney: Australian Government Publishers, 1974. Desmond, John, Pierre McDonagh, and Stephanie O'Donohoe. “Counter-Culture and Consumer Society.” Consumption Markets & Culture 4.3 (2000): 241-279. Doherty, Thomas. Teenagers and Teenpics: The Juvenilization of American Movies in the 1950s. Boston: Unwin Hyman, 1988. Elder, Bruce. Sound Experiment. Unpublished manuscript, 1988. Australian National Commission for UNESCO. Extract from Seminar on Entertainment and Society, Report on Research Project. 1976. Frolows, Arnold. Personal interview. 10 July 2013. Frank, Thomas. The Conquest of Cool: Business Culture, Counterculture, and the Rise of Hip Consumerism. Chicago: University of Chicago Press, 1997. Gerster, Robin, and Jan Bassett. Seizures of Youth: The Sixties and Australia. Melbourne: Hyland House, 1991. Griffen-Foley, Bridget. Changing Stations: The Story of Australian Commercial Radio, Sydney: UNSW Press, 2009. Harding, Richard. Outside Interference: The Politics of Australian Broadcasting. Melbourne: Sun Books, 1979. Heath, Joseph, and Andrew Potter. Nation of Rebels: Why Counterculture Became Consumer Culture. New York: Harper Collins, 2004. Hope, Cathy, and Adam Dickerson. “The Sydney and Melbourne Film Festivals, and the Liberalisation of Film Censorship in Australia”. Screening the Past 35 (2012). 12 Aug. 2014 ‹http://www.screeningthepast.com/2012/12/the-sydney-and-melbourne-film-festivals-and-the-liberalisation-of-film-censorship-in-australia/›. Hope, Cathy, and Adam Dickerson. “Is Happiness Festival-Shaped Any Longer? The Melbourne and Sydney Film Festivals and the Growth of Australian Film Culture 1973-1977”. Screening the Past 38 (2013). 12 Aug. 2014 ‹http://www.screeningthepast.com/2013/12/‘is-happiness-festival-shaped-any-longer’-the-melbourne-and-sydney-film-festivals-and-the-growth-of-australian-film-culture-1973-1977/›. Horne, Donald. Time of Hope: Australia 1966-72. Sydney: Angus and Robertson, 1980. Inglis, Ken. This Is the ABC: The Australian Broadcasting Commission, 1932-1983. Melbourne: Melbourne University Press, 1983. Langley, Greg. A Decade of Dissent: Vietnam and the Conflict on the Australian Homefront. Sydney: Allen and Unwin, 1992. Leary, Timothy. “Foreword.” Counterculture through the Ages: From Abraham to Acid House. Eds. Ken Goffman and Dan Joy. New York: Villard, 2007. ix-xiv. Leech, Kenneth. Youthquake: The Growth of a Counter-Culture through Two Decades. London: Sheldon Press, 1973. Martin, J., and C. Siehl. "Organizational Culture and Counterculture: An Uneasy Symbiosis. Organizational Dynamics, 12.2 (1983): 52-64. Martin, Peter. Personal interview. 10 July 2014. Matchett, Stuart. Personal interview. 10 July 2013. McClelland, Douglas. “The Arts and Media.” Towards a New Australia under a Labor Government. Ed. John McLaren. Victoria: Cheshire Publishing, 1972. McClelland, Douglas. Personal interview. 25 August 2010. Milesago. “Double Jay: The First Year”. n.d. 8 Oct. 2012 ‹http://www.milesago.com/radio/2jj.htm›. Milesago. “Part 5: 1971-72 - Sundown and 'Archie & Jughead's”. n.d. Keith Glass – A Life in Music. 12 Oct. 2012 ‹http://www.milesago.com/Features/keithglass5.htm›. Nicklin, Lenore. “Rock (without the Roll) around the Clock.” Sydney Morning Herald 18 Jan. 1975: 9. Robinson, Ted. Personal interview. 11 December 2013. Roszak, Theodore. The Making of a Counter Culture. New York: Anchor, 1969. Semmler, Clement. The ABC - Aunt Sally and Sacred Cow. Carlton: Melbourne University Press, 1981. Senate Standing Committee on Education, Science and the Arts and Jim McClelland. Second Progress Report on the Reference, All Aspects of Television and Broadcasting, Including Australian Content of Television Programmes. Canberra: Australian Senate, 1973. Thompson, Craig J., and Gokcen Coskuner‐Balli. "Countervailing Market Responses to Corporate Co‐optation and the Ideological Recruitment of Consumption Communities." Journal of Consumer Research 34.2 (2007): 135-152. Thoms, Albie. “The Australian Avant-garde.” An Australian Film Reader. Eds. Albert Moran and Tom O’Regan. Sydney: Currency Press, 1985. 279–280. Vercoe, Colin. Personal interview. 11 Feb. 2014. Walker, Keith. Personal interview. 11 July 2013. Webb, Marius. Personal interview. 5 Feb. 2013. Whiteley, Sheila. The Space between the Notes: Rock and the Counter-Culture. London: Routledge, 1992. Wiltshire, Kenneth, and Charles Stokes. Government Regulation and the Electronic Commercial Media. Monograph M43. Melbourne: Committee for Economic Development of Australia, 1976. Winter, Chris. Personal interview. 16 Mar. 2013.

The Digital TurnMuch of the 19th century disappeared from public view during the 20th century. Historians recovered what they could from archives and libraries, with the easy pickings-the famous and the fortunate-coming first. Latterly, social and political historians of different hues determinedly sought out the more hidden, forgotten, and marginalised. However, there were always limitations to resources-time, money, location, as well as purpose, opportunity, and permission. 'History' was principally a professionalised and privileged activity dominated by academics who had preferential access to, and significant control over, the resources, technologies and skills required, as well as the social, economic and cultural framework within which history was recovered, interpreted, approved and disseminated.Digitisation and the broader development of new communication technologies has, however, transformed historical research processes and practice dramatically, removing many constraints, opening up many opportunities, and allowing many others than the professional historian to trace and track what would have remained hidden, forgotten, or difficult to find, as well as verify (or otherwise), what has already been claimed and concluded. In the 21st century, the SEARCH button has become a dominant tool of research. This, along with other technological and media developments, has altered the practice of historians-professional or 'public'-who can now range deep and wide in the collection, portrayal and dissemination of historical information, in and out of the confines of the traditional institutional walls of retained information, academia, location, and national boundaries.This incorporation of digital technologies into academic historical practice generally, has raised, as Cohen and Rosenzweig, in their book Digital History, identified a decade ago, not just promises, but perils. For the historian, there has been the move, through digitisation, from the relative scarcity and inaccessibility of historical material to its (over) abundance, but also the emerging acceptance that, out of both necessity and preference, a hybridity of sources will be the foreseeable way forward. There has also been a significant shift, as De Groot notes in his book Consuming History, in the often conflicted relationship between popular/public history and academic history, and the professional and the 'amateur' historian. This has brought a potentially beneficial democratization of historical practice but also an associated set of concerns around the loss of control of both practice and product of the professional historian. Additionally, the development of digital tools for the collection and dissemination of 'history' has raised fears around the commercialised development of the subject's brand, products and commodities. This article considers the significance and implications of some of these changes through one protracted act of recovery and reclamation in which the digital made the difference: the life of a notorious 19th century professional agitator on both sides of the Atlantic, John De Morgan. A man thought lost, but now found."Who Is John De Morgan?" The search began in 1981, linked to the study of contemporary "race riots" in South East London. The initial purpose was to determine whether there was a history of rioting in the area. In the Local History Library, a calm and dusty backwater, an early find was a fading, but evocative and puzzling, photograph of "The Plumstead Common Riots" of 1876. It showed a group of men and women, posing for the photographer on a hillside-the technology required stillness, even in the middle of a riot-spades in hand, filling in a Mr. Jacob's sandpits, illegally dug from what was supposed to be common land. The leader of this, and other similar riots around England, was John De Morgan. A local journalist who covered the riots commented: "Of Mr. De Morgan little is known before or since the period in which he flashed meteorlike through our section of the atmosphere, but he was indisputably a remarkable man" (Vincent 588). Thus began a trek, much interrupted, sometimes unmapped and haphazard, to discover more about this 'remarkable man'. "Who is John De Morgan" was a question frequently asked by his many contemporary antagonists, and by subsequent historians, and one to which De Morgan deliberately gave few answers. The obvious place to start the search was the British Museum Reading Room, resplendent in its Victorian grandeur, the huge card catalogue still in the 1980s the dominating technology. Together with the Library's newspaper branch at Colindale, this was likely to be the repository of all that might then easily be known about De Morgan.From 1869, at the age of 21, it appeared that De Morgan had embarked on a life of radical politics that took him through the UK, made him notorious, lead to accusations of treasonable activities, sent him to jail twice, before he departed unexpectedly to the USA in 1880. During that period, he was involved with virtually every imaginable radical cause, at various times a temperance advocate, a spiritualist, a First Internationalist, a Republican, a Tichbornite, a Commoner, an anti-vaccinator, an advanced Liberal, a parliamentary candidate, a Home Ruler. As a radical, he, like many radicals of the period, "zigzagged nomadically through the mayhem of nineteenth century politics fighting various foes in the press, the clubs, the halls, the pulpit and on the street" (Kazin 202). He promoted himself as the "People's Advocate, Champion and Friend" (Allen). Never a joiner or follower, he established a variety of organizations, became a professional agitator and orator, and supported himself and his politics through lecturing and journalism. Able to attract huge crowds to "monster meetings", he achieved fame, or more correctly notoriety. And then, in 1880, broke and in despair, he disappeared from public view by emigrating to the USA.LostThe view of De Morgan as a "flashing meteor" was held by many in the 1870s. Historians of the 20th century took a similar position and, while considering him intriguing and culturally interesting, normally dispatched him to the footnotes. By the latter part of the 20th century, he was described as "one of the most notorious radicals of the 1870s yet remains a shadowy figure" and was generally dismissed as "a swashbuckling demagogue," a "democratic messiah," and" if not a bandit … at least an adventurer" (Allen 684). His politics were deemed to be reactionary, peripheral, and, worst of all, populist. He was certainly not of sufficient interest to pursue across the Atlantic. In this dismissal, he fell foul of the highly politicised professional culture of mid-to-late 20th-century academic historians. In particular, the lack of any significant direct linkage to the story of the rise of a working class, and specifically the British Labour party, left individuals like De Morgan in the margins and footnotes. However, in terms of historical practice, it was also the case that his mysterious entry into public life, his rapid rise to brief notability and notoriety, and his sudden disappearance, made the investigation of his career too technically difficult to be worthwhile.The footprints of the forgotten may occasionally turn up in the archived papers of the important, or in distant public archives and records, but the primary sources are the newspapers of the time. De Morgan was a regular, almost daily, visitor to the pages of the multitude of newspapers, local and national, that were published in Victorian Britain and Gilded Age USA. He also published his own, usually short-lived and sometimes eponymous, newspapers: De Morgan's Monthly and De Morgan's Weekly as well as the splendidly titled People's Advocate and National Vindicator of Right versus Wrong and the deceptively titled, highly radical, House and Home. He was highly mobile: he noted, without too much hyperbole, that in the 404 days between his English prison sentences in the mid-1870s, he had 465 meetings, travelled 32,000 miles, and addressed 500,000 people. Thus the newspapers of the time are littered with often detailed and vibrant accounts of his speeches, demonstrations, and riots.Nonetheless, the 20th-century technologies of access and retrieval continued to limit discovery. The white gloves, cradles, pencils and paper of the library or archive, sometimes supplemented by the century-old 'new' technology of the microfilm, all enveloped in a culture of hallowed (and pleasurable) silence, restricted the researcher looking to move into the lesser known and certainly the unknown. The fact that most of De Morgan's life was spent, it was thought, outside of England, and outside the purview of the British Library, only exacerbated the problem. At a time when a historian had to travel to the sources and then work directly on them, pencil in hand, it needed more than curiosity to keep searching. Even as many historians in the late part of the century shifted their centre of gravity from the known to the unknown and from the great to the ordinary, in any form of intellectual or resource cost-benefit analysis, De Morgan was a non-starter.UnknownOn the subject of his early life, De Morgan was tantalisingly and deliberately vague. In his speeches and newspapers, he often leaked his personal and emotional struggles as well as his political battles. However, when it came to his biographical story, he veered between the untruthful, the denial, and the obscure. To the twentieth century observer, his life began in 1869 at the age of 21 and ended at the age of 32. His various political campaign "biographies" gave some hints, but what little he did give away was often vague, coy and/or unlikely. His name was actually John Francis Morgan, but he never formally acknowledged it. He claimed, and was very proud, to be Irish and to have been educated in London and at Cambridge University (possible but untrue), and also to have been "for the first twenty years of his life directly or indirectly a railway servant," and to have been a "boy orator" from the age of