Journal articles on the topic 'Export demand screening'

Production subsidies tend to be provided as government development support instruments. This paper examines their potential impacts on lower-tier producers. Those impacts are partly elucidated by a mixed-methods study of small-scale fish producers of Seychelles targeting foreign fish markets. Scale disadvantages tend to prevent such producers from overcoming the entry barriers of foreign markets without government assistance, including subsidisation. In the study, a screening survey helped assign a group of 34 randomly-selected fish producers to a Managed Value Chain (MVC) – buyers and producers engaging in supply-demand matching coordination, and another 32 randomly-selected fish harvesters to an Open-market Value Chain (OVC) – comprising buyers and harvesters without intentional supply-demand matching coordination. Using 5 months of production-related data, the study first compared the means of the production capacity, level and efficiency of the producers. Four highest-producing MVC producers subsequently gave an interview on their operations. Results inter alia indicate that a gradually increasing range of fisheries subsidies have been helping MVC producers to raise their production capacity, standard and level. However, the subsidies have also been indicatively decreasing the productivity of commercial stocks. The study inter alia suggests that unless marine biological resources are carefully managed, export-oriented production subsidies threaten their environmental sustainability.

Spring bread wheat is the staple crop in Western Siberia and Kazakhstan, a significant portion of which goes for export. Wheat breeding with a high level of zinc in wheat grain is the most cost-effective and environmentally friendly way to address zinc deficiency in the diet. The purpose of this work was to evaluate the contribution of the factors ‘location’ and ‘genotype’ in the variability of zinc content in wheat grain, and to identify the best varieties as sources of this trait for breeding. The research on screening zinc content in the wheat grain of 49 spring bread wheat varieties from the KazakhstanSiberia Spring Wheat Trial (KASIB) nursery was carried out at 4 sites in Russia (Chelyabinsk, Omsk, Tyumen, Novosibirsk) and 2 sites in Kazakhstan (Karabalyk and Shortandy) in 2017–2018. The content of zinc in wheat grain was evaluated at the Ionomic Facility of University of Nottingham in the framework of the EU project European Plant Phenotyping Network-2020. The analysis of variance showed that the main contribution into the general phenotypic variation of the studied trait, 38.7 %, was made by the factor ‘location’ due to different contents of zinc and moisture in the soil of trial sites; the effect of the factor ‘year’ was 13.5 %, and the effect of the factor ‘genotype’ was 8.0 %. The most favorable environmental conditions for accumulation of zinc in wheat grain were observed in the Omsk region. In Omsk, the average zinc content in all studied varieties was 50.4 mg/kg, with 63.7 mg/kg in the best variety ‘OmGAU 100’. These values are higher than the target values of the international program Harvest Plus. ‘Novosibirskaya 16’ (49.4 mg/kg), ‘Silach’ (48.4 mg/kg), ‘Line 4-10-16’ (47.2 mg/kg), ‘Element 22’ (46.3 mg/kg) and ‘Lutescens 248/01’ (46.0 mg/kg) were identified as being the best varieties. Significant possibilities for the production of wheat grain with high zinc content, which is in demand for the production of bread and pastry products with functional properties, were identified in the Western Siberian region.

As demands on physician time mount, and patients and families increasingly expect accommodation and understanding of their specific, personal situations, care providers must boost efficiency and minimize the expense of their clinic processes and draw on connections with community resources. Third-party payors may also expect that the biopsychosocial needs of patients and families be addressed as an essential part of cancer care. Quality of care, cost, patient satisfaction, adherence to treatment, safety, and allocation of limited resources are all related to the identification and effective management of the psychosocial elements of cancer care. Experts suggest that health care has lagged far behind other industries in using technology to improve efficiency, and slow adoption of this technology means that critical information about the biopsychosocial needs of patients fails to reach the right professionals in a timely way. Systematic and automated screening can promote physician control in managing time, the efficiency of the clinical encounter, and rapid triage to other professionals and community resources.

Background: Phenotyping is an automated technique that can be used to distinguish patients based on electronic health records. To improve the quality of medical care and advance type 2 diabetes mellitus (T2DM) research, the demand for T2DM phenotyping has been increasing. Some existing phenotyping algorithms are not sufficiently accurate for screening or identifying clinical research subjects. Objective: We propose a practical phenotyping framework using both expert knowledge and a machine learning approach to develop 2 phenotyping algorithms: one is for screening; the other is for identifying research subjects. Methods: We employ expert knowledge as rules to exclude obvious control patients and machine learning to increase accuracy for complicated patients. We developed phenotyping algorithms on the basis of our framework and performed binary classification to determine whether a patient has T2DM. To facilitate development of practical phenotyping algorithms, this study introduces new evaluation metrics: area under the precision-sensitivity curve (AUPS) with a high sensitivity and AUPS with a high positive predictive value. Results: The proposed phenotyping algorithms based on our framework show higher performance than baseline algorithms. Our proposed framework can be used to develop 2 types of phenotyping algorithms depending on the tuning approach: one for screening, the other for identifying research subjects. Conclusions: We develop a novel phenotyping framework that can be easily implemented on the basis of proper evaluation metrics, which are in accordance with users’ objectives. The phenotyping algorithms based on our framework are useful for extraction of T2DM patients in retrospective studies.

In the global context, the epidemic of breast cancer (BC) is evident for the early 21st century. Evidence shows that national mammography screening programs have sufficiently reduced BC related mortality. Therefore, the great utility of the mammography-based screening is not an issue. However, both false positive and false negative BC diagnosis, excessive biopsies, and irradiation linked to mammography application, as well as sub-optimal mammography-based screening, such as in the case of high-dense breast tissue in young females, altogether increase awareness among the experts regarding the limitations of mammography-based screening. Severe concerns regarding the mammography as the “golden standard” approach demanding complementary tools to cover the evident deficits led the authors to present innovative strategies, which would sufficiently improve the quality of the BC management and services to the patient. Contextually, this article provides insights into mammography deficits and current clinical data demonstrating the great potential of non-invasive diagnostic tools utilizing circulating miRNA profiles as an adjunct to conventional mammography for the population screening and personalization of BC management.

544 Background: The American Cancer Society (ACS) supports 80% by 2018. We have an innovative solution to address barriers: compliance and capacity without diluting quality. Methods: The “gold standard” test is a high-quality colonoscopy. To improve compliancewe leverage the primary care physician (PCP) through navigators. The existing colonoscopists are saturated while screening only half. Quality, as reflected in the protective benefit, is called into question by large-scale studies. An estimated 7% of CRCs are diagnosed as “interval cancers.” occurring in patients compliant with screening. Results: First, when the PCP invites the patient, their “butts” show up! Compliance in our study more than doubled and exceeded the ACS 80% by 2018 goal. We present an update to the initial study (de Groen, NEJM 2014) adding 15,000 more consecutive cases and 4 years to the database; incidence dropped (83%) as did mortality (89%). This is the first large study to demonstrate no diminution of protection in the right colon! Our hypothesis is that the two-man technique simplifies visualizing the mucosal surface. The continual availability of an “expert” to “mentor and monitor” was sufficient to supervise 30 PCPs and thus augment capacity (4,000 cases rather than 1,000 cases per year per expert). With the average cost of $250,000 per case of advanced CRC, the savings are more than double the screening costs. Conclusions: The inclusion of the PCP in CRC screening addresses the barriers: enhanced compliance, augmented capacity without any diminution in quality. The PCP provides capacity needed to screen the underserved (more than half of the at risk population not “up to date” with screening colonoscopy). Rather than taking patients from traditional providers, the model has excelled in identifying the underserved. To achieve 80% by 2018 will require 6,000,000 additional annual screening colonoscopies but would prevent 100,000 cases of CRC and 25,000 deaths. At the current rate, 30,000 PCP colonoscopists could meet this demand. Utilizing PCPs using the team colonoscopy approach could one day result in near elimination of deaths from “the preventable cancer.”

Purpose of the study. To evaluate the results of breast cancer screening (BC) in the conditions of an unfavorable epidemiological situation COVID‑19 based on the analysis of the BC screening project in the Kaluga Region.Patients and methods. Screening system: creation and implementation in practice of mobile mammography complexes (MMC); training of medical personnel in the method of conducting a standardized mammographic examination (ME); quality control of ME; "Cloud" storage and software development for archiving patients; an independent review of mammograms by certified specialists; expert review of images in case of discrepancies in diagnoses; referral of patients diagnosed with BI-RADS IV and V to the regional oncological dispensary for further examination and treatment. From 04.2018 to 12.2020 patients were examined on MMC according to the BC screening protocol. We examined 47367 patients over the age of 40 years. SD 57.66 ± 8.17 years (38-93). During the COVID‑19 pandemic, imaging of breast diseases must be carried out in compliance with all safety regulations for both personnel and patients. Balancing the need to avoid delays in diagnosing BC while preventing infection requires careful attention to personal protective equipment, handling of diagnostic equipment, diagnostic facilities, and physical distancing and vigilance to maintain these measures.Results. From 07.2020 to 11.2020: a total of 10736 studies have been carried out. In the context of new coronavirus infection, we noted an increased demand among patients wishing to undergo BC screening. The flow of patients over the same period of previous years was less, which indicates the demand and justification for screening mammography and the use of MMC in an unfavorable epidemiological situation. 174 patients received category BI-RADS IV-V and were referred for a follow-up examination and required treatment at an oncological dispensary. In 39 patients (22.4 %), BC was verified, and appropriate treatment was carried out. In 135 cases, benign processes were verified.Conclusion. BC screening should not be stopped against the backdrop of the COVID‑19 epidemic since a delay in BC diagnosis later threatens to reveal more voluminous processes with a worse prognosis for treatment and rehabilitation than timely detected changes in the mammary glands in the early preclinical stages of the disease.

Abstract Pregnancy poses a unique challenge to patients with sickle cell disease and β-thalassemia, who often have exacerbations of hemolysis or anemia during the gestational period, experience higher rates of obstetric and fetal complications, and may have distinct underlying comorbidities related to vasculopathy and iron overload that can endanger maternal health. Optimal management of pregnant women with hemoglobinopathies requires both an understanding of the physiologic demands of pregnancy and the pathophysiology of disease-specific complications of inherited blood disorders. A multidisciplinary team of expert hematologists and high-risk obstetricians is therefore essential to ensuring appropriate antenatal maternal screening, adequate fetal surveillance, and early recognition of complications. Fortunately, with integrated and targeted care, most women with sickle cell disease and β-thalassemia can achieve successful pregnancy outcomes.

Background and context: It is the third leading cause of cancer deaths among females in Latin America and the Caribbean, and yet cervical cancer is almost entirely preventable and treatable. In a region where many lack even basic access to quality sexual and reproductive healthcare, screening and treatment services for HPV and cervical cancer are far from universally available. International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) and its member associations (MAs) are working to reverse this trend, identifying and bridging local gaps in access and services wherever possible. Aim: IPPF/WHR and its MAs seek to improve both providers' ability to deliver - and women's ability to access - quality cervical cancer screening and treatment through institutional capacity building, the introduction of new technologies, advocacy and community awareness efforts. Strategy/Tactics: 1) Increase cervical cancer services by training providers in the provision of low cost, high capacity screening and treatment methods, including visual inspection with acetic acid (VIA), HC2 and HPV DNA screening technologies, and a single-visit approach (SVA) to treatment using cryotherapy, thermocoagulation and LEEP. 2) Educate populations and increase demand for cervical cancer services by implementing public awareness campaigns and community information, education and communication (IEC) activities promoting the importance of early detection and treatment. 3) Improve and standardize clinical protocols and referral pathways by advocating among and collaborating with key decision-makers and local ministries of health. Program/Policy process: MAs are implementing small-scale pilot studies to incorporate VIA, HC2 and HPV DNA screening and new treatment to provide even greater numbers of women with potentially life-saving diagnostics and care in Belize, Honduras, El Salvador and Bolivia. As leading clinical experts and advocates, several MAs are also working with public sector counterparts to refine two-way referral pathways, standardize screening protocols and clinical guidelines, and to ensure data quality and collection. A range of Caribbean MAs have also been trained in the use of VIA, cryo and LEEP. Outcomes: From 2016 to 2017, MAs from Belize, Grenada, Suriname, and several additional Caribbean countries who received training in VIA and other screening and treatment techniques saw an average 7% increase in the number of direct cervical cancer services provided. MAs from Belize, Bolivia and Honduras also contributed to updated national cervical cancer protocols. What was learned: An effective national response to cervical cancer requires the support and collaboration of civil society organizations, which can deliver direct services and play a catalytic role in advancing technical recommendations and policy dialogue. Countries should continue to improve the quality of VIA services, until more advanced screening technologies become available and can be scaled up.

Abstract:The paper describes a knowledge-distribution system that supports decisions on placement of impaired employees. The knowledge base consists of job profiles and medical profiles. The job profiles list tasks and the physical abilities they require. Twenty-one abilities describe the task demands. Active workers rated the exertion, frequency and importance of the physical ability required for each task. Thirty-nine work conditions were rated this way. Using identical scales, experts assessed the impact of impairments on the physical abilities of individuals and the tolerance of work conditions. The screening matches the job profile against the impairment profile. This process has been automated. The program lists tasks and work conditions that may compromise an impaired employee. This information can be used to accommodate employees, restrict duties or design a rehabilitation program. Also, the paper discusses the impact of the system on the operations of medical services within an organization.

Abstract Background: Between 1987–1997, the demand for allogeneic blood (whole blood and packed RBC) in the US decreased due to concerns about safety of the blood supply1. Paradoxically, these concerns also led to a decrease in the available supply. During this same period, collection of allogeneic blood declined from 13.6 million to 11.9 million units, resulting in a 48% reduction in the margin between available supply and demand.1 Although both supply and demand for blood has since increased, the margin has further declined to only 6.1% in 2004 (allogeneic collection: 14.8 million units; transfusion: 13.9 million units)2. This situation is further exacerbated by procedures used for qualifying fully screened units. In 2004, 240,000 units were rejected after screening, leaving a margin of only 648,000 units available (4.5% of the supply). Given the introduction and adoption of treatments that reduce transfusions, such as erythropoiesis-stimulating agents (ESAs) for patients (pts) with chemotherapy-induced anemia (CIA), in the past 15 years, periodic shortages in the blood supply due to this limited surplus have been moderated. Purpose: To estimate the impact of limiting the use of ESAs for CIA on the US blood supply. Methods: A modeling simulation was employed using a top-down approach to compare the number of RBC units transfused in ESA-treated pts to the number of RBC units that would be transfused if ESAs were discontinued or limited in the same population. The excess number of RBC units that would be required if ESA treatment in CIA pts was limited was contrasted with the available marginal blood supply from 2004 (latest data available). Model inputs included incident cases of CIA pts treated with ESA, transfusion rates from clinical trials, and volume of RBC units required for ESA-treated and untreated pts. Data were obtained from published literature or expert opinion where published evidence was unavailable. Estimates were developed for multiple ESA reduction scenarios, and sensitivity analyses were conducted using a range of +/–10% for each input parameter. Results: Under the base case scenario, it was estimated that 492,002 incident CIA pts received a total of 372,809 RBC units despite ESA treatment. The model predicted that up to a third of the marginal US blood supply would be required to cover the incremental demand for blood that would arise from a 25% decrease in ESA use (incremental RBC units transfused: 118,602 units, sensitivity range: 63,030–210,110 units). For ESA use reductions of 50% and 75%, the model predicted 37% (237,203 units) and 55% (355,805 units) of the marginal US blood supply would be required, respectively. In the case of total cessation of ESA use for CIA, the available US blood supply could be exceeded (incremental demand: 474,407 units, sensitivity range: 252,119–840,441 units). Conclusions: This current model of blood demand showed limiting ESA use in CIA pts imposes considerable pressure on the available US blood supply given the small margin between usable blood and transfusion demand. This added pressure on the blood supply does not consider additional exacerbations due to regional and seasonal variation in the number of available units as well as donation frequency variations.

High-content screening is a powerful method to discover new drugs and carry out basic biological research. Increasingly, high-content screens have come to rely on supervised machine learning (SML) to perform automatic phenotypic classification as an essential step of the analysis. However, this comes at a cost, namely, the labeled examples required to train the predictive model. Classification performance increases with the number of labeled examples, and because labeling examples demands time from an expert, the training process represents a significant time investment. Active learning strategies attempt to overcome this bottleneck by presenting the most relevant examples to the annotator, thereby achieving high accuracy while minimizing the cost of obtaining labeled data. In this article, we investigate the impact of active learning on single-cell–based phenotype recognition, using data from three large-scale RNA interference high-content screens representing diverse phenotypic profiling problems. We consider several combinations of active learning strategies and popular SML methods. Our results show that active learning significantly reduces the time cost and can be used to reveal the same phenotypic targets identified using SML. We also identify combinations of active learning strategies and SML methods which perform better than others on the phenotypic profiling problems we studied.

To meet consumer requirement, the cultural and creative products underscore the route of developing personality products in a bid to satisfy unconventional and independent psychological demand of consumers. The purpose of this study is to explore correlation of consumer personality traits in selecting products or preference for products. Professional Dynamitic Program (PDP) personality traits testing has been used, and as for products three levels of emotional design proposed by Norman (2004) is adopted: Visceral, behavioral and reflective. The flow of study is divided into four major stages, the first stage of literature review and theoretical construction, the second stage on websites of Palace Museum Boutique Pavilion, Taiwan Cultural and Creative Souvenirs Pavilion and Pinkoi, and invite experts to screen cultural and creative products on bestseller list; the third stage focuses on PDP personality traits testing in a bid to understand consumers’ personality traits; The fourth stage provides cultural and creative products after screening and selection of questionnaire for individual intuitiveness of testee’s preference for product design. The conclusion of this study shows significant correlation in preference of consumers’ differential personality traits on design of cultural and creative products. It also conducts statistics on preference for levels of emotional design for cultural and creative products in accordance with different personality traits and the correlation result may provide reference for product planners, designers or sales.

Awareness of environmental risk and the demand for oil spill response planning associated with offshore marine operations has increased during the last decades. Environmental Risk Assessments (ERAs) are a crucial part of planning and execution of oil and gas (O&G) activities offshore. A sound ERA can support the O&G industry in environmental risk management (ERM) of operations. Authorities and Operating companies have requested updated methodology based on more recent research from oil spill events such as the Deep Water Horizon incident, with the possibility to perform more detailed analyses in e.g. sensitive areas. ERA Acute is developed to meet these requirements. It is a transparent method of quantitative analysis for environmental screenings, ERAs and Net Environmental Benefit Analyses (NEBAs) of oil spills in four compartments: Sea surface, shoreline, water column and sea floor. The methodology is grid-cell based and results can therefore be shown in a geographical information system (GIS) for any region globally. The user can identify areas of high risk - for use in decision support and spill response planning - independently of the region. Three levels of detail are defined, depending on availability of VEC data, suitable for screening purposes or more detailed studies. Calculations are carried out in two main steps: First, ERA Acute uses input from an oil spill fate and distribution model of choice to calculate exposure and impact to Valued Ecosystem Components (VECs) in each grid cell and for each simulation. Calculations follow a common methodology framework, applying different mechanisms of impact and recovery for each compartment. Impacts are summarised, and in the second step, potential lag-and/or restitution time and risk are calculated for each VEC. The resulting resource impact factor (RIF) is an index that combines the extent of impact and recovery time. A statistical approach is used, based on numerous oil spill simulations covering each season in order to capture variations in spill drift and fate, species abundance and vulnerability. This paper describes the method. ERA Acute methodology is validated in sensitivity studies, field validations, comparison to relevant ERA methods, and documented in several dissemination steps including a guideline for best industry practice. The ERA Acute project is carried out by a consortium of industry partners (Statoil, Total, Norwegian Oil and Gas Association) and experts in environmental risk analysis (Acona, Akvaplan-niva (project manager), DNV-GL and SINTEF), supported by the Research Council of Norway.

