Academic literature on the topic 'Knot Tying Board'

PURPOSE According to GLOBOCAN estimates, cervical cancer is the most common cancer among women in Nepal, with nearly 3,000 new cases and approximately 1,900 deaths in 2018. Trained health care providers are needed to prevent cervical cancer and diagnose and treat cervical cancer earlier to achieve better clinical outcomes. To address this need, ASCO used a 3-pronged approach to improve multidisciplinary cervical cancer care in Nepal, including 3 in-person training courses on cervical cancer screening and treatment, a 6-month tele-education Project ECHO program that included didactic and case presentations, and supplemental volunteer visits to provide additional clinical skills training. METHODS ASCO collected data from program participants via surveys and observational methods. In-person trainings and Project ECHO sessions were evaluated via surveys. Survey instruments included questions about practice changes and learning objectives. Surveys were conducted on-site and 6 months later for live trainings, and after each Project ECHO session, with a final survey to assess the program. Volunteer physicians provided observational data on physicians’ skills at the hospital site. RESULTS Results are available for 2 in-person trainings and the Project ECHO program. Seventy-nine percent of respondents from the in-person trainings reported making changes to their practice that included team-based care for patients with cervical cancer, increased screening for cervical cancer, and newly established or increased participation in tumor boards. All Project ECHO respondents reported incorporating changes into their work on the basis of their participation. Volunteers at the hospital site reported observing improvements in knot tying and holding of instruments, lymphadenectomy, and colposcopy. CONCLUSION Preliminary results of the project are positive according to self-reported outcomes and observed behaviors. They include improvements in multidisciplinary care, screening, and the ability to perform essential surgical procedures. The 3-pronged approach described here can be considered for other geographies and cancer types.

Introduction Hematopoietic cell transplantation (HCT) is a life-saving treatment option for many patients with blood disorders. Research has shown transplants occurring earlier in the disease course correlate with significantly improved outcomes (Koreth et al, JAMA, 2009). A recent study showed HLA typing with cytogenetic testing at the time of diagnosis increased the number of patients with acute myeloid leukemia (AML) receiving HCT in CR1 by 63%, resulting in a 37% increase in 2-year overall survival (Pagel et al, JCO Oncology Practice, 2020). However, many barriers still prevent patients from receiving a transplant (Majhail et al, BBMT, 2010). Applying 2018 U.S. Census estimates to the NMDP Transplant Needs Analysis (Murphy et al, BBMT, 2016) and using CIBMTR® (Center for International Blood and Marrow Transplant Research®) transplant data shows that in 2018, 49% of all AML patients in the U.S. who needed a transplant did not receive one. The goal of this research is to compare 2019 HCT referral survey data to a similar 2015 study (Meyer et al, JNCCN, 2019) and to better understand how a hematologist's/oncologist's referral patterns and perceptions of HCT may prevent patients with AML from receiving a transplant. Methods An online survey was conducted from September 19, 2019 - October 14, 2019 among 302 recruited, board-certified U.S. hematologists/oncologists who had seen at least 10 patients diagnosed with AML, acute lymphoblastic leukemia (ALL), or myelodysplastic syndromes (MDS) in the past year. Results focus on AML only. Pediatric-only physicians and physicians who personally perform HCT were excluded. The survey assessed the number of patients seen, referrals made, perceptions of HCT, and knowledge of National Comprehensive Cancer Network (NCCN®) AML HCT referral guidelines (NCCN®, 2020) among other topics. This survey replicated the screening criteria and questions used in the 2015 study (Meyer et al, JNCCN, 2019). T-tests and chi-square tests were used to determine changes compared to 2015 as well as differences by physician demographics. Results Physicians reported referring 50.7% of their patients with AML for HCT in the past 12 months in 2019, significantly higher than 40.3% as reported in 2015 (p=0.0001). Additionally, 71.6% of those patients were referred in CR1, compared to 60.3% in 2015 (p=0.001). Compared to 2015, the maximum age a physician was willing to refer any patient for transplant also increased: from 64.9 to 67.3 years for related HCT (p=0.01), and from 61.9 to 65.2 years for unrelated HCT (p=0.0002). In 2019, physicians with more years in practice (>20 years) referred a lower percentage of their AML patients for HCT in the past year compared to physicians with fewer years in practice (0-10 years) (p=0.001). In the 2019 knowledge check question based on NCCN risk stratification guidelines, 20.9%-25.5% of physicians indicated they either would not or did not know whether to refer a patient for transplant given 3 specific poor-risk cytogenetic categories, even though NCCN recommendations included referral for HCT. Physicians with more years in practice (>20 years) were significantly more likely than physicians with fewer years in practice (0-10 years) to answer that they did not know whether to refer a patient for HCT in all 6 cytogenetic/molecular marker examples shown, which included 2 favorable-risk, 1 intermediate-risk, and 3 poor-risk categories (p<0.05 for all 6 examples shown). Discussion While it is encouraging to see physicians referring a higher rate of patients with AML for HCT consultation, referring earlier, and referring older patients, barriers to timely HCT referral remain. Enhanced physician education regarding NCCN referral timing guidelines is recommended to ensure patients are referred for HCT consultation earlier in their disease course. Additional research is needed to understand why the number of years in practice is associated with referral rates, but an emphasis on continuing education on HCT referral guidelines could be useful, especially for physicians with more years in practice. The results of this research will be used to inform educational materials and encourage best practices, like HLA typing at diagnosis, for early transplant consultation. This will ultimately improve patient outcomes and close the HCT need gap among patients with AML. Table Disclosures Devine: Magenta Therapeutics: Consultancy.

