Journal articles on the topic 'Monash University Evaluation'

The Monash University Accident Research Centre (MUARC) in Melbourne, Australia, recently completed research which culminated in the development of a CD ROM-based perceptual and cognitive skills training product for young novice car drivers. This paper describes the design of an experiment, using an advanced driving simulator located at MUARC, to evaluate the instructional effectiveness of the product.

Colin Evers is Associate Professor in the School of Graduate Studies of the Faculty of Education at Monash University in Australia and Gabriele Lakomski is Head of the Department of Policy, Context and Evaluation Studies at the University of Melbourne in Australia. In this paper they reprise and develop some of the keys ideas which inform their book Knowing Educational Administration and in doing so set the scene for the papers which follow in this symposium.

Effective operation of a microgrid depends critically on accurate forecasting of its components. Recently, internet forecasting competitions have been used to determine the best methods for energy forecasting, with some competitions having a special focus on microgrids and COVID-19 energy-use forecasting. This paper describes forecasting for the IEEE Computational Intelligence Society 3rd Technical Challenge, which required predicting solar and building loads of a microgrid system at Monash University for the month of November 2020. The forecast achieved the lowest error rate in the competition. We review the literature on recent energy forecasting competitions and metrics and explain how the solution drew from top-ranked solutions in previous energy forecasting competitions such as the Global Energy Forecasting Competition series. The techniques can be reapplied in other forecasting endeavours, while approaches to some of the time-series forecasting are more ad hoc and specific to the competition. Novel thresholding approaches were used to improve the quality of the input data. As the training and evaluation phase of the challenge occurred during COVID-19 lockdown and reopening, the building demand was subject to pandemic-related effects. Finally, we assess other data sources which would have improved the model forecast skill such as data from different numerical weather prediction (NWP) models, solar observations, and high-resolution price and demand data in the vicinity of the campus.

Objective: The DSM-IV classification in its definition and description of the gender identity disorder omits a number of diagnostically significant features. This paper attempts to correct the deficiencies. Method: The text under the headings: ‘Diagnostic features’, ‘Specifiers’, ‘Associated disorders’, ‘Laboratory findings’, ‘Prevalence’, ‘Course’ and ‘Differential diagnosis’ is subjected to a detailed scrutiny, using the author's experience as consultant psychiatrist to the Monash University Gender Dysphoria Clinic over a period of 25 years as source and background. Results of two studies of male-to-female and female-to-male transsexuals are given in the Table. Results: DSM-IV criteria are augmented and the symptomatology focused. The existing gaps in the delineation of specifiers and associated features are closed by providing additional clinical material. The description of the course and the differential diagnosis are enriched. Conclusions: Although the critical analysis of the DSM-IV classification of the gender identity disorder has shown the manual to be adequate, it nevertheless has shortcomings which may impede exact diagnosis.

The need to rationalise teaching resources underpinned a project at Monash University that used a Delphi technique to re-examine the teaching curriculum of two key topic areas in the medical curriculum – ophthalmology and dermatology – from an undergraduate, graduate and vocational perspective. Using Bloom’s taxonomy the learning objectives from these topic areas were collated and analysed. This process allowed the revising and redistributing of learning objectives of the curricula to reduce the likelihood of duplication of teaching or more importantly gaps in teaching occurring. This process highlighted the potential utility of using a transgenerational approach to curriculum planning but the outcomes are limited due to the small number of participating educators and the lack of formal evaluation of the method.

IntroductionPostnatal mental health problems, which are an international public health priority, are a suitable target for preventive approaches. The financial burden of these disorders is borne across sectors in society, including health, early childhood, education, justice and the workforce. This paper describes the planned economic evaluation of What Were We Thinking, a psychoeducational intervention for the prevention of postnatal mental health problems in first-time mothers.Methods and analysisThe evaluation will be conducted alongside a cluster-randomised controlled trial of its clinical effectiveness. Cost-effectiveness and costs-utility analyses will be conducted, resulting in estimates of cost per percentage point reduction in combined 30-day prevalence of depression, anxiety and adjustment disorders and cost per quality-adjusted life year gained. Uncertainty surrounding these estimates will be addressed using non-parametric bootstrapping and represented using cost-effectiveness acceptability curves. Additional cost analyses relevant for implementation will also be conducted. Modelling will be employed to estimate longer term cost-effectiveness if the intervention is found to be clinically effective during the period of the trial.Ethics and disseminationApproval to conduct the study was granted by the Southern Health (now Monash Health) Human Research Ethics Committee (24 April 2013; 11388B). The study was registered with the Monash University Human Research Ethics Committee (30 April 2013; CF12/1022-2012000474). The Education and Policy Research Committee, Victorian Government Department of Education and Early Childhood Development approved the study (22 March 2012; 2012_001472). Use of the EuroQol was registered with the EuroQol Group; 16 August 2012.Trial registration numberThe trial was registered with the Australian New Zealand Clinical Trials Registry on 7 May 2012 (registration number ACTRN12613000506796).

Purpose Monash University Library (MUL) has embraced eLearning as a strategy in its contribution to information research and learning skills development within the university. The purpose of this paper is to describe an evaluation of the implementation of the strategy with recommendations for sustaining and improving practice. Design/methodology/approach The evaluation is divided into four categories using a mixed methods methodology for evidence gathering. Quantitative and qualitative data are obtained from both primary and secondary sources for an enriched understanding of practices. Findings Findings suggest that library staff have gained knowledge and skills indicating a sustainable strategy. However, further work is required to sustain staff development and support staff requirements in the long term. Research limitations/implications This research is limited by its wide focus. Although this is mostly resolved through the use of multiple data collection methods, the thoroughness of the evaluation may have suffered while attempting to be comprehensive. Practical implications The conclusions of this evaluation as well as methods of its execution can be shared with other institutions wishing to produce eLearning resources in a sustainable and effective manner. Originality/value MUL develops its eLearning resources in-house, whereas many other institutions outsource. The findings of this case study could be viewed as a positive indication of this in-house practice, which in turn might inform other organisations who are looking for a financially beneficial eLearning alternative.

Abstract Introduction Culture is a concept most people instinctively understand, but may struggle to fully articulate. Culture is not limited to ethnicity and religion, but encompasses age, gender, sexual orientation, occupation, socioeconomic status, ethnic origin or migrant experience, religious or spiritual belief, and dis/ability. Given the breadth and complexity of culture, healthcare professionals in particular are challenged to interact with an increasingly multicultural world and various cultural groups. There is a growing need for appropriate training models to enhance cultural awareness, and cultural competence, including in pharmacy schools. “Interdisciplinary” can be defined as “relating to more than one branch of knowledge” [1], and international collaboration allows the connection of knowledge of different cultures. Developing a teaching intervention internationally, across three continents allows wider exposure to different cultures and can help students appreciate what culture may mean in different countries and how different ways of living are accepted and/or perceived in different societies. Aim To design and disseminate an online cultural communication module for use by pharmacy students across three countries and continents Methods A team from the Schools of Pharmacy at University College London (UCL), UK; Monash University, Australia and University of North Carolina (UNC), USA worked collaboratively to build an online module to help pharmacy students understand the importance of cultural awareness when communicating with patients. The Schools identified a range of cultural groups and scenarios in which pharmacist led communications could occur. Each School designed and filmed three scenarios, with two versions: one relatively good demonstration of communication and one poor. A range of actors, patients and pharmacists from different cultural groups (e.g. ethnic background, disability, LGBTQi, gender etc.) were involved in the design and filming. The module required students to reflect on the roleplays and provided feedback in the form of summary key points for each topic area. This module was embedded into the existing curricula for all Year 1 (Monash and UCL) and Year 2 (UNC) students in 2019. Students were informed as part of their regular course communication. A Likert style evaluation survey, including free text responses about the module was included, Questions were adapted from previous teaching evaluations. This data was recorded via each School’s Learning Management System. Descriptive statistics and a basic thematic analysis were conducted. Results Across the three Schools, a total of 525 students were offered the online module and 208 completed it. At UNC, 72.2% of students who completed would recommend the module to others, at UCL 83% and Monash 88%. Students’ feedback fell under three themes as seen in Table 1. Conclusion The innovation and strength of this learning intervention comes from the international collaboration. The online module allows students to identify and be culturally aware of a diverse group of people across three continents, allowing a unique and rich experience for all students through this collaboration and developing them not only as culturally competent healthcare professionals but also global citizens. References 1. Oxford Dictionaries, Oxford University Press, Definition of Interdisciplinary in English, Oxford, 2020. [Accessed 11th October 2020]. Available from: https://premium-oxforddictionaries-com.libproxy.ucl.ac.uk/definition/english/interdisciplinary

While the psychometric and statistical models underlying the design of computer adaptive tests (CAT) are well understood, relatively few working models exist for the purpose of foreign language assessment. Likewise, little has been published concerning the practical considerations affecting the implementation of such tests. in the process of constructing the Monash/Melbourne French CAT, we discovered much about putting testing theory into practice. The present paper reports this experience in three parts. In a preliminary section, we describe the academic context in which the French CAT was created and trialed. This is followed by a detailed consideration of the test presentation platform and operating algorithms. Lastly, we give an evaluation of the first administration of the French CAT, accompanied by a discussion of the test's reliability and validity as a placement instrument for first year Australian university students.