Background: The rising breast-cancer burden in middle-income countries is straining the capacity of health systems to provide early detection and diagnostic services. To bring these services to women in a northern region of Peru, community education and clinical breast exam (CBE) by midwives was introduced as a method for screening asymptomatic women and evaluating women with symptoms; if positive, women were evaluated further by fine needle aspiration (FNA) by a trained physician at a local hospital. Aim: During the pilot phase, this early detection program resulted in increased demand for cytopathology services, invasive procedures for patients, delays in results, and high rates of benign findings. We added basic triage ultrasound (US), performed and interpreted by general physicians at a local hospital, to further evaluate women with a positive CBE and reduce the number of unnecessary FNAs. We aim to evaluate the changes in the FNA rate. Methods: PATH worked with an expert radiologist to develop a breast-US training program that included: teaching physicians to perform and interpret breast US using a triage algorithm based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) and a standardized checklist to document clinical and US findings. The triage algorithm was reviewed and validated by oncologists at Peru's national cancer institute, and later introduced in ten networks in northern Peru. Results: After adding triage ultrasound in 2015, a total of 133 CBE+ women received US at the local hospital; 73 women had a finding on US indicating a need for FNA biopsy, and all received it. Eleven of these women were subsequently diagnosed with breast cancer. Without triage US, all 133 CBE+ women would have received FNA. This represents a 55% decrease (60/133) in FNA biopsies. Conclusion: Triage ultrasound, as part of a resource-adapted model of breast screening, combined with FNA sampling increases the ability of general physicians to manage CBE+ women locally, thereby reducing health system burdens and assuring that patients at highest risk receive timely referrals to a specialized hospital. Triage ultrasound reduces the biopsy rate following a positive CBE. As ultrasound technology becomes more accessible and less expensive, we anticipate there will be an even more significant role for it in early detection models.

Introduction:Rising costs and the rapidly increasing volume of findings from research in health care are driving the demand for comprehensive information to inform the allocation of resources. Health technology assessment (HTA) applies rigorous processes to provide high-quality synthesized information to policymakers and healthcare payers. HTA involves combining large amounts of research publications to systematically evaluate the properties, effects, and impacts on a topic of interest.Methods:The time and resources required to complete a full HTA are often demanding. There is an opportunity to apply high-performance computing (inclusive of artificial intelligence and machine learning disciplines) to HTA. This project applied high-computing technology to create a research synthesis tool to support HTA and then developed a service that integrates as much relevant data as possible to strengthen HTA. This was a joint project that combined expertise from the areas of health technology, machine learning, information technology, and innovation.Results:The information gathered for this phased project from HTA subject matter experts and other stakeholders was collated to inform a research synthesis tool and a broader concept of the project.Conclusions:The results of this study will inform the design of a research synthesis tool that covers the entire HTA process (literature search, screening titles and abstracts, data extraction, quality assessment, and analysis). The collaborators included Alberta Innovates, the Alberta Machine Intelligence Institute, the University of Alberta, Cybera, and PolicyWise. Alberta Innovates, which is an accelerator and innovator of research in the province of Alberta, Canada, was the primary source of funding for this project.

An aging population leads to increasing demand for sustained quality of life with the aid of novel implants. Patients expect fast healing and few complications after surgery. Increased biofunctionality and antimicrobial behavior of implants, in combination with supportive stem cell therapy, can meet these expectations. Recent research in the field of bone implants and the implementation of autologous mesenchymal stem cells in the treatment of bone defects is outlined and evaluated in this review. The article highlights several advantages, limitations and advances for metal-, ceramic- and polymer-based implants and discusses the future need for high-throughput screening systems used in the evaluation of novel developed materials and stem cell therapies. Automated cell culture systems, microarray assays or microfluidic devices are required to efficiently analyze the increasing number of new materials and stem cell-assisted therapies. Approaches described in the literature to improve biocompatibility, biofunctionality and stem cell differentiation efficiencies of implants range from the design of drug-laden nanoparticles to chemical modification and the selection of materials that mimic the natural tissue. Combining suitable implants with mesenchymal stem cell treatment promises to shorten healing time and increase treatment success. Most research studies focus on creating antibacterial materials or modifying implants with antibacterial coatings in order to address the increasing number of complications after surgeries that are mostly caused by bacterial infections. Moreover, treatment of multiresistant pathogens will pose even bigger challenges in hospitals in the future, according to the World Health Organization (WHO). These antibacterial materials will help to reduce infections after surgery and the number of antibiotic treatments that contribute to the emergence of new multiresistant pathogens, whilst the antibacterial implants will help reduce the amount of antibiotics used in clinical treatment.

PURPOSE Germline testing (GT) is a central feature of prostate cancer (PCA) treatment, management, and hereditary cancer assessment. Critical needs include optimized multigene testing strategies that incorporate evolving genetic data, consistency in GT indications and management, and alternate genetic evaluation models that address the rising demand for genetic services. METHODS A multidisciplinary consensus conference that included experts, stakeholders, and national organization leaders was convened in response to current practice challenges and to develop a genetic implementation framework. Evidence review informed questions using the modified Delphi model. The final framework included criteria with strong (> 75%) agreement (Recommend) or moderate (50% to 74%) agreement (Consider). RESULTS Large germline panels and somatic testing were recommended for metastatic PCA. Reflex testing—initial testing of priority genes followed by expanded testing—was suggested for multiple scenarios. Metastatic disease or family history suggestive of hereditary PCA was recommended for GT. Additional family history and pathologic criteria garnered moderate consensus. Priority genes to test for metastatic disease treatment included BRCA2, BRCA1, and mismatch repair genes, with broader testing, such as ATM, for clinical trial eligibility. BRCA2 was recommended for active surveillance discussions. Screening starting at age 40 years or 10 years before the youngest PCA diagnosis in a family was recommended for BRCA2 carriers, with consideration in HOXB13, BRCA1, ATM, and mismatch repair carriers. Collaborative (point-of-care) evaluation models between health care and genetic providers was endorsed to address the genetic counseling shortage. The genetic evaluation framework included optimal pretest informed consent, post-test discussion, cascade testing, and technology-based approaches. CONCLUSION This multidisciplinary, consensus-driven PCA genetic implementation framework provides novel guidance to clinicians and patients tailored to the precision era. Multiple research, education, and policy needs remain of importance.

In Brazil, until the 1980s, the context of blood as transfusion therapy was marked by paid donations. Thus, self-interest has surpassed solidarity as a motivator to donate. Recruiting donors involves advising the population due to the difficulties related to the myths around donation. With the COVID-19 pandemic, recruiting convalescent plasma (CP) donors has been a hard. This is an observational, prospective and non-interventionist study carried out in a hemotherapy unit of the Unified Health System, in central-western Brazil. Data collection was carried out from 06/19/2020 to 07/31/2020. The subjects were contacted by the Recruitment and Collection (CR) sector, through an active search, using lists of patients previously diagnosed with COVID-19. The study was also published on social and traditional networks, which resulted in self-reference. Convalescent COVID-19 patients tested, of both genders, aged between 18 and 60 years, weight over 60 kg, without symptoms for more than 14 days, and nulliparous donors were invited to the study. Those who met the criteria were scheduled for clinical and serological screening. The subjects eligible for donation, with IgG reagent, signed the Free and Informed Consent Form. Individuals with positive RT-PCR and / or non-reactive IgG were excluded. During the study period, RC made 308 and received 1,797 calls (2,105 contacts), generating 242 (11.5%) screening appointments, 173 (8.2%) of which resulted from self-referral and 69 (3.2%) from active search. Of these, 131 (6.2%) subjects attended the appointment. After clinical screening, 37 (28.25%) subjects were ineligible, 37 (28.25%) after serological tests and 57 (43.5%) were eligible for donation. The ineligibility causes in clinical and serological screening are described in table 1. Many countries face difficulties in meeting the demand for blood and its components during the pandemic (Barone & DeSimone. Transfusion, 2020), especially in those where blood commercialization is prohibited, as in Brazil. The purpose of recruiting donors is to make blood donation habitual to Brazilians, as it occurs in developed countries. Figure 2 shows self-referral rates after dissemination in traditional media. The ads focused on the donor's ability to save lives by encouraging altruism (Ronse, et al. 2018).On the other hand, despite attracting more people, most were not eligible for donation, demonstrating a great capacity to raise awarenessamong the population, but it was necessary to improve criterias and demonstrate them clearly for the likely donor. Of the 26 donors, 22 (84.6%) are older than 29. For these, awareness-raising occurred mainly through the television media 9(34.6%) and 5(19.3%) through personal contact. In the youngest 4(15.4%), the stimulus was social networks (Sümnig, et al. Transfusion, 2018). Marketing was important for recruitment. As blood donation is not usual for most brazilians, it is essential to plan, develop, evaluate strategies, enabling new forms of collection. Another difficulty encountered was the logistics for this donation type. As the donor is convalescent, the recruitment, screening, and collection was restricted to a physical space, isolated from conventional donos (Bloch, et al. J Clin Invest. 2020). In conclusion, the COVID-19 pandemic has become a public health challenge worldwide. Many recovered patients could donate CP. However, it is necessary to define the ideal requirements for donor selection to ensure the therapeutic viability and efficacy of PC transfusion. Blood collection teams need to strengthen strategies to inform the population about blood donation needs. The information available in the traditional and digital media about the donation process can increase the donation rate and guarantee a safe blood component. Strategies such as a greater number of insertions in social networks with well-defined criteria for donating plasma from a convalescent donor, clarification of exclusion criteria in the means of greater reach, creation of easily accessible channels to the donor (registrations, central doubts),in addition to stratifying by age group and proposing different dissemination strategies and thanksgiving for the donation, forming a network of donations. The combined efforts of these actions will contribute with expert advice and experience, technical guidance and additional support to potentially save more lives. Disclosures No relevant conflicts of interest to declare.

BACKGROUND Cecal intubation is one of the goals of a quality colonoscopy; however, many factors increasing the risk of incomplete colonoscopy have been implicated. The implications of missed pathology and the demand on health care resources for return colonoscopies pose a conundrum to many physicians. The optimal course of action after incomplete colonoscopy is unclear.OBJECTIVES: To assess endoscopic completion rates of previously incomplete colonoscopies, the methods used to complete them and the factors that led to the previous incomplete procedure.METHODS: All patients who previously underwent incomplete colonoscopy (2005 to 2010) and were referred to St Paul’s Hospital (Vancouver, British Columbia) were evaluated. Colonoscopies were re-attempted by a single endoscopist. Patient charts were reviewed retrospectively.RESULTS: A total of 90 patients (29 males) with a mean (± SD) age of 58±13.2 years were included in the analysis. Thirty patients (33%) had their initial colonoscopy performed by a gastroenterologist. Indications for initial colonoscopy included surveillance or screening (23%), abdominal pain (15%), gastrointestinal bleeding (29%), change in bowel habits or constitutional symptoms (18%), anemia (7%) and chronic diarrhea (8%). Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician. Eighty-seven (97%) colonoscopies were subsequently completed in a single attempt at the institution. Seventy-six (84%) colonoscopies were performed using routine manoeuvres, patient positioning and a variable-stiffness colonoscope (either standard or pediatric). A standard 160 or 180 series Olympus gastroscope (Olympus, Japan) was used in five patients (6%) to navigate through sigmoid diverticular disease; a pediatric colonoscope was used in six patients (7%) for similar reasons. Repeat colonoscopy on the remaining three patients (3%) failed: all three required surgery for strictures (two had obstructing malignant masses and one had a severe benign obstructing sigmoid diverticular stricture).CONCLUSION: Most patients with previous incomplete colonoscopy can undergo a successful repeat colonoscopy at a tertiary care centre with instruments that are readily available to most gastroenterologists. Other modalities for evaluation of the colon should be deferred until a second attempt is made at an expert centre.

The aim of this article is to examine studentsʼ experiences of cross-border education based on a single course carried out in collaboration between two networks, Barents Cross-Border University (BCBU) and the Thematic Network of Social Work (TNSWUA), as well as the experiences of teachers in the course. The course was a part of the curriculum for the Master’s Degree Programme (BCBU) in Comparative Social Work. Most of the students were studying in this Master’s Programme, some of them were exchange students at the University of Lapland (UL) and the rest were social work students at UL and the University of Iceland (UI). The course ran for two weeks in April 2015, and included lectures, discussions and workshops; parts of the course were delivered electronically, while other sections were delivered by teachers on-site. This course provided a broad multi-professional introduction to the field of addiction and substance abuse care. Students learned about screening the alcohol culture and the relationship between society, addiction, gender, family, life phases, ageing, maternity and substance use. The data for this study was collected through focus group discussion, with students reflecting on one question: ‘Do we need cross-border education?’ Data from instructors was collected through discussions during the planning and post-course discussions. Overall, the experiences of students and instructors were positive. The collaboration did not face insuperable challenges. The findings highlighted four main themes: globalization, networking, comparing theory and practice, and using technology. Globalization has set new demands for social work and its professionals. Experts in cultural diversity and international social issues, as well as people with a comparative approach to different societies, are needed the world over. Regarding implications for cross-border education, we would recommend collaboration in the particular field of social work, developing specific courses together supported by both universities and international networks of universities.

Purpose Reconfigurable vibrating screen (RVS) is an innovative beneficiation machine designed at Tshwane University of Technology, Republic of South Africa (RSA); with adjustable screen structure to ensure sorting, sizing and screening of varying mineral particles (sizes and quantities) demanded by the customers in a cost-effective manner through the screen structure geometric transformation. In order to ensure that this machine is optimally maintained and managed when utilized in surface and underground mining industries, there is a need to establish or ascertain the best maintenance practices that would be used in optimally managing the RVS machine using decision making techniques. In view of this, the purpose of this paper is to ascertain the best maintenance practices that would be used to optimally maintain and manage the RVS machine when used in surface and underground mines. Design/methodology/approach Decision making techniques such as weighted decision matrix (WDM) and analytical hierarchy process (AHP) were used in this research work to establish the best maintenance practice for optimally maintaining and managing the RVS machine using relevant literature survey on maintenance management systems as well as the different maintenance criteria decision indices obtained from different conventional vibrating screen machine manufacturers and maintenance experts. Findings Based on the results obtained from the WDM analysis, it was anticipated that e-maintenance (e-M) system embedded with diagnosing and prognosing algorithms; with a cumulative weight score of 2.37 is the best maintenance practice for managing the RVS machine when used in surface mines, while AHP with deeper decision making analysis anticipated that the robotic-driven maintenance (RM) system with an important decision criteria; safety, and a cumulative hierarchy score of 28.6 percent, supported by e-M management system with a cumulative hierarchy score of 17.6 percent are the best maintenance mix that could be used in optimally maintaining and managing the RVS machine, when used in a craggy and hazardous underground mining environment. Practical implications To this effect, it could be anticipated that e-M management system (endowed with the ability to detect fault on the machine, diagnose and prognose the different subsystems of the RVS machine and ascertain the reconfiguration time and process of the RVS machine in recovering production loss during the maintenance of the machine as well as meeting customers demand, etc.) is the best maintenance practice for optimally maintaining the RVS machine when utilized in surface mines while both e-M management system and RM management system (endowed with the ability to carry out automated maintenance tasks achievement under little or no maintenance manager intervention) are also anticipated as the best customized maintenance practices mix that could be used in optimally maintaining the RVS machine, when used in dangerous and hazardous underground mining environment. Originality/value This maintenance management system evaluation and selection for optimal RVS machine functionality will serve as a useful information to different mining machines (and other related machines) maintenance managers, in selecting the best maintenance management system for ensuring optimal functionality, reliability and maintainability of machines used in their industries.

Background Our research arises from anticipated increases in demand for psychological trauma services in the UK, with particular reference to armed forces veterans with post-traumatic stress disorder (PTSD). Commissioning and service provider activity to improve veterans’ health is evolving. Objectives To explore what UK services exist and establish potentially effective models of care and effective treatments for armed forces veterans with PTSD. Design A four-stage rapid evidence synthesis comprising information gathering on UK service provision; an evidence review on models of care; a metareview on treatment effectiveness; and a synthesis highlighting research priorities. Setting For the evidence reviews, any setting that was relevant to the UK health and social care system. Participants UK armed forces veterans with PTSD following repeated exposure to traumatic events. Interventions Any model of care or treatment. Main outcome measures Any relevant outcome. Data sources Information about current UK practice. Searches of databases [including MEDLINE, PsycINFO and PILOTS (Published International Literature on Traumatic Stress)], guidelines and relevant websites, up to November 2016. Review methods We screened titles and abstracts using EPPI-Reviewer 4 (EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, UK) and EndNote X7 [Clarivate Analytics (formerly Thomson Reuters), Philadelphia, PA, USA]. Decisions to include papers were made by two reviewers independently. We conducted a narrative synthesis of research literature on models of care and on treatments, guided by information from UK practice. In our evidence reviews, we assessed (when appropriate) the quality of included studies using established criteria. To help interpret our findings, we consulted recently published public and patient involvement data, a veteran service user and experts with academic, military and commissioning backgrounds. Results We gathered information about current UK practice. Sixty-one studies were included in the rapid evidence review on models of care and seven systematic reviews in the rapid metareview of treatments. The quality of evidence in both evidence reviews was limited. Promising models of care from more robust studies (three randomised controlled trials and one qualitative study) were collaborative arrangements and community outreach for improving intervention access and uptake; integrated mental health services and behavioural intervention on increased smoking abstinence; and peer support as an acceptable complement to PTSD treatment. A poor fit was noted between the research literature and UK service provision. Promising treatments were psychosocial interventions (eye movement desensitisation and reprocessing, cognitive processing therapy, trauma-focused and exposure-based intervention) and pharmacotherapy (selective serotonin reuptake inhibitors, antidepressants, anticonvulsants, antipsychotics) for improving PTSD and mental health symptoms. Limitations The literature pool was larger than anticipated. Evidence for potentially effective models of care and potentially effective treatments is limited in quality and quantity. Although we aimed for a comprehensive evidence synthesis, pragmatic decisions in searching, screening and inclusion of studies may mean that relevant studies were overlooked. Conclusions There is tentative support for the effectiveness of some models of care and certain treatments currently delivered in UK practice. Our findings are timely for commissioners and service providers when developing present activity in veterans’ health care. Future work We report potential implications for future health-care practice, including early intervention for veterans transitioning from military life, improving general practitioners’ knowledge about services, implementing needs-based service design and tackling wider-system challenges. Regarding potential areas of future research, we have identified the need for more-robust (and longer) evaluative studies in the UK setting. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Abstract Abstract 4229 Introduction: Laboratory medicine services are critical to delivering high quality patient care. They operate to internationally recognized standards to ensure the quality and accuracy of their test results. Their responsibilities are wide ranging including enabling the clinician to confirm or exclude the presence of significant diseases, monitoring the progress of chronic conditions, providing expert advice in the management of patients with complex conditions, supporting research and development into new laboratory tests, systems and processes and supporting undergraduate teaching, postgraduate teaching and professional development. In the current economic climate, resources are diminishing in accordance with government austerity measures. At the same time, patients have increasing knowledge and therefore often have increasingly complex demands. To optimize primary care services, it is crucial that primary care physicians have appropriate access to tests. But a balance needs to be struck between a primary care physician's access and a laboratory's ability to limit access so that limited resources can be used to the maximum benefit of patients. Evidence based guidelines are critical. Laboratory tests can broadly be split into two categories: frequently ordered, inexpensive tests such as blood counts and infrequently ordered, expensive tests such as hereditary thrombophillia screens. In our institution, we chose to review vitamin B12 and folate testing as they are frequently requested, relatively inexpensive but time consuming assays. The aims of our study were to review the number of vitamin B12 and folate tests ordered by primary care physicians, to find out why the tests were being ordered and to see if they were being ordered appropriately. Methods: We reviewed our laboratory records to ascertain the number of vitamin B12 and folate assays carried out between 2004 and 2011. To find out why the tests was being ordered, the primary care physicians that use the laboratory in University Hospital Galway were sent out a questionnaire. To review whether or not clinical data was provided, 200 random request forms form March 2012 were reviewed. The literature was then reviewed to look at international guidelines. Results: The number of B12 and folate requests have risen year on year between 2004 and 2011, numbering 33,872 in 2004 and 96,544 in 2011. 69 of 172 primary health care centers responded to the survey. The main reasons given for ordering the test were unexplained neurological symptoms, macrocytosis, anemia and fatigue. 200 random request forms that the laboratory had received from primary care physicians were reviewed. 50% had clinical details. The reasons given for ordering the test were very varied, the most common being rountine screening and fatigue. 50 % had no clinical details provided. If the patient had had a recent full blood count in our laboratory, this was reviewed to see if any indication for the test could be ascertained. The majority (81%) had normal full blood counts. Discussion: According to the central statistics office, the population of our catchment area increased by 17% between 2002 and 2011. This did not account for the 185% increase in testing between 2004 and 2011. As vitamin B12 and folate were invariably requested in association with a ferritin level, this equates to €376,522 per year in assay cost alone. These tests are time consuming (around 40 minutes per batch) and labor intensive, which is increasingly a major factor as the main method for reducing laboratory costs to date has been to reduce the workforce. While the majority of primary care physicians knew the appropriate indications for B12 and folate testing when asked, this was not reflected in their practice. It was also worrying that many seemed unaware of important indications for testing such as unexplained cytopenias. On reviewing the literature, it is clear that there is no current guideline for vitamin B12 and folate testing. The most recent British committee for standards in hematology (BCSH) guideline was published in 1994 and is archived. Conclusion: In the current economic crisis, it is imperative that services are optimized so that patients do not suffer in the setting of decreased resources. This is best achieved when secondary and tertiary care institutions collaborate with primary care to deliver evidenced based health care. Disclosures: No relevant conflicts of interest to declare.