Abstract Abstract 3376 Poster Board III-264 The utilization of cord blood transplant (CBT) in adult patients is very limited because of the risk of graft failure or very delayed platelet recovery. We have developed the direct intra-bone (IB) cord blood transplant technique and we have transplanted 79 patients from March 2006 to May 2009. Patients are categorized by phase as: early n=15(18%); intermediate n=16(21%); advanced n=48(61%). Patients' disease/phase was as follows: AML 14/6/21, ALL 1/8/12, HD 0/0/3, NHL 0/0/6 CML 0/0/5, other diseases 0/0/3. Cord Blood Units (CBU) were selected establishing minimum cell dose as 1 ×10 7/kg and the maximum HLA disparity 2/6 with preference to Class I disparity versus Class II. The median cells dose (TNC) was 2.6 (1.35-5.4) 10 7//kg and the HLA disparity was: 12 = 5/6, 66 = 4/6 and 1 = 3/6. The majority of patients (n=69) were mismatched at class I (antigen level) while (n=10) were mismatched at class II level (mostly allelic level). Most of patients (82%) were in intermediate or very advanced phase of their disease and had no time for searching an adult hematopoietic source. Patients received TBI containing regimen (n= 61) or Treosulfan + Thiotepa + Fludarabine (n=10) or reduced intensity regimen (n=8). GVHD prophylaxis was Cyclosporin, ATG and Mycophenolic acid. Three out of 79 patients did not engrafted. Two were rescued with third party mesenchymal stromal cell infusion. All the other patients engrafted; median day of recovery of neutrophils (PMN) >500/109/L and platelets (PLT) > 20000109/L was 23 (14-44) and 35 (16-70) respectively. To verify the robustness of the engraftment we calculated the PMN and PLT median values at day 50,100,180 which were 2.6(0.9-12.2), 2.7 (0.8-10.3), 2.8 (0.8-7.2) /109/L and 77 (20-208), 125 (22-305), 147 (38-327) /109/L respectively. The outcomes at 2 years according to Kaplan-Meier are: OS = 46%+/-5; RI =18%+/-2; NRM = 39%+/-5. Cumulative incidence of PMN >500/109/L and PLT > 20000109/L was: 84+/-4 at day 50 and 82+/-4 at day 70. Acute GVHD incidence/severity was: GVHD grade 0-I n=51 (64%), II n=11 (14%), III-IV n=0. Chronic GVHD was: no CGVHD n =18 (23%); grade 1 n= 15 (19%); grade 2 n=11 (14%); grade 3 n=3 (4%). Cause of death were: Multiorgan failure/toxicity n= 10 (these patients died within 15 days from CBT); infections n= 15, Relapse n= 14 ( 5/14 progressions), Chronic GVHD/infection n=3. In conclusion, intrabone CBT is associated with high rate of engraftment, early and robust platelet recovery, lower acute GVHD. The rate of incidence of chronic GVHD is also low but in 3 cases was very severe. Considering that most patients were grafted in very advanced phase of their disease the relapse rate seem promising but not definitive conclusions can yet been drawn. Because the low rate of graft failure observed (3/79) and the high frequency of successful search of CBU, we made a simulation to evaluate the probability finding a CBU by 183 patients that started a search in the last two years at the IBMDR. The search was challenged with 168.000 CBU (listed in the Bone Marrow Donor Worldwide database) of which we knew the HLA class II at allelic level. This gave us the possibility to know if they were HLA matched according to the IBMDR compatibility standard applied for CBU matching algorithm: as maximum two differences at HLA first class (A, B loci) or one at HLA first class and one at DRB1 alleles (DNA typing 4 digits). Median body weight of these patients was 73 kg (45-105). We performed the first search without any consideration of the ratio recipient weight/TNC of CBU: the 97% (178 patients) found at least one compatible CBU. When we considered the standard TNC dose (>2,5 ×107 /kg) the percentage of individuals that found a suitable CBU was 78% (143 patients). If we accept a lower total nucleated cell dose associated with engraftment in the intra-bone study (1.35 ×107/kg) almost the totality of patients can find a compatible CBU (93% =171 patients). Twelve/183 individuals could not find any suitable unit: 10 were over 85 kilos of weight and in two of them had a very rare HLA phenotypes. These data indicate that an intra-bone cord blood transplant can be now offered to more than 90% of individuals for whom transplant is the sole chance of surviving. Disclosures: No relevant conflicts of interest to declare.