IntroductionEconomic evaluations of complex interventions in early child development are required to guide policy and programme development, but a few are yet available.Methods and analysisAlthough significant gains have been made in maternal and child health in resource-constrained environments, this has mainly been concentrated on improving physical health. The Learning Clubs programme addresses both physical and mental child and maternal health. This study is an economic evaluation of a cluster randomised controlled trial of the impact of the Learning Clubs programme in Vietnam. It will be conducted from a societal perspective and aims to identify the cost-effectiveness and the economic and social returns of the intervention. A total of 1008 pregnant women recruited from 84 communes in a rural province in Vietnam will be included in the evaluation. Health and cost data will be gathered at three stages of the trial and used to calculate incremental cost-effectiveness ratios per percentage point improvement of infant’s development, infant’s health and maternal common mental disorders expressed in quality-adjusted life years gained. The return on investment will be calculated based on improvements in productivity, the results being expressed as benefit–cost ratios.Ethics and disseminationThe trial was approved by Monash University Human Research Ethics Committee (Certificate Number 2016–0683), Australia, and approval was extended to include the economic evaluation (Amendment Review Number 2018-0683-23806); and the Institutional Review Board of the Hanoi School of Public Health (Certificate Number 017-377IDD- YTCC), Vietnam. Results will be disseminated through academic journals and conference presentations.Trial registration numberACTRN12617000442303.

The ability to think critically and creatively are essential graduate attributes for science students yet many science graduates lack these skills and may struggle to gain employment. As undergraduate science educators, we are aiming to improve critical thinking, creativity and the promotion of deeper learning in our students. We have designed and implemented an innovative and creative approach to assessment to engage students with laboratory practicals, which are a core component of the biomedical sciences at Monash University. Through the introduction of an innovative approach to assessment using small group student produced videos, we aim to improve skills in theoretical understanding, data analysis and presentation.This paper details the design of instructional guidelines for small group student produced video assessment, the implementation of the video assessment into 2nd and 3rd year biochemistry laboratory practical classes and the generation of research outcomes and evaluation of this novel assessment technique. Observation of student behaviour during the laboratory classes found students were filming/photographing their experiments and appeared far more engaged with the actual experiments than in previous years. In addition, many student videos demonstrated high levels of creativity and critical thinking. The student produced video assessment did provide an opportunity for creative and critical thinking in students but there are still aspects to be improved.

AbstractIntroductionAn appreciation of the experience of Ebola survivors is critical for community engagement and an effective outbreak response. Few qualitative, descriptive studies have been conducted to date that concentrate on the voices of Ebola survivors.ProblemThis study aimed to explore the experiences of Ebola survivors following the West African epidemic of 2014.MethodAn interpretive, qualitative design was selected using semi-structured interviews as the method of data collection. Data were collected in August 2015 by Médecins Sans Frontières (MSF) Belgium, for the purposes of internal evaluation. Data collection occurred at three sites in Liberia and Sierra Leone and involved 25 participants who had recovered from Ebola. Verbal consent was obtained, audio recordings were de-identified, and ethics approval was provided by Monash University (Melbourne, Australia).FindingsTwo major themes emerged from the study: “causes of distress” and “sources of resilience.” Two further sub-themes were identified from each major theme: the “multiplicity of death,” “abandonment,” “self and community protection and care,” and “coping resources and activities.” The two major themes were dominant across all three sample groups, though each survivor experienced infection, treatment, and recovery differently.ConclusionsBy identifying and mobilizing the inherent capacity of communities and acknowledging the importance of incorporating the social model of health into culturally competent outbreak responses, there is an opportunity to transcend the victimization effect of Ebola and empower communities, ultimately strengthening the response.SchwerdtlePM, De ClerckV, PlummerV. Experiences of Ebola survivors: causes of distress and sources of resilience. Prehosp Disaster Med. 2017;32(3):234–239.

IntroductionColorectal cancer (CRC) is the second most common cancer in Malaysia and cases are often detected late. Improving screening uptake is key in down-staging cancer and improving patient outcomes. The aim of this study is to develop, implement and evaluate an intervention to improve CRC screening uptake in Malaysia in the context of the COVID-19 pandemic. The evaluation will include ascertaining the budgetary impact of implementing and delivering the intervention.Methods and analysisThe implementation research logic model guided the development of the study and implementation outcome measures were informed by the 'Reach, Effectiveness, Adoption, Implementation and Maintenance' (RE-AIM) framework. This CRC screening intervention for Malaysia uses home-testing and digital, small media, communication to improve CRC screening uptake. A sample of 780 people aged 50–75 years living in Segamat district, Malaysia, will be selected randomly from the South East Asia Community Observatory (SEACO) database. Participants will receive a screening pack as well as a WhatsApp video of a local doctor to undertake a stool test safely and to send a photo of the test result to a confidential mobile number. SEACO staff will inform participants of their result. Quantitative data about follow-up clinic attendance, subsequent hospital tests and outcomes will be collected. Logistic regression will be used to investigate variables that influence screening completion and we will conduct a budget impact-analysis of the intervention and its implementation. Qualitative data about intervention implementation from the perspective of participants and stakeholders will be analysed thematically.Ethics and disseminationEthics approval has been granted by Monash University Human Research Ethics Committee (MUHREC ID: 29107) and the Medical Review and Ethics Committee (Reference: 21-02045-O7G(2)). Results will be disseminated through publications, conferences and community engagement activities.Trial registration numberNational Medical Research Register Malaysia: 21-02045-O7G(2).

IntroductionWith more women working and surviving breast cancer, issues concerning sustainable employment must be addressed. Support to transition back to work is a gap in survivorship care. This paper describes the feasibility trial protocol for ‘Beyond Cancer’, a multimodal occupational rehabilitation programme to support breast cancer survivors’ return to work. Breast cancer survivors are hypothesised to show improved work status, work capacity and perceived support at work at 6 months postintervention relative to baseline and a historical usual care group.Methods and analysisThe prospective feasibility design allows determination of change in primary (work status) as well as secondary outcome measures work capacity and perceived support at work. Participants: breast cancer survivors of working age, unable to work in their prediagnosis capacity for >3 months, their employers and a historical usual care group. Key intervention elements: an evidence-based biopsychosocial assessment and health coaching programme, employer education and support, and return to work (RTW) planning and monitoring. Health coaching empowers survivors to return to social function, including work. Employer education and support facilitates communication and improves workplace support. For employers, we predict change in confidence in effectively supporting employees’ RTW. Multilevel regression modelling will provide indications of efficacy for primary and secondary outcomes, and thematic analysis will examine perceived efficacy and acceptability.Ethics and disseminationEthics approval has been granted by Monash and Curtin University Human Research Ethics Committees (HREC: 13300, HRE2019-0280, respectively). The evaluation of this innovative programme will provide the foundation for an Randomised Controlled Trial (RCT) and national roll-out, thus improving the quality of life of those who have been directly affected by breast cancer across Australia. Results will be published in peer-reviewed journals, presented at relevant conferences and disseminated to survivorship-focused organisations.Trial registration numberRegistered trial with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618001985279); Pre-results.

IntroductionRegionalised trauma systems have been shown to improve outcomes for trauma patients. However, the evaluation of these trauma systems has been oriented towards in-hospital care. Therefore, the epidemiology and care delivered to the injured patients who died in the prehospital setting remain poorly studied. This study aims to provide an overview of a methodological approach to reviewing trauma deaths in order to assess the preventability, identify areas for improvements in the system of care provided to these patients and evaluate the potential for novel interventions to improve outcomes for seriously injured trauma patients.Methods and analysisThe planned study is a retrospective review of prehospital and early in-hospital (<24 hours) deaths following traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria between 2008 and 2014. Eligible patients will be identified from the Victorian Ambulance Cardiac Arrest Registry and linked with the National Coronial Information System. For patients who were transported to hospital, data will be linked the Victoria State Trauma Registry. The project will be undertaken in four phases: (1) survivability assessment; (2) preventability assessment; (3) identification of potential areas for improvement; and (4) identification of potentially useful novel technologies. Survivability assessment will be based on predetermined anatomical injuries considered unsurvivable. For patients with potentially survivable injuries, multidisciplinary expert panel reviews will be conducted to assess the preventability as well as the identification of potential areas for improvement and the utility of novel technologies.Ethics and disseminationThe present study was approved by the Victorian Department of Justice and Regulation HREC (CF/16/272) and the Monash University HREC (CF16/532 – 2016000259). Results of the study will be published in peer-reviewed journals and reports provided to Ambulance Victoria, the Victorian State Trauma Committee and the Victorian State Government Department of Health and Human Services.

This paper highlights the growing need for the provision of discipline-based flexible online courses for teachers in Higher Education as well as acknowledging the significance of interdisciplinary cooperation in this endeavour. It describes the approaches taken in designing and delivering these courses and discusses some of the challenges inherent in developing, implementing and evaluating such disciplinebased Higher Education courses, through examining the Graduate Certificate in Law Teaching (GCLT) Course in the Faculty of Law at Monash University, Australia.

Contemporary undergraduate courses in research methods are challenging to teach because of the wide scope of the subject matter, limited student contact hours and the complexity of supervising research projects undertaken by novices. Focus group assignments within class offer an interesting and enjoyable way for students to develop and apply research skills and reflect on the process of being both a researcher and a research participant in social science disciplines. Using focus groups enables deep learning, formative assessment and the development of reflexive research skills. This article discusses the use of focus group assignments as a key assessment tool in a Sociological research methods course taught at Monash University, Australia. The use of focus groups as a teaching tool is further assessed through analysing the reflections and evaluations given by students participating in the course.

Abstract Objectives Mindfulness is now widely used therapeutically in health settings, but for a range of reasons, it is not commonly integrated into the education of health professionals. This article aims to share practical insights and lessons learned from teaching mindfulness as core curriculum to the whole cohorts of medical students at Monash University. Methods This reflective article will provide a personal perspective drawing on many years’ experience since the early 1990s of integrating mindfulness into the core medical curriculum including outlining the mindfulness-based lifestyle program delivered to the medical students. This will provide a backdrop to sharing important lessons relating to preparation, integration, delivery and review of mindfulness curriculum. A range of practical issues will be explored including making the case for it to faculty, finding the right language, giving it a context and rationale, using the most conducive teaching style, having the right tutors, carefully dealing with resistance, finding appropriate methods of assessment and the importance of review. Results Evaluations and feedback on the program over a number of years have shown a high level of acceptance and utilisation of mindfulness-based skills by students. Since its inception, mindfulness training has now become integral in the training of many other health professional students at Monash. Conclusions If done effectively, mindfulness can be successfully introduced and integrated into core curriculum of medical and allied health students using it as a meta-skill to support the development of student wellbeing a range of important clinical competencies.