ten (unlikely but true). He promised that "Some day-nay any day-that the public desire it, I am ready to tell the story of my strange life from earliest recollection to the present time" (St. Clair 4). He never did and the 20th century could unearth little evidence in relation to any of his claims.The blend of the vague, the unlikely and the unverifiable-combined with an inclination to self-glorification and hyperbole-surrounded De Morgan with an aura, for historians as well as contemporaries, of the self-seeking, untrustworthy charlatan with something to hide and little to say. Therefore, as the 20th century moved to closure, the search for John De Morgan did so as well. Though interesting, he gave most value in contextualising the lives of Victorian radicals more generally. He headed back to the footnotes.Now FoundMeanwhile, the technologies underpinning academic practice generally, and history specifically, had changed. The photocopier, personal computer, Internet, and mobile device, had arrived. They formed the basis for both resistance and revolution in academic practices. For a while, the analytical skills of the academic community were concentrated on the perils as much as the promises of a "digital history" (Cohen and Rosenzweig Digital).But as the Millennium turned, and the academic community itself spawned, inter alia, Google, the practical advantages of digitisation for history forced themselves on people. Google enabled the confident searching from a neutral place for things known and unknown; information moved to the user more easily in both time and space. The culture and technologies of gathering, retrieval, analysis, presentation and preservation altered dramatically and, as a result, the traditional powers of gatekeepers, institutions and professional historians was redistributed (De Groot). Access and abundance, arguably over-abundance, became the platform for the management of historical information. For the search for De Morgan, the door reopened. The increased global electronic access to extensive databases, catalogues, archives, and public records, as well as people who knew, or wanted to know, something, opened up opportunities that have been rapidly utilised and expanded over the last decade. Both professional and "amateur" historians moved into a space that made the previously difficult to know or unknowable now accessible.Inevitably, the development of digital newspaper archives was particularly crucial to seeking and finding John De Morgan. After some faulty starts in the early 2000s, characterised as a "wild west" and a "gold rush" (Fyfe 566), comprehensive digitised newspaper archives became available. While still not perfect, in terms of coverage and quality, it is a transforming technology. In the UK, the British Newspaper Archive (BNA)-in pursuit of the goal of the digitising of all UK newspapers-now has over 20 million pages. Each month presents some more of De Morgan. Similarly, in the US, Fulton History, a free newspaper archive run by retired computer engineer Tom Tryniski, now has nearly 40 million pages of New York newspapers. The almost daily footprints of De Morgan's radical life can now be seen, and the lives of the social networks within which he worked on both sides of the Atlantic, come easily into view even from a desk in New Zealand.The Internet also allows connections between researchers, both academic and 'public', bringing into reach resources not otherwise knowable: a Scottish genealogist with a mass of data on De Morgan's family; a Californian with the historian's pot of gold, a collection of over 200 letters received by De Morgan over a 50 year period; a Leeds Public Library blogger uncovering spectacular, but rarely seen, Victorian electoral cartoons which explain De Morgan's precipitate departure to the USA. These discoveries would not have happened without the infrastructure of the Internet, web site, blog, and e-mail. Just how different searching is can be seen in the following recent scenario, one of many now occurring. An addition in 2017 to the BNA shows a Master J.F. Morgan, aged 13, giving lectures on temperance in Ledbury in 1861, luckily a census year. A check of the census through Ancestry shows that Master Morgan was born in Lincolnshire in England, and a quick look at the 1851 census shows him living on an isolated blustery hill in Yorkshire in a railway encampment, along with 250 navvies, as his father, James, works on the construction of a tunnel. Suddenly, literally within the hour, the 20-year search for the childhood of John De Morgan, the supposedly Irish-born "gentleman who repudiated his class," has taken a significant turn.At the end of the 20th century, despite many efforts, John De Morgan was therefore a partial character bounded by what he said and didn't say, what others believed, and the intellectual and historiographical priorities, technologies, tools and processes of that century. In effect, he "lived" historically for a less than a quarter of his life. Without digitisation, much would have remained hidden; with it there has been, and will still be, much to find. De Morgan hid himself and the 20th century forgot him. But as the technologies have changed, and with it the structures of historical practice, the question that even De Morgan himself posed – "Who is John De Morgan?" – can now be addressed.SearchingDigitisation brings undoubted benefits, but its impact goes a long way beyond the improved search and detection capabilities, into a range of technological developments of communication and media that impact on practice, practitioners, institutions, and 'history' itself. A dominant issue for the academic community is the control of "history." De Groot, in his book Consuming History, considers how history now works in contemporary popular culture and, in particular, examines the development of the sometimes conflicted relationship between popular/public history and academic history, and the professional and the 'amateur' historian.The traditional legitimacy of professional historians has, many argue, been eroded by shifts in technology and access with the power of traditional cultural gatekeepers being undermined, bypassing the established control of institutions and professional historian. While most academics now embrace the primary tools of so-called "digital history," they remain, De Groot argues, worried that "history" is in danger of becoming part of a discourse of leisure, not a professionalized arena (18). An additional concern is the role of the global capitalist market, which is developing, or even taking over, 'history' as a brand, product and commodity with overt fiscal value. Here the huge impact of newspaper archives and genealogical software (sometimes owned in tandem) is of particular concern.There is also the new challenge of "navigating the chaos of abundance in online resources" (De Groot 68). By 2005, it had become clear that:the digital era seems likely to confront historians-who were more likely in the past to worry about the scarcity of surviving evidence from the past-with a new 'problem' of abundance. A much deeper and denser historical record, especially one in digital form seems like an incredible opportunity and a gift. But its overwhelming size means that we will have to spend a lot of time looking at this particular gift horse in mouth. (Cohen and Rosenzweig, Web).This easily accessible abundance imposes much higher standards of evidence on the historian. The acceptance within the traditional model that much could simply not be done or known with the resources available meant that there was a greater allowance for not knowing. But with a search button and public access, democratizing the process, the consumer as well as the producer can see, and find, for themselves.Taking on some of these challenges, Zaagsma, having reminded us that the history of digital humanities goes back at least 60 years, notes the need to get rid of the "myth that historical practice can be uncoupled from technological, and thus methodological developments, and that going digital is a choice, which, I cannot emphasis strongly enough, it is not" (14). There is no longer a digital history which is separate from history, and with digital technologies that are now ubiquitous and pervasive, historians have accepted or must quickly face a fundamental break with past practices. However, also noting that the great majority of archival material is not digitised and is unlikely to be so, Zaagsma concludes that hybridity will be the "new normal," combining "traditional/analogue and new/digital practices at least in information gathering" (17).ConclusionA decade on from Cohen and Rozenzweig's "Perils and Promises," the digital is a given. Both historical practice and historians have changed, though it is a work in progress. An early pioneer of the use of computers in the humanities, Robert Busa wrote in 1980 that "the principal aim is the enhancement of the quality, depth and extension of research and not merely the lessening of human effort and time" (89). Twenty years later, as Google was launched, Jordanov, taking on those who would dismiss public history as "mere" popularization, entertainment or propaganda, argued for the "need to develop coherent positions on the relationships between academic history, the media, institutions…and popular culture" (149). As the digital turn continues, and the SEARCH button is just one part of that, all historians-professional or "amateur"-will take advantage of opportunities that technologies have opened up. Looking across the whole range of transformations in recent decades, De Groot concludes: "Increasingly users of history are accessing the past through complex and innovative media and this is reconfiguring their sense of themselves, the world they live in and what history itself might be about" (310). ReferencesAllen, Rob. "'The People's Advocate, Champion and Friend': The Transatlantic Career of Citizen John De Morgan (1848-1926)." Historical Research 86.234 (2013): 684-711.Busa, Roberto. "The Annals of Humanities Computing: The Index Thomisticus." Computers and the Humanities 14.2 (1980): 83-90.Cohen, Daniel J., and Roy Rosenzweig. Digital History: A Guide to Gathering, Preserving, and Presenting the Past on the Web. Philadelphia, PA: U Pennsylvania P, 2005.———. "Web of Lies? Historical Knowledge on the Internet." First Monday 10.12 (2005).De Groot, Jerome. Consuming History: Historians and Heritage in Contemporary Popular Culture. 2nd ed. Abingdon: Routledge, 2016.De Morgan, John. Who Is John De Morgan? A Few Words of Explanation, with Portrait. By a Free and Independent Elector of Leicester. London, 1877.Fyfe, Paul. "An Archaeology of Victorian Newspapers." Victorian Periodicals Review 49.4 (2016): 546-77."Interchange: The Promise of Digital History." Journal of American History 95.2 (2008): 452-91.Johnston, Leslie. "Before You Were Born, We Were Digitizing Texts." The Signal 9 Dec. 2012, Library of Congress. <https://blogs.loc.gov/thesignal/292/12/before-you-were-born-we-were-digitizing-texts>.Jordanova, Ludmilla. History in Practice. 2nd ed. London: Arnold, 2000.Kazin, Michael. A Godly Hero: The Life of William Jennings Bryan. New York: Anchor Books, 2006.Saint-Clair, Sylvester. Sketch of the Life and Labours of J. De Morgan, Elocutionist, and Tribune of the People. Leeds: De Morgan & Co., 1880.Vincent, William T. The Records of the Woolwich District, Vol. II. Woolwich: J.P. Jackson, 1890.Zaagsma, Gerban. "On Digital History." BMGN-Low Countries Historical Review 128.4 (2013): 3-29.

Scientific Program Oral Presentations Authors Title Abstract CONSTANTIN MUNTEANU, Mihail HOTETEU, Diana MUNTEANU, Gabriela DOGARU - 12 minutes PERSPECTIVES OF BALNEOLOGY - INTERNATIONAL DATA INPUTS, NATIONAL OUTPUTS Link L1 UMBERTO SOLIMENE - 14 minutes CLIMATE AND HEALTH: A NEW CHALLENGE FOR AN OLD SCIENCE Link L2 Zeki KARAGÜLLE - 14 minutes BALNEOLOGICAL TREATMENTS WITH NATURAL HYDROGEN SULFIDE (H2S) Waters Link L3 Constantin Florin Dragan, Liliana Padure, Gelu Onose - 12 minutes SPECIFIC ADVANCED QUANTIFICATIONS ON THE RELATIONSHIP BETWEEN THE ANGULATION OF THE MAIN SCOLIOTIC CURVE AND LEG SWING IN THE GAIT PHASES, IN CHILDREN AND ADOLESCENTS WITH AND WITHOUT POSTURAL TREATMENT Link L4 Irina ALBADI, Camelia CIOBOTARU, Andreea-Alexandra LUPU, Ionela BALASA, Claudiu FATU, Enghin SACHIR, Gelu ONOSE - 12 minutes A MULTIMODAL APPROACHES TO MANAGE REHABILITATION THERAPY OF DISFUNCTIONALS ASPECTS TO A PACIENT WITH GOUT, MIELLITUS DIABETES, ATRIAL FIBRILATION AND MIDDLE CEREBRAL ARTERY STROKE Link L5 ELENA RAEVSCHI - 12 minutes PREVENTION CONSIDERATIONS IN Cardiovascular Diseases regarding the premature mortality reduction Link L6 ANIȘOARA CIMIL - 12 minutes THE EFFECTIVENESS OF THE REHABILITATION PROGRAMME ACCORDING TO THE ETIOPATHOGENESIS OF PROSTHETIC JOINT PATHOLOGY Link L7 TRAIAN -VIRGILIU SURDU, Monica SURDU, Olga SURDU - 10 minutes FOURTH INDUSTRIAL REVOLUTION (INDUSTRY 4.0) AND MODERN THERMAL MEDICINE (THERME 4.0) IN XXIST CENTURY Link L8 Gabriela DOGARU, Akos MOLNAR, Marieta MOTRICALA - 10 minutes EFFECTS OF CARBONATED MINERAL WATER AND MOFETTE IN BĂILE TUŞNAD IN EXPERIMENTALLY INDUCED ISCHEMIC HEART DISEASE Link L9 Q & A – 12 minutes Authors Title Abstract Aurelian Anghelescu, Valentin Deaconu, Catalina Axente,Elena Constantin, Gelu Onose - 12 minutes THERAPEUTIC DIFFICULTIES IN A YOUNG PATIENT WITH MULTIDRUG RESISTANT EPILEPSY (NEEDING VAGAL NERVE ELECTROSTIMULATION), SEQUELAE AFTER CONGENITAL VASCULAR CEREBRAL MALFORMATION, WITH CHRONIC GAIT IMPAIRMENTS AND RECENT TRAUMATIC BRAIN COMPLICATION Link L10 Luminița NIRLU, Alexandru G. STAVRICĂ, Laura Georgiana Popescu, Ana Carmen Albeșteanu, Ali-Osman Saglam, Gelu Onose - 12 minutes DIAGNOSTIC PARTICULARITIES AND MULTIMODAL THERAPEUTIC AND REHABILITATION APPROACHES TO A COMPLEX CASE OF POST ISCHEMIC STROKE WITH DYSPHAGIA AND DYSPHONIA, ASSOCIATING MILLARD-GUBLER AND WALLENBERG SYNDROMES - CASE REPORT Link L11 Cristina Octaviana DAIA, Croitoru Stefana, Mariana Axente, Gelu ONOSE - 14 minutes IONTOPHORESIS AND LASER APPLICATIONS IN FACIAL NERVE PALSY Link L12 Doina Maria MOLDOVAN, Gabriela DOGARU - 12 minutes SPLINTING VERSUS SURGICAL TREATMENT IN MALLET FINGER Link L13 Doina Maria MOLDOVAN, Gabriela DOGARU - 12 minutes EARLY REHABILITATION IN PATIENT AFTER TREATMENT FOR DISTAL RADIUS FRACTURE Link L14 Liliana PADURE, Raluca PETCU, Anca Irina GRIGORIU - 12 minutes THE IMPACT OF MULTIFACTORIAL GAIT ANALYSIS ON THE DIAGNOSIS AND REHABILITATION OF CHILDREN WITH WALKING DISORDERS Link L15 Valerica Creanga-Zarnescu, Ana-Maria Fatu, Mihaela Lungu, Violeta Sapira, Anamaria Ciubara - 12 minutes REHABILITATION POSSIBILITIES