“I suppose in reality not a leaf goes yellow in autumn without ceasing to care about its sap and making the parent tree very uncomfortable by long growling and grumbling - but surely nature might find some less irritating way of carrying on business if she would give her mind to it. Why should the generations overlap one another at all? Samuel Butler, The Way of All Flesh1 Millenials or Generation Y physicians (born 1977/1980-1995) today form the majority of medical personnel, from medical students and residents in their early twenties and thirties to young attending physicians hitting forty; practicing side-by-side with Generation X (1965-1976/1980) in their late thirties to early fifties; Baby Boomers (1946-1964) in their mid-fifties, sixties and early seventies; and the last of the Silent Generation or Traditionalists (1925-1945) in their mid-seventies, eighties and nineties.2,3 Among 734 Fellows of the Philippine Society of Otolaryngology – Head and Neck Surgery alone, there are currently 18 Traditionalists, 192 Boomers, 360 Generation X, and 164 Millenials. Assuming the 862 board-certified Diplomates waiting to become full-fledged Fellows and 182 Residents-in-Training are also Millenials, there are a total of 1,208 Millenials in the field of Otolaryngology Head and Neck Surgery in the Philippines. With four distinct generations simultaneously in the workforce, it is not unusual to hear older physicians gripe about “these Millenials,” and how different they are from previous generations. The so-called generation gap has been used to characterize inter-generational relations, wherein the preceding generation historically puts down the younger, and the succeeding generation usually complains about the older one. I posit that central to this conflict is a clash between tradition -- the way things should be done (as perceived by the older generation) -- and disruption, the way things can be done differently (from the perspective of the younger generation). In particular (meaning no offense to the “in-between” Generation X, and at risk of being overly simplistic), this is highlighted by the supposed looming showdown between Baby Boomers who are not yet ready to leave and Millenials who can hardly wait to take over.4 Tradition, a “statement, belief or practice handed down from generation to generation” comes from the Old French tradicion “transmission, presentation, handing over” and directly from the Latin traditionem “delivery, surrender, a handing down, a giving up,” from tradere “deliver, hand over,” derived from trans – “over” + dare “to give.”5 Although older generations may like to think they uphold tradition (giving them the right and duty to pass it on to succeeding ones), a large part of what defines each generation in the first place is their departure from the statements, beliefs or practices of their predecessors. Such a transition may have been gradual or sudden, and more pronounced in some generations than in others. Our post-war Boomer generation grew up in a world where face-to-face communication was supplemented by the written (handwritten, typewritten, typeset or telegraphed) and spoken (rotary-dial telephone) word. In medicine and medical education, history and physical examination were taught through lectures (with overhead and opaque projectors, slides on carousels and filmstrips) and live demonstrations on patients and on one another. The advent of word processing and advances in telecommunications and technology that became available to Generation X (who in the Philippines include “martial law babies” oblivious to our “wonder years” of the sixties) gradually changed the landscape of medical education and practice, but it would take the digital and internet revolution to finally, drastically change the world-- and Millenials were the primary beneficiaries of this change. Disruption, from the Latin disruptionem “a breaking asunder,” which comes from disrumpere “break apart, split, shatter, break to pieces,” from dis- “apart” + rumpere “to break”6 perhaps best describes the Baby Boomer generation’s experience of the technological revolution that Millenials grew up with. Suddenly, everything could be had in a split-second and the world was connected in real time. No longer did one have to master penmanship, typing and speed-reading, and homes no longer displayed dictionaries and encyclopedias. Even the library card catalogue and periodicals index became obsolete, as most anything became instantly available and accessible – including information, fast food and relationships. Millenials grew up with this transition, and readily mastered the rapidly changing technology. The locus of socialization was no longer face-to-face interaction within the family, but the worldwide web and social media. In medical education, lectures gave way to podcasts and webinars; heavy textbooks gave way to electronic references; and even dissection gave way to 3D virtual human anatomy. The Millenials’ expertise in, and dependence on, technology can both be their boon and bane – as I often note when residents and students automatically search their peripheral brains (a.k.a. mobile devices) to answer a ward round question. But they are also as quick to intuitively master the diagnostic and therapeutic tools that did not exist when their older colleagues were in residency.7 The early access that Millenials and Generation X had to computer resources in childhood certainly laid “a critical foundation for use of these systems later in life,” compared to Baby Boomers and Traditionalists whose “lack of early experience may limit their enthusiasm” for such tools.3 As Cole puts it, “Baby Boomers don't react well to a 20-something coming in and disrupting the way things have ‘always been’ while Millennials don't react well when they're told to shoot for the moon and ‘do big things,’ and then when they walk in the door with new ideas ready to disrupt age-old models, get told to know their place.”8 Thus, older generations of physicians may question how the stock knowledge and clinical eye of Millenials can compare to theirs, who learned medicine without these tools, and wonder how Millenials would fare in conflict and catastrophic situations when technology fails, or in low- and middle-income rural settings where technology is scarce. Conversely, Millenials wonder why Boomers