As a result of my work on the Australasian Legal Literature Index (ALLI) at Monash University, Melbourne, I was invited to the Harvard Law Library in Cambridge, Massachusetts, to assess their foreign and international law journal collection and to set up a system to index the journals in the collection that were not indexed elsewhere. The primary purpose of my study was to identify the problems and to attempt to provide solutions. The project metamorphosed into evaluating the basic current awareness needs of the Harvard Law School Faculty and finding a solution for providing access to the journal collection. An indication of the enormity of the task is to compare the holdings of the Harvard foreign and international law collection, (some 4,000 journals), to the some 500 publications indexed by the Index to Foreign Legal Periodicals, the major U.S. index to foreign materials.

Teaching green chemistry at Monash University started in earnest in 1999 with the launch of a 12-lecture final year undergraduate course. The course was designed to introduce students to the field of green chemistry. The students had no prior knowledge of the field or indeed what green chemistry meant. The course covered a definition of green chemistry, historical issues, and challenges, together with an introduction to the principles and tools of green chemistry, evaluating the effects of chemistry and technology, general areas of green chemistry, and presenting examples of successful and developing green chemistry technologies. Several general references were used, although specific examples were from the primary literature. Another feature of the course was the analysis of recent papers. In addition, experiments linking into the course have been developed, and there are plans for postgraduate training, professional development, and community outreach involving postgraduate candidates.

IntroductionIncreasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries.Methods and analysisRISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.EthicsStudy protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University.Trial registration numberACTRN12618000633280; Pre-results.

IntroductionIncreasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries.Methods and analysisRISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.EthicsStudy protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University.Trial registration numberACTRN12618000633280; Pre-results.

IntroductionUp to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care. We describe the methodology of a cluster randomised controlled trial (cRCT) evaluating the efficacy and cost-effectiveness of an interdisciplinary model of care aimed at reducing the burden of smoking and COPD in Australian primary care settings.Methods and analysisA cRCT is being undertaken to evaluate an interdisciplinary model of care (RADICALS — Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers). General practice clinics across Melbourne, Australia, are identified and randomised to the intervention group (RADICALS) or usual care. Patients who are current or ex-smokers, of at least 10 pack years, including those with an existing diagnosis of COPD, are being recruited to identify 280 participants with a spirometry-confirmed diagnosis of COPD. Handheld lung function devices are being used to facilitate case-finding. RADICALS includes individualised smoking cessation support, home-based pulmonary rehabilitation and home medicines review. Patients at control group sites receive usual care and Quitline referral, as appropriate. Follow-ups occur at 6 and 12 months from baseline to assess changes in quality of life, abstinence rates, health resource utilisation, symptom severity and lung function. The primary outcome is change in St George’s Respiratory Questionnaire score of patients with COPD at 6 months from baseline.Ethics and disseminationThis project has been approved by the Monash University Human Research Ethics Committee and La Trobe University Human Ethics Committee (CF14/1018 – 2014000433). Results of the study will be disseminated in peer-reviewed journals and research conferences. If the intervention is successful, the RADICALS programme could potentially be integrated into general practices across Australia and sustained over time.Trial registration numberACTRN12614001155684; Pre-results.

“Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 212 NOTICIAS / NEWS (“transfer”, 2017) 1) CONGRESOS / CONFERENCES: 1. 8th Asian Translation Traditions Conference: Conflicting Ideologies and Cultural Mediation – Hearing, Interpreting, Translating Global Voices SOAS, University of London, UK (5-7 July 2017) www.translationstudies.net/joomla3/index.php 2. 8th International Conference of the Iberian Association of Translation and Interpreting (AIETI8), Universidad de Alcalá, Madrid, Spain (8-10 March 2017) www.aieti8.com/es/presentation 3. MultiMeDialecTranslation 7 – Dialect translation in multimedia University of Southern Denmark, Odense, Denmark (17-20 May 2017) https://mmdtgroup.org 4. Texts and Contexts: The Phenomenon of Boundaries Vilnius University, Lithuania (27-28 April 2017) www.khf.vu.lt/aktualijos/skelbimai/220-renginiai/1853-texts-andcontexts- the-phenomenon-of-boundaries 5. 21st FIT World Congress: Disruption and Diversification Australian Institute of Interpreters and Translators (AUSIT), Brisbane, Australia (3-5 August 2017) www.fit2017.org/call-for-papers 6. 6th International Conference on PSIT (PSIT6) - Beyond Limits in Public Service Interpreting and Translating: Community Interpreting & Translation University of Alcalá, Spain (6-8 March 2017) www.tisp2017.com “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 213 7. International Conference: What Grammar Should Be Taught to Translators-to-be? University of Mons, Belgium (9-10 March 2017) Contact: gudrun.vanderbauwhede@umons.ac.be; indra.noel@umons.ac.be; adrien.kefer@umons.ac.be 8. The Australia Institute of Interpreters and Translators (AUSIT) 2016 National Conference Monash University, Melbourne, Australia (18-19 November 2017) www.ausit.org/AUSIT/Events/National_Miniconference_2016_Call_ for_Papers.aspx 9. 1st Congrès Mondial de la Traductologie – La traductologie : une discipline autonome Société Française de Traductologie, Université de Paris Ouest- Nanterre-La Défense, France (10-14 April 2017) www.societe-francaise-traductologie.com/congr-s-mondial 10. Working Our Core: for a Strong(er) Translation and Interpreting Profession Institute of Translation & Interpreting, Mercure Holland House Hotel, Cardiff (19-20 May 2017) www.iti-conference.org.uk 11. International conference T&R5 – Écrire, traduire le voyage / Writing, translating travel Antwerp , Belgium (31 May - 1 June 2018) winibert.segers@kuleuven.be 12. Retranslation in Context III - An international conference on retranslation Ghent University, Belgium (7-8 February 2017) www.cliv.be/en/retranslationincontext3 “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 214 13. 11th International Conference on Translation and Interpreting: Justice and Minorized Languages under a Postmonolingual Order Universitat Jaume I, Castelló de la Plana, Spain (10-12 May 2017) http://blogs.uji.es/itic11 14. 31è Congrès international d’études francophones (CIÉF) : Session de Traductologie – La francophonie à l’épreuve de l’étranger du dedans Martinique, France (26 June – 2 July 2017) https://secure.cief.org/wp/?page_id=913 15. Complexity Thinking in Translation Studies: In Search of Methodologies KU Leuven, Belgium (1-2 June 2017) www.ufs.ac.za/humanities/unlistedpages/ complexity/complexity/home-page 16. 1st International Conference on Dis/Ability Communication (ICDC): Perspectives & Challenges in 21st Century Mumbai University, India (9-11 January 2017) www.icdc2016-universityofmumbai.org 17. Lost and Found in Transcultural and Interlinguistic Translation Université de Moncton, Canada (2-4 November 2017) gillian lane-mercier@mcgill.ca; michel.mallet@umoncton.ca; denise.merkle@umoncton.ca 18. Translation and Cultural Memory (Conference Panel) American Comparative Literature Association's 2017 Annual Meeting University of Utrecht, The Netherlands (6-9 July 2017) www.acla.org/translation-and-cultural-memory 19. Media for All 7 – A Place in Between Hamad bin Khalifa University, Doha, Qatar (23-25 October 2017) http://tii.qa/en/7th-media-all-international-conference “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 215 20. Justice and Minorized Languages in a Postmonolingual Order. XI International Conference on Translation and Interpreting Universitat Jaume I, Castellón, Spain (10-12 May 2017) monzo@uji.es http://blogs.uji.es/itic11/ 21. On the Unit(y) of Translation/Des unités de traduction à l'unité de la traduction Paris Diderot University, Université libre de Bruxelles and University of Geneva (7 July 2017 (Paris) / 21 October 2017 (Brussels) / 9 December 2017 (Geneva) www.eila.univ-paris-diderot.fr/recherche/conf/ciel/traductologieplein- champ/index?s[]=traductologie&s[]=plein&s[]=champ 22. The Translator Made Corporeal: Translation History and the Archive British Library Conference Centre, London, UK (8 May 2017) deborah.dawkin@bl.uk 23. V International Conference Translating Voices Translating Regions - Minority Languages, Risks, Disasters and Regional Crises Europe House and University College London, UK (13-15 December 2017) www.ucl.ac.uk/centras/translation-news-and-events/vtranslatingvoices 24. 8th Annual International Translation Conference - 21st Century Demands: Translators and Interpreters towards Human and Social Responsibilities Qatar National Convention Centre, Doha, Qatar (27-28 March 2017) http://tii.qa/en/8th-annual-international-translation-conference 25. Complexity Thinking in Translation Studies: In Search of Methodologies KU Leuven, Belgium (1-2 June 2017) www.ufs.ac.za/humanities/unlistedpages/ complexity/complexity/home-page “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 216 26. 15th International Pragmatics Conference (IPrA 2017) – Films in Translation – All is Lost: Pragmatics and Audiovisual Translation as Cross-cultural Mediation (Guillot, Desilla, Pavesi). Conference Panel. Belfast, Northern Ireland, UK (16-21 July 2017) http://ipra.ua.ac.be/main.aspx?c=*CONFERENCE2006&n=1296 2) CURSOS, SEMINARIOS, POSGRADOS / COURSES, SEMINARS, MA PROGRAMMES: 1. MA in Intercultural Communication in the Creative Industries University of Roehampton, London, UK www.roehampton.ac.uk/postgraduate-courses/Intercultural- Communication-in-the-Creative-Industries 2. Máster Universitario en Comunicación Intercultural, Interpretación y Traducción en los Servicios Públicos Universidad de Alcalá, Spain www3.uah.es/master-tisp-uah 3. Máster Universitario de Traducción Profesional Universidad de Granada, Spain http://masteres.ugr.es/traduccionprofesional/pages/master 4. Workshop: History of the Reception of Scientific Texts in Translation – Congrès mondial de traductologie Paris West University Nanterre-La Défense, France (10-14 April 2017) https://cmt.u-paris10.fr/submissions 5. MA programme: Traduzione audiovisiva, 2016-2017 University of Parma, Italy www.unipr.it/node/13980 “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 217 6. MA in the Politics of Translation Cairo University, Egypt http://edcu.edu.eg 7. Research Methods in Translation and Interpreting Studies University of Geneva, Switzerland (Online course) www.unige.ch/formcont/researchmethods-distance1 www.unige.ch/formcont/researchmethods-distance2 8. MA programme: Investigación en Traducción e Interpretation, 2016-2017 Universitat Jaume I, Castellón, Spain monzo@uji.es www.mastertraduccion.uji.es 9. MA programme: Traduzione Giuridica - Master di Secondo Livello University of Trieste, Italy Italy http://apps.units.it/Sitedirectory/InformazioniSpecificheCdS /Default.aspx?cdsid=10374&ordinamento=2012&sede=1&int=web &lingua=15 10. Process-oriented Methods in Translation Studies and L2 Writing Research University of Giessen, Germany (3-4 April 2017) www.uni-giessen.de/gal-research-school-2017 11. Research Methods in Translation and Interpreting Studies (I): Foundations and Data Analysis (Distance Learning) www.unige.ch/formcont/researchmethods-distance1 Research Methods in Translation and Interpreting Studies (II): Specific Research and Scientific Communication Skills (Distance Learning) www.unige.ch/formcont/researchmethods-distance2 University of Geneva, Switzerland “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 218 3) LIBROS / BOOKS: 1. Carl, Michael, Srinivas Bangalore and Moritz Schaeffer (eds) 2016. New Directions in Empirical Translation Process Research: Exploring the CRITT TPR-DB. Cham: Springer. http://link.springer.com/book/10.1007/978-3-319-20358-4 2. Antoni Oliver. 2016. Herramientas tecnológicas para traductores. Barcelona: UOC. www.editorialuoc.com/herramientas-tecnologicas-para-traductores 3. Rica Peromingo, Juan Pedro. 2016. Aspectos lingüísticos y técnicos de la traducción audiovisual (TAV). Frakfurt am Main: Peter Lang. www.peterlang.com?432055 4.Takeda, Kayoko and Jesús Baigorri-Jalón (eds). 2016. New Insights in the History of Interpreting. Amsterdam: John Benjamins. https://benjamins.com/#catalog/books/btl.122/main 5. Esser, Andrea, Iain Robert Smith & Miguel Á. Bernal-Merino (eds). 2016. Media across Borders: Localising TV, Film and Video Games. London: Routledge. www.routledge.com/products/9781138809451 6. Del Pozo Triviño, M., C. Toledano Buendía, D. Casado-Neira and D. Fernandes del Pozo (eds) 2015. Construir puentes de comunicación en el ámbito de la violencia de género/ Building Communication Bridges in Gender Violence. Granada: Comares. http://cuautla.uvigo.es/sos-vics/entradas/veruno.php?id=216 7. Ramos Caro, Marina. 2016. La traducción de los sentidos: audiodescripción y emociones. Munich: Lincom Academic Publishers. http://lincom-shop.eu/epages/57709feb-b889-4707-b2cec666fc88085d. sf/de_DE/?ObjectPath=%2FShops%2F57709feb“ Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 219 b889-4707-b2cec666fc88085d% 2FProducts%2F%22ISBN+9783862886616%22 8. Horváth , Ildikó (ed.) 216. The Modern Translator and Interpreter. Budapest: Eötvös University Press. www.eltereader.hu/media/2016/04/HorvathTheModernTranslator. pdf 9. Ye, Xin. 2016. Educated Youth. Translated by Jing Han. Artarmon: Giramondo. www.giramondopublishing.com/forthcoming/educated-youth 10. Martín de León, Celia and Víctor González-Ruiz (eds). 2016. From the Lab to the Classroom and Back Again: Perspectives on Translation and Interpreting Training. Oxford: Peter Lang. www.peterlang.com?431985 11. FITISPos International Journal, 2016 vol.3: A Retrospective View on Public Service Translation and Interpreting over the Last Decade as well as the Progress and Challenges that Lie Ahead www3.uah.es/fitispos_ij 12. Dore, Margherita (ed.) 2016. Achieving Consilience. Translation Theories and Practice. Newcastle: Cambridge Scholars Publishing. www.cambridgescholars.com/achieving-consilience 13. Antonini, Rachele & Chiara Bucaria (eds). 2016. Nonprofessional Interpreting and Translation in the Media. Frankfurt am Main: Peter Lang. www.peterlang.com/index.cfm?event=cmp.ccc.seitenstruktur.detai lseiten&seitentyp=produkt&pk=82359&cid=5&concordeid=265483 14. Álvarez de Morales, Cristina & Catalina Jiménez (eds). 2016. Patrimonio cultural para todos. Investigación aplicada en traducción accesible. Granada: Tragacanto. www.tragacanto.es/?stropcion=catalogo&CATALOGO_ID=22 “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 220 15. Poznan Studies in Contemporary Linguistics, special issue on Language Processing in Translation, Volume 52, Issue 2, Jun 2016. www.degruyter.com/view/j/psicl.2016.52.issue-2/issuefiles/ psicl.2016.52.issue-2.xml?rskey=z4L1sf&result=6 16. Translation and Conflict: Narratives of the Spanish Civil War and the Dictatorship Contact: alicia.castillovillanueva@dcu.ie; lucia.pintado@dcu.ie 17. Cerezo Merchán, Beatriz, Frederic Chaume, Ximo Granell, José Luis Martí Ferriol, Juan José Martínez Sierra, Anna Marzà y Gloria Torralba Miralles. 2016. La traducción para el doblaje. Mapa de convenciones. Castelló de la Plana: Publicacions de la Universitat Jaume I. www.tenda.uji.es/pls/www/!GCPPA00.GCPPR0002?lg=CA&isbn=97 8-84-16356-00-3 18. Martínez Tejerina, Anjana. 2016. El doblaje de los juegos de palabras. Barcelona: Editorial UOC. www.editorialuoc.com/el-doblaje-de-los-juegos-de-palabras 19. Chica Núñez, Antonio Javier. 2016. La traducción de la imagen dinámica en contextos multimodales. Granada: Ediciones Tragacanto. www.tragacanto.es 20. Valero Garcés, Carmen (ed.) 2016. Public Service Interpreting and Translation (PSIT): Training, Testing and Accreditation. Alcalá: Universidad de Alcalá. www1.uah.es/publicaciones/novedades.asp 21. Rodríguez Muñoz, María Luisa and María Azahara Veroz González (Eds) 2016. Languages and Texts Translation and Interpreting in Cross Cultural Environments. Córdoba: Universidad de Córdoba. www.uco.es/ucopress/index.php/es/catalogo/materias- 3/product/548-languages-and-texts-translation-and-interpreting“ Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 221 in-cross-cultural-environments 22. Mereu, Carla. 2016. The Politics of Dubbing. Film Censorship and State Intervention in the Translation of Foreign Cinema in Fascist Italy. Oxford: Peter Lang. www.peterlang.com/view/product/46916 23. Venuti, Lawrence (ed.) 2017. Teaching Translation: Programs, Courses, Pedagogies. New York: Routledge. www.routledge.com/Teaching-Translation-Programs-coursespedagogies/ VENUTI/p/book/9781138654617 24. Jankowska, Anna. 2015. Translating Audio Description Scripts. Translation as a New Strategy of Creating Audio Description. Frankfurt: Peter Lang. www.peterlang.com/view/product/21517 25. Cadwell, Patrick and Sharon O'Brien. 2016. Language, culture, and translation in disaster ICT: an ecosystemic model of understanding. Perspectives: Studies in Translatology. www.tandfonline.com/doi/full/10.1080/0907676X. 2016.1142588 26. Baumgarten, Stefan and Chantal Gagnon (eds). 2016. Translating the European House - Discourse, Ideology and Politics (Selected Papers by Christina Schäffner). Newcastle: Cambridge Scholars Publishing. www.cambridgescholars.com/translating-the-european-house 27. Gambier, Yves and Luc van Doorslaer (eds) 2016. Border Crossings – Translation Studies and other disciplines. Amsterdam: John Benjamins. www.benjamins.com/#catalog/books/btl.126/main 28. Setton, Robin and Andrew Dawrant. 2016. Conference Interpreting – A Complete Course. Amsterdam: John Benjamins. https://benjamins.com/#catalog/books/btl.120/main “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 222 29. Setton, Robin and Andrew Dawrant. 2016. Conference Interpreting – A Trainer’s Guide. Amsterdam: John Benjamins. https://benjamins.com/#catalog/books/btl.121/main 5) REVISTAS / JOURNALS: 1. Technology and Public Service Translation and Interpreting, Special Issue of Translation and Interpreting Studies 13(3) Contact: Nike Pokorn (nike.pokorn@ff.uni-lj.si) & Christopher Mellinger (cmellin2@kent.edu) www.atisa.org/tis-style-sheet 2. Translator Quality – Translation Quality: Empirical Approaches to Assessment and Evaluation, special issue of Linguistica Antverpiensia, New Series (16/2017) Contact: Geoffrey S. Koby (gkoby@kent.edu); Isabel Lacruz (ilacruz@kent.edu) https://lans-tts.uantwerpen.be/index.php/LANSTTS/ announcement 3. Special Issue of the Journal of Internationalization and Localization on Video Game Localisation: Ludic Landscapes in the Digital Age of Translation Studies Contacts: Xiaochun Zhang (xiaochun.zhang@univie.ac.at) and Samuel Strong (samuel.strong.13@ucl.ac.uk) 4. mTm Translation Journal: Non-thematic issue, Vol. 8, 2017 www.mtmjournal.gr Contacts: Anastasia Parianou (parianou@gmail.com) and Panayotis Kelandrias (kelandrias@ionio.gr) “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 223 5. CLINA - An Interdisciplinary Journal of Translation, Interpreting and Intercultural Communication, Special Issue on Interpreting in International Organisations. Research, Training and Practice, 2017 (2) revistaclina@usal.es http://diarium.usal.es/revistaclina/home/call-for-papers 6. Technology and Public Service Translation and Interpreting, Special Issue of Translation and Interpreting Studies, 2018, 13(3) www.atisa.org/call-for-papers 7. Literatura: teoría, historia, crítica, special issue on Literature and Translation www.literaturathc.unal.edu.co 8. Tradumàtica: Journal of Translation Technologies Issue 14 (2016): Translation and mobile devices www.tradumatica.net/revista/cfp.pdf 9. Ticontre. Teoria Testo Traduzione. Special issue on Narrating the Self in Self-translation www.ticontre.org/files/selftranslation-it_en.pdf 10. Terminology, International Journal of Theoretical and Applied Issues in Specialized Communication Thematic issue on Food and Terminology, 23(1), 2017 www.benjamins.com/series/term/call_for_papers_special_issue_23 -1.pdf 11. Cultus: the Journal of Intercultural Communication and Mediation. Thematic issue on Multilinguilism, Translation, ELF or What?, Vol. 10, 2017 www.cultusjournal.com/index.php/call-for-papers 12. Translation Spaces Special issue on No Hard Feelings? Exploring Translation as an Emotional Phenomenon “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 224 Contact: severine.hubscher-davidson@open.ac.uk 13. Revista electrónica de didáctica de la traducción y la interpretación (redit), Vol. 10 www.redit.uma.es/Proximo.php 14. Social Translation: New Roles, New Actors Special issue of Translation Studies 12(2) http://explore.tandfonline.com/cfp/ah/rtrs-si-cfp 15. Translation in the Creative Industries, special issue of The Journal of Specialised Translation 29, 2018 www.jostrans.org/Translation_creative_industries_Jostrans29.pdf 16. Translation and the Production of Knowledge(s), special issue of Alif 38, 2018 Contact: mona@monabaker.com,alifecl@aucegypt.edu, www.auceg ypt.edu/huss/eclt/alif/Pages/default.aspx 17. Revista de Llengua i Dret http://revistes.eapc.gencat.cat/index.php/rld/index 18. Call for proposals for thematic issues, Linguistica Antverpiensia New Series https://lans-tts.uantwerpen.be/index.php/LANSTTS/ announcement/view/8 19. Journal On Corpus-based Dialogue Interpreting Studies, special issue of The Interpreters’ Newsletter 22, 2017 www.openstarts.units.it/dspace/handle/10077/2119 20. Díaz Cintas, Jorge, Ilaria Parini and Irene Ranzato (eds) 2016. Ideological Manipulation in Audiovisual Translation, special issue of “Altre Modernità”. http://riviste.unimi.it/index.php/AMonline/issue/view/888/show Toc “Transfer” XII: 1-2 (mayo 2017), pp. 212-225. ISSN: 1886-554 225 21. PUNCTUM- International Journal of Semiotics, special issue on Semiotics of Translation, Translation in Semiotics. Volume 1, Issue 2 (2015) http://punctum.gr 22. The Interpreters' Newsletter, Special Issue on Dialogue Interpreting, 2015, Vol. 20 www.openstarts.units.it/dspace/handle/10077/11848 23. Gallego-Hernández, Daniel & Patricia Rodríguez-Inés (eds.) 2016. Corpus Use and Learning to Translate, almost 20 Years on. Special Issue of Cadernos de Tradução 36(1). https://periodicos.ufsc.br/index.php/traducao/issue/view/2383/s howToc 24. 2015. Special Issue of IberoSlavica on Translation in Iberian- Slavonic Cultural Exchange and beyond. https://issuu.com/clepul/docs/iberoslavica_special_issue 26. The AALITRA Review: A Journal of Literary Translation, 2016 (11) www.lib.latrobe.edu.au/ojs/index.php/AALITRA/index 27. Transcultural: A Journal of Translation and Cultural Studies 8.1 (2016): "Translation and Memory" https://ejournals.library.ualberta.ca/index.php/TC/issue/view/18 77/showToc 28. JoSTrans, The Journal of Specialised Translation, issue 26 www.jostrans.org 29. L’Écran traduit, 5 http://ataa.fr/revue/archives/4518