Introduction Such symptoms as hard, complex, bodily or mental feelings, that turn our everyday life into a hell, at first, lead us to a doctor, and then - to a psychotherapist. A sick man is keen to get rid of a symptom. A doctor prescribes medication, that is ought to eliminate a symptom. A psychotherapist searches for a reason of the problem that needs to be removed. There is such an idea that a neurotic symptom, in particular, an anxiety - is a pathological (spare or extra) response of a body. It is generally believed that such anxiety doesn’t have some real, objective reasons and that it is the result of a nervous system disorder, or some disruption of a cognitive sphere etc. Meanwhile, it is known that in the majority of cases, medical examinations of anxious people show that they don’t have any organic damages, including nervous system. It often happens that patients even wish doctors have found at least any pathology and have begun its treatment. And yet - there is no pathology. All examinations indicate a high level of functionality of a body and great performance of the brain's work. Doctors throw their hands up, as they can't cure healthy people. One of my clients told me her story of such medical examinations (which I’ll tell you with her permission). She said that it was more than 10 years ago. So, when she told her doctor all of her symptoms - he seemed very interested in it. He placed a helmet with electrodes on her head and wore some special glasses, when, according to her words, he created some kind of stressful situation for her brain, as she was seeing some flashings of bright pictures in her eyes. She said that he had been bothered with her for quite a long time, and at the end of it he had told her that her brain had been performing the best results in all respects. He noted that he’d rarely got patients with such great health indicators. My client asked the doctor how rare that was. And he answered: “one client in two or three months.” At that moment my client didn’t know whether to be relieved, flattered or sad. But since then, when someone told her that anxiety was a certain sign of mental problems, or problems with the nervous system, or with a body in general, she answered that people who had anxiety usually had already got all the required medical examinations sufficiently, and gave them the advice to go through medical screening by themselves before saying something like that. Therefore, we see a paradoxical situation, when some experts point to a neurotic anxiety as if it is a kind of pathology, in other words - some result of a nervous system disorder. Other specialists in the same situation talk about cognitive impairments. And some, after all the examinations, are ready to send such patients into space Main text I don’t agree with the statement that any neurotic anxiety that happens is excessive and unfounded. It often happens that there is objective, specific and real causes for appearance of anxiety conditions. And these causes require solutions. And it’s not about some organic damages of the brain or nervous system. The precondition that may give a rise to anxiety disorder is the development of such a life story that at some stage becomes too toxic - when, on the one hand, a person interacts with the outside world in a way that destroys his or her personality, and, on the other hand, this person uses repression and accepts such situation as common and normal. Repression - is an essential condition for the development of a neurotic symptom. Sigmund Freud was the first who pointed this out. Repression is such a defense mechanism that helps people separate themselves from some unpleasant feelings of discomfort (pain) while having (external or internal) irritations. It is the situation when, despite the presence of irritations and painful feelings, a person, however, doesn't feel any of it and is not aware of them in his or her conscious mind. Repression creates the situation of so-called emotional anesthesia. As a result, a displacement takes place, so a body starts to signal about the existing toxic life situation via a symptom. Anxiety disorder is usually an appropriate response (symptom) of a healthy body to an unhealthy life situation, which is seen by a person as normal. And it’s common when such a person is surrounded by others (close people), who tend to benefit from such situation, and so they actively maintain this state of affairs, whether it is conscious for them or not. At the beginning of a psychotherapy almost all clients insist that everything is good in their lives, even great, as it is like in everyone else’s life. They say that they have only one problem, which is that goddamn symptom. So they focus all of their attention on that symptom. They are not interested in all the other aspects of their life, and they show their irritation when it comes to talking about it. People want to get rid of it, whatever it takes, but they often tend to keep their lives the way that it was. In such cases a psychotherapist is dealing with the resistance of clients, trying to turn their attention from a symptom to their everyday situation that includes their way of thinking, interactions with themselves and with others and with the external world in order to have the opportunity to see the real problem, to live it through, to rethink and to change the story of their lives. For better understanding about how it works I want to tell you three allegorical tales. The name of the first tale is “A frog in boiling water”. There is one scientific anecdote and an assumption (however, it is noted that such experiments were held in 19 century), that if we put a frog in a pot with warm water and start to slowly heat the water, then this frog get used to the temperature rise and stays in a hot water, the frog doesn’t fight the situation, slowly begins to lose its energy and at the last moment it couldn’t find enough strength and energy to get out of that pot. But if we throw a frog abruptly in hot water - it jumps out very quickly. It is likely that a frog, that is seating in boiling water, will have some responses of the body (symptoms). For example, the temperature of its body will rise, the same as the color of it, etc., that is an absolutely normal body response to the existing situation. But let us keep fantasizing further. Imagine a cartoon where such a frog is the magical cartoon hero, that comes to some magical cartoon doctor, shows its skin, that has changed the color, to the doctor, and asks to change the situation by removing this unpleasant symptom. So the doctor prescribes some medication to return the natural green color of the frog’s skin back. The frog gets back in its hot water. For some period of time this medication helps. But then, after a while, the frog’s body gets over the situation, and the redness of the frog's skin gets back. And the magical cartoon doctor states that the resistance of the body to this medication has increased, and each time prescribes some more and more strong drugs. In this example with the frog it is perfectly clear that the true solution of the problem requires the reduction of the water temperature in that pot. We could propose that magical cartoon frog to think and try to realize that: 1) the water in that pot is hot, and that is the reason why the skin is red; 2) the frog got used to this situation and that is why it is so unnoticeably for this frog; 3) if the temperature of the water in the pot still stay so hot, without any temperature drop, then all the medication works only temporarily; 4) if we lower the temperature in that pot - the redness disappears on its own, automatically and without any medication. Also this cartoon frog, that will go after the doctor to some cartoon physiotherapist, will face the necessity to give itself some answers for such questions as: 1) What is going on? Who has put this frog in that pot? Who is raising the temperature progressively? Who needs it? And what is the purpose or benefit for this person in that? Who benefits? 2) Why did the frog get into the pot? What are the benefits in it for the frog? Or why did the frog agree to that? 3) What does the frog lose when it gets out of this pot? What are the consequences of it for the frog? What does the frog have to face? What are the possible difficulties on the way? Who would be against the changes? With whom the frog may confront? 4) Is the frog ready to take control over its own pot in its own hands and start to regulate the temperature of the water by itself, so to make this temperature comfortable for itself? Is this frog ready to influence by itself on its own living space, to take the responsibility for it to itself? The example “A frog in boiling water” is often used as a metaphorical portrayal of the inability of people to respond (or fight back) to significant changes that slowly happen in their lives. Also this tale shows that a body, while trying to adjust to unfavorable living conditions, will react with a symptom. And it is very important to understand this symptom. Symptom - is the response of a body, it’s a way a body adjusts to some unfriendly environment. Symptom, on the one hand, informs about the existence of a problem, and from the other hand - tries to regulate this problem, at least in some way (like, to remove or reduce), at the level on which it can do it. The process is similar to those when, for example, in a body, while it suffers from some infectious disease, the temperature rises. Thus, on the one hand, the temperature informs about the existence of some infection. On the other hand, the temperature increase creates in a body the situation that is damaging for the infection. So, it would be good to think about in what way does an anxiety symptom help a body that is surrounded by some toxic life situation. And this is a good topic for another article. Here I want to emphasize that all the attempts to remove a symptom without a removal of a problem, without changing the everyday life story, may lead to strengthening of the symptom in the body. Even though the removal of a symptom without elimination of its cause has shown success, it only means that the situation was changed into the condition of asymptomatic existence of a problem. And it is, in its essence, a worse situation. For example, it can cause an occurrence of cancer. The tale “A frog in boiling water” is about the tendency of people to treat a symptom, instead of seeing their real problems, as its cause, and trying to solve it. People don’t want to see their problems, but it doesn’t mean that the problem doesn’t exist. The problem does exist and it continues to destroy a person, unnoticeably for him or her. A person with panic disorder could show us anxiety that is out of control (fear, panic), which, by its essence, seems to exist without any logical reason. Meanwhile the body of such a person could be in such processes that are similar to those that occur in the conditions of some real dangers, when the instinct for self-preservation is triggered and an automatic response of a body to fight or flight implements for its full potential. We can see or feel signs of this response, for example, in cases when some person tries to avoid some real or imaginary danger via attempts to escape (the feeling of fear), or tries to handle the situation by some attempts to fight (the feeling of anger). As I mentioned before, many doctors believe that such fear is pathological, as there is no real reason for such intense anxiety. They may see the cause of the problem in worrisome temper, so they try to remove specifically anxiety rather than help such patients to understand specific reason of their anxiety, they use special psychotherapeutic methods that are designed to help clients to develop logical thinking, so it must help them to realize the groundlessness of their anxiety. In my point of view, such anxiety often has specific, real reasons, when this response of a body, fight or flight, is absolutely appropriate, but not excessive or pathological. Inadequacy, in fact, is in the unconsciousness, but not in the reactions of a body. For a better understanding of the role of anxiety in some toxic environment, that isn’t realized, I want to tell you another allegorical tale called “The wolf and the hare”. Let us imagine that two cages were brought together in one room. The wolf was inside one cage and the hare was in another. The cages were divided by some kind of curtain that makes it impossible for them to see each other. At this point a question arises whether the animals react to each other in some way in such a situation, or not? I think that yes, they will. Since there are a lot of other receptors that participate in the receiving and processing of the sensory information. As well as sight and hearing, we have of course a range of other senses. For example, animals have a strong sense of smell. It is well known that people, along with verbal methods of communicating information, like language and speaking, also have other means of transmitting information - non-verbal, such as tone of voice, intonation, look, gestures, body language, facial expressions etc., that gives us the opportunity to receive additional information from each other. The lie detector works by using this principle: due to detecting non-verbal signals, it distinguishes the level of the accuracy of information that is transmitted. It is assumed, that about 30% of information, that we receive from the environment, comes through words, vision, hearing, touches etc. This is the information that we are aware of in our consciousness, so we could consciously (logically) use it to be guided by. And approximately 70% of everyday information about the reality around us we receive non-verbally, and this information in the majority of cases could remain in us without any recognition. It is the situation when we’ve already known something, and we even have already started to respond to it via our body, but we still don’t know logically and consciously that we know it. We can observe the responses of our own body without understanding what are the reasons for such responses. We can recognize this unconscious information through certain pictures, associations, dreams, or with the help of psychoanalysis. Psychoanalysis is a great tool that can help to recognize the information from the unconscious mind, so that it can be logically processed further on, in other words, a person then receives the opportunity to indicate the real problems and to make right decisions. But let us return to the tale where the hare and the wolf stay in one room and don’t see each other, and, maybe, don’t hear, though - feel. These feelings (in other words - non-verbal information that the hare receives) activate a certain response in the hare’s body. And it reacts properly and adequately to the situation, for instance, the body starts to produce adrenaline and runs the response “fight or flight”. So the hare starts to behave accordingly and we could see the following symptoms: the hare is running around his cage, fussing, having some tremor and an increased heart rate, etc.. And now let us imagine this tale in some cartoon. The hare stays in its house, and the wolf wanders about this house. But the hare doesn’t see the wolf. Though the body of the hare gives some appropriate responses. And then that cartoon hare goes to a cartoon doctor and asks that doctor to give it some pill from its tremor and the increased heart rate. And in general asks to treat in some way this incomprehensible, confusing, totally unreasonable severe anxiety. If we try to replace the situation from this fairy-tale to a life story, we could see that it fits well to the script of interdependent relationships, where there are a couple “a victim and an aggressor”, and where such common for our traditional families’ occurrences as a domestic family violence, psychological and physical abuse take place. Only in 2019 a law was passed that follows the European norms and gives a legislative definition of such concepts as psychological domestic abuse, sexual abuse, physical abuse, bullying, that criminalizes all of these occurrences, establishes the punishment and directly points to people that could be a potential abuser. Among them are: a husband towards his wife, parents towards their children, a wife towards her husband, a superior towards a subordinate, a teacher towards his or her students, children towards each other etc.. When it comes to recognition of something as unacceptable, it seems more easy to put to that category such occurrences as physical and sexual abuse, as we could see here some obvious events. For example, beating or sexual harassment. Our society is ready to respond to these incidents in more or less adequate way, and to recognize them as a crime. But it is harder to deal with the recognition of psychological abuse as an offence. Psychological abuse in our families is common. Psychological abuse occurs through such situations, when one person, while using different psychological manipulations, such as violation of psychological borders, imposition of feeling of guilty or shame, etc., force another person to give up his or her needs and desires, and so in such a way make this person live another’s life. Such actions have an extremely negative effect on the mental health of these people, just as much as physical abuse. It can destroy a person from the inside, ruin self-esteem and a feeling of self-worth, create the situation of absolute dependence such victim from an abuser, including financial dependence etc.. It often happens that psychological abuse takes place against the backdrop of demonstrations of care and love. So you've got this story about the wolf and the hare, that are right next to each other, and the shield between two of them is a repression - a psychological defense mechanism, when a person turns a blind eye to such offences, that take place in his or her own life and towards him or her. And this person considers this as normal, doesn't realize, doesn't have a resource to realize, that it is a crime. Most importantly - doesn’t feel anything, as a repression takes place. But a body responds in a right way - from a certain point of the existence of such a toxic situation the response “fight or flight” is launched in a body at full, in other words - the fear and anxiety with the associated symptoms. The third allegorical tale I called “Defective suit”, which I read in the book of Clarissa Pinkola Estés with the name “Running With the Wolves". “Once one man came to a tailor and started to try on a suit. When he was standing in front of a mirror, he saw that the costume had uneven edges. - Don’t worry, - said the tailor. - If you hold the short edge of the suit by your left hand - nobody notices it. But then the man saw that a lapel of a jacket folded up a little bit. - It's nothing. You only need to turn your head and to nail it by your chin. The customer obeyed, but when he put on trousers, he saw that they were pulling. - All right, so just hold your trousers like this by your right hand - and everything will be fine, - the tailor comforts him. The client agreed with him and took the suit. The next day he put on his new suit and went for a walk, while doing everything exactly in the way that the tailor told him to. He waddled in a park, while holding the lapel by his chin, and holding the short edge of the suit by his left hand, and holding his trousers by his right hand. Two old men, who were playing checkers, left the game and started to watch him. - Oh, God! - said one of them. - Look at that poor cripple. - Oh, yes - the limp - is a disaster. But I'm wondering, where did he get such a nice suit?” Clarissa wrote: “The commentary of the second old man reflects the common response of the society to a woman, who built a great reputation for herself, but turned into a cripple, while trying to save it. “Yes, she is a cripple, but look how great her life is and how lovely she looks.” When the “skin” that we put on ourselves towards society is small, we become cripples, but try to hide it. While fading away, we try to waddle perky, so everyone could see that we are doing really well, everything is great, everything is fine”. As for me, this tale is also about the process of forming a symptom in a situation when one person tries very hard to match to another one, whether it is a husband, a wife or parents. It’s about a situation when such a person always tries to support the other one, while giving up his or her own needs and causing oneself harm in such a way by feeling a tension every day, that becomes an inner normality. And so this person doesn’t give oneself a possibility to relax, to be herself (or himself), to be spontaneous, free. As a result, in this situation the person, who was supported, looks perfect from the outside, but those who tried to match, arises some visible defect, like a limp - a symptom. And so this person lives like a cripple, under everyday stress and tension, trying to handle it, while sacrificing herself (or himself) and trying to maintain this situation, so not to lose the general picture of a beautiful family and to avoid shame. The tailor, who made this defective suit and tells how to wear the suit properly, in order to keep things going as they are going, often is a mother who raised a problematic child and then tells another person how to deal with her child in the right way. It is the situation when a mother-in-law tells her daughter-in-law how to treat her son properly. In other words, how to support him, when to keep silent, to handle, how to fit in, so that her problematic son and this relationship in general looks perfect. Or vice versa, when a mother-in-law tells her son-in-law how to support her problematic daughter, how to fit in etc.. When, for example, a woman acts like this in her marriage and with her husband, with these excessive efforts to fit in - then after a while everybody will talk like: “Look at this lovely man: he lives with his sick wife, and their family seems perfect!”. But when such a woman becomes brave enough to relax and to just let the whole thing go, everybody will see that the relationship in her marriage isn’t perfect, and it is the other one who has problems. Each time when someone tries excessively to match up to another one, while turning oneself in some kind of a cripple, - he or she, on the one hand, supports the comfort of that person, to whom he or she tries to match up, and on the other hand - such a situation always arises in that person such conditions as a continuous tension, anxiety, fear to act spontaneously. A symptom - is like a visible defect, that shows itself through the body (and may look like some kind of injury). It is the result of a hidden inner prison. As a result of evolution, a pain tells us about a problem that is needed to be solved. When we repress our pain we can’t see our needs and our problems at full. And then a body starts to talk to us via a symptom. Psychotherapy aims for providing a movement from a symptom to a resumption of sensitivity to feelings, a resumption of the ability to feel your psychological pain, so you can realize your own toxic story. In this perspective another fairy-tale looks interesting to analyze - it is Andersen's fairytale “Princess and the Pea”. In the tale a prince wanted to find a princess to marry. There was one requirement for women candidates, so the prince could select her among commoner - high level of sensitivity, as the real princess would feel a pea through the mountain of mattresses, and so she could have the ability to feel discomfort, to be in a good contact with her body, to tell about her discomfort without such feeling as shame and guilt, and to refuse that discomfort, so to have the readiness to solve her problems and to demand from others the respect for her needs. It is common for our culture that the expression “a princess on a pea” very often uses for a negative meaning. So people who are in good contact with their body and who can demand comfort for themselves are often called capricious. At the same time the heroes who are ready to suffer and to tolerate their pain, who are able to repress (stop to feel) their pain represents a good example to be followed in our society. So, we may see the next algorithm in cases of various anxiety disorders: the existence of some toxic situation that brings some danger to a person. And we need not to be confused: a danger exists not for a body, but for a personality. A toxic live situation as well as having a panic attack is not a threat for the health of a body (that is what medical examinations show), and vice versa - it’s like every day intensive sport training, that could be good for your health only to some degree. A toxic situation destroys a person as a personality, who longs for one self’s expression; the existence of such a defense mechanism as repression - it’s a life with closed eyes, in pink glasses, when there is inability (or the absence of the desire) to see its own toxic story; 3.the presence of a symptom - a healthy response of a body “fight or flight” to some toxic situation; displacement - it’s replacement of the attention from the situation to a symptom, when a person starts to see and search for the problem in some other place, not where it really is. A symptom takes as some spare, pathological reaction that we need to get rid of. The readiness to fight the symptom arises, and that is the goal of such methods of therapy as pharmacological therapy, CBT and many others; the absence of adequate actions that are directed towards the change of a toxic situation itself. The absence of the readiness to show aggression when it comes to protect its space. All of it is a mechanism of formation of primary anxiety and preparation for launch of secondary anxiety. A complete anxiety disorder is the interaction between a primary and a secondary anxiety.