OF APHASIC PATIENT Link L16 Cristina DAIA, Simona SCHEK, Stefana CROITORU, Alina GHERGHICEANU, Gelu ONOSE - 12 minutes FAVORABLE REHABILITATION RESULTS ON A PATIENT WITH SEVERE LEFT HEMIPLEGIA AFTER AN INTRAPARENCHYMAL HEMATOMA Link L17 Elena VIZITIU, Mihai CONSTANTINESCU, Sînziana Călina SILIȘTEANU - 12 minutes THE ROLE OF THERAPEUTIC SWIMMING IN THE PROPHYLAXIS OF SCOLIOSIS IN THE "C" LEFT IN CHILDREN DURING THE PREPUBERTAL PERIOD Link L18 Q & A – 12 minutes Authors Title Abstract Alexandru G. STAVRICĂ, Luminiţa Nirlu, Laura Georgiana Popescu, Ana Carmen Albeşteanu, Gelu ONOSE - 12 minutes DIAGNOSTIC AND THERAPEUTIC APPROACHES IN REHABILITATION CORRELATED TO A CASE OF TETRAPARESIS (WITH PREDOMINANCE OF PARAPARESIS) AFTER SEVERE CCT - BIFRONTO - BASAL AND BITEMPORAL CONTUSION. Link L19 Ana Maria Bumbea, Otilia Rogoveanu, Carmen,Albu Rodica Traistaru, Catalin,Bostina, Bogdan Stefan Bumbea, Roxana Dumitrascu, Borcan Madalina MANAGEMENT OF SPASTICITY IN NEUROLOGICAL PATIENTS Link L20 Laura Georgiana Popescu, Luminița Nirlu, Ana Carmen Albeșteanu, Ali Osman Saglam, Gelu Onose - 12 minutes PARTICULARITIES OF COMPLEX THERAPEUTICALLY-REHABILITATIVE MANAGEMENT, STEPWISE, IN A PATIENT WITH POST-CCT PSYCHO-COGNITIVE IMPAIRMENT IN A LARGE POLYTRAMATIC CONTEXT - CASE REPORT Link L21 Adrian MELNIC, Oleg PASCAL - 12 minutes DEVELOPING STRATEGIES TO ADDRESS COMORBIDITY IN STROKE REHABILITATION. Link L22 Dorin-Gheorghe TRIFF, Simona POP - 12 minutes MONOGENIC DISEASES WITH MUSCULO ARTICULAR LAXITY. DIAGNOSTIC CRITERIA AND PRINCIPLES OF RECOVERY THERAPY Link L23 Catalin Ionite, Dragos Arotaritei, Mihai Ilea, Mariana Rotariu - 12 minutes THE USE OF ELASTIC BANDS IN THE RECOVERY OF ANKLE SPRAINS Link L24 Mariana Rotariu, Marius Turnea, Calin Corciova, Catalin Ionite - 12 minutes THE EFFECTS OF CUBE THERAPY IN THE RECOVERY OF THE ARTHROSIS HAND IN GERIATRICS Link L25 Cristian Ştefan LIUŞNEA - 12 minutes FITNESS AND WELLNESS. CONCEPTUAL DELIMITATIONS Link L26 Adriana LUPU - 12 minutes NSAID THERAPY OF MUSCULOSKELETAL PAINS AND ITS PARTICULARITIES IN THE PATIENTS SUFFERING FROM CARDIOVASCULAR DISORDERS Link L27 Q & A – 12 minutes Authors Title Abstract Mihaela MANDU, Cristinel Dumitru BADIU, Raluca PETCU, Cosmin OPREA, Gelu ONOSE - 12 minutes CLINICAL-EVOLUTIVE PARTICULARITIES AND A MULTIMODAL THERAPEUTIC-REHABILITATIVE, AS WELL AS THROUGH CONNECTED CARES, APPROACH, IN A CASE OF HEMIPLEGIA AFTER ISCHEMIC CARDIO-EMBOLIC STROKE WITHIN A POLYPATHOLOGICAL CONTEXT Link L28 Ana Carmen Albesteanu, Laura Georgiana Popescu, Luminița Nirlu, Ali Osman Saglam, Gelu Onose - 12 minutes MULTIMODAL - REHABILITATIVE THERAPEUTICAL APPROACHES IN A COMPLEX OF PATHOLOGY INCLUDING POSSIBLY EVOLVING DISCARIOTIC TYPE - CASE REPORT Link L29 Liliana PADURE, Cristian Adam, Laura Fierbinteanu - 12 minutes ATTACHMENT - PROGNOSTIC FACTOR IN MEDICAL RECOVERY Link L30 Prof. Alexandru Vlad Ciurea - 20 minutes MOTILITY OR MORBIDITY IN NEUROSURGERY Link L31 Valerica CREANGA-ZARNESCU, Ana-Maria FATU, Anamaria CIUBARA, Violeta SAPIRA,Aurelia ROMILA, Mihaela LUNGU - 12 minutes EXERCISES PROGRAM AND REHABILITATION IN PARKINSON’S DISEASE Link L32 Irina VERINCEANU,Alice MUNTEANU, Andreea STOICA, Stefan ISPAS - 12 minutes THE CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Link L33 Marius Turnea, Catalin Ionite, Mihai Ilea, Dragos Arotaritei - 12 minutes STATISTICAL ANALYSIS OF PHYSIOTHERAPEUTIC MEANS USED IN THE RECOVERY OF MUSCLE INJURIES IN ATHLETES Link L34 Mihaiela CHICU, Eugen BITERE - 10 minutes THE ROLE OF IL1β IN CARTILAGINOUS DISTRUCTION IN RHEUMATOID ARTHRITIS Link L35 Mihaiela CHICU, Eugen BITERE - 10 minutes THE ROLE OF THE INFLAMMASOMS IN THE PATHOGENESIS OF INFLAMMATORY REACTION Link L36 Q & A – 8 minutes Authors Title Abstract Prof. Dr. Gelu Onose, (Keynote Speaker) Vlad Ciobanu, Corina Sporea - 20 minutes A TOPICAL SYSTEMATIC LITERATURE REVIEW AND REAPPRAISAL ON ESSAYS TOWARDS SYSTEMATIZING CLINICAL ASSESSMENT INSTRUMENTS USED TO EVALUATE NEURO-functional deficits after spinal cord injuries, mainly in adults, including through the ICF(-DH) conceptual framework Link L37 Diana-Elena SERBAN, Aurelian ANGHELESCU, Elena CONSTANTIN, Gelu ONOSE - 12 minutes THE ACQUISITION OF SELF-DEFENSE TECHNIQUES AND PROCEDURES AGAINST THE ACT OF AGGRESSION IN THE PACIENT WITH PARAPLEGIA, WHEEL-CHAIR INDEPENDENT Link L38 Aurelian Anghelescu, Elena Constantin, Anca Sanda Mihaescu, Gelu Onose - 12 minutes “PREVENTION IS CURE, EDUCATION IS ESSENTIAL” - RESPONSIBLE IMPLICATION OF YOUNG PEOPLE IN EDUCATIONAL AND PROPHYLACTIC ACTIONS AGAINST ACCIDENTAL CERVICAL SPINAL CORD INJURY AND SEVERE DISABILITIES BY DIVING IN UNVERIFIED WATERS. Link L39 Alexandra SPORICI, Irina ANGHEL, Lapadat MAGDALENA, Gelu ONOSE - 12 minutes RECOVERABLE RESULTS AT A PATIENT WITH AIS/FRANKEL D INCOMPLETE TETRAPLEGIA / POST SPINAL CORD INJURY BY FALLING FROM A HEIGHT, ON AN ANKYLOSING SPONDYLITIS BACKGROUND Link L40 Ioana ANDONE, Carmen CHIPĂRUȘ, Andreea FRUNZA, Aura SPÎNU, Simona STOICA, Liliana ONOSE, George PATRASCU, Gelu ONOSE -12 minutes CLINICAL, PARACLINICAL ASPECTS AND COMPLEX THERAPEUTICAL APPROACHES IN A PATIENT WITH INCOMPLETE PARAPLEGIA, POST THORACIC MENIGIOMA SURGICALLY TREATED, IN NEUROFIBROMATOSIS CONTEXT Link L41 Cristina Octaviana DAIA, Alina-Elena Gherghiceanu, Helene Ivan, Gelu ONOSE - 12 minutes RESEARCH ON NEUROREHABILITATION RESULTS IN VERTEBRO-MEDULLARY POST-TRAUMATIC CONDITIONS ASSOCIATING FRACTURES, IN A POLITRAMATIC CONTEXT Link L42 Ali-Osman Saglam, Alexandru G. Stavrica, Ana Carmen Albeşteanu, Laura Georgiana Popescu, Luminita Nirlu, Gelu Onose - 12 minutes MEDICAL-REHABILITATION ENDEAVORS, CARE INTERVENTIONS AND CONNOTATIONS OF A MEDICO-SOCIAL TYPE, IN A COMPLEX POLYPATHOLOGICAL CASE: PARAPLEGIA, SPONDYLODISCITIS, KIDNEY FAILURE IN THE HAEMODIALYSIS STAGE AND BILATERAL NEPHROSTOMIES AFTER SURGICALY TREATTED BLADDER NEOPLASM. Link L43 Sorina Petrușan-Dunca, Liviu Lazăr, Tiberiu-Dorin Corha - 12 minutes INDICATIONS AND LIMITIS OF REHABILITATION TREATMENT FOR LUMBAR DISCOPATHY IN PREGNACY Link L44 Q & A – 8 minutes Authors Title Abstract Elena Silvia SHELBY, Mihaela AXENTE, Liliana PĂDURE - 12 minutes CHARCOT MARIE TOOTH DISEASE. CASE PRESENTATION. GENETIC DISEASES WHICH REQUIRE physical rehabilitation Link L45 Link L46 Simona Carniciu - 12 minutes Influence of nutrition and exercise on the use of different energy substrates in the prevention of metabolic diseases Link L81 Simona-Isabelle STOICA, Carmen Elena CHIPĂRUȘ, Magdalena Vasilica LAPADAT, George PĂTRAȘCU, Gelu ONOSE - 12 minutes CLINICAL-THERAPEUTIC AND RECUPERATORY FEATURES IN A PATIENT WITH PLURIPATOLOGY: ISCHEMIC STROKE, ISCHEMIC HEART DISEASE (SECHELAR MYOCARDIAL INFARCTION), CHRONIC KIDNEY DISEASE AND MONSTROUS GOUT- CASE PRESENTATION Link L47 Eugen BITERE, Mihaiela CHICU - 12 minutes PATHOPHYSIOLOGY OF ATHEROGENESIS AND CARDIOVASCULAR RISK IN CHRONIC INFLAMMATORY DISEASES Link L48 Victoria CHIHAI, Alisa TĂBÎRȚĂ, Anastasia ROTĂREANU, Vladlena MIHAILOV, Mihail CÎRÎM - 12 minutes THE IMPACT OF ACTIVE KINETIC PROGRAMS ON CLINICAL AND FUNCTIONAL STATUS ADRESSED TO PEOPLE WITH DIABETIC ANGIOPATHY Link L49 Ana-Maria Fătu, Ana Maria Pâslaru, Valerica Creangă-Zărnescu, Alexandru Nechifor, Mădălina Verenca, Mihaela Lungu, Anamaria Ciubară - 12 minutes THE IMPACT OF COGNITIVE DECLINE ON STROKE REHABILITATION Link L50 Alisa TĂBÎRŢĂ, Victoria CHIHAI - 12 minutes THE USE OF TRINITY AMPUTATION AND PROSTHESIS EXPERIENCE SCALES IN THE COMPLEX REHABILITATION OF PERSONS WITH LOWER LIBM AMPUTATION Link L51 Ilie ONU, Mariana ROTARIU, Elvina MIHALAȘ, Călin CORCIOVĂ - 12 minutes STUDY ON EFFICIENCY OF ELECTROTHERAPY AND PHYSIOTHERAPY MANAGEMENT ON HERNIATED LUMBAR DISC Link L52 María G. Souto Figueroa, Antonio Freire Magariños RESEARCH - SURVEY TO 142 THERMALIST WHO HAVE PERFORMED A THERMAL CURE AT THE BATHS OF BAÑOS DE MOLGAS (OURENSE) AND AUGAS SANTAS (LUGO) - GALICIA – SPAIN Link L53 Q & A – 12 minutes Authors Title Abstract Irina Ionica - 12 minutes ACUPUNCTURE IN REHABILITATION - A GENERAL VIEW Link L54 Denisa COAJĂ, Gabriela DOGARU - 12 minutes THE HEALTH BENEFITS OF FINNISH SAUNA BATHING Link L55 Otilia ROGOVEANU, Florin GHERGHINA , Rodica TRAISTARU - 12 minutes SPINA BIFIDA – FUNCTIONAL REHABILITATION METHODS IN CHILDREN Link L56 Mihaela DUTESCU, Raluca OLTEAN, Petru NENADICI - 12 minutes GEOAGIU BAI RESORT - OUR EXPERIENCE OF MEDICAL REHABILITATION TREATMENT Link L57 Dumitru MIHĂILĂ, SILISTEANU Sinziana Calina, ȚICULEANU Mihaela (Ciurlică) - 12 minutes THE METEOROLOGICAL COMPLEX AND THE HUMAN PATHOLOGY. CASE STUDY – SUCEAVA COUNTY Link L58 Mariana VARODI, Gabriela DOGARU - 12 minutes EFFICACY OF NATURAL THERAPEUTIC FACTORS FROM OCNA SIBIULUI SPA RESORT IN GONARTHROSIS Link L59 Boróka-Panna GÁSPÁR, Gabriela DOGARU - 12 minutes BONE HYDRATION AND MINERAL WATERS Link L60 CALIN BOCHIS, LIVIU LAZAR, HORAȚIU URECHESCU, CARMEN NISTOR-CSEPPENTO, FELICIA CIOARA, NICOLETA PASCALAU, ALIN BOCHIS , DIANA IOVANOVICI - 12 minutes CORRELATION OF VAS PAIN SCORE WITH FUNCTION AT THE PACIENTS WITH TEMPOROMANDIBULAR OSTEOARTHRITIS Link L61 Marian Romeo CALIN, Ileana RADULESCU, Mihaela Antonina CALIN, Elena Roxana ALMASAN - 12 minutes RADIOMETRIC ASSESSMENT OF PELOID AND SALT WATER USED FOR THERAPY AND BALNEARY TRATAMENT FROM TECHIRGHIOL LAKE, ROMANIA Link L62 Q & A – 12 minutes Authors Title Abstract Cristina PETRESCU - 12 minutes EFFICACY NATURAL THERAPEUTIC FACTORS FROM BAILE GOVORA IN BRONCHIAL ASTHMA Link L63 PARASCHIVA POSTOLACHE - 12 minutes PULMONARY REHABILITATION SAVES LIVES AND IMPROVES LIFE Link L64 DOINA-CLEMENTINA COJOCARU, PARASCHIVA POSTOLACHE - 12 minutes ASSESSMENT OF DYSPNEA IN PULMONARY REHABILITATION PRACTICE Link L65 PARASCHIVA POSTOLACHE, CRISTINA LACATUSI - 12 minutes HELIOTHERAPY, CLIMATOTHERAPY AND PATIENTS WITH RESPIRATORY DISEASES Link L66 CONSTANTIN MUNTEANU, DIANA MUNTEANU, MIHAIL HOTETEU - 12 minutes BIOLOGICAL INSIGHTS OF SPELEOTHERAPY Link L67 PARASCHIVA POSTOLACHE, CRISTINA LACATUSI, DOINA-CLEMENTINA COJOCARU - 12 minutes AEROSOLS AND BREATHING Link L68 PARASCHIVA POSTOLACHE, MADALINA ZEBEGA - 12 minutes RESPIRATORY MUSCLE TRAINING AND RESPIRATORY REHABILITATION Link L69 CRISTI FRENȚ, GEORGETA MAIORESCU - 12 minutes DEVELOPMENTS AND INVOLUTIONS OF TOURISM IN THE SPA RESORTS IN ROMANIA AND THE CASE STUDY FOR LACUL SĂRAT RESORT Link L70 Dragos Arotaritei, Andrei Gheorghita, Mariana Rotariu, Marius Turnea - 12 minutes MATHEMATICAL MODEL OF SULPHUR ABSORPTION PROCESS, A POSSIBLE APPLICATION IN CURE WITH SULPHUROUS MINERAL WATER Link L71 Q & A – 12 minutes Authors Title Abstract Mihai Ciocanu, Anișoara Cimil - 12 minutes THE EFFICIENCY OF THE REHABILITATION SERVICE IN HOSPITAL CONDITIONS Link L72 Sinziana Calina SILIȘTEANU, Andrei Emanuel SILIȘTEANU - 12 minutes TRIAL ON THE WATER CONSUMPTION BY THE PERSONS IN THE GROUP AGED 19-30 YEARS Link L73 Liviu Lazăr, Florin Marcu, Felicia Cioară, Carmen Nistor Csepentö - 12 minutes MANAGEMENT OF SPECIAL ARTERIAL DISEASES Link L74 Mihaela-Carmen SUCEVEANU, Paul-Nicolae SUCEVEANU - 12 minutes EVOLUTION OF CARDIOVASCULAR RISK FACTORS AFTER MORE THAN 2 PERIODIC HOSPITALIZATIONS IN THE COVASNA HOSPITAL FOR CARDIOVASCULAR REHABILITATION Link L75 Mihaela DUTESCU, Adina TRAILA, Margit SERBAN, Emilia URSU, Dorina MIU, Ioana MALITA, Bianca CIRESAN - 12 minutes THE EFFICIENCY OF MEDICAL REHABILITATION TREATMENT IN PATIENTS WITH HEMOPHILIA AFTER SURGICAL ORTHOPEDIC INTERVENTIONS - THE EXPERIENCE OF "CRISTIAN SERBAN" BUZIAS CENTER Link L76 Dorin-Gheorghe TRIFF, Simona POP - 12 minutes PRECURSORS OF BALENOLOGY EDUCATION IN ROMANIA Link L77 Dr. Eugenia Dumitrescu, Dr. Carmen Enescu - 12 minutes ANTIALLERGIC PROCEDURES MOST COMMONLY USED IN PHYSICAL RECOVERY MEDICINE AND BALNEOLOGY Link L78 Mihail HOTETEU, Constantin MUNTEANU, Diana MUNTEANU, Gabriela DOGARU - 12 minutes PELOIDS - PERSPECTIVES ON RESEARCH AND FUTURE PLANS Link L79 Liliana Stanciu, Daniela Profir, Viorica Marin, Doinița Oprea, Elena Ionescu, Elena Almășan, Carmen Oprea - 12 minutes THE SCIENCE OF AGING WELL Link L80 Q & A – 12 minutes POSTER SESSION Authors Title Abstract Andra Pintilie, Liliana Pădure, Andrada Mirea, Corina Sporea Proprioceptive Functional Vibration Stimulation as therapeutic tool in spasticity management of jump gait pattern of spastic diplegic children with cerebral palsy Poster 1 Andra Pintilie, Liliana Pădure, Andrada Mirea, Corina Sporea Modern computerized techniques for gait’s functional evaluation through a specialized wireless inertial sensor – premise for orthopedic corrective shoes wear in children with gait disorders secondary to Cerebral Palsy Poster 2 Ana Maria PÂSLARU, Ana Maria FĂTU, Anamaria CIUBARĂ The role of medical recovery in oncology Poster 3 Maria Veronica MORCOV, Liliana PADURE, Cristian Gabriel MORCOV, Gelu ONOSE Exercises availed by sensor-based computer advanced devices: part of the interactive cognitive recovery – adjuvant of the therapy applied in the Centrul National Clinic de Recuperare Neuropsihomotorie Copii “Dr. N. Robanescu” Poster 4 Avram Mihai, Liliana Padure, Gelu Onose Theoretical fundamentals and conceptual premise for advanced proprioceptive and sensory stimulus apparatus, with sequential evaluation for the treatment of the recuperator in the equilibrium disorder, from Cerebral Palsy (PC) casuistry. Poster 5 Andrada MIREA, Gelu ONOSE, Madalina LEANCA, Florin-Petru GRIGORAS, Mihaela AXENTE, Liliana PADURE, Corina SPOREA Respiratory management in patients with rare progressive neuromuscular diseases Poster 6 Mihaela MANDU, Elena CONSTANTIN, Cristinel Dumitru BADIU, Cosmin Daniel OPREA, Cristina DAIA, Gelu ONOSE Presentation od the Fugl Meyer Assesment scale and related suggesttion in order to enhance its level of implementation in inner neurorehabilitation units Poster 7 ALEXANDRU BOGDAN-CĂTĂLIN, ALINA SIMONA ȘOVREA, ANNE-MARIE CONSTANTIN, ADINA BIANCA BOȘCA, CARMEN GEORGIU, MONICA POPA Complex oral rehabilitation in an elderly patient with periodontal disease who exercises regularly Poster 8 Dorin-Gheorghe TRIFF, Simona POP MORBIDITY BY OSTEO-MUSCULO-ARTICULAR DISEASES IN THE OCCUPATIONAL ENVIRONMENT IN MARAMURES COUNTY. THE IMPORTANCE OF MEDICAL RECOVERY AND RECORDS THROUGH ELECTRONIC DATA MANAGEMENT SYSTEMS Poster 9 Authors Title Abstract Mihaela Antonina CALIN, Marian Romeo CALIN, Constantin Munteanu New evidence on the effects of pelotherapy on local microcirculation Poster 10 Izabela Lazar, Gabriela Dogaru The effectiveness of balnear treatment in the management of psoriasis Poster 11 Dorin-Gheorghe TRIFF, Mușata Dacia BOCOȘ CORRELATIONS OF OSTEOMUSCULO-ARTICULAR DISEASES WITH WORK ABILITY, PERCEIVED SELF EFFICACY AND OCCUPATIONAL STRESSORS AT A REGULAR MEDICAL CHECK-UP IN PRE-UNIVERSITY EDUCATION UNITS Poster 