Aim/Background: The aim of our study was to identify the predictive factors of functional outcome at 3 months post stroke, at Tingandogo University Hospital, in Ouagadougou, Burkina Faso, in order to contribute to the improvement of the functional prognosis of patients suffering from stroke. Materials and methods: This involved a hospital study, longitudinal prospective and anaytical, of patients hospitalized for stroke, from March 2015 to February 2016, at the Tingandogo University Hospital, in Ouagadougou, then followed in outpatient neurology, for at least 3 months, after discharge from hospital. The sociodemographic, clinical and CT characteristics of the patients on admission, the mortality at 3 months, and the evaluation of the functional outcome of the survivors at 3 months by the modified Rankin score (mRS) were analyzed. Motor functional outcome was considered favorable if mRS ≤ 2 and unfavorable if mRS ≥ 3. Multivariate analysis with logistic regression made it possible to identify independent predictors of functional outcome at 3 months post-stroke. Results: A total of 232 patients were collected, i.e. 62.9% of cerebral infarction and 37.1% of intracerebral hemorrhage, with a male predominance (62.93%), an average age of 60.9 years +/- 14.5 years. On admission, 6% of patients were in a coma and 35.8% had severe to very severe neurological impairment. Motor physiotherapy indicated in 77.3% of patients was but only performed in 47.4% At 3 months post stroke, 27 patients had died (31%). Among the 160 surviving patients, 91 patients (56.9%) were autonomous or independent (mRS≤2) and 69 patients (43.1%) were still dependent (mRS≥3). The independent predictors of unfavorable functional outcome (mRS≥3) at 3 months post-stroke were: age ≥ 60 years (p = 0.007), pre-stroke disability (p = 0.032), severe neurological deficit at admission (p = 0.018), impaired alertness on admission (p = 0.005) and large infarcts (p=0.004). Conclusion: Advanced age, pre-stroke disability, clinical and CT markers of the extent of brain damage, influence functional outcome at 3 months post-stroke in our context. Improving the quality of care for all patients, even the oldest, and better access to quality functional rehabilitation will help improve the functional prognosis of stroke patients.

Background: The prognosis is poor for most patients with lymphoma who do not respond to initial therapy, leaving an unmet need for effective therapies for this patient population. Pembrolizumab, a programmed death 1 (PD-1) inhibitor, has shown clinically meaningful antitumor activity and manageable safety in multiple tumor types, including relapsed or refractory (R/R) classic Hodgkin lymphoma (R/R cHL) and R/R primary mediastinal large B-cell lymphoma. Results of preclinical studies have shown that lymphocyte activation gene-3 (LAG-3), a cell surface immunomodulatory receptor protein, is elevated in hematologic malignancies and that blockade of LAG-3 and the PD-1/PD ligand 1 (PD-L1) axis has synergistic antitumor activity in solid tumors. MK-4280 is a humanized anti-LAG-3 monoclonal antibody that blocks the interaction between LAG-3 and its ligand. The current study will evaluate the safety and efficacy of pembrolizumab combined with MK-4280 in patients with selected hematologic malignancies. Study Design and Methods: This phase 1-2 multisite, multicohort, open-label study (NCT03598608) will have a safety lead-in phase to establish the preliminary recommended phase 2 dose (RP2D) followed by an efficacy expansion phase. In the safety lead-in phase, a modified toxicity probability interval design will be used to establish the RP2D of pembrolizumab plus MK-4280. Dose-limiting toxicities will be assessed during the first cycle. The study will enroll patients with PD-1/PD-L1 inhibitor-naive R/R cHL (cohort 1), PD-1/PD-L1 inhibitor-refractory R/R cHL (cohort 2), R/R diffuse large B-cell lymphoma (cohort 3), and R/R indolent non-Hodgkin lymphoma (cohort 4). Adult patients (age ≥18 years) with ECOG PS 0 or 1 and adequate organ function who meet the standard eligibility criteria for pembrolizumab studies, such as no prior receipt of anti-PD-1 antibody and no active infection necessitating systemic therapy, will be enrolled. Patients will receive pembrolizumab 200 mg every 3 weeks and MK-4280 for 35 cycles (~2 years) or until documented disease progression, unacceptable toxicity, intercurrent illness preventing further administration of study drug, or withdrawal from study. Tumor response will be assessed by computed tomography/positron emission tomography every 12 weeks to confirm complete response or as clinically indicated, using revised response criteria for malignant lymphoma. Patients will be monitored for adverse events (AEs) until 30 days after study treatment end (90 days for serious AEs). After confirmed disease progression or start of new anticancer therapy, patients will be contacted by telephone every 12 weeks for survival status. All-patients-as-treated (APaT), defined as all patients who received ≥1 dose of the study drug, will constitute the safety population. The full analysis set, defined as all patients with a baseline assessment who have measurable disease by investigator assessment and who were administered a dose of study intervention, regardless of dose level, will constitute the efficacy population. The primary objective is to determine the safety and tolerability of MK-4280 plus pembrolizumab and establish its RP2D. Secondary objectives are to evaluate the objective response rate of MK-4280 when combined with pembrolizumab per investigator assessment and to evaluate the pharmacokinetics of MK-4280 and pembrolizumab. Exploratory objectives are to evaluate overall survival, progression-free survival, and best overall response for MK-4280 and pembrolizumab; to assess the presence of circulating MK-4280 and anti-pembrolizumab antibodies; to assess target engagement and pharmacodynamics of MK-4280 through biomarker evaluation; and to identify molecular biomarkers associated with clinical response/resistance, safety, pharmacodynamics, and/or the mechanism of action of MK-4280 and pembrolizumab. At least 14 patients (≥3 per cohort) will be enrolled in the safety lead-in phase; approximately 120 patients (≤30 per cohort) will be enrolled in the efficacy expansion phase. Disclosures Armand: Serventa: Research Funding; Sigma-Tau: Research Funding; Otsuka: Research Funding; Merck & Co.: Employment, Membership on an entity's Board of Directors or advisory committees, Other: Travel fees, gifts, and others, Research Funding; Roche: Research Funding; Pfizer Inc: Research Funding; Affimed: Research Funding; Bristol Myers Squibb Pharmaceuticals: Employment, Membership on an entity's Board of Directors or advisory committees, Other: Travel fees, gifts, and others, Research Funding; Infinity Pharmaceuticals: Employment, Membership on an entity's Board of Directors or advisory committees; Dana-Farber Cancer Institute: Employment. Zinzani:PORTOLA: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; ROCHE: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; SANDOZ: Membership on an entity's Board of Directors or advisory committees; SANOFI: Consultancy; CELGENE: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; EUSAPHARMA: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; KYOWA KIRIN: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; CELLTRION: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; GILEAD: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; JANSSEN-CILAG: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; SERVIER: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; IMMUNE DESIGN: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; MSD: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; VERASTEM: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Palcza:Merck & Co., Inc.: Employment, Other: Stock ownership. Healy:Merck & Co., Inc.: Employment, Other: Stock ownership. Nahar:Merck & Co., Inc.: Employment. Marinello:Merck & Co., Inc.: Employment, Other: Travel fees, gifts, and others; stock or other ownership. Gregory:Gilead: Membership on an entity's Board of Directors or advisory committees; AbbVie: Other: grant pending, Research Funding; Monash University: Research Funding; Janssen: Other: grant pending, Research Funding; Roche: Speakers Bureau; Beigene: Other: Grant pending, Research Funding; Melbourne Haematology: Consultancy, Honoraria, Other: Travel fees and conference support, Speakers Bureau; Celgene: Other: grant pending, Research Funding; MSD: Other: grant pending, Research Funding.