AbstractAt present, the entire globe gets engaged in importing and exporting the products for promoting their business in which supply chain management is playing a vital role. The main aspect of any effective supply chain management is the transportation of cargoes. To avoid the damages of cargoes during transportation and for minimizing the cost, the returnable containers are used. The present research deals with an inventory model of Non-Vessel Operating Common Carrier (NVOCC) for returnable containers with price dependent demand under fuzzy environment. In this study, it is presumed that the import of cargoes is less than the export. The Empty Container Repositioning (ECR) and the leasing options are utilized to replace the deficit containers which prevent shortages. The proportion of the used containers returned, the proportion of the repositioned containers and the fraction of repairable from the returned containers are considered as Triangular Fuzzy Numbers [TFNs]. Fuzzy inventory model is framed for the purpose of attaining optimal length of the screening, the repositioning cycle and the leasing cycle which are used to minimize the expected total cost and the proposed model is illustrated with the numerical example. The sensitivity analysis is performed to show the effect of fuzziness of return rate, repositioning rate and repairable percentage along with the changes in parameters.

AbstractA demand-driven approach is becoming increasingly central in the efforts to improve agricultural research and development. However, the question of how exactly demand is studied usually remains unstated and is rarely discussed. We therefore carried out a systematic review in order to better understand how farmers’ demand for seed in root, tuber and banana seed systems is studied. The review is based on data from a consultation with an expert panel and a structured literature search in the SCOPUS database. Screening the gathered articles resulted in 46 studies on a global scale, fitting the scope of our investigation. Through qualitative analysis and categorization of these studies, we developed a classification scheme according to the types of approaches applied in the retained studies. One group of studies explicitly articulates farmers’ preferences and choices through surveys or engagements in trials, auctions, choice experiments and interviews. Other studies implicitly articulate farmers’ demand by characterising their current use of varieties and seed. We discuss opportunities and limitations in the use of each type of study and we reflect on the body of available literature as a whole. Our conclusion is that a framework is necessary that purposefully combines the existing different methods and that it is necessary to involve stakeholders in a process where demand is articulated. Together, these two steps would characterise existing demands in a more effective and precise way, thus providing better guidance to decision-makers in their reactions pertaining to seed systems.

Growing concerns about the safety of long-term opioid therapy and its uncertain efficacy for non-cancer pain have led to relatively rapid opioid deprescribing in chronic pain patients who have been taking opioid for years. To date, empirically supported processes for safe and effective opioid tapering are lacking. Opioid tapering programs have shown high rates of dropouts and increases in patient distress and suicidal ideation. Therefore, safe strategies for opioid deprescribing that are more likely to succeed are urgently needed. In response to this demand, the EMPOWER study has been launched to examine the effectiveness of behavioral medicine strategies within the context of patient-centered opioid tapering in outpatient settings (https://empower.stanford.edu/). The EMPOWER protocol requires an efficient process for ensuring that collaborative opioid tapering would be offered to the most appropriate patients while identifying patients who should be offered alternate treatment pathways. As a first step, clinicians need a screening tool to identify patients with Opioid Use Disorder (OUD) and to assess for OUD severity. Because such a tool is not available, the study team composed of eight chronic pain and/or addiction experts has extended a validated screening instrument to develop a brief and novel consensus screening tool to identify OUD and assess for OUD severity for treatment stratification. Our screening tool has the potential to assist busy outpatient clinicians to assess OUD among patients receiving long-term opioid therapy for chronic pain.

At the 2020 “Luftschlösser” (castles in the air) conference, experts from a wide range of pneumological fields discussed technical innovations in pneumology, which can be seen in many different areas of the field, including e-health, screening, diagnostics, and therapy. They contribute to substantial advancements ranging from the innovative use of diagnostic tools to novel treatments for chronic lung diseases. Artificial intelligence enables broader screening, which can be expected to have beneficial effects on disease progression and overall prognosis. There is still a high demand for clinical trials to investigate the usefulness and risk-benefit ratio. Open questions remain especially about the quality and utility of medical apps in an inadequately regulated market. This article weighs the pros and cons of technical innovations in specific subspecialties of pneumology based on the lively exchange of ideas among various pneumological experts.

Abstract Background Cervical cancer disproportionately affects women in sub-Saharan Africa, compared with other world regions. In Ethiopia, a National Cancer Control Plan published in 2015, outlines an ambitious strategy to reduce the incidence and mortality of cervical cancer. This strategy includes widespread screening using visual inspection with acetic acid (VIA). As the national screening program has rolled out, there has been limited inquiry of provider experiences. This study aims to describe cancer control experts’ perspectives regarding the cancer control strategy and implementation of VIA. Methods Semi-structured interviews with 18 participants elicited provider perspectives on cervical cancer prevention and screening. Open-ended interview questions queried barriers and facilitators to implementation of a new national screening program. Responses were analyzed using thematic analysis and mapped to the Integrated Behavioral Model. Participants were health providers and administrators with positionality as cancer control experts including screening program professionals, oncologists, and cancer focal persons at town, zone, and federal health offices at eleven government facilities in the Arsi, Bale, and Shoa zones of the Oromia region, and in the capital Addis Ababa. Results The cancer control plan and screening method, VIA, were described by participants as contextually appropriate and responsive to the unique service delivery challenges in Ethiopia. Screening implementation barriers included low community- and provider-awareness of cervical cancer and screening, lack of space and infrastructure to establish the screening center, lack of materials including cryotherapy machines for the “screen-and-treat” approach, and human resource issues such as high-turnover of staff and administration. Participant-generated solutions included additional training for providers, demand creation to increase patient flow through mass media campaigns, decentralization of screening from large regional hospitals to local health centers, improved monitoring and evaluation, and incentivization of screening services to motivate health providers. Conclusions As the Ethiopian government refines its Cancer Control Plan and scales up screening service implementation throughout the country, the findings from this study can inform the policies and practices of cervical cancer screening. Provider perspectives of barriers and facilitators to effective cancer control and screening implementation reveal areas for continued improvement such as provider training and coordination and collaboration in the health system.

Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clinical development; once approved, new healthcare infrastructures and services, including primary healthcare, will be necessary to accommodate a huge demand for early and large-scale detection of AD. The increasing global accessibility of digital consumer electronics has opened up new prospects for early diagnosis and management of mild cognitive impairment (MCI) with particular regard to AD. This new wave of innovation has spurred research in both academia and industry, aimed at developing and validating a new “digital generation” of tools for the assessment of the cognitive performance. In light of this paradigm shift, an international working group (the Global Advisory Group on Future MCI Care Pathways) convened to elaborate on how digital tools may be optimally integrated in screening-diagnostic pathways of AD The working group developed consensus perspectives on new algorithms for large-scale screening, detection, and diagnosis of individuals with MCI within primary medical care delivery. In addition, the expert panel addressed operational aspects concerning the implementation of unsupervised at-home testing of cognitive performance. The ultimate intent of the working group’s consensus perspectives is to provide guidance to developers of cognitive tests and tools to facilitate the transition toward globally accessible cognitive screening aimed at the early detection, diagnosis, and management of MCI due to AD.

Abstract Arterial hypertension [HT] is a global epidemic that requires adequate treatment to reduce cardiovascular morbidity and mortality. Secondary causes of HT and specifically endocrine hypertension [EHT] (primary hyperaldosteronism [PA], pheochromocytoma/paraganglioma [PPGL] and Cushing syndrome [CS]) can potentially be cured by surgery or treated by targeted medication. However, diagnosis of EHT requires expertise in test selection and interpretation of test results. The availability of experts outnumbers its demand. Thus, preselecting tools are necessary to identify patients who require further referral to an expert. Since targeted metabolomics [TM] is a new method showing promising results in profiling cardiovascular diseases and endocrine conditions associated with HT, we tested the ability of TM in discriminating primary hypertension [PHT] from EHT cases. The study included 282 adult patients (52% female; mean age 49 years) from the European multicentre consortium ENSAT-HT (www.ensat-ht.eu). Of these, 59 were diagnosed with PHT and 223 with EHT (40 CS, 107 PA and 76 PPGL). TM was performed on stored blood samples with a mass spectrometry based approach using the AbsoluteIDQTM p180 Kit (BIOCRATES Life Sciences, Austria). In total, 188 metabolites were determined, of which 155 were eligible for statistical analyses according to established selection criteria. To identify relevant discriminating metabolites, a series of univariate and multivariate analyses were applied. Since the distribution of the patients between the clinical entities was different according to sex (p<0.001) and age (p=0.001), analyses were also performed separately for each sex and age group (cut-off 50 years). Thereby, we identified 4 common metabolites (C18:1, C18:2, spermidine, ornithine) from the comparison of PHT with each endocrine hypertension subgroup (CS, PA, PPGL) separately. The ROC curve for discrimination between PHT and EHT built upon these 4 metabolites had an area under the curve (AUC) of 0.79 (95%CI 0.73-0.85). In the comparison of PHT and EHT as a common group 38 metabolites were identified. Using the top 15 metabolites from the latter comparison (C3-DC, C9, C16, C16:1, C18:1, C18:2, arginine, aspartate, glutamate, ornithine, spermidine, lysoPCaC20:4, PCaaC38:6, PCaaC40:6, PCaaC42:1) the AUC was 0.86 (95%CI 0.81-0.91). We conclude that TM is associated with distinct metabolic pattern in PHT and EHT and is a promising pre-screening tool for identifying EHT patients.

Purpose: To explore factors contributing to depression identified by patients and mental health nurse specialists. Background: Heart failure incidence approaches 10 per 1,000 Americans after age 65 years. Nearly half of all patients with heart failure experience depression, an independent risk factor for increased cardiovascular morbidity and mortality. Methods: Patients with heart failure ( n = 175; mean age = 63.1 years, SD = 13; range age 25-over 89 years) were screened for depression, using the PHQ-9 and CESD. Mental health clinical nurse specialist referrals were made based on a combination of questionnaire scores (i.e., moderate to severe depression) and patient narratives, including expressed feelings of depression, loneliness, sadness, or suicidal thoughts. Content analysis research methods were used to categorize patient and mental health nurse specialist consultation narratives and identify factors contributing to depression. Results: Using the PHQ-9 and CESD screening questionnaires, 75 (43%) patients reported having felt depressed during the previous month, resulting in 47 (27%) patient referrals to the mental health clinical nurse specialist. Patients most often reported depressive symptoms due to complex illness care, loss of independence or function, self-care demands, financial concerns, and life stressors. The advanced practice mental health nurse consultations revealed patients most often experienced fatigue and insomnia, grief and situational depression, anger, and regret reactions. Patients were more likely to disclose mental health illnesses, domestic and family issues, and illicit substance use to the mental health clinical nurse specialist than to investigators administering the PHQ-9 and CESD. Implications: Exploring patient and expert mental health nurse narratives identified unique contributing factors of depression in heart failure, which warrant further study. The mental health clinical nurse specialist determined whether patients experienced grief responses or depression, an important distinguishing factor in screening for depression, with implications for research and clinical practice.

The idea of specimen self-collection or self-STI testing is not new. In 2019, the World Health Organization (WHO) published the “WHO Consolidated Guideline on Self-Care Interventions for Health” as a first installment in a planned series for various diseases (8). The first document focused on “Sexual and Reproductive Health and Rights”. Self-care including self-testing has the readily apparent benefits of privacy, confidentiality, speed, convenience, and access if the price is affordable. It is “people-centered” (9) and enables active participation in one’s own health. It is also a health system approach as it can reduce burden on stretched systems with world-wide shortages in medical personnel or other barriers to health care access. Potential risks include: low specimen return rates, uncertain follow-up (linkage to care including treatment, repeat testing including test of cure, partner notification, counseling on risk reduction), unintended/unnecessary use (resulting in false positives with their own set of associated problems), incorrect use, lack of understanding of window periods (resulting in false negatives), lack of surveillance data generation, among other issues (9). The WHO systematically reviewed evidence for self-testing or specimen self-collection for GC, CT and syphilis, including US studies, and published a meta-analysis of available evidence (9). Programs offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI1.043 to 4.498), prior to the pandemic (9). U. S. laboratory research on the equivalence and/or superiority of self-collected versus provider-collected specimens for test sensitivity was reported by Gaydos et al (summarized or referenced in (10)). Based on this evidence, WHO issued a new recommendation in 2019 “Self-collection of samples for Neisseria gonorrhoeae and Chlamydia trachomatis should be made available as an additional approach to deliver STI testing services for individuals using STI testing services” (8). In addition, WHO issued a new and conditional recommendation: “Self-collection of samples for Treponema pallidum (syphilis) and Trichomonas vaginalis may be considered as an additional approach to deliver STI testing services for Individuals using STI testing services” (8). Thus, even before the COVID-19 pandemic, substantial expert agreement existed concerning benefits of this approach.

Consumption of edamame (vegetable soybeans) has increased significantly in the U.S. over the last 20 years. Although market demand has been increasing, most edamame is still imported from Asian countries. A team of multistate plant-breeding programs in the mid-Atlantic and Southeast U.S. has focused on developing new breeding lines that grow well in the U.S. and deliver what domestic growers, processors and consumers need and expect from their edamame. In our study, sensory evaluation was used to identify edamame genotypes and sensory attributes preferred by consumers to support breeding selection criteria. In the first year (reported as our “screening study”), 20 edamame genotypes were grown in three locations: Newport, AR, and Blacksburg and Painter, VA. In the second year (reported as our “validation study”), 10 edamame genotypes selected after our screening study were grown in Blacksburg and Painter, VA, Portageville, MO, and Stoneville, MS. In both years of research, untrained participants (adults; vegetable consumers not allergic to soy; N ≥ 50) used a traditional 9-point acceptability (hedonic) scale (1 = “dislike extremely”; 9 = “like extremely”) to evaluate overall-liking, aroma, appearance, taste, and texture, and a 5-point scale (1 = “not sweet,” 5 = “extremely sweet”) to evaluate sweetness intensity. Next, participants used a check-all-that-apply (CATA) list of selected sensory terms to describe the sensory characteristics of each edamame sample. Overall acceptability of edamame genotypes was significantly different among all genotypes (p < 0.05). Samples described as “bitter,” “sour” (flavor) or “starchy” (texture) were associated with lower acceptability scores while “salty” and “sweet” (flavor) were correlated with higher acceptability. Sensory data from the screening study were used to select the best genotypes by use of a defined decision process based on the consumer data. The validation study tested the selection decisions and further supported the genotype choices. Sensory evaluation is a powerful tool to direct breeders to improve market acceptability and develop new edamame genotypes. Both screening and validation studies illustrate the significant role of consumer sensory data in support of genotypes targeted for domestic (U.S.) production.

In Japan, according to the “Law to Support Persons with Developmental Disabilities” and the project “Healthy Parents and Children 21 (Second Phase),” every prefecture, city, and town needs to identify children affected by developmental disorders and provide support to these children and their parents as early as possible. Public health nurses (PHNs) are responsible for the early detection of cases and complete a diverse range of tasks relating to screening and supporting procedures. The number of children who are waiting to receive specialized medical care in institutions is increasing. Furthermore, the demands for expert personnel such as child psychiatrists, child psychologists, occupational therapists, as well as the establishment of more specialized institutions, are escalating. Various professionals encounter many challenges in identifying children affected by developmental disabilities and in providing effective treatments. Rehabilitative care for children with developmental disorders may be applied to developmental support as for other normal children. It is necessary to promote the skills of professionals relating to maternal and child care. Hence, this study aimed to identify the difficulties experienced by PHNs in providing early care to children with developmental disorders, and to examine ways to improve their performance in the future

Abstract Background While the second wave of COVID-19 pandemic almost reached its climax, unfortunately, new viral strains are rapidly spreading, and numbers of infected young adults are rising. Consequently, chest high-resolution computed tomography (HRCT) demands are increasing, regarding patients’ screening, initial evaluation and follow up. This study aims to evaluate the detection accuracy of ultra-low-dose chest CT in comparison with the routine low-dose chest CT to reduce the irradiation exposure hazards. Results This study was prospectively conducted on 250 patients during the period from 15th December 2020 to 10th February 2021. All of the included patients were clinically suspected of COVID-19 infection. All patients were subjected to routine low-dose (45 mAs) and ultra-low-dose (22 mAs) chest CT examinations. Finally, all patients had confirmatory PCR swab tests and other dedicated laboratory tests. They included 149 males and 101 females (59.6%:40.4%). Their age ranged from 16 to 84 years (mean age 50 ± 34 SD). Patients were divided according to body weight; 104 patients were less than 80 kg, and 146 patients were more than 80 kg. HRCT findings were examined by two expert consultant radiologists independently, and data analysis was performed by other two expert specialist and consultant radiologists. The inter-observer agreement (IOA) was excellent (96–100%). The ultra-low-dose chest CT reached 93.53–96.84% sensitivity and 90.38–93.84% accuracy. The signal-to-noise ratio (SNR) is 12.8:16.1; CTDIvol (mGy) = 1.1 ± 0.3, DLP (mGy cm) = 42.2 ± 7.9, mean effective dose (mSv/mGy cm) = 0.59 and absolute cancer risk = 0.02 × 10-4. Conclusion Ultra-low-dose HRCT can be reliably used during the second wave of COVID-19 pandemic to reduce the irradiation exposure hazards.

Abstract Background Automating cytology-based cervical cancer screening could alleviate the shortage of skilled pathologists in developing countries. Up until now, computer vision experts have attempted numerous semi and fully automated approaches to address the need. Yet, these days, leveraging the astonishing accuracy and reproducibility of deep neural networks has become common among computer vision experts. In this regard, the purpose of this study is to classify single-cell Pap smear (cytology) images using pre-trained deep convolutional neural network (DCNN) image classifiers. We have fine-tuned the top ten pre-trained DCNN image classifiers and evaluated them using five class single-cell Pap smear images from SIPaKMeD dataset. The pre-trained DCNN image classifiers were selected from Keras Applications based on their top 1% accuracy. Results Our experimental result demonstrated that from the selected top-ten pre-trained DCNN image classifiers DenseNet169 outperformed with an average accuracy, precision, recall, and F1-score of 0.990, 0.974, 0.974, and 0.974, respectively. Moreover, it dashed the benchmark accuracy proposed by the creators of the dataset with 3.70%. Conclusions Even though the size of DenseNet169 is small compared to the experimented pre-trained DCNN image classifiers, yet, it is not suitable for mobile or edge devices. Further experimentation with mobile or small-size DCNN image classifiers is required to extend the applicability of the models in real-world demands. In addition, since all experiments used the SIPaKMeD dataset, additional experiments will be needed using new datasets to enhance the generalizability of the models.