12 Doroteea Teoibas-Serban, Valentin Stan, Dan Blendea PREVENTION OF LUMBAR DISC HERNIATION IN YOUNG ADULT POPULATION: A PRACTICAL APPROACH Poster 13 Călin Corciovă, Cătălina Luca, Robert Fuior, Flavia Corciovă Development a Monitoring Device for Arm Rehabilitation Poster 14 Simona Daniela Zavalichi, Marius Andrei Zavalichi, Sorin Stratulat, Florin Mitu Cardiovascular rehabilitation: challenges in a case of acute myocardial infarction and familial hypercholesterolemia Poster 15 Simona-Isabelle STOICA, Ioana TANASE, Gelu ONOSE Influences and consequences resulting in addictions in general and to chronic alcoholism, especially for patients with spinal cord injury Poster 16 Roxana Dumitrascu, Ana Maria Bumbea, Carmen Albu, Otilia Rogoveanu, Catalin Bostina, Rodica Traistaru, Borcan Madalina BIOMECHANICAL DYSFUNCTIONS OF THE FOOT – MAJOR IMPACT ON THE KINETIC CHAIN Poster 17 Otilia Rogoveanu, Gherghina Florin, Caimac Dan, Trifu Ramona, Cruceru Andra, Beldie C Medical rehabilitation in post-stroke spastic hemiparesis in young patients Poster 18 Ana Maria Bumbea, Otilia Rogoveanu, Roxana Dumitrascu, Bogdan Stefan Bumbea, Catalin Bostina, Albu Carmen, Borcan Madalina PERIPHERAL MAGNETIC STIMULATION - A CHALLENGE IN VERTEBRAL POSTTRAUMATIC RECOVERY Poster 19 Authors Title Abstract Dănuţ PĂCURAR, Mihaela Ramona PĂCURAR KNEE ARTHROPLASTY RECOVERY OF AN CANCER PATIENT Poster 20 Dănuţ PĂCURAR, Mihaela Ramona PĂCURAR THE IMPACT OF OSTEOARTICULAR PATHOLOGY IN POSTSTROKE RECOVERY Poster 21 Borcan Madalina, Bumbea Ana Maria, Bostina Catalin, Radoi Georgeta, Bumbea Bogdan EFFICIENT REHABILITATION TREATMENT IN A CASE WITH MAV-RUPTA MALFORMATION Poster 22 Demirgian Sibel, Nan Simona, Lulea Adela, Lascu Ioana, Marin Viorica Is possible the management of synovial chondromatosis of the hip by arthroscopy or complex balneal treament? Poster 23 Mădălina Codruța Verenca, Sorina Mierlan, Claudiu Elisei Tanase The Efficiency of Medical Treatment of Scoliosis – Paediatrics Poster 24 Florentina NASTASE¹, Alin Laurentiu TATU², Madalina Codruta VERENCA¹ Orthopaedic manifestations of Neurofibromatosis type 1 – case report Poster 25 Simona CARNICIU, Anatolie BACIU, Vasile FEDAS The attenuation of energy metabolic misbalance by means of aerobic, hypoxic, hypothermal adaptation and environment optimization at recreation resort center Poster 26 Irina Anghel, Alexandra Sporici, Magdalena Lapadat, Gelu Onose Complex clinical and therapeutic rehabilitation approach of a patient with Complete AIS/Frankel A quadriplegia post cervical spinal cord injury after accidental fall off a trailer and multiple complications occurring during disease progression - case study Poster 27 Ana-Maria Pelin , Monica Georgescu , Cristina Stefanescu , Costinela Georgescu Molecular treatment strategies in osteoporosis Poster 28

To the unrefined or under-bred person, the visiting-card is but a trifling and insignificant piece of paper; but to the cultured disciple of social law it conveys a subtle and unmistakable intelligence. Its texture, style of engraving, and even the hour of leaving it, combine to place the stranger whose name it bears in a pleasant or disagreeable attitude, even before his manners, conversation, and face have been able to explain his social position (1920 etiquette manual quoted in Curtin 138). There’s a scene in the ‘90s TV series Ab Fab where Eddy, stumbling from her car, fresh from Harvey Nicks and tipsy on Bolly, shouts into her mobile ‘it’s ok Bubbles, I’m coming into the office now’ as she enters the office. When it first aired this was a wry comment on the vacuous, superfluous nature of new communication technologies. Now, it’s like ‘so what?’ Why not attempt to convey constantly the banal minutiae of the every day? Indeed, what troubles the technological verisimilitude is not that Eddy desires absolute proximity but that she’s not texting. In these days of ‘intensive propinquity’ (Kang 2002), however, it is easy to overlook the fact that telepresence—text’s uncanny power to stand in for the corporeal body—has a long history. Indeed, one such precursor to today’s technologies of telepresence would undoubtedly appeal to Eddy and Pats. In this paper, I want to consider the extent to which the British eighteenth-century visiting card conceptually, culturally and materially anticipates a range of contemporary technologies of propinquity. Acting as complex cultural avatars, these visiting cards conveyed the desires of class and gender in the construction of identity. The British pictorial visiting card of the early eighteenth century developed from the practice of using playing cards as visiting cards, the caller’s name being inscribed on the back of the playing card. In the mid eighteenth century the custom of using playing cards as visiting cards was replaced by cards manufactured for the express purpose of notifying those with whom one wished to make contact. At first these cards, printed on ‘stout paper or thin card’, were relatively plain, except for ‘an ornamental frame of tasteful design’ that surrounded the edge thus leaving the centre blank so that the caller could write their name. Soon, however, visiting cards were being printed with illustrations. These cards commonly left room for a short message in addition to the caller’s name (Staff 10). By the latter part of the eighteenth century, most visiting cards carried elaborate designs which varied according to the taste, hobbies or professional interests of the intended consumers. For those connected to the military, for example, there were cards illustrated with swords, cannons, flags or a person in uniform was depicted. Cards left by recent callers were commonly displayed in special receptacles on mantelpieces or small tables so that visitors ‘had a chance to see whom the family numbered among its social circle and be suitably impressed’ (Pool 66). At the close of the eighteenth century, the highly illustrated visiting card gave way to an understated and smaller format. No longer pictorial, visiting cards of the nineteenth-century, as Maurice Rickards notes, were ‘reticent’ in style and ‘espoused sobriety’ in typography and design. Victorian culture took seriously the materialities of visiting card practice as the exchange and expression of symbolic capital. As Rickards explains: In Britain, the etiquette of typographic style and layout was rigorously observed: the wording was engraved; printing was in black, card colour was white. A man’s town address appeared in the lower left-hand corner, his club on the right …. Unmarried daughters living at home did not have cards of their own. They appeared compendiously on their mother's cards (351). Visiting cards demonstrate the rich prehistory of contemporary technologies of telepresence in terms of the imaginative, symbolic and rhetorical functions they performed. Telepresence can be defined as the degree to which geographically dispersed agents experience a sense of physical and/or psychological proximity through the use of particular communication technologies. Like many of the media forms they anticipate, visiting cards were used to stand in for the corporeal presence of their author. As a late nineteenth-century etiquette manual explained: ‘the stress laid by Society upon the correct usage of these magic bits of paste-board, will not seem unnecessary, when it is remembered that the visiting card … frequently is made to take the place of one’s self’ (quoted in Davidoff 42). Visiting cards functioned as avatars of presence and identity, a complex language system which allowed the discursive agents to mediate social relations according to the varying degrees of intimacy that were desired. As long as all parties could read the codes and conventions, the level of acquaintanceship could be increased, maintained or decreased. For example, if one wanted to ‘put an end to an unsatisfactory acquaintanceship’, help was, literally, at hand. Instead of the ‘intolerable’ practice of ‘cutting’ – the procedure of pointedly refusing to recognise a person with whom one formerly had been in close contact – one would slowly reduce the time spent calling to the minimum length required. ‘After this’, advises an 1897 guide called Manners for Men, the gentleman ‘may leave cards once more without asking if the ladies of the family are at home. In this way he can gradually and with perfect courtesy break off the intimacy’ (quoted in Curtin 144). But communication might sometimes break down inadvertently. A participant’s failure to interpret the signs correctly could have unpleasant consequences. Because of this, etiquette manuals warned that servants be instructed on how to observe the difference between calling and card leaving. The intricacy inherent in the semiotics of ‘speaking by the card’ is demonstrated by the role servants were expected to play. Protocol demanded that a call was answered with a call and a card by a card. Returning a call with a card could be interpreted as a snub. In some cases that was the intention of one of the participants; leaving a card instead of calling in person was an easily understood gesture intended to scale down a particular acquaintanceship. However, it might just be a mistake. One of the many complications adhering to the practice of calling and leaving cards was that one could not assume the person to whom a card belonged had, in fact, ‘called’ upon one. As Michael Curtin explains: In practice, cards very often substituted for calls since the person receiving the call was not at home. In this case, a card equalled a call, though there was a complication. Since … cards were delivered in person, one who meant to leave cards was easily confused with another who called but merely left cards because no one was at home (141). The first problem, then, is how the caller deploys the card and how the receiver interprets this action; to what degree does the card stand for the physical presence of the caller? Even in the pre-Barthesian era, authorial intention was problematic: did the caller intend to see the person on whom they called or did the card stand for a less intimate mode of communication? Further complicating matters were the servants. Unlike Wilkie Collins’ depiction of a passive and neutral butler bearing a visiting card—‘waiting not like a human being who took an interest in the proceedings but … like an article of furniture’ (85)—many etiquette manuals warned that servants were actively involved in the chain of communication. Servants, as Curtin outlines, often went to call in place of their ‘mistresses’ and ‘therefore should be exactly instructed as to their mistress’s wishes, whether to call or to leave a card’. Likewise, ‘those servants who answered the door should be made to understand this distinction, to inquire into the caller’s intention’ and record this in writing (141). Visiting cards reproduced divisions of class by regulating the public and the private. The finely nuanced signifying system of these cards addressed only middle-class and aristocratic participants. For the middle classes and the aristocracy, privacy was the inherited right which visiting cards sought to protect. Those of the working class, as Davidoff argues, had to accept that their homes could be entered at any time by members of the ‘superior’ class, who would walk in and ‘at once become involved in the life of the family by asking questions, dispensing charity or giving orders’ (46). If the visiting card was significant as a medium of telepresence, enabling subjects to imagine, desire, fear or forestall each other’s presence, in 1854 this function was enhanced with the addition of a photographic image. The carte-de-visite reworked and conflated the technical, formal and social uses of both portraiture and the visiting card. Distinguished from the older types of visiting card by being smaller in dimension, usually measuring 4½ x 2½ inches, the carte-de-visite also carried a photographic print which was affixed to the cardboard of which it was made. Mediating the performance of identity in new ways, cards now visually depicted their bearers: Thus for a ceremonial visit, the print would represent the visitor with his hands imprisoned in spotless gloves, his head slightly inclined, as for a greeting, his hat resting graciously on his right thigh. According to etiquette, if the weather were bad, an umbrella faithfully reproduced under the arm of a visitor would eloquently declare the merit of his walk (quoted in McCauley 28). The role played by the carte-de-visite in the performance of gender is emphasised by an 1862 article on ‘flirting’ which warned that a woman would be so branded ‘if she be lavish in the distribution of her carte-de-visite’ (‘Flirts’ 163). The carte-de-visite was also an important element in the production of celebrity and the emerging commodity culture. While functioning as a visiting card, the particular topics and scenes represented on the carte-de-visite meant that it became a popular object to collect and display. Often depicting royalty, politicians or military leaders, this new mode of portraiture, as an 1862 newspaper put it, made ‘the public thoroughly acquainted with all its remarkable men’ to the extent that ‘we know their personality long before we see them’ (Wynter 673). The carte-de-visite familiarised the famous and made famous the familiar: The commercial value of the human face was never tested to such an extent as it is at the present moment in these handy photographs. No man, or woman either knows but that some accident may elevate them to the position of the hero of the hour (Wynter 673). Although invented to modernise the existing visiting card, the carte-de-visite neither replaced the older version nor was it used solely for calling. For the bourgeoisie, argues McCauley, the carte-de-visite album became a ‘faddish parlour amusement’ (48). As an enabler of telepresence, the carte-de-visite seemed to promise future generations an intimate knowledge of their distant ancestors. It would collapse time, bringing history into the present. As one nineteenth century journalist remarked, ‘it is very pleasing to have one’s relatives and acquaintances reunited in an album … you converse with them, it seems as if they were there beside you’ (quoted in McCauley 48). In general, the literature on presence, virtual presence and telepresence limits its historiography to an examination of electronic media (for example, Goldberg, Sconce, and Sobchack). As this paper has suggested, what’s needed is research that focuses on those forms of analogue textual culture that, functioning as avatars of corporeality and presence, might be regarded as fabulous. Works Cited Kang, Kathy. ‘Intensive Propinquity and ::fc:: Style’, paper delivered at the Fibreculture Conference, November 22 - 24, Museum of Contemporary Art, Sydney, 2002. Collins, Wilkie. The New Magdalen. 1873. Gloucestershire, UK: Sutton, 1995. Curtin, Michael. Propriety and Position: A Study of Victorian Manners, London: Garland, 1987. Davidoff, Leonore. The Best Circles: Society, Etiquette and the Season, London: Croom, 1973. ‘Flirts,’ The Living Age. 74 (1862). Goldberg, Ken, ed. The Robot in the Garden: Telerobotics and Telepistemology in the Age of the Internet, Cambridge, MA: MIT P, 2000. McCauley, Elizabeth Anne, A. A. E. Disderi and the Carte de Visite Portrait Photograph, New Haven: Yale U P, 1985. Pool, Daniel. What Jane Austen Ate and Charles Dickens Knew: From Fox Hunting to Whist: The Facts of Daily Life in Nineteenth-Century, New York: Simon & Schuster, 1993. Rickards, Maurice. The Encyclopedia of Ephemera: A Guide to the Fragmentary Documents of Everyday Life for the Collector, Curator, and Historian, ed. Michael Twyman, New York: Routledge, 2000. Sconce, Jeffrey. Haunted Media: Electronic Presence from Telegraphy to Television, Durham: Duke UP, 2000. Sobchack, Vivian. ‘The Scene of the Screen: Envisioning Cinematic and Electronic “Presence”’. Materialities of Communication. Ed. Hans Ulrich Gumbrecht and K. Ludwig Pfeiffer, trans. William Whobrey. Stanford: Stanford U P. 83 - 106. Staff, Frank. The Picture Postcard and its Origins, London: Lutterworth, 1979. Wynter A. ‘Cartes De Visite,’ The Living Age. 72 (1862). Citation reference for this article MLA Style Milne, Esther. "‘Magic Bits of Paste-board’" M/C: A Journal of Media and Culture <http://www.media-culture.org.au/0401/02-milne.php>. APA Style Milne, E. (2004, Jan 12). ‘Magic Bits of Paste-board’. M/C: A Journal of Media and Culture, 7, <http://www.media-culture.org.au/0401/02-milne.php>