Abstract BACKGROUND Chordoma and chondrosarcoma account for the majority of skull base tumors affecting the petroclival region. Chondrosarcoma has better prognosis than chordoma; heavy particle therapy is often indicated for residual/recurrent chordoma. Preoperative, precise diagnosis of the tumor would be desirable, as it can potentially impact on the choice of a surgical approach and the aggressiveness of surgery. METHODS We conducted a radiomics study to create a machine learning model distinguishing chondrosarcoma from chordoma. We collected DICOM T2-weighted images and T1-weighted images with gadolinium (GdT1) enhancement in the consective patients of chordoma or chondrosarcoma who underwent surgery at The University of Tokyo Hospital from September of 2012 to January of 2019. We selected patients with uniform MRI images. VOI (volume of interest) was set using Monaco (https://www.elekta.com/software-solutions/treatment-management/external-beam-planning/monaco.html). Not only sematic features but also agnostic features were calculated. The original images and 8 wavelet transformed images were calculated for texture agnostic features such as Gray-Level Co-occurrence Matrix (GLCM). Features were selected by recursive feature elimination (RFE). The final model evaluation was performed by average area under the curve (AUC). RESULTS The study population included 17 chordomas and 22 chondrosarcomas in a total of 39 patients. 476 features were obtained per image sequence. The number of features per case was 476 × 2 = 952 The most accurate machine learning model was created using the extracted three features from only T2. The best AUC was 0.77 ± 0.11 in logistic regression (dataset was divided randomly into halves, average value of AUC calculated six times). CONCLUSIONS This novel machine learning model can differentiate chordoma and chondrosarcoma reasonably well. A validation study with a larger number of patients is warranted.

Background Writing and digital storage have largely replaced organic memory for encoding and retrieval of information in the modern era, with a corresponding decrease in emphasis on memorization in Western education. In health professional training, however, there remains a large corpus of information for which memorization is the most efficient means of ensuring: A) that the trainee has the required information readily available; and B) that a foundation of knowledge is laid, upon which the medical trainee builds multiple, complex layers of detailed information during advanced training. The carefully staged progression in early- to late- years’ medical training from broad concepts (e.g. gross anatomy and pharmacology) to in-depth, specialised disciplinary knowledge (e.g. surgical interventions and follow-on care post-operatively) has clear parallels to the progression of training and knowledge exposure that Australian Aboriginal youths undergo in their progression from childhood to adulthood to Tribal Elders. Methods As part of the Rural Health curriculum and the undergraduate Nutrition and Dietetics program in the Monash University Faculty of Medicine, Nursing, and Health Sciences, we tested Australian Aboriginal techniques of memorization for acquisition and recall of novel word lists by first-year medical students (N = 76). We also examined undergraduate student evaluations (N = 49) of the use of the Australian Aboriginal memory technique for classroom study of foundational biomedical knowledge (the tricarboxylic acid cycle) using qualitative and quantitative analytic methods drawing from Bloom’s taxonomy for orders of thinking and learning. Acquisition and recall of word lists were assessed without memory training, or after training in either the memory palace technique or the Australian Aboriginal narrative technique. Results Both types of memory training improved the number of correctly recalled items and reduced the frequency of specific error types relative to untrained performance. The Australian Aboriginal method resulted in approximately a 3-fold greater probability of improvement to accurate recall of the entire word list (odds ratio = 2.82; 95% c.i. = 1.15–6.90), vs. the memory palace technique (odds ratio = 2.03; 95% c.i. = 0.81–5.06) or no training (odds ratio = 1.5; 95% c.i. = 0.54–4.59) among students who did not correctly recall all list items at baseline. Student responses to learning the Australian Aboriginal memory technique in the context of biomedical science education were overwhelmingly favourable, and students found both the training and the technique enjoyable, interesting, and more useful than rote memorization. Our data indicate that this method has genuine utility and efficacy for study of biomedical sciences and in the foundation years of medical training.