Ribosomal DNA (rDNA) has become the primary target molecule for phylogenetic reconstruction and the cultivation-independent detection and quantification of microorganisms (barcoding). With the advent of high-throughput sequencing technologies (Next Generation Sequencing (NGS), PCR-based amplicon sequencing of rDNA fragments for diversity screening is now a routine technology, at least in environmental sciences. The resulting exponential increase of publicly available rDNA sequences demands specialized reference databases (Fig. 1). SILVA (from Latin silva, meaning forest) is designed to provide a comprehensive web resource for up-to-date, quality-controlled databases of aligned rDNA sequences from the Bacteria, Archaea and Eukaryota domains and the corresponding online services (Glöckner et al. 2017, Quast et al. 2012). The current SILVA database (release 132) contains 6,073,181 small subunit and 907,382 large subunit rRNA gene sequences. All sequences are checked for anomalies, carry a rich set of sequence-associated contextual information, multiple taxonomic classifications (EMBL-EBI/ENA, RDP and GTDB) and the latest validly-described nomenclature. SILVA maintains manually curated reference alignments of 75,000 ribosomal RNA genes, both 16S/18S (small subunit, SSU) and 23S/28S (large subunit, LSU). With every full release, a manually curated guide tree is provided that contains the latest taxonomy and nomenclature based on multiple references. SILVA is the only rDNA database project worldwide where special emphasis is given to the consistent naming of clades of uncultivated (environmental) sequences where no validly-described cultivated representative is available (Yilmaz et al. 2014). SILVA incorporates other unique features, including a comprehensive 23S/28S database of aligned rDNA sequences and alignments that contain Eukaryota sequences. SILVA is an active partner of RNACentral. RNAcentral is a public resource that offers integrated access to a comprehensive and up-to-date set of non-coding RNA sequences provided by a collaborating group of Expert Databases. The SILVA team is a member of the Bergey’s Board of Trustees which provides the authoritative taxonomy for Bacteria and Archaea as well as the Protist Reference Taxonomy Project UniEuk funded by the Gordon and Betty Moore Foundation to create a unified taxonomic framework In 2018 SILVA became an ELIXIR Core Data Resource. ELIXIR Core Data Resources are a set of European data resources of fundamental importance to the wider life-science community and the long-term preservation of biological data. To facilitate classification tasks for high-throughput rDNA data the SILVAngs has been implemented and released in 2013. SILVAngs is a data analysis service for rDNA reads from high-throughput sequencing (NGS) approaches based on an automatic software pipeline. It uses the SILVA rDNA databases, taxonomies, and alignments as a reference. It facilitates the classification of rDNA reads and provides a wealth of results (tables, graphs and sequence files) for download. SILVAngs serves several thousands of registered users, which processes thousands of projects per year. The application spectrum of the SILVA databases ranges from environmental sciences, microbiology, agriculture, biochemistry, biotechnology to medicine in academia and industry.

The borderline between fiction and non-fiction is, like much that is liminal, deeply attractive to observers, and among the consequences of this is a proliferation of names; 'faction', 'fictocriticism' and the shifting pairing of docudrama/dramadoc operate to indicate the blending of different types of fictional and non-fictional material. All of these produce that feeling of unease proper to liminal states. In his recent study, Derek Paget notes how it is the seriousness of the truth claims of that version of non-fiction called documentary that makes its mixing with drama so fraught with potential for controversy. In Queensland we might recall some of the arguments over the screening of Joh's Jury, but Paget underpins his analysis of material like the 1992 HBO/Granada production Hostages with reference to the four year sentence imposed in 1997 on German documentary maker Michael Born for faking material for his documentaries (1). Here not making clear the hybridity of the material was not just an impropriety, but a crime. Yet the liminal material that most fascinates me hides its hybrid nature behind a shifting collection of different terms, ones like 'projection', 'forecast', 'extrapolation' or even (on bad days) 'mission statement'. This particular body of writing is accessible non-fiction about the future. As one who has used science fiction as my basic tool for thinking about the future since I was a child, the question 'how do you write non-fictionally about something that has not yet happened?' fascinates me. That it does not seem to bother other people all that much is what seems strange. How is it that non-fiction about the future differs from science fiction about the future (and for those unfamiliar with or disdainful about the genre, sf can be set in the present, the past or the future)? Certainly one can see distinctions at the extremes; the arrival of tentacled telepathic aliens travelling faster than light characterises sf rather than science, but as another space probe sets off for the Red Planet and visionary future missions are planned, how smug can we be about the difference between the projections of what will be found and the calm descriptive passages of Kim Stanley Robinson's Red Mars? Indeed the example of the Mars probe was prompted by my current piece of sf reading -- Paul McCauley's Fairyland -- where the 21st century inhabitants of a nanotech-enhanced Europe pursue their affairs against the background of the arrival of television pictures of the first landing of humans on Mars. Sf really loves to vaunt its relationship to science. Devotees of sf, fans and aware readers alike, can reel off a collection of instances when sf seemed to have predicted future scientific or technological developments. The core one here is Arthur C. Clarke's statement of the principles of communication satellites over a decade before the launch of Telstar. (It is quite possible that those people under the age of 50 who know what Telstar is -- the 'r' is now a very important distinguishing feature -- only do so because of its function in this prime example.) Most of the other examples are at heart ones of naming rather than scientific principles -- waldos are now more or less what Robert Heinlein called them in the novella Waldo, and cyberspace is the word used to name something not very much like the inhabitable virtual space in William Gibson's Neuromancer, though many pretend otherwise. There are more, but they are vastly outnumbered by the instances of irrelevance or worse, failed prediction. Most readers have favourite moments when people in the control room of a space ship reach for a slide rule or feed in punch cards, but sf, especially genre sf (i.e. not literary fiction or utopian allegory set in the future), is in the business of entertainment not prediction. Science fiction needs science to give it generic clout, or as Darko Suvin demands, to provide the cognitive support for its imaginative operations (13). Sf writers, even those given to fantastic elements, like to provide acknowledgement pages where they thank the scientists who aren't to blame for any mistakes but helped a lot. Anne McCaffrey is much given to thanking Jack Cohen, but then so are a lot of other people -- Cohen is a biologist, great fan of the genre and a major deliverer of lectures on scientific topics at sf fan conventions. Writers like David Brin actually are scientists with serious credentials. People heavily involved in sf can trot out reams of these instances as well as mentioning how writers without scientific training can still stay within credible parameters when designing new worlds by feeding the data of their desired planet into a computer program which will give them its physical properties and save them from being bombarded with reader's letters pointing out their mistakes. But all of this wonderful fertile mix of science and fiction comes to an abrupt halt when the field of play is science itself in its public guise. Here science is real, science is earnest and sf is a serious problem -- it gives people bad ideas and worse it is popular, especially with the young. While sf is constantly trying to make claims for its own scientificity, trying to show that science and the fiction that has taken its name are absolutely made for each other, entwined together for ever and ever amen, science keeps disentangling the fictional tendrils, pushing off the importunate lover, and trying to deny it was ever tempted to get involved. Sf has so much to gain from the relationship -- status and difference from its fictional like; science has so much to lose. But there is something for science to gain -- and if it's not as even-handed as Fred Astaire giving Ginger Rogers class while she gave him sex appeal, that is a pretty accurate description of the trade (and yes, to continue the analogy, sf does have to do it backwards and in high heels). Sf is the blonde or the beefcake that pulls in the punters for the serious business of the factual, but having called people in, it must be disowned. If you haven't heard my title, you haven't been watching televised technology programmes like Australia's great export success (forget about Neighbours, I mean Beyond 2000, already operating to overcome the lack of prescience about how long the title would work) and you've been missing some news and current affairs too. It seems particularly common in non-fiction segments on robotics. A small mechanical device shambles towards the camera as a voice-over intones "This may look like science fiction, but it is actually a scene from a laboratory in downtown Tokyo" (or it might be from the Media Labs at MIT -- the difference being in the visible pizza boxes). The viewer has been hailed with something familiar and attractive, which has then been disavowed to allow the truth to shine through. Why does the catch phrase occur? Why invoke science fiction only to deny it? A piece of writing about the future cast in the non-fictional mode calls on science fiction for one of several reasons: it may want to attract readers; it may need an accompanying graphic; or it may want to talk about a wonderful new gizmo of some kind and feel the need to attach the unknown to something (however bizarrely) known. Sf is the solution to all these problems since it is arresting or popular (more fun that dusty old science might be feared to be -- I must say I don't have this view of science, but it underwrites the establishment of organisations for the Public Understanding of Science and other pieces of science PR) and it produces pictures purporting to be of the future that have more appeal than the other bodies of futurological graphics. If you don't use stills from sf films or TV (and these are certainly preferable in terms of respectability to the kind of material used for the covers of sf novels or comics), what you are left with are graphs or architects' drawings and these can only do so much. I don't really know all that many people who share my fondness for the Southern Oscillation Index graph on the weather forecast, after all. I recently came across a different use of sf in something of a scientific context. It was not disavowed quite, and I did not even find it accurate, but it points to the symbiotic elements of the couple which is not a couple. It was a review of Richard Ellis's The Search for the Giant Squid (Guardian Weekly 10 Jan. 99). Much of the material referred to in the book was fictional, but the squid and the core of the book was scientific. Michael Dirda, the reviewer, starts a paragraph in the middle of the review by saying: "When he wants to, Ellis can make his science almost science fictional: 'It is now assumed that the sperm whale captures its prey by emitting sound beams of such intensity that they can stun or even kill the prey.'" Now that doesn't sound science fictional to me -- it sounds pretty much pure David Attenborough. And neither Dirda nor Ellis appear to disavow the sf evoked. It is as if there was a convention by which a scientifically-inflected piece of journalism had to gesture to sf come what may, but only had to deny it if it involved the future where the risk of the truth claims of the scientific being compromised by the sf is presumably greater. The basic requirement in being seen to speak truthfully about the future is to reduce apparent fictionality. The best way to do this is to call on the most powerful available truth-speaking discourse, that is to speak scientifically or even more these days, economically. Science can talk very seriously indeed about the future (though it is being tempted into dangerous waters by computer technology working with terms like nanobots and foglets), but as for economics... Well, it has a whole practice which it calls futures, which is entirely speculative, but which can result in the most hallowed production of the 'real' to be encountered -- actual money. To a surprising, or perhaps that should be suspicious, extent, science disguises the fact that it speaks of the future. It engages in inventions which will become usable, discovers things which will change how current practices will be conducted, projects variations in demand; all these wonderful things which only reveal in the tense of the associated verb that their time of actuality is not quite yet. The area that is most overt about its practice of non-fictional future speaking is actually called futurology. Futurology is centred far more in the social sciences and this makes it comparatively weak from the outset. It may be that its honesty about what it engages in reduces its social power. Announcing oneself a futurologist may work as a chat-up line (though the social occasion at which it did so might give one pause) but it doesn't convert into truth-speaking power -- much better to claim to specialise in futures. Yet, when futurology calls on sf, at least it is not necessary for it to engage in the same processes of disavowal or even denial. Academics get used to being disappointed by articles that sound as if they would be really promising for a current or projected piece of work, but one of my greatest disappointments was with a brief piece by Jim Dator with the great title "What Do 'You' Do When Your Robot Bows, as Your Clone Enters Holographic MTV?". Dator is currently head of the Hawaii Research Center for Futures Studies at the University of Hawaii and chair of the World Future Studies Federation. He is thus someone who constantly works with the problem at the core of my concern. As I recall, when I went in search of the Dator article, I had expectations of an etiquette guide for the multiply present, but what I got was more a piece noting how wow! humans may not (continue to) be the peak of evolution for that much longer. Well, Charles Darwin died for that thought long ago anyway and why would Alan Turing have bothered with his Test if he hadn't suspected something similar. Although it's quite an old article at the speed Dator publishes, its calling on an sf scenario, however low-key, to draw attention to non-fictional writing is characteristic of the practice shared with science. I may have been saddened by its failure to even try to deliver on the promise of its title, but at least futurology does not see the necessity of disavowal. In all the reading I've done over the years in both areas there has only been one occasion when I've encountered any disclaimer in a science fictional work which has any parallel to the insistent disclaimers of science fictionality in science writing. It is not of course a disclaimer of scientificity. Instead it is an emphatic assertion of fictionality. What, you ask could possibly require this in a piece of science fiction? Ah, what but autobiography and within that the suspicion of sexual confession. Nicola Griffith puts a post-note to her most recent novel Slow River (both an ecological and a psycho-sexual thriller). It reads: "There is a disturbing tendency among readers -- particularly critics -- to assume that any woman who writes about abuse, no matter how peripherally, must be speaking from her own experience. This is, in Joanna Russ's terms, a denial of the writer's imagination. Should anyone be tempted to assume otherwise, let me be explicit: Slow River is fiction not autobiography. I made it up." So there you have a hierarchy of threats to status, perhaps: science, science fiction and (women's) autobiography. Observe however that I have not put the economic on the list. References Dator, Jim. "What Do 'You' Do When Your Robot Bows, as Your Clone Enters Holographic MTV?" Futures 21 (4 Aug. 1989): 361-5. Paget, Derek. No Other Way to Tell It: Dramadoc/Docudrama on Television. Manchester: Manchester UP, 1998. Suvin, Darko. Metamorphoses of Science Fiction: On the Poetics and History of a Literary Genre. New Haven: Yale UP, 1979 Recommendations Griffith, Nicola. Slow River. New York: Del Rey, 1995. McCauley, Paul. Fairyland. London: Vista, 1995. Citation reference for this article MLA style: Frances Bonner. "This May Look like Science Fiction, But..." M/C: A Journal of Media and Culture 2.1 (1999). [your date of access] <http://www.uq.edu.au/mc/9902/look.php>. Chicago style: Frances Bonner, "This May Look like Science Fiction, But...," M/C: A Journal of Media and Culture 2, no. 1 (1999), <http://www.uq.edu.au/mc/9902/look.php> ([your date of access]). APA style: Frances Bonner. (1999) This may look like science fiction, but... M/C: A Journal of Media and Culture 2(1). <http://www.uq.edu.au/mc/9902/look.php> ([your date of access]).