Introduction In an era of upheaval and uncertainty for higher education institutions around the world, scholars, like those in many in other professions, are increasingly using social media to build communities around mutual support and professional development. These communities appear to offer opportunities for participants to exert more positive influence over the types of interactions they engage in with colleagues, in many cases being valued as more altruistic, transformational, or supportive than established academic structures (Gibson, and Gibbs; Mewburn, and Thomson; Maitzen). What has been described as ‘digital scholarship’ applies social media to “different facets of scholarly activity in a helpful and productive way” (Carrigan 5), with online scholarly communities being likened to evolutions of face-to-face practices including peer mentoring (Ferguson, and Wheat) or a “virtual staffroom” (Mewburn, and Thomson). To a large extent, these accounts of scholarly practice adapted for digital media have resonance. From writing groups (O’Dwyer, McDonough, Jefferson, Goff, and Redman-MacLaren) to conference attendance (Spilker, Silva, and Morgado) and funding (Osimo, Priego, and Vuorikari), the transformational possibilities of social media have been applied to almost every facet of existing academic practices. These practices have increasingly attracted scrutiny from higher education institutions, with social media profiles of staff both a potential asset and risk to institutions’ brands. Around the world, institutions use social media for marketing, student recruitment, student support and alumni communication (Palmer). As such, social media policies have emerged in recent years in attempts to ensure staff engage in ways that align with the interests of their employers (Solberg; Carrigan). However, engagement via social media is also still largely considered “supplementary to ‘real’ scholarly work” (Mussell 347).Paralleling this trend, guides to effectively managing an online profile as a component of professional reputation have also become increasingly common (e.g. Carrigan). While public relations and management literatures have approached reputation management in terms of how an organisation is regarded by its multiple stakeholders (Fombrun) this is increasingly being applied to individuals on social media. According to Gandini a “reputation economy” (22) has come to function for knowledge workers who seek to cultivate a reputation as a good community member through sociality in order to secure more (or better) work.The popularity of professional social media communities and scrutiny of participants raises questions about the work involved in building and participating in them. This article explores these questions through analysis of tweets from the first year of #ECRchat, a Twitter group for early career researchers (ECRs). The group was established in 2012 to provide an opportunity for ECRs (typically within five years of PhD completion) to discuss career-related issues. Since it was founded, the group has been administered through partnerships between early career scholars using a Twitter account (@ECRchat) and a blog. Tweets, the posts of 140 characters or fewer, which appear on a user’s profile and in followers’ feeds (Twitter) are organised into a ‘chat’ by participants through the use of the hashtag ‘#ECRchat’. Participants vote on chat topics and take on the role of hosting on a volunteer basis. The explicit career focus of this group provides an ideal case study to explore how work is represented in an online professionally-focused community, in order to reflect on what this might mean for the norms of knowledge work.Digital Labour The impact of Internet Communication Technologies (ICT), including social media, on the lives of workers has long been a source of both concern and hope. Mobile devices, wireless Internet and associated communications software enable increasing numbers of people to take work home. This flexibility has been welcomed as the means by which workers might more successfully access jobs and manage competing commitments (Raja, Imaizumi, Kelly, Narimatsu, and Paradi-Guilford). However, hours worked from home are often unpaid and carry with them a strong likelihood of interfering with rest, recreation and family time (Pocock and Skinner). Melissa Gregg describes this as “presence bleed” (2): the dilutions of focus from everyday activities as workers increasingly use electronic devices to ‘check in’ during non-work time. Moving beyond the limitations of this work-life balance approach, which tends to over-state divisions between employment and other everyday life practices, a growing literature seeks to address work in online environments by analysing the types of labour being practiced, rather than seeing such practices as adjunct to physical workplaces. Responding to claims that digital communication heralds a new age of greater freedom, creativity and democratic participation, this work draws attention to the reliance of such networks on unpaid labour (e.g. Hearn; Hesmondhalgh) with ratings, reviews and relationship maintenance serving business’ economic ends alongside the individual interests which motivate participants. The immaterial, affective, and often precarious labour that has been observed is “simultaneously voluntarily given and unwaged, enjoyed and exploited” (Terranova). This work builds particularly on feminist analysis of work (see McRobbie for a discussion of this), with behind the scenes moderator, convenor, and community builder roles largely female and largely unrecognised, be they activist (Gleeson), creative (Duffy) or consumer (Arcy) groups. For some, this suggests the emergence of a new ‘women’s work’ of affective immaterial labour which goes into building transformational communities (Jarrett). Yet, digital labour has not yet been foregrounded within research into higher education, where it is largely practiced in the messy intersections of employment, unpaid professional development, and leisure. Joyce Goggin argues that convergence of these spheres is a feature of digital labour. Consequently, this article seeks to add a consideration of digital labour, specifically the cultural politics of work that emerge in these spaces, to the literature on digital practices as a translation of existing academic responsibilities online. In the context of widespread concerns over academic workload and job market (Bentley, Coates, Dobson, Goedegebuure, and Meek) and the growing international engagement and impact agenda (Priem, Piwowar, and Hemminger), it raises questions about the implications of these practices. Researching Twitter Communities This article analyses tweets from the publicly available Twitter timeline, containing the hashtag #ECRchat, during scheduled chats, from 1 July 2012 to 31 July 2013 (the first year of operation). Initially, all tweets in this time period were analysed in anonymised form to determine the most commonly mentioned topics during chats. This content analysis removed the most common English language words, such as: the; it; I; and RT (which stands for retweet), which would otherwise appear as top results in almost any content analysis regardless of the community of interest. This was followed by qualitative analysis of tweets, to explore in more depth how important issues were articulated and rationalised within the group. This draws on Catherine Driscoll’s and Melissa Gregg’s idea of “sympathetic online cultural studies” which seeks to explore online communities first and foremost as communities rather than as exemplars of online communications (15-20). Here, a narrative approach was undertaken to analyse how participants curated, made sense of, and explained their own career stories (drawing on Pamphilon). Although I do not claim that participants are representative of all ECRs, or that the ideas given the most attention during chats are representative of the experiences of all participants, representations of work articulated here are suggestive of the kinds of public utterances that were considered reasonable within this open online space. Participants are identified according to the twitter handle and user name they had chosen to use for the chats being analysed. This is because the practical infeasibility of guaranteeing online anonymity (readers need only to Google the text of any tweet to associate it with a particular user, in most cases) and the importance of actively involving participants as agents in the research process, in part by identifying them as authors of their own stories, rather than informants (e.g. Butz; Evans; Svalastog and Eriksson).Representations of Work in #ECRchat The co-creation of the #ECRchat community through participant hosts and community votes on chat topics gave rise to a discussion group that was heavily focused on ‘the work’ of academia, including its importance in the lives of participants, relative appeal over other options, and negative effects on leisure time. I was clear that participants regarded participation as serving their professional interests, despite participation not being paid or formally recognised by employers. With the exception of two discussions focused on making decisions about the future of the group, #ECRchat discussions during the year of analysis focused on topics designed to help participants succeed at work such as “career progression and planning”, “different routes to postdoc funding”, and “collaboration”. At a micro-level, ‘work’ (and related terms) was the most frequently used term in #ECRchat, with its total number of uses (1372) almost double that of research (700), the next most used term. Comments during the chats reiterated this emphasis: “It’s all about the work. Be decent to people and jump through the hoops you need to, but always keep your eyes on the work” (Magennis).The depth of participants’ commitment comes through strongly in discussions comparing academic work with other options: “pretty much everyone I know with ‘real jobs’ hates their work. I feel truly lucky to say that I love mine #ECRchat” (McGettigan). This was seen in particular in the discussion about ‘careers outside academia’. Hashtags such as #altac (referring to alternative-academic careers such as university research support or learning and teaching administration roles) and #postac (referring to PhD holders working outside of universities in research or non-research roles) used both alongside the #ECRchat hashtag and separately, provide an ongoing site of these kinds of representations. While participants in #ECRchat sought to shift this perception and were critically aware that it could lead to undesirable outcomes: “PhDs and ECRs in Humanities don’t seem to consider working outside of academia – that limits their engagement with training #ECRchat” (Faculty of Humanities at the University of Manchester), such discussions frequently describe alternative academic careers as a ‘backup plan’, should academic employment not be found. Additionally, many participants suggested that their working hours were excessive, extending the professional into personal spaces and times in ways that they did not see as positive. This was often described as the only way to achieve success: “I hate to say it, but one of the best ways to improve track record is to work 70+ hours a week, every week. Forever. #ecrchat” (Dunn). One of the key examples of this dynamic was the scheduling of the chat itself. When founded in 2012, #ECRchat ran in the Australian evening and UK morning, eliding the personal/work distinction for both its coordinators and participants. While considerable discussion was concerned with scheduling the chat during times when a large number of international participants could attend, this discussion centred on waking rather than working hours. The use of scheduled tweets and shared work between convenors in different time zones (Australia and the United Kingdom) maintained an around the clock online presence, extending well beyond the ordinary working hours of any individual participant.Personal Disclosure The norms that were articulated in #ECRchat are perhaps not surprising for a group of participants seeking to establish themselves in a profession where a long-hours culture and work-life interference are common (Bentley, Coates, Dobson, Goedegebuure, and Meek). However, what is notable is that participation frequently involved the extension of the personal into the professional and in support of professional aims. In the chat’s first year, an element of personal disclosure and support for others became key to acting as a good community member. Beyond the well-established norms of white collar workers demonstrating professionalism by deploying “courtesy, helpfulness, and kindness” (Mills