Abstract Background: Zanubrutinib (zanu) is a selective next-generation Bruton tyrosine kinase (BTK) inhibitor designed to have high specificity for BTK and minimize off-target effects (Guo, J Med Chem 2019;62:7923-40). In a phase 1/2 study, zanu demonstrated complete and sustained BTK occupancy in both peripheral blood mononuclear cells and lymph nodes and was associated with durable clinical responses in patients (pts) with CLL/SLL (Tam, Blood 2019;134:851-9). Here, we present interim results for the phase 3 SEQUOIA (BGB-3111-304; NCT03336333) trial, which evaluated the efficacy and safety of zanu vs BR in TN pts with CLL/SLL. Methods: SEQUOIA is an open-label, global phase 3 study that randomized TN pts with CLL/SLL without del(17p) to receive zanu 160 mg twice daily until progressive disease or unacceptable toxicity, or bendamustine 90 mg/m 2 on day 1 and 2 and rituximab 375 mg/m 2 in cycle 1, 500 mg/m 2 in cycles 2-6 for 6 × 28-day cycles. Adult pts with CLL/SLL who met International Workshop on CLL (iwCLL) criteria for treatment (Hallek, Blood 2008;111:5446-56) were eligible if they were either ≥65 y or unsuitable for treatment with fludarabine, cyclophosphamide and rituximab. Central verification of del(17p) status by fluorescence in situ hybridization was required. Pts were stratified by age (&lt;65 y vs ≥65 y), Binet Stage (C vs A/B), IGHV mutational status, and geographic region. The primary endpoint was independent review committee (IRC)-assessed progression-free survival (PFS) for zanu vs BR. Secondary endpoints included PFS by investigator assessment (INV), overall response rate (ORR; by IRC and INV), overall survival (OS), and safety. Responses for CLL and SLL were assessed per modified iwCLL criteria (Hallek, Blood 2008;111:5446-56; J Clin Oncol 2012;30:2820-2) and Lugano criteria (Cheson, J Clin Oncol 2014;32:3059-68), respectively. Adverse events (AEs) were recorded until disease progression to support safety evaluation over an equivalent time period. Results: From 31 Oct 2017-22 Jul 2019, 479 pts without del(17p) were randomized to zanu (n=241) and BR (n=238). Treatment groups were well balanced for demographic and disease characteristics (zanu vs BR): median age, 70.0 y vs 70.0 y; unmutated IGHV, 53.4% (125/234) vs 52.4% (121/231); and del(11q), 17.8% vs 19.3%. At median follow-up (26.2 mo), PFS by IRC was significantly prolonged with zanu vs BR (HR 0.42, 95% CI 0.28-0.63, 1-sided and 2-sided P&lt;0.0001; Figure); similar results were observed by INV (HR 0.42, 95% CI 0.27-0.66, 1-sided P&lt;0.0001, 2-sided P=0.0001). Treatment benefit for zanu was observed across subgroups for age, Binet stage, bulky disease, and del(11q) status. Treatment benefit was also observed for pts with unmutated IGHV (HR 0.24, 1-sided and 2-sided P&lt;0.0001), but not for mutated IGHV (HR 0.67, 1-sided P=0.0929). Estimated 24-mo PFS (IRC) for zanu vs BR was 85.5% (95% CI 80.1%- 89.6%) vs 69.5% (95% CI 62.4%-75.5%). ORR by IRC for zanu vs BR was 94.6% (95% CI 91.0%-97.1%) vs 85.3% (95% CI 80.1%-89.5%). Complete response rate was 6.6% with zanu and 15.1% with BR. ORR by INV for zanu vs BR was 97.5% (95% CI 94.7%-99.1%) vs 88.7% (95% CI 83.9%-92.4%) Estimated 24-mo OS for zanu vs BR was 94.3% (95% CI 90.4%-96.7%) and 94.6% (95% CI 90.6%-96.9%). The most common AEs are shown in the Table. AEs of interest occurring during the full reporting period (pooled terms, zanu vs BR) included atrial fibrillation (any grade [gr]: 3.3% vs 2.6%), bleeding (any gr/gr≥3: 45.0%/3.8% vs 11.0%/1.8%), hypertension (any gr: 14.2% vs 10.6%), infection (any gr/gr≥3: 62.1%/16.3% vs 55.9%/18.9%), and neutropenia (any gr/gr≥3: 15.8%/11.7% vs 56.8%/51.1%). Treatment discontinuation due to AEs occurred in 20 pts (8.3%) receiving zanu vs 31 pts (13.7%) receiving BR; 85.5% of pts receiving zanu remain on treatment. AEs leading to death occurred in 11 pts (4.6%) receiving zanu vs 12 pts (5.3%) receiving BR. No sudden deaths were reported. Conclusions: In this global registrational trial, zanu demonstrated statistically significant improvement in PFS compared to BR as assessed by IRC. Superiority was also observed in PFS by INV as well as ORR by both IRC and INV. Zanu was generally well tolerated, with low rates of atrial fibrillation consistent with those observed in the phase 3 ASPEN (Tam, Blood 2020;136:2038-2050) and ALPINE studies (Hillmen, EHA 2021 #LB1900). These data support the potential utility of zanu in the frontline management of pts with TN CLL/SLL. Figure 1 Figure 1. Disclosures Tam: AbbVie: Consultancy, Honoraria, Research Funding; BeiGene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Pharmacyclics: Honoraria; Novartis: Honoraria; Loxo: Consultancy; Roche: Consultancy, Honoraria. Giannopoulos: Polish Myeloma Consortium, Next Generation Hematology Association: Membership on an entity's Board of Directors or advisory committees; Sandoz: Consultancy, Honoraria; Pfizer: Honoraria; Teva: Honoraria; TG Therapeutics: Research Funding; Abbvie: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Astra-Zeneca: Consultancy, Honoraria, Research Funding; Bei-Gene: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Sanofi-Genzyme: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria, Research Funding; Karyopharm: Consultancy, Honoraria, Research Funding; GSK: Consultancy, Honoraria, Research Funding; Gilead: Honoraria, Research Funding. Jurczak: Astra Zeneca: Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Research Funding; Bayer: Research Funding; BeiGene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celtrion: Research Funding; Celgene: Research Funding; Debbiopharm: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Loxo Oncology: Membership on an entity's Board of Directors or advisory committees; Sandoz: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Epizyme: Research Funding; Incyte: Research Funding; Merck: Research Funding; Takeda: Research Funding; TG Therapeutics: Research Funding. Šimkovič: Janssen, Gilead, Roche, AstraZeneca, and AbbVie: Other: consultancy fees, advisory board participation fees, travel grants, and honoraria; University Hospital Hradec Kralove: Current Employment; AbbVie: Consultancy, Current equity holder in publicly-traded company, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen-Cilag: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; Merck: Current equity holder in publicly-traded company; Eli Lilly: Current equity holder in publicly-traded company; J&J: Current equity holder in publicly-traded company; Gilead: Other: Travel, Accommodations, Expenses. Shadman: Abbvie, Genentech, AstraZeneca, Sound Biologics, Pharmacyclics, Beigene, Bristol Myers Squibb, Morphosys, TG Therapeutics, Innate Pharma, Kite Pharma, Adaptive Biotechnologies, Epizyme, Eli Lilly, Adaptimmune , Mustang Bio and Atara Biotherapeutics: Consultancy; Mustang Bio, Celgene, Bristol Myers Squibb, Pharmacyclics, Gilead, Genentech, Abbvie, TG Therapeutics, Beigene, AstraZeneca, Sunesis, Atara Biotherapeutics, GenMab: Research Funding. Österborg: BeiGene: Research Funding; Gilead: Research Funding. Laurenti: Janssen: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria; Gilead: Honoraria; Roche: Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; BeiGene: Honoraria. Walker: BeiGene: Consultancy; Acerta: Consultancy. Opat: Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Astra Zeneca: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BeiGene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Research Funding; Sandoz: Research Funding; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; CSL Behring: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Honoraria, Membership on an entity's Board of Directors or advisory committees; Monash Health: Current Employment. Chan: AbbVie: Membership on an entity's Board of Directors or advisory committees; Eusa: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; GSK: Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Travel, Accommodations, Expenses; Celgene: Other: Travel, Accommodations, Expenses; Roche: Speakers Bureau. Ciepluch: Copernicus Wojewodzkie Centrum Onkologii: Current Employment. Greil: Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; AstraZeneca: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Sandoz: Honoraria, Research Funding; Amgen: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sankyo: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Daiichi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; MSD: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding. Trněný: AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Portola: Honoraria, Membership on an entity's Board of Directors or advisory committees; MorphoSys: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; 1st Faculty of Medicine, Charles University, General Hospital in Prague: Current Employment; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Celgene: Consultancy; Amgen: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Gilead Sciences: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; Incyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; AstraZeneca: Honoraria. Brander: Verastem: Consultancy; ArQule: Research Funding; Genentech: Consultancy, Research Funding; TG Therapeutics: Consultancy, Research Funding; Juno Therapeutics/Celgene/Bristol Myers Squibb: Research Funding; MEI Pharma: Research Funding; Novartis: Research Funding; LOXO: Research Funding; Ascentage: Research Funding; AstraZeneca: Research Funding; BeiGene: Research Funding; DTRM: Research Funding; AbbVie: Consultancy, Other: informCLL registry steering committee, Research Funding; Pfizer: Consultancy, Other: Biosimilars outcomes research panel; NCCN: Other: panel member; ArQule/Merck: Consultancy; Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding. Flinn: Loxo: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Juno Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Nurix Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; IGM Biosciences: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Forma Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Forty Seven: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; MorphoSys: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Roche: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Janssen: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Novartis: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Takeda: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Great Point Partners: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Genentech: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; AstraZeneca: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; AbbVie: Consultancy, Other: All Consultancy and Research Funding payments made to Sarah Cannon Research Institute, Research Funding; Gilead Sciences: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Celgene: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Curis: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Infinity Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Karyopharm Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Kite, a Gilead Company: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Incyte: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Merck: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; BeiGene: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Calithera Biosciences: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Seagen: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; TG Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Iksuda Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Constellation Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; ArQule: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Unum Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Agios: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Verastem: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Acerta Pharma: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Yingli Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Trillium Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Teva: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Rhizen Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Portola Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Pfizer: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Triphase Research & Development Corp.: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Century Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Hutchison MediPharma: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Vincerx Pharma: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Sarah Cannon Research Institute: Current Employment; Servier Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Yingli Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Seagen: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Servier Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Unum Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute, Research Funding; Johnson & Johnson: Current holder of individual stocks in a privately-held company; Seattle Genetics: Research Funding. Verner: Janssen-Cilag Pty Ltd: Research Funding. Brown: Janssen: Consultancy; MEI Pharma: Consultancy; Rigel: Consultancy; Bristol-Myers Squib/Juno/Celegene: Consultancy; Novartis: Consultancy; Invectys: Other: Data Safety Monitoring Committee Service; TG Therapeutics: Research Funding; Abbvie: Consultancy; Acerta/Astra-Zeneca: Consultancy; Beigene: Consultancy; Catapult: Consultancy; Loxo/Lilly: Research Funding; Sun: Research Funding; Nextcea: Consultancy; Gilead: Research Funding; SecuraBio: Research Funding; Eli Lilly and Company: Consultancy; Genentech/Roche: Consultancy; Pfizer: Consultancy; Morphosys AG: Consultancy. Kahl: AbbVie, Adaptive, ADCT, AstraZeneca, Bayer, BeiGene, Bristol-Myers Squibb, Celgene, Genentech, Incyte, Janssen, Karyopharm, Kite, MEI, Pharmacyclics, Roche, TG Therapeutics, and Teva: Consultancy; AbbVie, Acerta, ADCT, AstraZeneca, BeiGene, Genentech: Research Funding. Ghia: Sunesis: Research Funding; Roche: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Gilead: Consultancy, Research Funding; Celgene/Juno/BMS: Consultancy, Honoraria; BeiGene: Consultancy, Honoraria; ArQule/MSD: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria, Research Funding; Acerta/AstraZeneca: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding. Tian: BeiGene: Current Employment; AbbVie: Ended employment in the past 24 months. Marimpietri: BeiGene USA: Current Employment, Current equity holder in publicly-traded company, Divested equity in a private or publicly-traded company in the past 24 months. Paik: BeiGene USA, Inc.: Current Employment, Current equity holder in publicly-traded company. Cohen: BeiGene: Current Employment, Current equity holder in publicly-traded company, Other: Travel, Accommodations, Expenses. Huang: BeiGene: Current Employment, Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company, Divested equity in a private or publicly-traded company in the past 24 months, Other: Travel, Accommodations, Expenses; Protara Therapeutics: Current holder of individual stocks in a privately-held company, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company). Robak: Biogen, Abbvie, Octapharma, Janssen: Honoraria, Other: Advisory board; AstraZeneca, Abbvie, Janssen, Octapharma, Gilead,Oncopeptides AB, Pharmacyclics, Pfizer, GlaxoSmithKline, Biogen: Research Funding; Medical University of Lodz: Current Employment. Hillmen: Pharmacyclics: Honoraria, Research Funding; Roche: Research Funding; Gilead: Research Funding; AstraZeneca: Honoraria; SOBI: Honoraria; BeiGene: Honoraria; AbbVie: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding; Janssen: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding. OffLabel Disclosure: Zanubrutinib is an investigational agent and has not been approved for TN CLL/SLL without del(17p) in the US