insist on their old ways and just don’t get it! Perhaps we can learn from Mohr et al.3 about bridging generational issues in medical and surgical education—for instance, between the Socratic Method whereby Boomers may appear to intimidate learners9 versus the Millenial expectation that presentation of information be tailored to their needs, individually or via available technology.10 It could be helpful for Millenials who are “outcomes-oriented and value doing more than knowing”11 “to realize that Traditionalists and Boomers ‘know how to do’ and are ready and able to teach.”3 On the other hand, “when instructing Boomers in new technology or information,” the Millenial teacher “should recognize that this role reversal is uncomfortable to older generations” and “mitigate discomfort … by focus(ing) on the relevance of the information and creat(ing) an environment in which it is ‘safe’ to ask questions and challenge the teacher.”3 Indeed, if inter-generational differences could be surmounted, there is much that Boomers can learn from Millenials, and vice versa. If as Cole observes, “this great debate is hauntingly similar to a parent/child argument,”8 it is because Boomers and Millennials are “also each other’s children and parents, bound together in an intricate web of love, support, anxiety, resentment, and interdependence.”4 Perhaps by involving Generation X in bridging the great divide, and fostering an environment that allows for inter-generational differences in teaching and learning styles, non-disruptive disruption of tradition can take place. Each generation must have the humility (as opposed to intellectual arrogance) to accept that they can learn from other generations – younger or older—for truly meaningful medical progress to take place. We cannot do otherwise, for Generation Z (born after 1995, and about to enter Medical School) is already poised to join the fray. References Butler S. The Way of All Flesh. New York: Dover Publications, 2004. 315 pages. The Center for Generational Kinetics. How to determine generational birth years. November 28, 2016 ©2016 [cited 2017 Nov 2.] Available from: http://genhq.com/generational_birth_years/ Mohr NM, Moreno-Walton L, Mills AM, Brunett PH, Promes SB. Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I). Acad Emerg Med. 2011 Feb;18(2):190-199. DOI: 10.1111/j.1553-2712.2010.00985.x PMID: 21314779 PMCID: PMC3076332 Taylor P, Pew Research Center. The Next America: Boomers, Millenials, and the Looming Generational Showdown. New York: PublicAffairs, 2016. 384 pages. Harper D. Online Etymology Dictionary © 2001-2017 [Cited 2017 November 2.] Available from: https://www.etymonline.com/word/tradition Harper D. Online Etymology Dictionary © 2001-2017 [Cited 2017 November 2.] Available from: https://www.etymonline.com/word/disruption Sopher M. How Millenial Doctors Will Shape the Future of Health Care. Blog on the Internet, Baltimore: Rendia, 2016 October 26. [Cited 2017 November 2.] Available from: https://blog.rendia.com/millennials/ Cole N. The Real Reason Baby Boomers and Millenials Don’t See Eye to Eye (Written by a Millenial). Southeast Asia. 2017 Jan 20 [Cited 2017 November 2] Available from: https://www.inc.com/nicolas-cole/the-real-reason-baby-boomers-and-millennials-dont-see-eye-to-eye-written-by-a-mi.html Seabrook M. Intimidation in medical education: students' and teachers' perspectives. Studies Higher Educ. 2004;29(1):59–74. http://dx.doi.org/10.1080/1234567032000164877 Feiertag J, Berge ZL. Training generation N: How educators should approach the Net Generation. Education and Training. 2008 September;50(6):457–64. DOI: 10.1108/00400910810901782 Mangold K. Educating a new generation: teaching baby boomer faculty about millennial students. Nurse Educ. 2007 Jan-Feb;32(1):21-23. PMID: 17220763

From elephants to ABBA fans, silicon to hormone, the following discussion uses a new research method to look at printed text, motion pictures and a teenage rebel icon. If by ‘print’ we mean a mechanically reproduced impression of a cultural symbol in a medium, then printing has been with us since before microdot security prints were painted onto cars, before voice prints, laser prints, network servers, record pressings, motion picture prints, photo prints, colour woodblock prints, before books, textile prints, and footprints. If we accept that higher mammals such as elephants have a learnt culture, then it is possible to extend a definition of printing beyond Homo sapiens. Poole reports that elephants mechanically trumpet reproductions of human car horns into the air surrounding their society. If nothing else, this cross-species, cross-cultural reproduction, this ‘ability to mimic’ is ‘another sign of their intelligence’. Observation of child development suggests that the first significant meaningful ‘impression’ made on the human mind is that of the face of the child’s nurturer – usually its mother. The baby’s mind forms an ‘impression’, a mental print, a reproducible memory data set, of the nurturer’s face, voice, smell, touch, etc. That face is itself a cultural construct: hair style, makeup, piercings, tattoos, ornaments, nutrition-influenced skin and smell, perfume, temperature and voice. A mentally reproducible pattern of a unique face is formed in the mind, and we use that pattern to distinguish ‘familiar and strange’ in our expanding social orbit. The social relations of patterned memory – of imprinting – determine the extent to which we explore our world (armed with research aids such as text print) or whether we turn to violence or self-harm (Bretherton). While our cultural artifacts (such as vellum maps or networked voice message servers) bravely extend our significant patterns into the social world and the traversed environment, it is useful to remember that such artifacts, including print, are themselves understood by our original pattern-reproduction and impression system – the human mind, developed in childhood. The ‘print’ is brought to mind differently in different discourses. For a reader, a ‘print’ is a book, a memo or a broadsheet, whether it is the Indian Buddhist Sanskrit texts ordered to be printed in 593 AD by the Chinese emperor Sui Wen-ti (Silk Road) or the US Defense Department memo authorizing lower ranks to torture the prisoners taken by the Bush administration (Sanchez, cited in ABC). Other