xvii), this community building relied on personal disclosure which to some extent collapsed personal and professional boundaries.By disclosing individual struggles, anxieties, and past experiences participants contributed to a culture of support. This largely functioned through discussions of work stress rather than leisure: “I definitely don’t have [work-life balance]. I think it’s because I don’t have a routine so work and home constantly blend into one another” (Feely). Arising from these discussions, ideas to help participants better navigate and build academic careers was one of the main ways this community support and concern was practiced: “I think I’m often more productive and less anxious if I'm working on a couple of things in parallel, too #ecrchat” (Brian).Activities such as preparing meals, caring for family, and leisure activities, became part of the discussion. “@snarkyphd Sorry, late, had to deal with toddler. Also new; currently doing casual teaching/industry work & applying for postdocs #ecrchat” (Ronald). Exclusively professional profiles were considered less engaging than the combination of personal and professional that most participants adopted: “@jeanmadams I’ve answered a few queries on ResearchGate, but agree lack of non-work opinions / personality makes them dull #ecrchat” (Tennant). However, this is not to suggest that these networks become indistinguishable from more informal, personal, or leisurely uses of social media: “@networkedres My ‘professional’ online identity is slightly more guarded than my ‘facebook’ id which is for friends and family #ECRchat” (Wheat). Instead, disclosure of certain kinds of work struggles came to function as a positive contribution to a more reflexive professionalism. In the context of work-focused discussion, #ECRchat opens important spaces for scholars to question norms they considered damaging or at least make these tacit norms explicit and receive support to manage them. Affective Labour The professional goals and focus of #ECRchat, combined with the personal support and disclosure that forms the basis for the supportive elements in this group is arguably one of its strongest and most important elements. Mark Carrigan suggests that the practices of revealing something of the struggles we experience could form the basis for a new collegiality, where common experiences which had previously not been discussed publicly are for the first time recognised as systemic, not individual challenges. However, there is work required to provide context and support for these emotional experiences which is largely invisible here, as has typically been the case in other communities. Such ‘affective labour’ “involves the production and manipulation of affect and requires (virtual or actual) human contact, labour in the bodily mode … the labour is immaterial, even if it is corporeal and affective, in the sense that its products are intangible, a feeling of ease, well-being, satisfaction, excitement or passion” (Hardt, and Negri 292). In #ECRchat, this ranges from managing the schedule and organising discussions – which involves following up offers to help, assisting people to understand the task, and then ensuring things go ahead as planned –to support offered by members of the group within discussions. This occurs in the overlaps between personal and professional representations, taking a variety of forms from everyday reassurance, affirmation, and patience: “Sorry to hear - hang in there. Hope you have a good support network. #ECRchat” (Galea) to empathy often articulated alongside the disclosure discussed earlier: “The feeling of guilt over not working sounds VERY familiar! #ecrchat” (Vredeveldt).The point here is not to suggest that this work is not sufficiently valued by participants, or that it does not parallel the kinds of work undertaken in more formal job roles, including in academia, where management, conference convening or participation in professional societies, and teaching, as just a few examples, involve degrees of affective labour. However, as a consequence of the (semi)public nature of these groups, the interactions observed here appear to represent a new inflection of professional reputation work, where, in building online professional communities, individuals peg their professional reputations to these forms of affective labour. Importantly, given the explicitly professional nature of the group, these efforts are not counted as part of the formal workload of those involved, be they employed (temporarily or more securely) inside or outside universities, or not in the paid workforce. Conclusion A growing body of literature demonstrates that online academic communities can provide opportunities for collegiality, professional development, and support: particularly among emerging scholars. These accounts demonstrate the value of digital scholarly practices across a range of academic work. However, this article’s discussion of the work undertaken to build and maintain #ECRchat in its first year suggests that these practices at the messy intersections of employment, unpaid professional development, and leisure constitute a new inflection of professional reputation and service work. This work involves publicly building a reputation as a good community member through a combination of personal disclosure and affective labour.In the context of growing emphasis on the economic, social, and other impacts of academic research and concerns over work intensification, this raises questions about possible scope for, and impact of, formal recognition of digital academic labour. While institutions’ work planning and promotion processes may provide opportunities to recognise work developing professional societies or conferences as a leadership or service to a discipline, this new digital service work remains outside the purview of such recognition and reward systems. Further research into the relationships between academic reputation and digital labour will be needed to explore the implications of this for institutions and academics alike. 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Bones are one of the oldest materials used to create musical instruments. Currently, the world’s oldest known instruments are flutes made out of bones (Turk, Turk, and Otte 11). In fact, bones have been used to create or enhance musical instruments in a variety of settings throughout history and in modern day instrument making. Bone bull roarers, jaw bone percussion, clappers, trumpets, drum shells, lyres, or construction parts, such as frets, plectrums, pipes and pipe fittings, embouchure adjustments, or percussive strikes are just a few of the more common uses of bones in musical instrument construction. One man even made a guitar out of the skeleton of his dead uncle to memorialise the person who influenced his musical tastes and career (Bienstock). Bones can therefore be taken as a somewhat common material for making musical instruments. All of these instruments share a common trait, and not just the obvious one that they are all made out of or incorporate bones. None of these instruments are intended to represent something monstrous. Instead, they represent the ephemeral nature of humanity (Cupchik 33), a celebration of lineage or religious beliefs (Davis), or simply are the materials available or suitable to create a sound-making device (Regan). It is not possible to know the full intentions of a maker, in many cases, but a link to monstrosity and a representation of the ‘horrific’ or ‘freakish’ seems missing for the most. There are instruments, however, that do house this sentiment and some that utilise bones in the construction with the purpose of making this connection between the remains and something beast-like. In this article, I argue that the Bone Guitar Thing (BGT) built and played by raxil4 is one of those instruments. Introducing the 'Thing' Raxil4 is the stage name of sonic artist Andrew Page. He has been playing his Bone Guitar Thing for almost twenty years in a variety of settings (Page, email interview, 25 June 2021). The instrument has undergone slight changes during that time, but primarily it has retained its specific visual, timbral, and underlying associative features. The BGT is complex, more so than it may seem at first. By investigating the materials used, the performance techniques employed, and raxil4’s intentions as a musician, instrument maker, and community member within his circles of activity, the monstrous nature of the BGT comes to light. The resultant series of entanglements exhibits and supports a definition of what is a 'monster' that, like several definitions in monster theory discourse (Levina and Bui 6; Cohen 7; Mittman 51), includes challenging that which may be seen as ‘normal’ and thereby may nurture levels of unease or fear. However, in the case of the BGT, that which is monstrous is simultaneously being taken as something positive alongside its beast-like characteristics, and rather than evolving into something that needs to be repressed or eliminated, the ’monster’ here becomes a hero or champion, colleague, or even a friend. The Bone Guitar Thing is not really a guitar. It is a zither with a piece of driftwood for a base, (currently) five strings, and an electric pick-up (see Fig. 1). The bridge for the instrument is two bones, and the pitch and timbre of the strings is sometimes changed with bones used for Cage-like preparation (Cage 7-8; Bunger). Bones are also used to play the instrument, sometimes like a plectrum, others like a hammered dulcimer, or occasionally, simply pounding the string or the soundboard with great force to make a combination of percussive and string sounds. Glissandos are created by using the plectrum bones as a slide, and Page also uses jaw bones to introduce ratchet sounds, string scraping, and precise pitch bending (with the sharper edged part of the bones) (raxil4, “Livestream”). The instrument is electric, so the bones are enhanced with guitar pedals (typically reverb, distortion, and octave-splitter; Page, email interview, 25 June 2021), but the tonal qualities retain a semblance of the bone usage. Fig. 1: raxil4's Bone Guitar Thing. Photograph: Andrew Page. Page often uses the BGT as part of his sonic arsenal to perform dark ambient music, noisescapes, improv music, or live film soundtracks both in live concerts and recording situations. He plays solo as much as with ensembles, and more often improvises his music or parts, but occasionally works with predetermined organisation or scores of some description (although he admits to typically abandoning predetermined passages or scores during live performances; Page, email interview, 14 July 2021). Currently in London, raxil4 presents concerts in a variety of settings, typically well-suited for his brand of sonic art, such as Ryan Jordan’s long-running concert series Noise=Noise (raxil4 feat. King Sara), experimental music shows at the Barbican (raxil4 + King Sara + P23), and dark ambient showcases promoted and arranged by one of his record labels, Sombre Soniks (Wright). Sounds beyond Words: Monstrous Music One series of performances in which raxil4 used the BGT took the form of an immersive theatre show produced by Dread Falls Theatre called Father Dagon, based on the works of horror author H. P. Lovecraft. The performance incorporated a breaking of the ’fourth wall’ in which the audience wanders freely through the performance space, with actor- and sometimes audience-interactive musical performances of partially improvised, partially composed passages by musicians located throughout the set. Director and writer Victoria Snaith considered the use of live, semi-mobile, experimental music dispersed through the audience (mixed with an overall backing soundtrack) as heightening the intensity of the experience by introducing unfamiliar aspects to the setting. She discusses having made this decision based on Lovecraft’s own approach to story-telling that highlights a sense of unfamiliarity and therefore sense of “fear of the unknown”. The usefulness of creating unfamiliarity in this context can serve to support the parts of the narrative that contains supernatural and monstrous aspects. Given that the elements of the supernatural and horrible monsters in Lovecraftian tales are primarily indescribable (both because Lovecraft would recount beasts and fantastic magical happenings in his works as being such, and because in a practical theatrical situation, these things would be impossible to describe, especially without text or specific props or costumes, which the show purposefully uses sparingly, also as a conscious choice to embrace the unknown). Sounds created on instruments that are unique, or generated through unusual performance techniques would lend themselves to being more difficult to describe, and therefore fitting to support a desire to present something regarded as also difficult to describe, that being supernatural happenings or horrific creatures. (Connor 77) Page’s use of the BGT in these performances added directly to this notion both sonically and visually. The homemade nature of his instrument increased the potential that audience members would be less familiar with the source of his sounds, even if they were watching him perform, and the resultant soundscape he provided introduced harsh timbres, undulating pads, and aggressive punctuation of movement. Page sees the BGT as an instrument “reclaimed from the watery depths” (matching the theme of the show’s narrative), therefore as one fitting into the Lovecraft show “quite nicely” (Page, email interview, 25 June 2021). He likens the sounds created by the BGT as presenting “otherworldly melodies” akin to those played by Erich Zann (a character in another Lovecraft story who conjures a gateway to an alternate dimension full of indescribable creatures and nightmares via performing unusual music on his viola de gamba), which Page also sees as fitting (ibid.). His instrument in this setting as a producer and provider of unfamiliarity is supportive of constructing and maintaining a definition of “monstrous” or “terrifying” (Levina and Bui 6). Fig. 2: raxil4 performing in Dread Falls Theatre's Father Dagon, London 2012. Photograph: Pierre Ketteridge. Finding Community in the 'Freakish' Raxil4 also notes that the Bone Guitar Thing is appropriate for creative input within improv music circles (Page, email interview, 25 June 2021). Generally speaking, contemporary improv music (meaning the broad genre) is improvised performance focussing on sonic exploration over melodic, harmonic, or rhythmic content (even though all will be present in most cases; Toop 132-137). In