Introduction Negative stereotyping of alternative diets such as veganism and other plant-based diets has been common in Australia, conventionally a meat-eating culture (OECD qtd. in Ting). Indeed, meat consumption in Australia is sanctioned by the ubiquity of advertising linking meat-eating to health, vitality and nation-building, and public challenges to such plant-based diets as veganism. In addition, state, commercial enterprises, and various community groups overtly resist challenges to Australian meat-eating norms and to the intensive animal husbandry practices that underpin it. Hence activists, who may contest not simply this norm but many of the customary industry practices that comprise Australia’s meat production, have been accused of promoting a vegan agenda and even of undermining the “Australian way of life”.If veganism meansa philosophy and way of living which seeks to exclude—as far as is possible and practicable—all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose; and by extension, promotes the development and use of animal-free alternatives for the benefit of humans, animals and the environment. In dietary terms it denotes the practice of dispensing with all products derived wholly or partly from animals. (Vegan Society)then our interest in this article lies in how a stereotyped label of veganism (and other associated attributes) is being used across Australian public spheres to challenge the work of animal activists as they call out factory farming for entrenched animal cruelty. This is carried out in three main parts. First, following an outline of our research approach, we examine the processes of stereotyping and the key dimensions of vegan stereotyping. Second, in the main part of the article, we reveal how opponents to such animal activist organisations as Animals Australia attempt to undermine activist calls for change by framing them as promoting an un-Australian vegan agenda. Finally, we consider how, despite such framing, that organisation is generating productive public debate around animal welfare, and, further, facilitating the creation of new activist identifications and identities.Research ApproachData collection involved searching for articles where Animals Australia and animal activism were yoked with veg*n (vegan and vegetarian), across the period May 2011 to 2016 (discussion peaked between May and June 2013). This period was of interest because it exposed a flare point with public discord being expressed between communities—namely between rural and urban consumers, farmers and animal activists, Coles Supermarkets (identified by The Australian Government the Treasury as one of two major supermarkets holding over 65% share of Australian food retail market) and their producers—and a consequent voicing of disquiet around Australian identity. We used purposive sampling (Waller, Farquharson, and Dempsey 67) to identify relevant materials as we knew in advance the case was “information-rich” (Patton 181) and would provide insightful information about a “troublesome” phenomenon (Emmel 6). Materials were collected from online news articles (30) and readers’ comments (167), online magazines (2) and websites (2) and readers’ comments (3), news items (Factiva 13), Australian Broadcasting Commission television (1) and radio (1), public blogs (2), and Facebook pages from involved organisations, specifically Australia’s National Farmers’ Federation (NFF, 155 posts) and Coles Supermarkets (29 posts). Many of these materials were explicitly responsive to a) Animals Australia’s Make It Possible campaign against Australian factory farming (launched and highly debated during this period), and b) Coles Supermarket’s short-lived partnership with Animals Australia in 2013. We utilised content analysis so as to make visible the most prominent and consistent stereotypes utilised in these various materials during the identified period. The approach allowed us to code and categorise materials so as to determine trends and patterns of words used, their relationships, and key structures and ways of speaking (Weerakkody). In addition, discourse analysis (Gee) was used in order to identify and track “language-in-use” so as to make visible the stereotyping deployed during the public reception of both the campaign and Animals Australia’s associated partnership with Coles. These methods enabled a “nuanced approach” (Coleman and Moss 12) with which to spot putdowns, innuendos, and stereotypical attitudes.Vegan StereotypingStereotypes creep into everyday language and are circulated and amplified through mainstream media, speeches by public figures, and social media. Stereotypes maintain their force through being reused and repurposed, making them difficult to eradicate due to their “cumulative effects” and influence (Harris and Sanborn 38; Inzlicht, Tullett, Legault, and Kang; Pickering). Over time stereotypes can become the lens through which we view “the world and social reality” (Harris and Sanborn 38; Inzlicht et al.). In summation, stereotyping:reduces identity categories to particular sets of deeds, attributes and attitudes (Whitley and Kite);informs individuals’ “cognitive investments” (Blum 267) by associating certain characteristics with particular groups;comprises symbolic and connotative codes that carry sets of traits, deeds, or beliefs (Cover; Rosello), and;becomes increasingly persuasive through regulating language and image use as well as identity categories (Cover; Pickering; Rosello).Not only is the “iterative force” (Rosello 35) of such associative stereotyping compounded due to its dissemination across digital media sites such as Facebook, YouTube, websites, and online news, but attempts to denounce it tend to increase its “persuasive power” (29). Indeed, stereotypes seem to refuse “to die” (23), remaining rooted in social and cultural memory (Whitley and Kite 10).As such, despite the fact that there is increasing interest in Australia and elsewhere in new food norms and plant-based diets (see, e.g., KPMG), as well as in vegan lifestyle options (Wright), studies still show that vegans remain a negatively stereotyped group. Previous studies have suggested that vegans mark a “symbolic threat” to Western, conventionally meat-eating cultures (MacInnis and Hodson 722; Stephens Griffin; Cole and Morgan). One key UK study of national newspapers, for instance, showed vegans continuing to be discredited in multiple ways as: 1) “self-evidently ridiculous”; 2) “ascetics”; 3) having a lifestyle difficult and impossible to maintain; 4) “faddist”; 5) “oversensitive”; and 6) “hostile extremists” (Cole and Morgan 140–47).For many Australians, veganism also appears anathema to their preferred culture and lifestyle of meat-eating. For instance, the NFF, Meat & Livestock Australia (MLA), and other farming bodies continue to frame veganism as marking an extreme form of lifestyle, as anti-farming and un-Australian. Such perspectives are also circulated through online rural news and readers’ comments, as will be discussed later in the article. Such representations are further exemplified by the MLA’s (Lamb, Australia Day, Celebrate Australia) Australia Day lamb advertising campaigns (Bembridge; Canning). For multiple consecutive years, the campaign presented vegans (and vegetarians) as being self-evidently ridiculous and faddish, representing them as mentally unhinged and fringe dwellers. Such stereotyping not only invokes “affective reactions” (Whitley and Kite 8)—including feelings of disgust towards individuals living such lifestyles or holding such values—but operates as “political baits” (Rosello 18) to shore-up or challenge certain social or political positions.Although such advertisements are arguably satirical, their repeated screening towards and on Australia Day highlights deeply held views about the normalcy of animal agriculture and meat-eating, “homogenizing” (Blum 276; Pickering) both meat-eaters and non-meat-eaters alike. Cultural stereotyping of this kind amplifies “social” as well as political schisms (Blum 276), and arguably discourages consumers—whether meat-eaters or non-meat-eaters—from advocating together around shared goals such as animal welfare and food safety. Additionally, given the rise of new food practices in Australia—including flexitarian, reducetarian, pescatarian, kangatarian (a niche form of ethical eating), vegivores, semi-vegetarian, vegetarian, veganism—alongside broader commitments to ethical consumption, such stereotyping suggests that consumers’ actual values and preferences are being disregarded in order to shore-up the normalcy of meat-eating.Animals Australia and the (So-Called) Vegan Agenda of Animal ActivismGiven these points, it is no surprise that there is a tacit belief in Australia that anyone labelled an animal activist must also be vegan. Within this context, we have chosen to primarily focus on the attitudes towards the campaigning work of Animals Australia—a not-for-profit organisation representing some 30 member groups and over 2 million individual supporters (Animals Australia, “Who Is”)—as this organisation has been charged as promoting a vegan agenda. Along with the RSPCA and Voiceless, Animals Australia represents one of the largest animal protection organisations within Australia (Chen). Its mission is to:Investigate, expose and raise community awareness of animal cruelty;Provide animals with the strongest representation possible to Government and other decision-makers;Educate, inspire, empower and enlist the support of the community to prevent and prohibit animal cruelty;Strengthen the animal protection movement. (Animals Australia, “Who Is”)In delivery of this mission, the organisation curates public rallies and protests, makes government and industry submissions, and utilises corporate outreach. Campaigning engages the Web, multiple forms of print and broadcast media, and social media.With regards to Animals Australia’s campaigns regarding factory farming—including the Make It Possible campaign (see fig. 1), launched in 2013 and key to the period we are investigating—the main message is that: the animals kept in these barren and constrictive conditions are “no different to our pets at home”; they are “highly intelligent creatures who feel pain, and who will respond to kindness and affection – if given the chance”; they are “someone, not something” (see the Make It Possible transcript). Campaigns deliberately strive to engender feelings of empathy and produce affect in viewers (see, e.g., van Gurp). Specifically they strive to produce mainstream recognition of the cruelties entrenched in factory farming practices and build community outrage against these practices so as to initiate industry change. Campaigns thus expressly challenge Australians to no longer support factory farmed animal products, and to identify with what we have elsewhere called everyday activist positions (Rodan and Mummery, “Animal Welfare”; “Make It Possible”). They do not, however, explicitly endorse a vegan position. Figure 1: Make It Possible (Animals Australia, campaign poster)Nonetheless, as has been noted, a common counter-tactic used within Australia by the industries targeted by such campaigns, has been to use well-known negative stereotypes to discredit not only the charges of systemic animal cruelty but the associated organisations. In our analysis, we found four prominent interconnected stereotypes utilised in both digital and print media to discredit the animal welfare objectives of Animals Australia. Together these cast the organisation as: 1) anti-meat-eating; 2) anti-farming; 3) promoting a vegan agenda; and 4) hostile extremists. These stereotypes are examined below.Anti-Meat-EatingThe most common stereotype attributed to Animals Australia from its campaigning is of being anti-meat-eating. This charge, with its associations with veganism, is clearly problematic for industries that facilitate meat-eating and within a culture that normalises meat-eating, as the following example expresses:They’re [Animals Australia] all about stopping things. They want to stop factory farming – whatever factory farming is – or they want to stop live exports. And in fact they’re not necessarily about: how do I improve animal welfare in the pig industry? Or how do I improve animal welfare in the live export industry? Because ultimately they are about a meat-free future world and we’re about a meat producing industry, so there’s not a lot of overlap, really between what we’re doing. (Andrew Spencer, Australian Pork Ltd., qtd. in Clark)Respondents engaging this stereotype also express their “outrage at Coles” (McCarthy) and Animals Australia for “pedalling [sic]” a pro-vegan agenda (Nash), their sense that Animals Australia is operating with ulterior motives (Flint) and criminal intent (Brown). They see cultural refocus as unnecessary and “an exercise in futility” (Harris).Anti-FarmingTo be anti-farming in Australia is generally considered to be un-Australian, with Glasgow suggesting that any criticism of “farming practices” in Australian society can be “interpreted as an attack on the moral integrity of farmers, amounting to cultural blasphemy” (200). Given its objectives, it is unsurprising that Animals Australia has been stereotyped as being “anti-farming”, a phrase additionally often used in conjunction with the charge of veganism. Although this comprises a misreading of veganism—given its focus on challenging animal exploitation in farming rather than entailing opposition to all farming—the NFF accused Animals Australia of being “blatantly anti-farming and proveganism” (Linegar qtd. in Nason) and as wanting “to see animal agriculture phased out” (National Farmers’ Federation). As expressed in more detail:One of the main factors for VFF and other farmers being offended is because of AA’s opinion and stand on ALL farming. AA wants all farming banned and us all become vegans. Is it any wonder a lot of people were upset? Add to that the proceeds going to AA which may have been used for their next criminal activity washed against the grain. If people want to stand against factory farming they have the opportunity not to purchase them. Surely not buying a product will have a far greater impact on factory farmed produce. Maybe the money could have been given to farmers? (Hunter)Such stereotyping reveals how strongly normalised animal agriculture is in Australia, as well as a tendency on the part of respondents to reframe the challenge of animal cruelty in some farming practices into a position supposedly challenging all farming practices.Promoting a Vegan AgendaAs is already clear, Animals Australia is often reproached for promoting a vegan agenda, which, it is further suggested, it keeps hidden from the Australian public. This viewpoint was evident in two key examples: a) the Australian public and organisations such as the NFF are presented as being “defenceless” against the “myopic vitriol of the vegan abolitionists” (Jonas); and b) Animals Australia is accused of accepting “loans from liberation groups” and being “supported by an army of animal rights lawyers” to promote a “hard core” veganism message (Bourke).Nobody likes to see any animals hurt, but pushing a vegan agenda and pushing bad attitudes by group members is not helping any animals and just serves to slow any progress both sides are trying to resolve. (V.c. Deb Ford)Along with undermining farmers’ “legitimate business” (Jooste), veganism was also considered to undermine Australia’s rural communities (Park qtd. in Malone).Hostile ExtremistsThe final stereotype linking veganism with Animals Australia was of hostile extremism (cf. Cole and Morgan). This means, for users, being inimical to Australian national values but, also, being akin to terrorists who engage in criminal activities antagonistic to Australia’s democratic society and economic livelihood (see, e.g., Greer; ABC News). It is the broad symbolic threat that “extremism” invokes that makes this stereotype particularly “infectious” (Rosello 19).The latest tag team attacks on our pork industry saw AL giving crash courses in how to become a career criminal for the severely impressionable, after attacks on the RSPCA against the teachings of Peter Singer and trying to bully the RSPCA into vegan functions menu. (Cattle Advocate)The “extremists” want that extended to dairy products, as well. The fact that this will cause the total annihilation of practically all animals, wild and domestic, doesn’t bother them in the least. (Brown)What is interesting about these last two dimensions of stereotyping is their displacement of violence. That is, rather than responding to the charge of animal cruelty, violence and extremism is attributed to those making the charge.Stereotypes and Symbolic Boundary ShiftingWhat is evident throughout these instances is how stereotyping as a “cognitive mechanism” is being used to build boundaries (Cherry 460): in the first instance, between “us” (the meat-eating majority) and “them” (the vegan minority aka animal activists); and secondly between human interest and livestock. This point is that animals may hold instrumental value and receive some protection through such, but any more stringent arguments for their protection at the expense of perceived human interests tend to be seen as wrong-headed (Sorenson; Munro).These boundaries are deeply entrenched in Western culture (Wimmer). They are also deeply problematic in the context of animal activism because they fragment publics, promote restrictive identities, and close down public debate (Lamont and Molnár). Boundary entrenching is clearly evident in the stereotyping work carried out by industry stakeholders where meat-eating and practices of industrialised animal agriculture are valorised and normalised. Challenging Australia’s meat production practices—irrespective of the reason given—is framed and belittled as entailing a vegan agenda, and further as contributing to the demise of farming and rural communities in Australia.More broadly, industry stakeholders are explicitly targeting the activist work by such organisations as Animals Australia as undermining the ‘Australian way of life’. In their reading, there is an irreconcilable boundary between human and animal interests and between an activist minority which is vegan, unreasonable, extremist and hostile to farming and the meat-eating majority which is representative of the Australian community and sustains the Australian economy. As discussed so far, such stereotyping and boundary making—even in their inaccuracies—can be pernicious in the way they entrench identities and divisions, and close the possibility for public debate.Rather than directly contesting the presuppositions and inaccuracies of such stereotyping, however, Animals Australia can be read as cultivating a process of symbolic boundary shifting. That is, rather than responding by simply underlining its own moderate position of challenging only intensive animal agriculture for systemic animal cruelty, Animals Australia uses its campaigns to develop “boundary blurring and crossing” tactics (Cherry 451, 459), specifically to dismantle and shift the symbolic boundaries conventionally in place between humans and non-human animals in the first instance, and between those non-human animals used for companionship and those used for food in the second (see fig. 2). Figure 2: That Ain’t No Way to Treat a Lady (Animals Australia, campaign image on back of taxi)Indeed, the symbolic boundaries between humans and animals left unquestioned in the preceding stereotyping are being profoundly shaken by Animals Australia with campaigns such as Make It Possible making morally relevant likenesses between humans and animals highly visible to mainstream Australians. Namely, the organisation works to interpellate viewers to exercise their own capacities for emotional identification and moral imagination, to identify with animals’ experiences and lives, and to act upon that identification to demand change.So, rather than reactively striving to refute the aforementioned stereotypes, organisations such as Animals Australia are modelling and facilitating symbolic boundary shifting by building broad, emotionally motivated, pathways through which Australians are being encouraged to refocus their own assumptions, practices and identities regarding animal experience, welfare and animal-human relations. Indeed the organisation has explicitly framed itself as speaking on behalf of not only animals but all caring Australians, suggesting thereby the possibility of a reframing of Australian national identity. Although such a tactic does not directly contest this negative stereotyping—direct contestation being, as noted, ineffective given the perniciousness of stereotyping—such work nonetheless dismantles the oppositional charge of such stereotyping in calling for all Australians to proudly be a little bit anti-meat-eating (when that meat is from factory farmed animals), a little bit anti-factory farming, a little bit pro-veg*n, and a little bit proud to consider themselves as caring about animal welfare.For Animals Australia, in other words, appealing to Australians to care about animal welfare and to act in support of that care, not only defuses the stereotypes targeting them but encourages the work of symbolic boundary shifting that is really at the heart of this dispute. 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Newspapers and the 7:15 Showing Cinemagoing involves planning. Even in the most impromptu instances, one has to consider meeting places, line-ups and competing responsibilities. One arranges child care, postpones household chores, or rushes to finish meals. One must organise transportation and think about routes, traffic, parking or public transit. And during the course of making plans for a trip to the cinema, whether alone or in the company of others, typically one turns to locate a recent newspaper. Consulting its printed page lets us ascertain locations, a selection of film titles and their corresponding show times. In preparing to feed a cinema craving, we burrow through a newspaper to an entertainment section, finding a tableau of information and promotional appeals. Such sections compile the mini-posters of movie advertisements, with their truncated credits, as well as various reviews and entertainment news. We see names of shopping malls doubling as names of theatres. We read celebrity gossip that may or may not pertain to the film selected for that occasion. We informally rank viewing priorities ranging from essential theatrical experiences to those that can wait for the videotape release. We attempt to assess our own mood and the taste of our filmgoing companions, matching up what we suppose are appropriate selections. Certainly, other media vie to supplant the newspaper's role in cinemagoing; many now access on-line sources and telephone services that offer the crucial details about start times. Nonetheless, as a campaign by the Newspaper Association of America in Variety aimed to remind film marketers, 80% of cinemagoers refer to newspaper listings for times and locations before heading out. The accuracy of that association's statistics notwithstanding, for the moment, the local daily or weekly newspaper has a secure place in the routines of cinematic life. A basic impetus for the newspaper's role is its presentation of a schedule of show times. Whatever the venue -- published, phone or on-line -- it strikes me as especially telling that schedules are part of the ordinariness of cinemagoing. To be sure, there are those who decide what film to see on site. Anecdotally, I have had several people comment recently that they no longer decide what movie to see, but where to see a (any) movie. Regardless, the schedule, coupled with the theatre's location, figures as a point of coordination for travel through community space to a site of film consumption. The choice of show time is governed by countless demands of everyday life. How often has the timing of a film -- not the film itself, the theatre at which it's playing, nor one's financial situation --determined one's attendance? How familiar is the assessment that show times are such that one cannot make it, that the film begins a bit too earlier, that it will run too late for whatever reason, and that other tasks intervene to take precedence? I want to make several observations related to the scheduling of film exhibition. Most generally, it makes manifest that cinemagoing involves an exercise in the application of cinema knowledge -- that is, minute, everyday facilities and familiarities that help orchestrate the ordinariness of cultural life. Such knowledge informs what Michel de Certeau characterises as "the procedures of everyday creativity" (xiv). Far from random, the unexceptional decisions and actions involved with cinemagoing bear an ordering and a predictability. Novelty in audience activity appears, but it is alongside fairly exact expectations about the event. The schedule of start times is essential to the routinisation of filmgoing. Displaying a Fordist logic of streamlining commodity distribution and the time management of consumption, audiences circulate through a machine that shapes their constituency, providing a set time for seating, departure, snack purchases and socialising. Even with the staggered times offered by multiplex cinemas, schedules still lay down a fixed template around which other activities have to be arrayed by the patron. As audiences move to and through the theatre, the schedule endeavours to regulate practice, making us the subjects of a temporal grid, a city context, a cinema space, as well as of the film itself. To be sure, one can arrive late and leave early, confounding the schedule's disciplining force. Most importantly, with or without such forms of evasion, it channels the actions of audiences in ways that consideration of the gaze cannot address. Taking account of the scheduling of cinema culture, and its implication of adjunct procedures of everyday life, points to dimensions of subjectivity neglected by dominant theories of spectatorship. To be the subject of a cinema schedule is to understand one assemblage of the parameters of everyday creativity. It would be foolish to see cinema audiences as cattle, herded and processed alone, in some crude Gustave LeBon fashion. It would be equally foolish not to recognise the manner in which film distribution and exhibition operates precisely by constructing images of the activity of people as demographic clusters and generalised cultural consumers. The ordinary tactics of filmgoing are supplemental to, and run alongside, a set of industrial structures and practices. While there is a correlation between a culture industry's imagined audience and the life that ensues around its offerings, we cannot neglect that, as attention to film scheduling alerts us, audiences are subjects of an institutional apparatus, brought into being for the reproduction of an industrial edifice. Streamline Audiences In this, film is no different from any culture industry. Film exhibition and distribution relies on an understanding of both the market and the product or service being sold at any given point in time. Operations respond to economic conditions, competing companies, and alternative activities. Economic rationality in this strategic process, however, only explains so much. This is especially true for an industry that must continually predict, and arguably give shape to, the "mood" and predilections of disparate and distant audiences. Producers, distributors and exhibitors assess which films will "work", to whom they will be marketed, as well as establish the very terms of success. Without a doubt, much of the film industry's attentions act to reduce this uncertainty; here, one need only think of the various forms of textual continuity (genre films, star performances, etc.) and the economies of mass advertising as ways to ensure box office receipts. Yet, at the core of the operations of film exhibition remains a number of flexible assumptions about audience activity, taste and desire. These assumptions emerge from a variety of sources to form a brand of temporary industry "commonsense", and as such are harbingers of an industrial logic. Ien Ang has usefully pursued this view in her comparative analysis of three national television structures and their operating assumptions about audiences. Broadcasters streamline and discipline audiences as part of their organisational procedures, with the consequence of shaping ideas about consumers as well as assuring the reproduction of the industrial structure itself. She writes, "institutional knowledge is driven toward making the audience visible in such a way that it helps the institutions to increase their power to get their relationship with the audience under control, and this can only be done by symbolically constructing 'television audience' as an objectified category of others that can be controlled, that is, contained in the interest of a predetermined institutional goal" (7). Ang demonstrates, in particular, how various industrially sanctioned programming strategies (programme strips, "hammocking" new shows between successful ones, and counter-programming to a competitor's strengths) and modes of audience measurement grow out of, and invariably support, those institutional goals. And, most crucially, her approach is not an effort to ascertain the empirical certainty of "actual" audiences; instead, it charts the discursive terrain in which the abstract concept of audience becomes material for the continuation of industry practices. Ang's work tenders special insight to film culture. In fact, television scholarship has taken full advantage of exploring the routine nature of that medium, the best of which deploys its findings to lay bare configurations of power in domestic contexts. One aspect has been television time and schedules. For example, David Morley points to the role of television in structuring everyday life, discussing a range of research that emphasises the temporal dimension. Alerting us to the non- necessary determination of television's temporal structure, he comments that we "need to maintain a sensitivity to these micro-levels of division and differentiation while we attend to the macro-questions of the media's own role in the social structuring of time" (265). As such, the negotiation of temporal structures implies that schedules are not monolithic impositions of order. Indeed, as Morley puts it, they "must be seen as both entering into already constructed, historically specific divisions of space and time, and also as transforming those pre-existing division" (266). Television's temporal grid has been address by others as well. Paddy Scannell characterises scheduling and continuity techniques, which link programmes, as a standardisation of use, making radio and television predictable, 'user friendly' media (9). John Caughie refers to the organization of flow as a way to talk about the national particularities of British and American television (49-50). All, while making their own contributions, appeal to a detailing of viewing context as part of any study of audience, consumption or experience; uncovering the practices of television programmers as they attempt to apprehend and create viewing conditions for their audiences is a first step in this detailing. Why has a similar conceptual framework not been applied with the same rigour to film? Certainly the history of film and television's association with different, at times divergent, disciplinary formations helps us appreciate such theoretical disparities. I would like to mention one less conspicuous explanation. It occurs to me that one frequently sees a collapse in the distinction between the everyday and the domestic; in much scholarship, the latter term appears as a powerful trope of the former. The consequence has been the absenting of a myriad of other -- if you will, non-domestic -- manifestations of everyday-ness, unfortunately encouraging a rather literal understanding of the everyday. The impression is that the abstractions of the everyday are reduced to daily occurrences. Simply put, my minor appeal is for the extension of this vein of television scholarship to out-of-home technologies and cultural forms, that is, other sites and locations of the everyday. In so doing, we pay attention to extra-textual structures of cinematic life; other regimes of knowledge, power, subjectivity and practice appear. Film audiences require a discussion about the ordinary, the calculated and the casual practices of cinematic engagement. Such a discussion would chart institutional knowledge, identifying operating strategies and recognising the creativity and multidimensionality of cinemagoing. What are the discursive parameters in which the film industry imagines cinema audiences? What are the related implications for the structures in which the practice of cinemagoing occurs? Vectors of Exhibition Time One set of those structures of audience and industry practice involves the temporal dimension of film exhibition. In what follows, I want to speculate on three vectors of the temporality of cinema spaces (meaning that I will not address issues of diegetic time). Note further that my observations emerge from a close study of industrial discourse in the U.S. and Canada. I would be interested to hear how they are manifest in other continental contexts. First, the running times of films encourage turnovers of the audience during the course of a single day at each screen. The special event of lengthy anomalies has helped mark the epic, and the historic, from standard fare. As discussed above, show times coordinate cinemagoing and regulate leisure time. Knowing the codes of screenings means participating in an extension of the industrial model of labour and service management. Running times incorporate more texts than the feature presentation alone. Besides the history of double features, there are now advertisements, trailers for coming attractions, trailers for films now playing in neighbouring auditoriums, promotional shorts demonstrating new sound systems, public service announcements, reminders to turn off cell phones and pagers, and the exhibitor's own signature clips. A growing focal point for filmgoing, these introductory texts received a boost in 1990, when the Motion Picture Association of America changed its standards for the length of trailers, boosting it from 90 seconds to a full two minutes (Brookman). This intertextuality needs to be supplemented by a consideration of inter- media appeals. For example, advertisements for television began appearing in theatres in the 1990s. And many lobbies of multiplex cinemas now offer a range of media forms, including video previews, magazines, arcades and virtual reality games. Implied here is that motion pictures are not the only media audiences experience in cinemas and that there is an explicit attempt to integrate a cinema's texts with those at other sites and locations. Thus, an exhibitor's schedule accommodates an intertextual strip, offering a limited parallel to Raymond Williams's concept of "flow", which he characterised by stating -- quite erroneously -- "in all communication systems before broadcasting the essential items were discrete" (86-7). Certainly, the flow between trailers, advertisements and feature presentations is not identical to that of the endless, ongoing text of television. There are not the same possibilities for "interruption" that Williams emphasises with respect to broadcasting flow. Further, in theatrical exhibition, there is an end-time, a time at which there is a public acknowledgement of the completion of the projected performance, one that necessitates vacating the cinema. This end-time is a moment at which the "rental" of the space has come due; and it harkens a return to the street, to the negotiation of city space, to modes of public transit and the mobile privatisation of cars. Nonetheless, a schedule constructs a temporal boundary in which audiences encounter a range of texts and media in what might be seen as limited flow. Second, the ephemerality of audiences -- moving to the cinema, consuming its texts, then passing the seat on to someone else -- is matched by the ephemerality of the features themselves. Distributors' demand for increasing numbers of screens necessary for massive, saturation openings has meant that films now replace one another more rapidly than in the past. Films that may have run for months now expect weeks, with fewer exceptions. Wider openings and shorter runs have created a cinemagoing culture characterised by flux. The acceleration of the turnover of films has been made possible by the expansion of various secondary markets for distribution, most importantly videotape, splintering where we might find audiences and multiplying viewing contexts. Speeding up the popular in this fashion means that the influence of individual texts can only be truly gauged via cross-media scrutiny. Short theatrical runs are not axiomatically designed for cinemagoers anymore; they can also be intended to attract the attention of video renters, purchasers and retailers. Independent video distributors, especially, "view theatrical release as a marketing expense, not a profit center" (Hindes & Roman 16). In this respect, we might think of such theatrical runs as "trailers" or "loss leaders" for the video release, with selected locations for a film's release potentially providing visibility, even prestige, in certain city markets or neighbourhoods. Distributors are able to count on some promotion through popular consumer- guide reviews, usually accompanying theatrical release as opposed to the passing critical attention given to video release. Consequently, this shapes the kinds of uses an assessment of the current cinema is put to; acknowledging that new releases function as a resource for cinema knowledge highlights the way audiences choose between and determine big screen and small screen films. Taken in this manner, popular audiences see the current cinema as largely a rough catalogue to future cultural consumption. Third, motion picture release is part of the structure of memories and activities over the course of a year. New films appear in an informal and ever-fluctuating structure of seasons. The concepts of summer movies and Christmas films, or the opening weekends that are marked by a holiday, sets up a fit between cinemagoing and other activities -- family gatherings, celebrations, etc. Further, this fit is presumably resonant for both the industry and popular audiences alike, though certainly for different reasons. The concentration of new films around visible holiday periods results in a temporally defined dearth of cinemas; an inordinate focus upon three periods in the year in the U.S. and Canada -- the last weekend in May, June/July/August and December -- creates seasonal shortages of screens (Rice-Barker 20). In fact, the boom in theatre construction through the latter half of the 1990s was, in part, to deal with those short-term shortages and not some year-round inadequate seating. Configurations of releasing colour a calendar with the tactical manoeuvres of distributors and exhibitors. Releasing provides a particular shape to the "current cinema", a term I employ to refer to a temporally designated slate of cinematic texts characterised most prominently by their newness. Television arranges programmes to capitalise on flow, to carry forward audiences and to counter-programme competitors' simultaneous offerings. Similarly, distributors jostle with each other, with their films and with certain key dates, for the limited weekends available, hoping to match a competitor's film intended for one audience with one intended for another. Industry reporter Leonard Klady sketched some of the contemporary truisms of releasing based upon the experience of 1997. He remarks upon the success of moving Liar, Liar (Tom Shadyac, 1997) to a March opening and the early May openings of Austin Powers: International Man of Mystery (Jay Roach, 1997) and Breakdown (Jonathan Mostow, 1997), generally seen as not desirable times of the year for premieres. He cautions against opening two films the same weekend, and thus competing with yourself, using the example of Fox's Soul Food (George Tillman, Jr., 1997) and The Edge (Lee Tamahori, 1997). While distributors seek out weekends clear of films that would threaten to overshadow their own, Klady points to the exception of two hits opening on the same date of December 19, 1997 -- Tomorrow Never Dies (Roger Spottiswoode, 1997) and Titanic (James Cameron, 1997). Though but a single opinion, Klady's observations are a peek into a conventional strain of strategising among distributors and exhibitors. Such planning for the timing and appearance of films is akin to the programming decisions of network executives. And I would hazard to say that digital cinema, reportedly -- though unlikely -- just on the horizon and in which texts will be beamed to cinemas via satellite rather than circulated in prints, will only augment this comparison; releasing will become that much more like programming, or at least will be conceptualised as such. To summarize, the first vector of exhibition temporality is the scheduling and running time; the second is the theatrical run; the third is the idea of seasons and the "programming" of openings. These are just some of the forces streamlining filmgoers; the temporal structuring of screenings, runs and film seasons provides a material contour to the abstraction of audience. Here, what I have delineated are components of an industrial logic about popular and public entertainment, one that offers a certain controlled knowledge about and for cinemagoing audiences. Shifting Conceptual Frameworks A note of caution is in order. I emphatically resist an interpretation that we are witnessing the becoming-film of television and the becoming-tv of film. Underneath the "inversion" argument is a weak brand of technological determinism, as though each asserts its own essential qualities. Such a pat declaration seems more in line with the mythos of convergence, and its quasi-Darwinian "natural" collapse of technologies. Instead, my point here is quite the opposite, that there is nothing essential or unique about the scheduling or flow of television; indeed, one does not have to look far to find examples of less schedule-dependent television. What I want to highlight is that application of any term of distinction -- event/flow, gaze/glance, public/private, and so on -- has more to do with our thinking, with the core discursive arrangements that have made film and television, and their audiences, available to us as knowable and different. So, using empirical evidence to slide one term over to the other is a strategy intended to supplement and destabilise the manner in which we draw conclusions, and even pose questions, of each. What this proposes is, again following the contributions of Ien Ang, that we need to see cinemagoing in its institutional formation, rather than some stable technological, textual or experiential apparatus. The activity is not only a function of a constraining industrial practice or of wildly creative patrons, but of a complex inter-determination between the two. Cinemagoing is an organisational entity harbouring, reviving and constituting knowledge and commonsense about film commodities, audiences and everyday life. An event of cinema begins well before the dimming of an auditorium's lights. The moment a newspaper is consulted, with its local representation of an internationally circulating current cinema, its listings belie a scheduling, an orderliness, to the possible projections in a given location. As audiences are formed as subjects of the current cinema, we are also agents in the continuation of a set of institutions as well. References Ang, Ien. Desperately Seeking the Audience. New York: Routledge, 1991. Brookman, Faye. "Trailers: The Big Business of Drawing Crowds." Variety 13 June 1990: 48. Caughie, John. "Playing at Being American: Games and Tactics." Logics of Television: Essays in Cultural Criticism. Ed. Patricia Mellencamp. Bloomington: Indiana UP, 1990. De Certeau, Michel. The Practice of Everyday Life. Trans. Steve Rendall. Berkeley: U of California P, 1984. Hindes, Andrew, and Monica Roman. "Video Titles Do Pitstops on Screens." Variety 16-22 Sep. 1996: 11+. Klady, Leonard. "Hitting and Missing the Market: Studios Show Savvy -- or Just Luck -- with Pic Release Strategies." Variety 19-25 Jan. 1998: 18. Morley, David. Television, Audiences and Cultural Studies. New York: Routledge, 1992. Newspaper Association of America. "Before They See It Here..." Advertisement. Variety 22-28 Nov. 1999: 38. Rice-Barker, Leo. "Industry Banks on New Technology, Expanded Slates." Playback 6 May 1996: 19-20. Scannell, Paddy. Radio, Television and Modern Life. Oxford: Blackwell, 1996. Williams, Raymond. Television: Technology and Cultural Form. New York: Schocken, 1975. Citation reference for this article MLA style: Charles Acland. "Matinees, Summers and Opening Weekends: Cinemagoing Audiences as Institutional Subjects." M/C: A Journal of Media and Culture 3.1 (2000). [your date of access] <http://www.uq.edu.au/mc/0003/cinema.php>. Chicago style: Charles Acland, "Matinees, Summers and Opening Weekends: Cinemagoing Audiences as Institutional Subjects," M/C: A Journal of Media and Culture 3, no. 1 (2000), <http://www.uq.edu.au/mc/0003/cinema.php> ([your date of access]). APA style: Charles Acland. (2000) Matinees, Summers and Opening Weekends: Cinemagoing Audiences as Institutional Subjects. M/C: A Journal of Media and Culture 3(1). <http://www.uq.edu.au/mc/0003/cinema.php> ([your date of access]).