fields see prints differently. For a musician, a ‘print’ may be the sheet music which spread classical and popular music around the world; it may be a ‘record’ (as in a ‘recording’ session), where sound is impressed to wax, vinyl, charged silicon particles, or the alloys (Smith, “Elpida”) of an mp3 file. For the fine artist, a ‘print’ may be any mechanically reproduced two-dimensional (or embossed) impression of a significant image in media from paper to metal, textile to ceramics. ‘Print’ embraces the Japanese Ukiyo-e colour prints of Utamaro, the company logos that wink from credit card holographs, the early photographs of Talbot, and the textured patterns printed into neolithic ceramics. Computer hardware engineers print computational circuits. Homicide detectives investigate both sweaty finger prints and the repeated, mechanical gaits of suspects, which are imprinted into the earthy medium of a crime scene. For film makers, the ‘print’ may refer to a photochemical polyester reproduction of a motion picture artifact (the reel of ‘celluloid’), or a DVD laser disc impression of the same film. Textualist discourse has borrowed the word ‘print’ to mean ‘text’, so ‘print’ may also refer to the text elements within the vision track of a motion picture: the film’s opening titles, or texts photographed inside the motion picture story such as the sword-cut ‘Z’ in Zorro (Niblo). Before the invention of writing, the main mechanically reproduced impression of a cultural symbol in a medium was the humble footprint in the sand. The footprints of tribes – and neighbouring animals – cut tracks in the vegetation and the soil. Printed tracks led towards food, water, shelter, enemies and friends. Having learnt to pattern certain faces into their mental world, children grew older and were educated in the footprints of family and clan, enemies and food. The continuous impression of significant foot traffic in the medium of the earth produced the lines between significant nodes of prewriting and pre-wheeled cultures. These tracks were married to audio tracks, such as the song lines of the Australian Aborigines, or the ballads of tramping culture everywhere. A typical tramping song has the line, ‘There’s a track winding back to an old-fashion shack along the road to Gundagai,’ (O’Hagan), although this colonial-style song was actually written for radio and became an international hit on the airwaves, rather than the tramping trails. The printed tracks impressed by these cultural flows are highly contested and diverse, and their foot prints are woven into our very language. The names for printed tracks have entered our shared memory from the intersection of many cultures: ‘Track’ is a Germanic word entering English usage comparatively late (1470) and now used mainly in audio visual cultural reproduction, as in ‘soundtrack’. ‘Trek’ is a Dutch word for ‘track’ now used mainly by ecotourists and science fiction fans. ‘Learn’ is a Proto-Indo-European word: the verb ‘learn’ originally meant ‘to find a track’ back in the days when ‘learn’ had a noun form which meant ‘the sole of the foot’. ‘Tract’ and ‘trace’ are Latin words entering English print usage before 1374 and now used mainly in religious, and electronic surveillance, cultural reproduction. ‘Trench’ in 1386 was a French path cut through a forest. ‘Sagacity’ in English print in 1548 was originally the ability to track or hunt, in Proto-Indo-European cultures. ‘Career’ (in English before 1534) was the print made by chariots in ancient Rome. ‘Sleuth’ (1200) was a Norse noun for a track. ‘Investigation’ (1436) was Latin for studying a footprint (Harper). The arrival of symbolic writing scratched on caves, hearth stones, and trees (the original meaning of ‘book’ is tree), brought extremely limited text education close to home. Then, with baked clay tablets, incised boards, slate, bamboo, tortoise shell, cast metal, bark cloth, textiles, vellum, and – later – paper, a portability came to text that allowed any culture to venture away from known ‘foot’ paths with a reduction in the risk of becoming lost and perishing. So began the world of maps, memos, bills of sale, philosophic treatises and epic mythologies. Some of this was printed, such as the mechanical reproduction of coins, but the fine handwriting required of long, extended, portable texts could not be printed until the invention of paper in China about 2000 years ago. Compared to lithic architecture and genes, portable text is a fragile medium, and little survives from the millennia of its innovators. The printing of large non-text designs onto bark-paper and textiles began in neolithic times, but Sui Wen-ti’s imperial memo of 593 AD gives us the earliest written date for printed books, although we can assume they had been published for many years previously. The printed book was a combination of Indian philosophic thought, wood carving, ink chemistry and Chinese paper. The earliest surviving fragment of paper-print technology is ‘Mantras of the Dharani Sutra’, a Buddhist scripture written in the Sanskrit language of the Indian subcontinent, unearthed at an early Tang Dynasty site in Xian, China – making the fragment a veteran piece of printing, in the sense that Sanskrit books had been in print for at least a century by the early Tang Dynasty (Chinese Graphic Arts Net). At first, paper books were printed with page-size carved wooden boards. Five hundred years later, Pi Sheng (c.1041) baked individual reusable ceramic characters in a fire and invented the durable moveable type of modern printing (Silk Road 2000). Abandoning carved wooden tablets, the ‘digitizing’ of Chinese moveable type sped up the production of printed texts. In turn, Pi Sheng’s flexible, rapid, sustainable printing process expanded the political-cultural impact of the literati in Asian society. Digitized block text on paper produced a bureaucratic, literate elite so powerful in Asia that Louis XVI of France copied China’s print-based Confucian system of political authority for his own empire, and so began the rise of the examined public university systems, and the civil service systems, of most European states (Watson, Visions). By reason of its durability, its rapid mechanical reproduction, its culturally agreed signs, literate readership, revered authorship, shared ideology, and distributed portability, a ‘print’ can be a powerful cultural network which builds and expands empires. But print also attacks and destroys empires. A case in point is the Spanish conquest of Aztec America: The Aztecs had immense libraries of American literature on bark-cloth scrolls, a technology which predated paper. These libraries were wiped out by the invading Spanish, who carried a different book before them (Ewins). In the industrial age, the printing press and the gun were seen as the weapons of rebellions everywhere. In 1776, American rebels staffed their ‘Homeland Security’ units with paper makers, knowing that defeating the English would be based on printed and written documents (Hahn). Mao Zedong was a book librarian; Mao said political power came out of the barrel of a gun, but Mao himself came out of a library. With the spread of wireless networked servers, political ferment comes out of the barrel of the cell phone and the internet chat room these days. Witness the cell phone displays of a plane hitting a tower that appear immediately after 9/11 in the Middle East, or witness the show trials of a few US and UK lower ranks who published prints of their torturing activities onto the internet: only lower ranks who published prints were arrested or tried. The control of secure servers and satellites is the new press. These days, we live in a global library of burning books – ‘burning’ in the sense that ‘print’ is now a charged silicon medium (Smith, “Intel”) which is usually made readable by connecting the chip to nuclear reactors and petrochemically-fired power stations. World resources burn as we read our screens. Men, women, children burn too, as we watch our infotainment news in comfort while ‘their’ flickering dead faces are printed in our broadcast hearths. The print we watch is not the living; it is the voodoo of the living in the blackout behind the camera, engaging the blood sacrifice of the tormented and the unfortunate. Internet texts are also ‘on fire’ in the third sense of their fragility and instability as a medium: data bases regularly ‘print’ fail-safe copies in an attempt to postpone the inevitable mechanical, chemical and electrical failure that awaits all electronic media in time. Print defines a moral position for everyone. In reporting conflict, in deciding to go to press or censor, any ‘print’ cannot avoid an ethical context, starting with the fact that there is a difference in power between print maker, armed perpetrators, the weak, the peaceful, the publisher, and the viewer. So many human factors attend a text, video or voice ‘print’: its very existence as an aesthetic object, even before publication and reception, speaks of unbalanced, and therefore dynamic, power relationships. For example, Graham Greene departed unscathed from all the highly dangerous battlefields he entered as a novelist: Riot-torn Germany, London Blitz, Belgian Congo, Voodoo Haiti, Vietnam, Panama, Reagan’s Washington, and mafia Europe. His texts are peopled with the injustices of the less fortunate of the twentieth century, while he himself was a member of the fortunate (if not happy) elite, as is anyone today who has the luxury of time to read Greene’s works for pleasure. Ethically a member of London and Paris’ colonizers, Greene’s best writing still electrifies, perhaps partly because he was in the same line of fire as the victims he shared bread with. In fact, Greene hoped daily that he would escape from the dreadful conflicts he fictionalized via a body bag or an urn of ashes (see Sherry). In reading an author’s biography we have one window on the ethical dimensions of authority and print. If a print’s aesthetics are sometimes enduring, its ethical relationships are always mutable. Take the stylized logo of a running athlete: four limbs bent in a rotation of action. This dynamic icon has symbolized ‘good health’ in Hindu and Buddhist culture, from Madras to Tokyo, for thousands of years. The cross of bent limbs was borrowed for the militarized health programs of 1930s Germany, and, because of what was only a brief, recent, isolated yet monstrously horrific segment of its history in print, the bent-limbed swastika is now a vilified symbol in the West. The sign remains ‘impressed’ differently on traditional Eastern culture, and without the taint of Nazism. Dramatic prints are emotionally charged because, in depicting Homo sapiens in danger, or passionately in love, they elicit a hormonal reaction from the reader, the viewer, or the audience. The type of emotions triggered by a print vary across the whole gamut of human chemistry. A recent study of three genres of motion picture prints shows a marked differences in the hormonal responses of men compared to women when viewing a romance, an actioner, and a documentary (see Schultheiss, Wirth, and Stanton). Society is biochemically diverse in its engagement with printed culture, which raises questions about equality in the arts. Motion picture prints probably comprise around one third of internet traffic, in the form of stolen digitized movie files pirated across the globe via peer-to-peer file transfer networks (p2p), and burnt as DVD laser prints (BBC). There is also a US 40 billion dollar per annum legitimate commerce in DVD laser pressings (Grassl), which would suggest an US 80 billion per annum world total in legitimate laser disc print culture. The actively screen literate, or the ‘sliterati’ as I prefer to call them, research this world of motion picture prints via their peers, their internet information channels, their television programming, and their web forums. Most of this activity occurs outside the ambit of universities and schools. One large site of sliterate (screen literate) practice outside most schooling and official research is the net of online forums at imdb.com (International Movie Data Base). Imdb.com ‘prints’ about 25,000,000 top pages per month to client browsers. Hundreds of sliterati forums are located at imdb, including a forum for the Australian movie, Muriel’s Wedding (Hogan). Ten years after the release of Muriel’s Wedding, young people who are concerned with victimization and bullying still log on to http://us.imdb.com/title/tt0110598/board/> and put their thoughts into print: I still feel so bad for Muriel in the beginning of the movie, when the girls ‘dump’ her, and how much the poor girl cried