my experience working with improv musicians since 1981, I find that these performers typically attempt to create sounds that are unusual or unexpected. Players often embrace extended techniques, repurposing non-musical items to be sound-making devices, and employ self-built instruments. Improv musicians seek to break free from the constraints of what may be seen as Western standard musical practices (ibid.), but they simultaneously strive to uphold some parallel aspects of artisanship and virtuosity, perhaps as a means to validate their departure from Classical/mainstream music norms. The instruments and approaches can be seen as factors that separate the experimental artists from the conservatory-based performers, yet still affords them the clout of being hard-working, innovative, expressive, and professional. As the name implies, improv music emphasises improvisation. André Hodier (23-36) in his classic book The Worlds of Jazz likens improvising jazz musicians to an alien race who battle each other on a daily basis (via jazz battles) in order to see who resides at the top of the improvisation chain. Improv musicians (some of whom come from a jazz background) tend to engage in this sort of hierarchical status ranking system using a much more ’polite’ and co-supportive mentality (at least in the scenes in which I have been privileged to participate). Improv musicians can occasionally embrace a friendly attitude that one should surpass the experimental nature of other performers, and may do so by presenting a new sound, technique, or instrument. The BGT can serve this function. It can stand out among other improv musicians’ gear, even if a majority of the instruments are self-built, through its use of bones and its intentional evocation of something horrific. Improvised music is sometimes looked down upon by musical communities who value conservatory training, popular music, or more traditional Western classical approaches to music. Referring to avant-garde jazz in the 60s and 70s, Valerie Wilmer (6) recounts that critics and Classical music enthusiasts perceived experimental and improv music as “‘freakish’ and only worthy of passing interest”. The dynamic is different today, but the overall attitude remains, at least in part. The improv music scene is creatively valid, but in comparison to conservative or more mainstream music, incorporates more experimental practices, therefore sometimes musical form, interactions, and preparation is less obvious to audience members outside the experimental music circles. The Bone Guitar Thing also plays into this construction. It is artistically valid, yet perhaps simultaneously challenging to the less-experienced listener. The BGT in this setting is multifunctional. Page (email interview, 25 June 2021) sees the BGT as a means to cut through or rise above other improv musicians, partly by being more recognisable as a “freakish” instrument at performances where the music is already considered freakish by some outsiders. Additionally, the fact that Page has taken the time to make this instrument, and uses notably practiced techniques to create the sounds he introduces, may position him as an innovative professional, rather than a non-trained imposter. The BGT can (at least for raxil4, but for others as well) become a monster among monsters that allows Page to validate his brand of creativity (Ibid). Musical ’freakishness’ appears in other settings as well. An example of this is a performance in which raxil4 took part where an ensemble provided experimental music for a live tattooing event (raxil4, “Listening”). Here, the congruency with being monstrous or freakish is perhaps more overt. Similar to the soundscape being performed, Fenske (6) points out that tattoos may still be seen as unfit or unexpected for certain classes, genders, or education levels, and may even still be associated with illustrated circus performers of the past. Furthermore, Kinzey (32) suggests that avant-garde and counter-culture communities (such as ones where tattooing and live music converge in a single event) often value uniqueness that serves to “erase boundaries between everyday life and art”. The combined performativity of live music and tattoo inking (both the artistic activity and the art itself) associates raxil4 and the BGT with this non-mainstream circle (to some degree), potentially conjuring an identity of something freakish or monstrous to people with different values. Engaging with Expressive Objects The conception and evolution of the Bone Guitar Thing has its roots in personal experience, art experimentation, and material culture related to Page’s life and the musical communities in which he played and plays. In the past, Page endeavored to make small sculptures to be given as Christmas and birthday gifts from materials he found on the shore of the River Thames, many including bones. Page then began to create new musical instruments with what he had available. Page’s brother is a doctor specialising in gunshot wounds and knife trauma, and his apartment was filled with remnants of his brother’s occupation, including a number of crutches. From these, Page crafted his first instruments in this period: crutch harps that utilised the leftover medical devices to build stringed sound generators. He claims the instruments at first were not overly successful, so he began to experiment with his bone sculptures to create more serviceable instruments. An early attempt was a percussion instrument made from various found bones, which Page deemed the “Xylobone” (see Fig. 4). This instrument and advanced crutch harps (6-string tenor (see Fig. 3.) and 2-string bass) became his first arsenal of sound makers, but Page felt the instruments ultimately failed to meet expectations and opted to rethink his approaches and designs. Fig. 3: One of Page's 6-stringed crutch harps. Photograph: Andrew Page. Fig. 4: The Xylobone - raxil4's bone xylophone percussion instrument. Photograph: Andrew Page. The BGT was intended to be more “playable”, “expressive”, and audible to battle louder co-performers. As mentioned, the driftwood base and bones for the instrument originated from the River Thames. The electronics come from a destroyed guitar that was the result of performing in a previous project in which Page was the singer, where the guitarist “had a habit of smashing his guitars on stage, in a sort of expensive tribute to [grunge guitarist] Kurt Cobain" (Page, email interview, 25 June 2021). The BGT started off as a 6-string zither that used guitar-gauge steel strings, but according to Page, given the harsh performance technique of beating or scraping the strings with bones, he was encouraged to switch to using wound, bass-gauge strings, affording him a lower pitch and greater resistance to energetic performance practices. One tuning peg, however, snapped off quite early in its life (as it was in a thinner, more weathered part of the driftwood), leaving the instrument one string shorter. Page says he likes to think that the instrument decided itself that it would be a “5-stringed beast” (ibid.). Conclusion The Bone Guitar Thing is, in fact, beast-like, at least in the settings, sonic attributes, and mindsets of the player and the communities in which the instrument is played, but it may not be the case that this beast-like nature is equal to being monstrous. Cohen (3-25) in his discussion of seven potential monster theories outlines several different notions of what can be considered “monstrous” and relates the monster in each theoretical situation to those fearing the monstrous construct. Most closely related to the situation in which the BGT is observed is a parallel theory based on the concept of “Us versus Them”, meaning “Us” as those who are dealing with the monster in question, and “Them” as being those on the side of the monster or the monster itself (Cohen 19-20). However, with the BGT, the monster is not unanimous with “them”, but rather with “us”. In all the situations outlined here, the instrument takes on the role of a beast, but not a negative role for Page (email interview, 14 July 2021) or fans of raxil4 (Wright). Instead, the beast is more like part of the team of noise makers actively engaged in the community’s activities of creation, entertainment, identity, and validation of values upheld thereof. Each of the performance settings can be argued to exhibit a sense of welcoming outsiders or praising diversity, rather than ostracising it. The Lovecraft performance and story were constructed on the premise of questioning what is a monster and who determines that definition. The Bone Guitar Thing supports and interacts precisely within this parameter to enhance the artistic commentary presented. Within the improv music setting, the instrument assists Page to achieve uniqueness among that which is already unique and highlights the values of community including a show of innovation, exploration, and personal performance technique development. For the live tattooing, the instrument stands out as a unifying sonic flag, connecting other (perhaps less-monstrous) artists into a stronger group of alternative creatives. Effectively, the BGT is a 'freak among freaks', serving to simultaneously fit in and rise above, all while maintaining a sense of “us” within respective circles. The beast-like nature is not entirely an outward force. Page (email interviews, 25 June 2021 and 14 July 2021) is aware that he has received no formal education in music. He admits he is less familiar with music theory, and more familiar with the science and technology behind the music. Page considers himself to be experimental in his approach to sound creation, which he sees as being more unique due to ignoring the “rulebooks” (ibid.). As a result, he feels (at least a slight) pressure of feeling “unprofessional” or “correct” in the eyes of Western conservatory-trained musicians and composers or those with a similar mentality (Page, email interview, 25 June 2021). The BGT was also, to a degree, built to battle being told what was “right”. For Page, his instrument is akin to a beast that helped him break free of the constraints of Western tonal and virtuosic constraints. “I made my own [instrument] so that nobody could tell me I was playing it the wrong way” (ibid.). His “beast” helped him break down barriers and asserted himself as an innovative musician and creative professional. So, then, the Bone Guitar Thing is a monster; sonically, visually, and physically. It represents a monster, it is called “the beast”, and it takes on the role of a terrifying creature raging through (sometimes, extremely quietly – raxil4; raxil 4 feat. King Sara; raxil4 + King Sara + P23) soundscapes, settings, and performances, rallying the like-minded and routing the unsuspecting or “others”. That is an overdramatic take on the situation, perhaps, but the instrument does uphold a series of values and creative aesthetics that fosters positive relationships between the artist, the community, and the sonic and physical qualities of the zither. Rather than being a device that places a horrific barrier to be overcome in an “us versus them” scenario, the monster takes on an alternate role and becomes a source of empowerment for “outsiders” or marginalised groups or people (Mittman 51). Thus the Bone Guitar Thing allows Page to demolish barriers and amalgamate fellow community members into a larger version of “us” to create a space in which the beast is no longer a monster. References Bienstock, Richard. “Man Builds Guitar Out of His Dead Uncle’s Skeleton.” Guitar World 11 Feb. 2021. Web. 13 June 2021 <https://www.guitarworld.com/news/man-builds-guitar-out-of-his-dead-uncles-skeleton-uses-it-to-play-black-metal>. Bunger, Richard. The Well-Prepared Piano. Colorado Springs: Colorado College Music P, 1973. Cage, John. Empty Words: Writings ’73-’78. Middletown, CT: Wesleyan University P, 1981. Cohen, Jeffrey Jerome. “Monster Culture (Seven Theses).” Monster Theory: Reading Culture. Minneapolis: U of Minnesota P, 1996. 3–25. Connor, Will. “Performing the Sounds of Darkness: An Exploratory Discussion of Musical Instruments and the Gothic Aesthetic.” The Dark Arts Journal: Reimaging the Gothic 2.I2 (Autumn 2016). 26 June 2021 <https://thedarkartsjournal.files.wordpress.com/2017/04/the-dark-arts-journal-2-21.pdf>. Cupchik, Jeffrey. “Buddhism as Performing Art: Visualizing Music in the Tibetan Sacred Ritual Music Liturgies.” Yale Journal of Music & Religion 1.1 (2015): 31–62. Davis, Josh. “Some Bronze Age Britons Turned the Bones of Dead Relatives into Musical Instruments.” Natural History Museum. 1 Sep. 2020. 23 June 2021 <https://www.nhm.ac.uk/discover/news/2020/september/bronze-age-britons-turned-the-bones-of-dead-relatives-into-musical-instruments.html>. Fenske, Mindy. Tattoos in American Visual Culture. New York: Palgrave, 2007. Hodier, André. The Worlds of Jazz. New York: Grove P, 1972. Kinzey, Jake. The Sacred and the Profane: An Investigation of Hipsters. Winchester, U.K.: Zero Books, 2012. Levina, Marina, and Diem-My T. Bui. “Introduction: Toward a Comprehensive Monster Theory in the 21st Century.” Monster Culture in the 21st Century: A Reader. Eds. Marina Levina and Diem-My T. Bui. New Delhi: Bloomsbury. 1–14. Mittman, Asa Simon. “Introduction: The Impact of Monsters and Monster Studies.” The Ashgate Research Companion to Monsters and the Monstrous. Eds. Asa Simon Mittman and Peter J. Dendle. London and New York: Routledge, 2013. 44–60. Raxil4. Listening Circuits: 19/06/21 with Live Tattooing from Catmouse. 21 June 2021. 23 June 2021 <https://www.youtube.com/watch?v=VZgUC5TTOxk&list=LL&index=3>. ———. raxil4 – Livestream for Iklecktik: 21/06/20. 22 June 2020. 23 June 2021 <https://www.youtube.com/watch?v=-zW-Mw2jRDQ&list=LL&index=6>. Raxil4 feat: King Sara. raxil4 feat: King Sara – Sawbones 13 – Live @ Noise=Noise (14/01/13). 26 Jan. 2013. 23 June 2021 <https://www.youtube.com/watch?v=fxFMA77yQ_A&list=LL&index=5>. raxil4 + King Sara + P23. raxil4 + King Sara + P23 – Barbican: 15/08/13. 11 Sep. 2018. 23 June 2021 <https://www.youtube.com/watch?v=N619ooZxx-0&list=LL&index=4>. Page, Andrew. Email interview. 25 June 2021. ———. Email interview. 14 July 2021. Regan, Marty. Video interview. 13 July 2021. Snaith, Victoria. Personal interview. 17 April 2016. Toop, David. Ocean of Sound. London: Serpent’s Tail, 2001. Turk, Matija, Ivan Turk, and Marcel Otte. “The Neanderthal Musical Instrument from Divje Babe I Cave (Slovenia): A Critical Review of the Discussion.” Applied Sciences 10-1226.2 (2020): 1–11. Wilmer, Valerie. As Serious as Your Life. London: Serpent’s Tail, 2018. Wright, Kevin. Email interview. 29 June 2021.