One of the most frequent comments about Internet-based media, particularly about newsgroups and the Web, is that they provide a forum for everyone, no matter how obscure or specific their interest -- you'll find dedicated fora for every field, from high-energy physics to learning Klingon, from the campaign for an independent country in Northern Italy to Indonesian cooking. This is seen as a positive development as often as it is regarded as a negative force -- optimists see these fora as potential bases for the formation of virtual communities which may be able to reinvigorate previously neglected niche groupings, while pessimists predict a further shattering of societies into disparate fragments with mutually almost unintelligible cultural attitudes. Examples supporting either view can be found amongst the multitudes of newsgroups and Websites available on the Net, but let us skip this debate for the moment; instead, let's focus on some of the potential consequences this situation may have for academia. It requires little prescience to predict that the next few years will see an increasing use of the Web and, to a smaller extent, newsgroups in academic teaching and research. Continuously updated Websites will enable students and scholars to work with the latest developments in their disciplines, rather than limiting themselves to whatever recent books and journals their university library has managed to acquire, and newsgroups can help put interested academics in touch with each other in order to exchange news and pointers to information on the Web, as well as discuss recent research. For anyone with a computer, much of this information will also be accessible more easily electronically, via the Internet, than physically through libraries, bookstores, and photocopies. If it is organised efficiently on the Web, interested researchers may also come to be able to better target precisely the information they need, avoiding the need to leaf through volumes of journals to find the one useful article they might contain. Such research isn't limited only to academics and university students anymore, though. As hypertext scholar George P. Landow notes, "hypertext provides the individualistic learner with the perfect means for exploration and enrichment of particular areas of study. By permitting one to move from relatively familiar areas to less familiar ones, a hypertext corpus encourages the autodidact, the continuing education student, and the student with little access to instructors" (Hypertext 129-30) -- particularly the ethos of information freedom that is widespread on the Internet means that any amateur enthusiast may conduct their own self-education with the materials available on the Web. This was already possible, after a fashion, in pre-Web times, of course, but the Net increases the amount of information available, and removes the physical and psychological barrier of entering a university library as a non-student, and facilitates connections to other (self-taught as well as 'official') students through newsgroups and email. What's more, the Web also allows adding one's own voice to academic debates: "in a book one can always move one's finger or pencil across the printed page, but one's intrusion always remains physically separate from the text. One may make a mark on the page, but one's intrusion does not affect the text itself" (Landow, Hypertext 44). By creating a Web page displaying one's own thoughts on the matter, providing links to related sites, and ideally receiving links from those sites, too, any outsider may now invade the discourse in an academic discipline. In most cases, such invasions may go largely unnoticed -- but nothing's to stop a self-taught enthusiast from creating a highly useful Website that even 'proper' academics may consider relevant, and so from adding own articles to the discipline's body of knowledge. As a side-effect of such presentation on the Web, then, texts by students are no longer so easily subordinated to those by revered authors, and disparities between them are less visible. The text as a site of authority can also become a site of resistance: in hypertext, indeed, opposition to the canonised texts is more likely to succeed in conditions of hypertextuality than in the print culture, if only because hypertext makes it easier to expose the contradictions and power moves in such texts, and the multiply constructed positions from which they might be read. (Snyder 77) Both these points pose a major problem for the currently prevalent conventions of academic debate, of course, which (despite post-structuralism's argument for the "death of the author") still evaluate the relevance of academic work partly based on its authorial source. Canonisation of particular scholars and their works (a process which is not limited only to literary disciplines) must ultimately fail -- "because all electronic texts are interrelated, none has well-defined borders; instead, each text reaches out to link up with past, present and future texts. It therefore becomes difficult to cordon off and to canonise a few great texts and authors" (Snyder 75). And generally, Nunberg notes, "media like the Web tend to resist attempts to impose the sort of solutions that enable us to manage (even imperfectly) the steady increase in the number of print documents -- the ramification of discourses and forms of publication, the imposition of systems of screening or refereeing, the restriction of the right to speak to 'qualified' participants" ("Farewell" 126). The freely accessible information on the Web includes texts by revered researchers as well as badly-informed beginners, and elaborate essays as well as superficial scribblings. This realisation has caused many academics who grew up with the apparent simplicities of print to regard Internet-based media with despair and, frequently, with contempt; Nunberg himself provides a good example by stating that "any undergraduate student is free to post her night thoughts on Mary Shelley or the Klingon verb to a 'potential audience' of millions (a quick search of the Web turns up numerous examples of both), and there will be nothing in its mode of circulation to distinguish it from communications from better-qualified contributors" ("Farewell" 127). Such remarkably condescending prose indicates more than anything a paralysing fear of an invasion of the proverbial academic ivory tower by the uncouth hordes of self-taught dilettantes who have no respect for scholarly authority: Nunberg's insistence that a notion of academic 'qualification' (expressed no doubt in degrees and positions) could do any more than indicate vaguely that an author might have something valuable to say, and that anybody not 'qualified' this way cannot possibly contribute anything worth one's while, is surprisingly hierarchistic. Surely, in reality the onus for determining a text's worth should (and must) always eventually lie with the individual reader; the sense a text makes, not the source that made the text, should determine its quality. It's easy to see that this emphasis which Nunberg and others place on a text's source is in fact determined by print as the still-prevalent technology of information dissemination. As Bolter describes it, "the idea of a relatively stable canon made sense in a culture dominated by printed books. ... But the notion of a standard has now collapsed, and the collapse is mirrored in the shift from the printed to the electronic writing space, in which a stable canon of works and authors is meaningless" (237). Landow elaborates that hypertext's effects are so basic, so radical, that it reveals that many of our most cherished, most commonplace ideas and attitudes toward literature and literary production turn out to be the result of that particular form of information technology and technology of cultural memory that has provided the setting for them. This technology -- that of the printed book and of its close relations, which include the typed or printed page -- engenders certain notions of authorial property, authorial uniqueness, and a physically isolated text that hypertext makes untenable. The evidence of hypertext, in other words, historicises many of our most commonplace assumptions, thereby forcing them to descend from the ethereality of abstraction and appear as corollaries to a particular technology rooted in specific times and places. (33) Today, on the Web, however, where anyone can participate by adding their own texts or simply rearranging others', we lose once and for all notions of the author or the text as a stable entity. Thus, Nunberg claims, "on the Web ... you can never have the kind of experience that you can have with the informational genres of print, the experience of interpreting a text simply as a newspaper or encyclopedia article without attending to its author, its publisher, or the reliability of its recommender. We read Web documents, that is, not as information but as intelligence, which requires an explicit warrant of one form or another" ("Farewell" 127-8). Again, however, Nunberg claims a simplicity of the print media which simply doesn't exist: he goes on to say that "we should look to electronic discourse to provide a counter and complement to the informational forms of print -- a domain that privileges the personal, the private, and the subjective against the impersonal, the public, and the objective" (133). In reality, though, anyone who today still reads a newspaper or any other form of printed information as an 'objective' source, without an awareness of its publisher's or its journalists' political and economic agenda, must certainly be regarded as a naïve fool -- not just in Australia, with its atrocious standards of print journalism. If the modern media have taught us anything, it is that there is no such thing as 'objective truth'; the Web, with its unprecedented opportunities for world-wide publication, just makes this fact particularly obvious. While they may contribute to more openness in dealing with contributions from non-traditionally qualified sources, however, such realisations won't completely eradicate academia's fear of an invasion by the self-trained and the untrained. Some hope is at hand, though: "at the very moment indeed when the new technologies of memory can make us fear an alarming glut of traces -- a true change of scale in the collective accumulation of archives, at once written, audio, visual, and audiovisual -- these same technologies increasingly lighten its load, at almost the same pace, by facilitating individualised retrieval" (Debray 146); more elaborate search engines and resource listings on the Web can help point interested researchers to useful contributions both from within and without the ivory tower, and multiple alternative engines and listings may cater for various definitions of what constitutes 'useful'. "In the future, it seems, there will be no fixed canons of texts and no fixed epistemological boundaries between disciplines, only paths of inquiry, modes of integration, and moments of encounter" (Hesse 31). This may also have negative implications, though. On the one hand, as Bazin writes, "the digital empire puts too much emphasis on relation and circulation per se, rather than on the acquisition of content. Instead of the substantialist metaphysics of the hidden meaning which a 'vertical' reading would attempt to reveal, it prefers the rhetoric of exchange and conversation. It counters the aesthetics of depth with a pragmatics of interface" (163-4), and researchers on the Web may stay on the surface of a discipline rather than explore the very depths of its discourse -- they may stick with digests, digest-digests, digest-digest-digests, to borrow from Ray Bradbury (55). "Electronic linking almost inevitably tends to lead to blending and mixing of genres and modes ... . Hypertextualising a text produces not an electronic book but a miniature electronic library" (Landow, "Twenty Minutes" 226-7), and sticking to one's research topic may prove difficult. On the other end of the scale, the Net's tendency to group interests off into niches may lead to specific deeply involved research being done without any awareness of related disciplines that may offer alternative approaches to a subject -- in short, without any knowledge of the bigger picture one's discipline fits into. To avoid both pitfalls demands a researcher's discipline and attention. On the positive side, the invasion of the ivory tower allows for unprecedented public involvement (as Net theorists have often promised it): we are witnessing the appearance ... of a 'dynamic textuality' ... that by freeing itself from the straitjacket of the book is transforming not only the individual's relation to the text but also the traditional model of producing and transmitting learning and practical knowledge. In the place vacated by a linear transmission, inherited from forebears and relatively individualised, a system for the coemergence of bodies of knowledge is tending to be progressively substituted -- a system in which instruction, self-apprenticing, intellectual creation, and diffusion all closely cooperate. (Bazin 163) Naturally, this process won't mean that anybody can now easily become a nuclear scientist, economic expert, or cultural historian -- in most fields, to make it to the very top of the profession will still require a level of access to materials and equipment that only academic and professional institutions can offer. Nonetheless, more self-trained amateur enthusiasts will now be able to make meaningful contributions to their discipline -- a development we already begin to see in fields as diverse as astronomy, computer sciences, and some forms of literary studies. At the very least, it will create among the participants a more interested, more informed and more involved public, thinking for themselves and questioning the commonplaces of a print-based culture. "We are promised ... less of the dogmatic and more of the ludic, less of the canonical and more of the festive. Fewer arguments from authority, though more juxtaposition of authorities" (Debray 146). The invasion of the ivory tower is no attack on the Bastille -- the new dilettante invaders come to learn and share, not to destroy. References Bazin, Patrick. "Toward Metareading." Nunberg 153-68. Bolter, Jay David. Writing Space: The Computer, Hypertext, and the History of Writing. Hillsdale, N.J.: Lawrence Erlbaum Associates, 1991. Bradbury, Ray. Fahrenheit 451. Berlin: Cornelsen-Velhagen & Klasing, 1985. Debray, Régis. "The Book as Symbolic Object." Nunberg 139-51. Hesse, Carla. "Books in Time." Nunberg 21-36. Landow, George P. Hypertext: The Convergence of Contemporary Critical Theory and Technology. Baltimore: Johns Hopkins UP, 1992. ---. "Twenty Minutes into the Future, or How Are We Moving beyond the Book?" Nunberg 209-37. Nunberg, Geoffrey. "Farewell to the Information Age." Nunberg 103-38. ---, ed. The Future of the Book. Berkeley: U of California P, 1996. Snyder, Ilana. Hypertext: The Electronic Labyrinth. Carlton South: Melbourne UP, 1996. Citation reference for this article MLA style: Axel Bruns. "Invading the Ivory Tower: Hypertext and the New Dilettante Scholars." M/C: A Journal of Media and Culture 2.2 (1999). [your date of access] <http://www.uq.edu.au/mc/9903/ivory.php>. Chicago style: Axel Bruns, "Invading the Ivory Tower: Hypertext and the New Dilettante Scholars," M/C: A Journal of Media and Culture 2, no. 2 (1999), <http://www.uq.edu.au/mc/9903/ivory.php> ([your date of access]). APA style: Axel Bruns. (1999) Invading the ivory tower: hypertext and the new dilettante scholars. M/C: A Journal of Media and Culture 2(2). <http://www.uq.edu.au/mc/9903/ivory.php> ([your date of access]).