and cried! Those girls were such biartches…I love how they got their comeuppance! bunniesormaybemidgets’s comment is typical of the current discussion. Muriel’s Wedding was a very popular film in its first cinema edition in Australia and elsewhere. About 30% of the entire over-14 Australian population went to see this photochemical polyester print in the cinemas on its first release. A decade on, the distributors printed a DVD laser disc edition. The story concerns Muriel (played by Toni Collette), the unemployed daughter of a corrupt, ‘police state’ politician. Muriel is bullied by her peers and she withdraws into a fantasy world, deluding herself that a white wedding will rescue her from the torments of her blighted life. Through theft and deceit (the modus operandi of her father) Muriel escapes to the entertainment industry and finds a ‘wicked’ girlfriend mentor. From a rebellious position of stubborn independence, Muriel plays out her fantasy. She gets her white wedding, before seeing both her father and her new married life as hollow shams which have goaded her abandoned mother to suicide. Redefining her life as a ‘game’ and assuming responsibility for her independence, Muriel turns her back on the mainstream, image-conscious, female gang of her oppressed youth. Muriel leaves the story, having rekindled her friendship with her rebel mentor. My methodological approach to viewing the laser disc print was to first make a more accessible, coded record of the entire movie. I was able to code and record the print in real time, using a new metalanguage (Watson, “Eyes”). The advantage of Coding is that ‘thinks’ the same way as film making, it does not sidetrack the analyst into prose. The Code splits the movie print into Vision Action [vision graphic elements, including text] (sound) The Coding splits the vision track into normal action and graphic elements, such as text, so this Coding is an ideal method for extracting all the text elements of a film in real time. After playing the film once, I had four and a half tightly packed pages of the coded story, including all its text elements in square brackets. Being a unique, indexed hard copy, the Coded copy allowed me immediate access to any point of the Muriel’s Wedding saga without having to search the DVD laser print. How are ‘print’ elements used in Muriel’s Wedding? Firstly, a rose-coloured monoprint of Muriel Heslop’s smiling face stares enigmatically from the plastic surface of the DVD picture disc. The print is a still photo captured from her smile as she walked down the aisle of her white wedding. In this print, Toni Collette is the Mona Lisa of Australian culture, except that fans of Muriel’s Wedding know the meaning of that smile is a magical combination of the actor’s art: the smile is both the flush of dreams come true and the frightening self deception that will kill her mother. Inserting and playing the disc, the text-dominant menu appears, and the film commences with the text-dominant opening titles. Text and titles confer a legitimacy on a work, whether it is a trade mark of the laser print owners, or the household names of stars. Text titles confer status relationships on both the presenters of the cultural artifact and the viewer who has entered into a legal license agreement with the owners of the movie. A title makes us comfortable, because the mind always seeks to name the unfamiliar, and a set of text titles does that job for us so that we can navigate the ‘tracks’ and settle into our engagement with the unfamiliar. The apparent ‘truth’ and ‘stability’ of printed text calms our fears and beguiles our uncertainties. Muriel attends the white wedding of a school bully bride, wearing a leopard print dress she has stolen. Muriel’s spotted wild animal print contrasts with the pure white handmade dress of the bride. In Muriel’s leopard textile print, we have the wild, rebellious, impoverished, inappropriate intrusion into the social ritual and fantasy of her high-status tormentor. An off-duty store detective recognizes the printed dress and calls the police. The police are themselves distinguished by their blue-and-white checked prints and other mechanically reproduced impressions of cultural symbols: in steel, brass, embroidery, leather and plastics. Muriel is driven in the police car past the stenciled town sign (‘Welcome To Porpoise Spit’ heads a paragraph of small print). She is delivered to her father, a politician who presides over the policing of his town. In a state where the judiciary, police and executive are hijacked by the same tyrant, Muriel’s father, Bill, pays off the police constables with a carton of legal drugs (beer) and Muriel must face her father’s wrath, which he proceeds to transfer to his detested wife. Like his daughter, the father also wears a spotted brown print costume, but his is a batik print from neighbouring Indonesia (incidentally, in a nation that takes the political status of its batik prints very seriously). Bill demands that Muriel find the receipt for the leopard print dress she claims she has purchased. The legitimate ownership of the object is enmeshed with a printed receipt, the printed evidence of trade. The law (and the paramilitary power behind the law) are legitimized, or contested, by the presence or absence of printed text. Muriel hides in her bedroom, surround by poster prints of the pop group ABBA. Torn-out prints of other people’s weddings adorn her mirror. Her face is embossed with the clown-like primary colours of the marionette as she lifts a bouquet to her chin and stares into the real time ‘print’ of her mirror image. Bill takes the opportunity of a business meeting with Japanese investors to feed his entire family at ‘Charlie Chan’’s restaurant. Muriel’s middle sister sloppily wears her father’s state election tee shirt, printed with the text: ‘Vote 1, Bill Heslop. You can’t stop progress.’ The text sets up two ironic gags that are paid off on the dialogue track: “He lost,’ we are told. ‘Progress’ turns out to be funding the concreting of a beach. Bill berates his daughter Muriel: she has no chance of becoming a printer’s apprentice and she has failed a typing course. Her dysfunction in printed text has been covered up by Bill: he has bribed the typing teacher to issue a printed diploma to his daughter. In the gambling saloon of the club, under the arrays of mechanically repeated cultural symbols lit above the poker machines (‘A’ for ace, ‘Q’ for queen, etc.), Bill’s secret girlfriend Diedre risks giving Muriel a cosmetics job. Another text icon in lights announces the surf nightclub ‘Breakers’. Tania, the newly married queen bitch who has made Muriel’s teenage years a living hell, breaks up with her husband, deciding to cash in his negotiable text documents – his Bali honeymoon tickets – and go on an island holiday with her girlfriends instead. Text documents are the enduring site of agreements between people and also the site of mutations to those agreements. Tania dumps Muriel, who sobs and sobs. Sobs are a mechanical, percussive reproduction impressed on the sound track. Returning home, we discover that Muriel’s older brother has failed a printed test and been rejected for police recruitment. There is a high incidence of print illiteracy in the Heslop family. Mrs Heslop (Jeannie Drynan), for instance, regularly has trouble at the post office. Muriel sees a chance to escape the oppression of her family by tricking her mother into giving her a blank cheque. Here is the confluence of the legitimacy of a bank’s printed negotiable document with the risk and freedom of a blank space for rebel Muriel’s handwriting. Unable to type, her handwriting has the power to steal every cent of her father’s savings. She leaves home and spends the family’s savings at an island resort. On the island, the text print-challenged Muriel dances to a recording (sound print) of ABBA, her hand gestures emphasizing her bewigged face, which is made up in an impression of her pop idol. Her imitation of her goddesses – the ABBA women, her only hope in a real world of people who hate or avoid her – is accompanied by her goddesses’ voices singing: ‘the mystery book on the shelf is always repeating itself.’ Before jpeg and gif image downloads, we had postcard prints and snail mail. Muriel sends a postcard to her family, lying about her ‘success’ in the cosmetics business. The printed missal is clutched by her father Bill (Bill Hunter), who proclaims about his daughter, ‘you can’t type but you really impress me’. Meanwhile, on Hibiscus Island, Muriel lies under a moonlit palm tree with her newly found mentor, ‘bad girl’ Ronda (Rachel Griffiths). In this critical scene, where foolish Muriel opens her heart’s yearnings to a confidante she can finally trust, the director and DP have chosen to shoot a flat, high contrast blue filtered image. The visual result is very much like the semiabstract Japanese Ukiyo-e woodblock prints by Utamaro. This Japanese printing style informed the rise of European modern painting (Monet, Van Gogh, Picasso, etc., were all important collectors and students of Ukiyo-e prints). The above print and text elements in Muriel’s Wedding take us 27 minutes into her story, as recorded on a single page of real-time handwritten Coding. Although not discussed here, the Coding recorded the complete film – a total of 106 minutes of text elements and main graphic elements – as four pages of Code. Referring to this Coding some weeks after it was made, I looked up the final code on page four: taxi [food of the sea] bq. Translation: a shop sign whizzes past in the film’s background, as Muriel and Ronda leave Porpoise Spit in a taxi. Over their heads the text ‘Food Of The Sea’ flashes. We are reminded that Muriel and Ronda are mermaids, fantastic creatures sprung from the brow of author PJ Hogan, and illuminated even today in the pantheon of women’s coming-of-age art works. That the movie is relevant ten years on is evidenced by the current usage of the Muriel’s Wedding online forum, an intersection of wider discussions by sliterate women on imdb.com who, like Muriel, are observers (and in some cases victims) of horrific pressure from ambitious female gangs and bullies. Text is always a minor element in a motion picture (unless it is a subtitled foreign film) and text usually whizzes by subliminally while viewing a film. By Coding the work for [text], all the text nuances made by the film makers come to light. While I have viewed Muriel’s Wedding on many occasions, it has only been in Coding it specifically for text that I have noticed that Muriel is a representative of that vast class of talented youth who are discriminated against by print (as in text) educators who cannot offer her a life-affirming identity in the English classroom. Severely depressed at school, and failing to type or get a printer’s apprenticeship, Muriel finds paid work (and hence, freedom, life, identity, independence) working in her audio visual printed medium of choice: a video store in a new city. Muriel found a sliterate admirer at the video store but she later dumped him for her fantasy man, before leaving him too. One of the points of conjecture on the imdb Muriel’s Wedding site is, did Muriel (in the unwritten future) get back together with admirer Brice Nobes? That we will never know. While a print forms a track that tells us where culture has been, a print cannot be the future, a print is never animate reality. At the end of any trail of prints, one must lift one’s head from the last impression, and negotiate satisfaction in the happening world. References Australian Broadcasting Corporation. “Memo Shows US General Approved Interrogations.” 30 Mar. 2005 http://www.abc.net.au>. 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Smith, T. “Elpida Licenses ‘DVD on a Chip’ Memory Tech.” The Register 20 Feb. 2005 http://www.theregister.co.uk/2005/02>. —. “Intel Boffins Build First Continuous Beam Silicon Laser.” The Register 20 Feb. 2005 http://www.theregister.co.uk/2005/02>. Watson, R. S. “Eyes And Ears: Dramatic Memory Slicing and Salable Media Content.” Innovation and Speculation, ed. Brad Haseman. Brisbane: QUT. [in press] Watson, R. S. Visions. Melbourne: Curriculum Corporation, 1994. Citation reference for this article MLA Style Watson, Robert. "E-Press and Oppress: Audio Visual Print Drama, Identity, Text and Motion Picture Rebellion." M/C Journal 8.2 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0506/08-watson.php>. APA Style Watson, R. (Jun. 2005) "E-Press and Oppress: Audio Visual Print Drama, Identity, Text and Motion Picture Rebellion," M/C Journal, 8(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0506/08-watson.php>.