IntroductionIn the year 2000, a group of likeminded individuals got together and convened the first annual World Barista Championship in Monte Carlo. With twelve competitors from around the globe, each competitor was judged by seven judges: one head judge who oversaw the process, two technical judges who assessed technical skills, and four sensory judges who evaluated the taste and appearance of the espresso drinks. Competitors had fifteen minutes to serve four espresso coffees, four cappuccino coffees, and four “signature” drinks that they had devised using one shot of espresso and other ingredients of their choice, but no alcohol. The competitors were also assessed on their overall barista skills, their creativity, and their ability to perform under pressure and impress the judges with their knowledge of coffee. This competition has grown to the extent that eleven years later, in 2011, 54 countries held national barista championships with the winner from each country competing for the highly coveted position of World Barista Champion. That year, Alejandro Mendez from El Salvador became the first world champion from a coffee producing nation. Champion baristas are more likely to come from coffee consuming countries than they are from coffee producing countries as countries that produce coffee seldom have a culture of espresso coffee consumption. While Ireland is not a coffee-producing nation, the Irish are the highest per capita consumers of tea in the world (Mac Con Iomaire, “Ireland”). Despite this, in 2008, Stephen Morrissey from Ireland overcame 50 other national champions to become the 2008 World Barista Champion (see, http://vimeo.com/2254130). Another Irish national champion, Colin Harmon, came fourth in this competition in both 2009 and 2010. This paper discusses the history and development of coffee and coffee houses in Dublin from the 17th century, charting how coffee culture in Dublin appeared, evolved, and stagnated before re-emerging at the beginning of the 21st century, with a remarkable win in the World Barista Championships. The historical links between coffeehouses and media—ranging from print media to electronic and social media—are discussed. In this, the coffee house acts as an informal public gathering space, what urban sociologist Ray Oldenburg calls a “third place,” neither work nor home. These “third places” provide anchors for community life and facilitate and foster broader, more creative interaction (Oldenburg). This paper will also show how competition from other “third places” such as clubs, hotels, restaurants, and bars have affected the vibrancy of coffee houses. Early Coffee Houses The first coffee house was established in Constantinople in 1554 (Tannahill 252; Huetz de Lemps 387). The first English coffee houses opened in Oxford in 1650 and in London in 1652. Coffee houses multiplied thereafter but, in 1676, when some London coffee houses became hotbeds for political protest, the city prosecutor decided to close them. The ban was soon lifted and between 1680 and 1730 Londoners discovered the pleasure of drinking coffee (Huetz de Lemps 388), although these coffee houses sold a number of hot drinks including tea and chocolate as well as coffee.The first French coffee houses opened in Marseille in 1671 and in Paris the following year. Coffee houses proliferated during the 18th century: by 1720 there were 380 public cafés in Paris and by the end of the century there were 600 (Huetz de Lemps 387). Café Procope opened in Paris in 1674 and, in the 18th century, became a literary salon with regular patrons: Voltaire, Rousseau, Diderot and Condorcet (Huetz de Lemps 387; Pitte 472). In England, coffee houses developed into exclusive clubs such as Crockford’s and the Reform, whilst elsewhere in Europe they evolved into what we identify as cafés, similar to the tea shops that would open in England in the late 19th century (Tannahill 252-53). Tea quickly displaced coffee in popularity in British coffee houses (Taylor 142). Pettigrew suggests two reasons why Great Britain became a tea-drinking nation while most of the rest of Europe took to coffee (48). The first was the power of the East India Company, chartered by Elizabeth I in 1600, which controlled the world’s biggest tea monopoly and promoted the beverage enthusiastically. The second was the difficulty England had in securing coffee from the Levant while at war with France at the end of the seventeenth century and again during the War of the Spanish Succession (1702-13). Tea also became the dominant beverage in Ireland and over a period of time became the staple beverage of the whole country. In 1835, Samuel Bewley and his son Charles dared to break the monopoly of The East India Company by importing over 2,000 chests of tea directly from Canton, China, to Ireland. His family would later become synonymous with the importation of coffee and with opening cafés in Ireland (see, Farmar for full history of the Bewley's and their activities). Ireland remains the highest per-capita consumer of tea in the world. Coffee houses have long been linked with social and political change (Kennedy, Politicks; Pincus). The notion that these new non-alcoholic drinks were responsible for the Enlightenment because people could now gather socially without getting drunk is rejected by Wheaton as frivolous, since there had always been alternatives to strong drink, and European civilisation had achieved much in the previous centuries (91). She comments additionally that cafés, as gathering places for dissenters, took over the role that taverns had long played. Pennell and Vickery support this argument adding that by offering a choice of drinks, and often sweets, at a fixed price and in a more civilized setting than most taverns provided, coffee houses and cafés were part of the rise of the modern restaurant. It is believed that, by 1700, the commercial provision of food and drink constituted the second largest occupational sector in London. Travellers’ accounts are full of descriptions of London taverns, pie shops, coffee, bun and chop houses, breakfast huts, and food hawkers (Pennell; Vickery). Dublin Coffee Houses and Later incarnations The earliest reference to coffee houses in Dublin is to the Cock Coffee House in Cook Street during the reign of Charles II (1660-85). Public dining or drinking establishments listed in the 1738 Dublin Directory include taverns, eating houses, chop houses, coffee houses, and one chocolate house in Fownes Court run by Peter Bardin (Hardiman and Kennedy 157). During the second half of the 17th century, Dublin’s merchant classes transferred allegiance from taverns to the newly fashionable coffee houses as places to conduct business. By 1698, the fashion had spread to country towns with coffee houses found in Cork, Limerick, Kilkenny, Clonmel, Wexford, and Galway, and slightly later in Belfast and Waterford in the 18th century. Maxwell lists some of Dublin’s leading coffee houses and taverns, noting their clientele: There were Lucas’s Coffee House, on Cork Hill (the scene of many duels), frequented by fashionable young men; the Phoenix, in Werburgh Street, where political dinners were held; Dick’s Coffee House, in Skinner’s Row, much patronized by literary men, for it was over a bookseller’s; the Eagle, in Eustace Street, where meetings of the Volunteers were held; the Old Sot’s Hole, near Essex Bridge, famous for its beefsteaks and ale; the Eagle Tavern, on Cork Hill, which was demolished at the same time as Lucas’s to make room for the Royal Exchange; and many others. (76) Many of the early taverns were situated around the Winetavern Street, Cook Street, and Fishamble Street area. (see Fig. 1) Taverns, and later coffee houses, became meeting places for gentlemen and centres for debate and the exchange of ideas. In 1706, Francis Dickson published the Flying Post newspaper at the Four Courts coffee house in Winetavern Street. The Bear Tavern (1725) and the Black Lyon (1735), where a Masonic Lodge assembled every Wednesday, were also located on this street (Gilbert v.1 160). Dick’s Coffee house was established in the late 17th century by bookseller and newspaper proprietor Richard Pue, and remained open until 1780 when the building was demolished. In 1740, Dick’s customers were described thus: Ye citizens, gentlemen, lawyers and squires,who summer and winter surround our great fires,ye quidnuncs! who frequently come into Pue’s,To live upon politicks, coffee, and news. (Gilbert v.1 174) There has long been an association between coffeehouses and publishing books, pamphlets and particularly newspapers. Other Dublin publishers and newspapermen who owned coffee houses included Richard Norris and Thomas Bacon. Until the 1850s, newspapers were burdened with a number of taxes: on the newsprint, a stamp duty, and on each advertisement. By 1865, these taxes had virtually disappeared, resulting in the appearance of 30 new newspapers in Ireland, 24 of them in Dublin. Most people read from copies which were available free of charge in taverns, clubs, and coffee houses (MacGiolla Phadraig). Coffee houses also kept copies of international newspapers. On 4 May 1706, Francis Dickson notes in the Dublin Intelligence that he held the Paris and London Gazettes, Leyden Gazette and Slip, the Paris and Hague Lettres à la Main, Daily Courant, Post-man, Flying Post, Post-script and Manuscripts in his coffeehouse in Winetavern Street (Kennedy, “Dublin”). Henry Berry’s analysis of shop signs in Dublin identifies 24 different coffee houses in Dublin, with the main clusters in Essex Street near the Custom’s House (Cocoa Tree, Bacon’s, Dempster’s, Dublin, Merchant’s, Norris’s, and Walsh’s) Cork Hill (Lucas’s, St Lawrence’s, and Solyman’s) Skinners’ Row (Bow’s’, Darby’s, and Dick’s) Christ Church Yard (Four Courts, and London) College Green (Jack’s, and Parliament) and Crampton Court (Exchange, and Little Dublin). (see Figure 1, below, for these clusters and the locations of other Dublin coffee houses.) The earliest to be referenced is the Cock Coffee House in Cook Street during the reign of Charles II (1660-85), with Solyman’s (1691), Bow’s (1692), and Patt’s on High Street (1699), all mentioned in print before the 18th century. The name of one, the Cocoa Tree, suggests that chocolate was also served in this coffee house. More evidence of the variety of beverages sold in coffee houses comes from Gilbert who notes that in 1730, one Dublin poet wrote of George Carterwright’s wife at The Custom House Coffee House on Essex Street: Her coffee’s fresh and fresh her tea,Sweet her cream, ptizan, and whea,her drams, of ev’ry sort, we findboth good and pleasant, in their kind. (v. 2 161) Figure 1: Map of Dublin indicating Coffee House clusters 1 = Sackville St.; 2 = Winetavern St.; 3 = Essex St.; 4 = Cork Hill; 5 = Skinner's Row; 6 = College Green.; 7 = Christ Church Yard; 8 = Crampton Court.; 9 = Cook St.; 10 = High St.; 11 = Eustace St.; 12 = Werburgh St.; 13 = Fishamble St.; 14 = Westmorland St.; 15 = South Great George's St.; 16 = Grafton St.; 17 = Kildare St.; 18 = Dame St.; 19 = Anglesea Row; 20 = Foster Place; 21 = Poolbeg St.; 22 = Fleet St.; 23 = Burgh Quay.A = Cafe de Paris, Lincoln Place; B = Red Bank Restaurant, D'Olier St.; C = Morrison's Hotel, Nassau St.; D = Shelbourne Hotel, St. Stephen's Green; E = Jury's Hotel, Dame St. Some coffee houses transformed into the gentlemen’s clubs that appeared in London, Paris and Dublin in the 17th century. These clubs originally met in coffee houses, then taverns, until later proprietary clubs became fashionable. Dublin anticipated London in club fashions with members of the Kildare Street Club (1782) and the Sackville Street Club (1794) owning the premises of their clubhouse, thus dispensing with the proprietor. The first London club to be owned by the members seems to be Arthur’s, founded in 1811 (McDowell 4) and this practice became widespread throughout the 19th century in both London and Dublin. The origin of one of Dublin’s most famous clubs, Daly’s Club, was a chocolate house opened by Patrick Daly in c.1762–65 in premises at 2–3 Dame Street (Brooke). It prospered sufficiently to commission its own granite-faced building on College Green between Anglesea Street and Foster Place which opened in 1789 (Liddy 51). Daly’s Club, “where half the land of Ireland has changed hands”, was renowned for the gambling that took place there (Montgomery 39). Daly’s sumptuous palace catered very well (and discreetly) for honourable Members of Parliament and rich “bucks” alike (Craig 222). The changing political and social landscape following the Act of Union led to Daly’s slow demise and its eventual closure in 1823 (Liddy 51). Coincidentally, the first Starbucks in Ireland opened in 2005 in the same location. Once gentlemen’s clubs had designated buildings where members could eat, drink, socialise, and stay overnight, taverns and coffee houses faced competition from the best Dublin hotels which also had coffee rooms “in which gentlemen could read papers, write letters, take coffee and wine in the evening—an exiguous substitute for a club” (McDowell 17). There were at least 15 establishments in Dublin city claiming to be hotels by 1789 (Corr 1) and their numbers grew in the 19th century, an expansion which was particularly influenced by the growth of railways. By 1790, Dublin’s public houses (“pubs”) outnumbered its coffee houses with Dublin boasting 1,300 (Rooney 132). Names like the Goose and Gridiron, Harp and Crown, Horseshoe and Magpie, and Hen and Chickens—fashionable during the 17th and 18th centuries in Ireland—hung on decorative signs for those who could not read. Throughout the 20th century, the public house provided the dominant “third place” in Irish society, and the drink of choice for itd predominantly male customers was a frothy pint of Guinness. Newspapers were available in public houses and many newspapermen had their own favourite hostelries such as Mulligan’s of Poolbeg Street; The Pearl, and The Palace on Fleet Street; and The White Horse Inn on Burgh Quay. Any coffee served in these establishments prior to the arrival of the new coffee culture in the 21st century was, however, of the powdered instant variety. Hotels / Restaurants with Coffee Rooms From the mid-19th century, the public dining landscape of Dublin changed in line with London and other large cities in the United Kingdom. Restaurants did appear gradually in the United Kingdom and research suggests that one possible reason for this growth from the 1860s onwards was the Refreshment Houses and Wine Licences Act (1860). The object of this act was to “reunite the business of eating and drinking”, thereby encouraging public sobriety (Mac Con Iomaire, “Emergence” v.2 95). Advertisements for Dublin restaurants appeared in The Irish Times from the 1860s. Thom’s Directory includes listings for Dining Rooms from the 1870s and Refreshment Rooms are listed from the 1880s. This pattern continued until 1909, when Thom’s Directory first includes a listing for “Restaurants and Tea Rooms”. Some of the establishments that advertised separate coffee rooms include Dublin’s first French restaurant, the Café de Paris, The Red Bank Restaurant, Morrison’s Hotel, Shelbourne Hotel, and Jury’s Hotel (see Fig. 1). The pattern of separate ladies’ coffee rooms emerged in Dublin and London during the latter half of the 19th century and mixed sex dining only became popular around the last decade of the 19th century, partly infuenced by Cesar Ritz and Auguste Escoffier (Mac Con Iomaire, “Public Dining”). Irish Cafés: From Bewley’s to Starbucks A number of cafés appeared at the beginning of the 20th century, most notably Robert Roberts and Bewley’s, both of which were owned by Quaker families. Ernest Bewley took over the running of the Bewley’s importation business in the 1890s and opened a number of Oriental Cafés; South Great Georges Street (1894), Westmoreland Street (1896), and what became the landmark Bewley’s Oriental Café in Grafton Street (1927). Drawing influence from the grand cafés of Paris and Vienna, oriental tearooms, and Egyptian architecture (inspired by the discovery in 1922 of Tutankhamen’s Tomb), the Grafton Street business brought a touch of the exotic into the newly formed Irish Free State. Bewley’s cafés became the haunt of many of Ireland’s leading literary figures, including Samuel Becket, Sean O’Casey, and James Joyce who mentioned the café in his book, Dubliners. A full history of Bewley’s is available (Farmar). It is important to note, however, that pots of tea were sold in equal measure to mugs of coffee in Bewley’s. The cafés changed over time from waitress- to self-service and a failure to adapt to changing fashions led to the business being sold, with only the flagship café in Grafton Street remaining open in a revised capacity. It was not until the beginning of the 21st century that a new wave of coffee house culture swept Ireland. This was based around speciality coffee beverages such as espressos, cappuccinos, lattés, macchiatos, and frappuccinnos. This new phenomenon coincided with the unprecedented growth in the Irish economy, during which Ireland became known as the “Celtic Tiger” (Murphy 3). One aspect of this period was a building boom and a subsequent growth in apartment living in the Dublin city centre. The American sitcom Friends and its fictional coffee house, “Central Perk,” may also have helped popularise the use of coffee houses as “third spaces” (Oldenberg) among young apartment dwellers in Dublin. This was also the era of the “dotcom boom” when many young entrepreneurs, software designers, webmasters, and stock market investors were using coffee houses as meeting places for business and also as ad hoc office spaces. This trend is very similar to the situation in the 17th and early 18th centuries where coffeehouses became known as sites for business dealings. Various theories explaining the growth of the new café culture have circulated, with reasons ranging from a growth in Eastern European migrants, anti-smoking legislation, returning sophisticated Irish emigrants, and increased affluence (Fenton). Dublin pubs, facing competition from the new coffee culture, began installing espresso coffee machines made by companies such as Gaggia to attract customers more interested in a good latté than a lager and it is within this context that Irish baristas gained such success in the World Barista competition. In 2001 the Georges Street branch of Bewley’s was taken over by a chain called Café, Bar, Deli specialising in serving good food at reasonable prices. Many ex-Bewley’s staff members subsequently opened their own businesses, roasting coffee and running cafés. Irish-owned coffee chains such as Java Republic, Insomnia, and O’Brien’s Sandwich Bars continued to thrive despite the competition from coffee chains Starbucks and Costa Café. Indeed, so successful was the handmade Irish sandwich and coffee business that, before the economic downturn affected its business, Irish franchise O’Brien’s operated in over 18 countries. The Café, Bar, Deli group had also begun to franchise its operations in 2008 when it too became a victim of the global economic downturn. With the growth of the Internet, many newspapers have experienced falling sales of their printed format and rising uptake of their electronic versions. Most Dublin coffee houses today provide wireless Internet connections so their customers can read not only the local newspapers online, but also others from all over the globe, similar to Francis Dickenson’s coffee house in Winetavern Street in the early 18th century. Dublin has become Europe’s Silicon Valley, housing the European headquarters for companies such as Google, Yahoo, Ebay, Paypal, and Facebook. There are currently plans to provide free wireless connectivity throughout Dublin’s city centre in order to promote e-commerce, however, some coffee houses shut off the wireless Internet in their establishments at certain times of the week in order to promote more social interaction to ensure that these “third places” remain “great good places” at the heart of the community (Oldenburg). Conclusion Ireland is not a country that is normally associated with a coffee culture but coffee houses have been part of the fabric of that country since they emerged in Dublin in the 17th century. These Dublin coffee houses prospered in the 18th century, and survived strong competition from clubs and hotels in the 19th century, and from restaurant and public houses into the 20th century. In 2008, when Stephen Morrissey won the coveted title of World Barista Champion, Ireland’s place as a coffee consuming country was re-established. 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