Introduction Documentary film has grown significantly in the past decade, with high profile films such as Fahrenheit 9/11, Supersize Me, and An Inconvenient Truth garnering increased attention both at the box office and in the news media. In addition, the rising prominence of web-based media has provided new opportunities for documentary to create social impact. Films are now typically released with websites, Facebook pages, twitter feeds, and web videos to increase both reach and impact. This combination of technology and broader audience appeal has given rise to a current landscape in which documentary films are imbedded within coordinated multi-media campaigns. New media have not only opened up new avenues for communicating with audiences, they have also created new opportunities for data collection and analysis of film impacts. A recent report by McKinsey and Company highlighted this potential, introducing and discussing the implications of increasing consumer information being recorded on the Internet as well as through networked sensors in the physical world. As they found: "Big data—large pools of data that can be captured, communicated, aggregated, stored, and analyzed—is now part of every sector and function of the global economy" (Manyika et al. iv). This data can be mined to learn a great deal about both individual and cultural response to documentary films and the issues they represent. Although film has a rich history in humanities research, this new set of tools enables an empirical approach grounded in the social sciences. However, several researchers across disciplines have noted that limited investigation has been conducted in this area. Although there has always been an emphasis on social impact in film and many filmmakers and scholars have made legitimate (and possibly illegitimate) claims of impact, few have attempted to empirically justify these claims. Over fifteen years ago, noted film scholar Brian Winston commented that "the underlying assumption of most social documentaries—that they shall act as agents of reform and change—is almost never demonstrated" (236). A decade later, Political Scientist David Whiteman repeated this sentiment, arguing that, "despite widespread speculation about the impact of documentaries, the topic has received relatively little systematic attention" ("Evolving"). And earlier this year, the introduction to a special issue of Mass Communication and Society on documentary film stated, "documentary film, despite its growing influence and many impacts, has mostly been overlooked by social scientists studying the media and communication" (Nisbet and Aufderheide 451). Film has been studied extensively as entertainment, as narrative, and as cultural event, but the study of film as an agent of social change is still in its infancy. This paper introduces a systematic approach to measuring the social impact of documentary film aiming to: (1) discuss the context of documentary film and its potential impact; and (2) argue for a social science approach, discussing key issues about conducting such research. Changes in Documentary Practice Documentary film has been used as a tool for promoting social change throughout its history. John Grierson, who coined the term "documentary" in 1926, believed it could be used to influence the ideas and actions of people in ways once reserved for church and school. He presented his thoughts on this emerging genre in his 1932 essay, First Principles of Documentary, saying, "We believe that the cinema's capacity for getting around, for observing and selecting from life itself, can be exploited in a new and vital art form" (97). Richard Barsam further specified the definition of documentary, distinguishing it from non-fiction film, such that all documentaries are non-fiction films but not all non-fiction films are documentaries. He distinguishes documentary from other forms of non-fiction film (i.e. travel films, educational films, newsreels) by its purpose; it is a film with an opinion and a specific message that aims to persuade or influence the audience. And Bill Nichols writes that the definition of documentary may even expand beyond the film itself, defining it as a "filmmaking practice, a cinematic tradition, and mode of audience reception" (12). Documentary film has undergone many significant changes since its inception, from the heavily staged romanticism movement of the 1920s to the propagandist tradition of governments using film to persuade individuals to support national agendas to the introduction of cinéma vérité in the 1960s and historical documentary in the 1980s (cf. Barnouw). However, the recent upsurge in popularity of documentary media, combined with technological advances of internet and computers have opened up a whole new set of opportunities for film to serve as both art and agent for social change. One such opportunity is in the creation of film-based social action campaigns. Over the past decade, filmmakers have taken a more active role in promoting social change by coordinating film releases with action campaigns. Companies such as Participant Media (An Inconvenient Truth, Food Inc., etc.) now create "specific social action campaigns for each film and documentary designed to give a voice to issues that resonate in the films" (Participant Media). In addition, a new sector of "social media" consultants are now offering services, including "consultation, strategic planning for alternative distribution, website and social media development, and complete campaign management services to filmmakers to ensure the content of nonfiction media truly meets the intention for change" (Working Films). The emergence of new forms of media and technology are changing our conceptions of both documentary film and social action. Technologies such as podcasts, video blogs, internet radio, social media and network applications, and collaborative web editing "both unsettle and extend concepts and assumptions at the heart of 'documentary' as a practice and as an idea" (Ellsworth). In the past decade, we have seen new forms of documentary creation, distribution, marketing, and engagement. Likewise, film campaigns are utilizing a broad array of strategies to engage audience members, including "action kits, screening programs, educational curriculums and classes, house parties, seminars, panels" that often turn into "ongoing 'legacy' programs that are updated and revised to continue beyond the film's domestic and international theatrical, DVD and television windows" (Participant Media). This move towards multi-media documentary film is becoming not only commonplace, but expected as a part of filmmaking. NYU film professor and documentary film pioneer George Stoney recently noted, "50 percent of the documentary filmmaker's job is making the movie, and 50 percent is figuring out what its impact can be and how it can move audiences to action" (qtd. in Nisbet, "Gasland"). In his book Convergence Culture, Henry Jenkins, coined the term "transmedia storytelling", which he later defined as "a process where integral elements of a fiction get dispersed systematically across multiple delivery channels for the purpose of creating a unified and coordinated entertainment experience" ("Transmedia"). When applied to documentary film, it is the elements of the "issue" raised by the film that get dispersed across these channels, coordinating, not just an entertainment experience, but a social action campaign. Dimensions of Evaluation It is not unreasonable to assume that such film campaigns, just like any policy or program, have the possibility to influence viewers' knowledge, attitudes, and behavior. Measuring this impact has become increasingly important, as funders of documentary and issue-based films want look to understand the "return on investment" of films in terms of social impact so that they can compare them with other projects, including non-media, direct service projects. Although we "feel" like films make a difference to the individuals who also see them in the broader cultures in which they are embedded, measurement and empirical analysis of this impact are vitally important for both providing feedback to filmmakers and funders as well as informing future efforts attempting to leverage film for social change. This type of systematic assessment, or program evaluation, is often discussed in terms of two primary goals—formative (or process) and summative (or impact) evaluation (cf. Muraskin; Trochim and Donnelly). Formative evaluation studies program materials and activities to strengthen a program, and summative evaluation examines program outcomes. In terms of documentary film, these two goals can be described as follows: Formative Evaluation: Informing the Process As programs (broadly defined as an intentional set of activities with the aim of having some specific impact), the people who interact with them, and the cultures they are situated in are constantly changing, program development and evaluation is an ongoing learning cycle. Film campaigns, which are an intentional set of activities with the aim of impacting individual viewers and broader cultures, fit squarely within this purview. Without formulating hypotheses about the relationships between program activities and goals and then collecting and analyzing data during implementation to test them, it is difficult to learn ways to improve programs (or continue doing what works best in the most efficient manner). Attention to this process enables those involved to learn more about, not only what works, but how and why it works and even gain insights about how program outcomes may be affected by changes to resource availability, potential audiences, or infrastructure. Filmmakers are constantly learning and honing their craft and realizing the impact of their practice can help the artistic process. Often faced with tight budgets and timelines, they are forced to confront tradeoffs all the time, in the writing, production and post-production process. Understanding where they are having impact can improve their decision-making, which can help both the individual project and the overall field. Summative Evaluation: Quantifying Impacts Evaluation is used in many different fields to determine whether programs are achieving their intended goals and objectives. It became popular in the 1960s as a way of understanding the impact of the Great Society programs and has continued to grow since that time (Madaus and Stufflebeam). A recent White House memo stated that "rigorous, independent program evaluations can be a key resource in determining whether government programs are achieving their intended outcomes as well as possible and at the lowest possible cost" and the United States Office of Management and Budget (OMB) launched an initiative to increase the practice of "impact evaluations, or evaluations aimed at determining the causal effects of programs" (Orszag 1). Documentary films, like government programs, generally target a national audience, aim to serve a social purpose, and often do not provide a return on their investment. Participant Media, the most visible and arguably most successful documentary production company in the film industry, made recent headlines for its difficulty in making a profit during its seven-year history (Cieply). Owner and founder Jeff Skoll reported investing hundreds of millions of dollars into the company and CEO James Berk added that the company sometimes measures success, not by profit, but by "whether Mr. Skoll could have exerted more impact simply by spending his money philanthropically" (Cieply). Because of this, documentary projects often rely on grant funding, and are starting to approach funders beyond traditional arts and media sources. "Filmmakers are finding new fiscal and non-fiscal partners, in constituencies that would not traditionally be considered—or consider themselves—media funders or partners" (BRITDOC 6). And funders increasingly expect tangible data about their return on investment. Says Luis Ubiñas, president of Ford Foundation, which recently launched the Just Films Initiative: In these times of global economic uncertainty, with increasing demand for limited philanthropic dollars, assessing our effectiveness is more important than ever. Today, staying on the frontlines of social change means gauging, with thoughtfulness and rigor, the immediate and distant outcomes of our funding. Establishing the need for evaluation is not enough—attention to methodology is also critical. Valid research methodology is a critical component of understanding around the role entertainment can play in impacting social and environmental issues. The following issues are vital to measuring impact. Defining the Project Though this may seem like an obvious step, it is essential to determine the nature of the project so one can create research questions and hypotheses based on a complete understanding of the "treatment". One organization that provides a great example of the integration of documentary film imbedded into a larger campaign or movement is Invisible Children. Founded in 2005, Invisible Children is both a media-based organization as well as an economic development NGO with the goal of raising awareness and meeting the needs of child soldiers and other youth suffering as a result of the ongoing war in northern Uganda. Although Invisible Children began as a documentary film, it has grown into a large non-profit organization with an operating budget of over $8 million and a staff of over a hundred employees and interns throughout the year as well as volunteers in all 50 states and several countries. Invisible Children programming includes films, events, fundraising campaigns, contests, social media platforms, blogs, videos, two national "tours" per year, merchandise, and even a 650-person three-day youth summit in August 2011 called The Fourth Estate. Individually, each of these components might lead to specific outcomes; collectively, they might lead to others. In order to properly assess impacts of the film "project", it is important to take all of these components into consideration and think about who they may impact and how. This informs the research questions, hypotheses, and methods used in evaluation. Film campaigns may even include partnerships with existing social movements and non-profit organizations targeting social change. The American University Center for Social Media concluded in a case study of three issue-based documentary film campaigns: Digital technologies do not replace, but are closely entwined with, longstanding on-the-ground activities of stakeholders and citizens working for social change. Projects like these forge new tools, pipelines, and circuits of circulation in a multiplatform media environment. They help to create sustainable network infrastructures for participatory public media that extend from local communities to transnational circuits and from grassroots communities to policy makers. (Abrash) Expanding the Focus of Impact beyond the Individual A recent focus has shifted the dialogue on film impact. Whiteman ("Theaters") argues that traditional metrics of film "success" tend to focus on studio economic indicators that are far more relevant to large budget films. Current efforts focused on box office receipts and audience size, the author claims, are really measures of successful film marketing or promotion, missing the mark when it comes to understanding social impact. He instead stresses the importance of developing a more comprehensive model. His "coalition model" broadens the range and types of impact of film beyond traditional metrics to include the entire filmmaking process, from production to distribution. Whiteman (“Theaters”) argues that a narrow focus on the size of the audience for a film, its box office receipts, and viewers' attitudes does not incorporate the potential reach of a documentary film. Impacts within the coalition model include both individual and policy levels. Individual impacts (with an emphasis on activist groups) include educating members, mobilizing for action, and raising group status; policy includes altering both agenda for and the substance of policy deliberations. The Fledgling Fund (Barrett and Leddy) expanded on this concept and identified five distinct impacts of documentary film campaigns. These potential impacts expand from individual viewers to groups, movements, and eventually to what they call the "ultimate goal" of social change. Each is introduced briefly below. Quality Film. The film itself can be presented as a quality film or media project, creating enjoyment or evoking emotion in the part of audiences. "By this we mean a film that has a compelling narrative that draws viewers in and can engage them in the issue and illustrate complex problems in ways that statistics cannot" (Barrett and Leddy, 6). Public Awareness. Film can increase public awareness by bringing light to issues and stories that may have otherwise been unknown or not often thought about. This is the level of impact that has received the most attention, as films are often discussed in terms of their "educational" value. "A project's ability to raise awareness around a particular issue, since awareness is a critical building block for both individual change and broader social change" (Barrett and Leddy, 6). Public Engagement. Impact, however, need not stop at simply raising public awareness. Engagement "indicates a shift from simply being aware of an issue to acting on this awareness. Were a film and its outreach campaign able to provide an answer to the question 'What can I do?' and more importantly mobilize that individual to act?" (Barrett and Leddy, 7). This is where an associated film campaign becomes increasingly important, as transmedia outlets such as Facebook, websites, blogs, etc. can build off the interest and awareness developed through watching a film and provide outlets for viewers channel their constructive efforts. Social Movement. In addition to impacts on individuals, films can also serve to mobilize groups focused on a particular problem. The filmmaker can create a campaign around the film to promote its goals and/or work with existing groups focused on a particular issue, so that the film can be used as a tool for mobilization and collaboration. "Moving beyond measures of impact as they relate to individual awareness and engagement, we look at the project's impact as it relates to the broader social movement … if a project can strengthen the work of key advocacy organizations that have strong commitment to the issues raised in the film" (Barrett and Leddy, 7). Social Change. The final level of impact and "ultimate goal" of an issue-based film is long-term and systemic social change. "While we understand that realizing social change is often a long and complex process, we do believe it is possible and that for some projects and issues there are key indicators of success" (Barrett and Leddy, 7). This can take the form of policy or legislative change, passed through film-based lobbying efforts, or shifts in public dialogue and behavior. Legislative change typically takes place beyond the social movement stage, when there is enough support to pressure legislators to change or create policy. Film-inspired activism has been seen in issues ranging from environmental causes such as agriculture (Food Inc.) and toxic products (Blue Vinyl) to social causes such as foreign conflict (Invisible Children) and education (Waiting for Superman). Documentary films can also have a strong influence as media agenda-setters, as films provide dramatic "news pegs" for journalists seeking to either sustain or generation new coverage of an issue (Nisbet "Introduction" 5), such as the media coverage of climate change in conjunction with An Inconvenient Truth. Barrett and Leddy, however, note that not all films target all five impacts and that different films may lead to different impacts. "In some cases we could look to key legislative or policy changes that were driven by, or at least supported by the project... In other cases, we can point to shifts in public dialogue and how issues are framed and discussed" (7). It is possible that specific film and/or campaign characteristics may lead to different impacts; this is a nascent area for research and one with great promise for both practical and theoretical utility. Innovations in Tools and Methods Finally, the selection of tools is a vital component for assessing impact and the new media landscape is enabling innovations in the methods and strategies for program evaluation. Whereas the traditional domain of film impact measurement included box office statistics, focus groups, and exit surveys, innovations in data collection and analysis have expanded the reach of what questions we can ask and how we are able to answer them. For example, press coverage can assist in understanding and measuring the increase in awareness about an issue post-release. Looking directly at web-traffic changes "enables the creation of an information-seeking curve that can define the parameters of a teachable moment" (Hart and Leiserowitz 360). Audience reception can be measured, not only via interviews and focus groups, but also through content and sentiment analysis of web content and online analytics. "Sophisticated analytics can substantially improve decision making, minimize risks, and unearth valuable insights that would otherwise remain hidden" (Manyika et al. 5). These new tools are significantly changing evaluation, expanding what we can learn about the social impacts of film through triangulation of self-report data with measurement of actual behavior in virtual environments. Conclusion The changing media landscape both allows and impels evaluation of film impacts on individual viewers and the broader culture in which they are imbedded. Although such analysis may have previously been limited to box office numbers, critics' reviews, and theater exit surveys, the rise of new media provides both the ability to connect filmmakers, activists, and viewers in new ways and the data in which to study the process. This capability, combined with significant growth in the documentary landscape, suggests a great potential for documentary film to contribute to some of our most pressing social and environmental needs. A social scientific approach, that combines empirical analysis with theory applied from basic science, ensures that impact can be measured and leveraged in a way that is useful for both filmmakers as well as funders. In the end, this attention to impact ensures a continued thriving marketplace for issue-based documentary films in our social landscape. References Abrash, Barbara. "Social Issue Documentary: The Evolution of Public Engagement." American University Center for Social Media 21 Apr. 2010. 26 Sep. 2011 ‹http://www.centerforsocialmedia.org/›. Aufderheide, Patricia. "The Changing Documentary Marketplace." Cineaste 30.3 (2005): 24-28. Barnouw, Eric. Documentary: A History of the Non-Fiction Film. New York: Oxford UP, 1993. Barrett, Diana and Sheila Leddy. 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