Abstract Background : Ibr, an established standard of care in CLL, is a once-daily Bruton tyrosine kinase inhibitor with significant progression-free survival (PFS) and overall survival benefit shown in multiple randomized phase 3 studies in first-line CLL. Ven, an oral BCL-2 inhibitor approved as a single agent or combined with rituximab or obinutuzumab for CLL treatment, achieves high rates of undetectable MRD (uMRD). Ibr and Ven, with distinct and complementary mechanisms of action, work synergistically to mobilize CLL cells from lymph nodes and lymphoid niches, enhance cell killing, and eliminate distinct CLL cell populations. CAPTIVATE (PCYC-1142; NCT02910583) is an international, multicenter phase 2 study evaluating first-line Ibr + Ven in 2 cohorts: MRD and Fixed-Duration (FD). Patients (pts) first received 3 cycles of Ibr followed by 12 cycles of combined Ibr + Ven. In the primary analysis of the MRD cohort, pts with Confirmed uMRD who after fixed duration treatment were randomized to placebo or continued Ibr had similar post-randomization 1-year DFS rates (95% and 100%, respectively) (Wierda, ASH 2020). Two-year post-randomization results are presented. Methods : Pts aged &lt;70 years with previously untreated CLL received 3 cycles of Ibr lead-in then 12 cycles of combined Ibr + Ven (oral Ibr 420 mg/day; oral Ven ramp-up to 400 mg/day). During cycle 16, pts with Confirmed uMRD (defined as uMRD serially over ≥2 assessments ≥3 mo apart, and in both peripheral blood [PB] and bone marrow [BM]) were randomized 1:1 to receive double-blind treatment with placebo or single-agent Ibr. Pts who did not meet the definition of Confirmed uMRD were randomized 1:1 to receive open-label treatment with single-agent Ibr or continued Ibr + Ven. Endpoints presented include 2-year DFS rate (defined as survival without progression [PD] or MRD relapse post-randomization) in pts with Confirmed uMRD randomized to placebo vs Ibr, rates of uMRD (&lt;10 -4 by 8-color flow cytometry), investigator-assessed best response per iwCLL, investigator-assessed PFS, and adverse events (AEs). Results : 164 pts were enrolled. Median age was 58 years (range, 28-69). High-risk features included unmutated IGHV (60% of pts), del(17p)/TP53 mutation (20%), complex karyotype (19%), and del(11q) without del(17p) (17%). After 12 cycles of Ibr + Ven, 149 pts were randomized: Confirmed uMRD to placebo (n=43) or Ibr (n=43); without Confirmed uMRD to Ibr (n=31) or Ibr + Ven (n=32). Median overall follow-up was 38.2 mo (range, 15.0-47.9); median post-randomization follow-up was 24.0 mo (range, 5.8-33.1). In pts with Confirmed uMRD randomized to placebo versus Ibr, no new DFS events occurred since the primary analysis; 2-year DFS rates post-randomization remained unchanged at 95% (placebo) vs 100% (Ibr), for a 4.7% difference (95% CI -1.6-10.9) and overall log-rank P=0.1573 (Figure 1). In the placebo and Ibr arms post-randomization, modest improvements were observed in complete response (CR) rates, including CR with incomplete bone marrow recovery (CRi) (Figure 2). Estimated 36-mo PFS rates were 95% with placebo and 100% with Ibr. In pts without Confirmed uMRD randomized to Ibr vs Ibr + Ven, greater improvements in best uMRD rates and CR/CRi rates were observed with Ibr + Ven than with Ibr post-randomization (Figure 2). Estimated 36-mo PFS rates were 97% with both Ibr and Ibr + Ven. Median treatment duration was 36.8 mo (range, 0.5-47.9) in all pts (N=164). Modest differences in AEs were observed across treatment arms post-randomization. During the overall study period across all-treated pts, the most frequent grade 3/4 AEs were neutropenia (36%), hypertension (10%), thrombocytopenia (5%), and diarrhea (5%). With up to 48 mo of treatment, AEs led to discontinuation of Ibr or Ven in 13% of pts; no new safety signals emerged. Conclusions : First-line Ibr + Ven is an all-oral, once-daily, chemotherapy-free regimen that provides deep responses in pts with CLL. With an additional year of follow-up and no new MRD relapses, PDs or deaths in pts with confirmed uMRD, the 2-year DFS rate in the MRD-guided placebo arm remained high at 95% while 3-year PFS rates were ≥95% across all randomized treatment arms. The results in pts with Confirmed uMRD support the potential for treatment-free remission with fixed-duration treatment, including in pts with high-risk features. High rates of uMRD were achieved; the safety profile of Ibr + Ven was consistent with known safety profile for each agent. Figure 1 Figure 1. Disclosures Ghia: Acerta/AstraZeneca: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria, Research Funding; ArQule/MSD: Consultancy, Honoraria; BeiGene: Consultancy, Honoraria; Celgene/Juno/BMS: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Research Funding; Sunesis: Research Funding; Roche: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Gilead: Consultancy, Research Funding. Allan: Celegene: Research Funding; AstraZeneca Pharmaceuticals LP, Genentech, a member of the Roche Group, Janssen Biotech Inc, TG Therapeutics Inc.: Research Funding; AbbVie: Consultancy, Honoraria; BeiGene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria; Pharmacyclics LLC, an AbbVie Company: Consultancy, Honoraria; Genentech: Consultancy, Research Funding; TG Therapeutics: Research Funding; Epizyme: Consultancy; AbbVie Inc, AstraZeneca Pharmaceuticals LP, BeiGene, Janssen Biotech Inc, Pharmacyclics LLC: Consultancy; AbbVie Inc, Ascentage Pharma, Epizyme, Genentech, a member of the Roche Group, Janssen Biotech Inc, Pharmacyclics LLC: Other: Advisory Committee. Siddiqi: Kite Pharma: Membership on an entity's Board of Directors or advisory committees; Juno therapeutics: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Abbvie: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BeiGene: Other: DSM Member, Speakers Bureau; PCYC: Speakers Bureau; Jannsen: Speakers Bureau; Dava Oncology: Honoraria; ResearchToPractice: Honoraria. Kipps: Janssen: Consultancy, Honoraria, Other, Research Funding, Speakers Bureau; Roche: Honoraria, Other; MD Anderson Cancer Center: Research Funding; Velos: Research Funding; CRIM: Research Funding; Indy Hematology Review: Other; TG Therapeutics: Other; Verstem: Other, Speakers Bureau; University of California, San Diego: Current Employment; Pharmacyclics/AbbVie: Honoraria, Research Funding; Breast Cancer Research Foundation: Research Funding; SCOR - The Leukemia and Lymphoma Society: Research Funding; National Cancer Institute/NIH: Honoraria, Research Funding; Genentech/Roche: Honoraria; European Research Initiative on CLL (ERIC): Honoraria; Bionest Partner: Other; Celgene: Consultancy, Honoraria, Other, Research Funding; Genetech: Honoraria, Other; Genentech-Roche: Consultancy; Gilead Sciences: Consultancy, Honoraria, Other, Speakers Bureau; DAVA Pharmaceuticals: Speakers Bureau; DAVAOncology: Consultancy, Honoraria, Other; AbbVie: Consultancy, Honoraria, Other, Speakers Bureau; Oncternal Therapeutics, Inc.: Current holder of stock options in a privately-held company, Other: Stock or other ownership, Patents & Royalties: Cirmtuzumab was developed by Thomas J. Kipps in the Thomas J. Kipps laboratory and licensed by the University of California to Oncternal Therapeutics, Inc., which provided stock options and research funding to the Thomas J. Kipps laboratory., Research Funding; Moores Cancer Center: Current Employment; MedImmune Inc: Research Funding; GlaxoSmithKline: Research Funding; Gilead Sciences, Inc.: Honoraria, Research Funding; Genentech, Inc.: Honoraria, Research Funding, Speakers Bureau; Pharmacyclics LLC, an Abbvie Company: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses, Research Funding, Speakers Bureau; Celgene Corporation: Consultancy, Honoraria, Research Funding; Abbott Laboratories: Consultancy, Research Funding. Kuss: Commonwealth Serum Laboratories: Other: Stock or other ownership; AbbVie: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau; Merck: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Kyowa Kirin: Consultancy, Honoraria; Mundipharma: Consultancy, Honoraria; Roche Pharmaceuticals: Consultancy, Honoraria, Speakers Bureau; Janssen: Speakers Bureau. Opat: AstraZeneca: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sandoz: Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; CSL: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Monash Health: Current Employment; BeiGene: Research Funding; Pharmacyclics LLC, an AbbVie Company: Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GIlead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Mundipharma: Consultancy, Honoraria, Research Funding. Flinn: Portola Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; TG Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Loxo: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Incyte: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Juno Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Forma Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Seagen: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Pfizer: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Roche: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Genentech: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; ArQule: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Merck: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Constellation Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Nurix Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Celgene: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Unum Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Novartis: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Great Point Partners: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; MorphoSys: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Verastem: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; BeiGene: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Teva: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Acerta Pharma: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Janssen: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; IGM Biosciences: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Takeda: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Curis: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Karyopharm Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Calithera Biosciences: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Gilead Sciences: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Iksuda Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Kite, a Gilead Company: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; Yingli Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Agios: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Infinity Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Rhizen Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Forty Seven: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; AstraZeneca: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding; AbbVie: Consultancy, Other: All Consultancy and Research Funding payments made to Sarah Cannon Research Institute, Research Funding; Trillium Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Triphase Research & Development Corp.: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding; Century Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Hutchison MediPharma: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Vincerx Pharma: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Sarah Cannon Research Institute: Current Employment; Servier Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Yingli Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Seagen: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Servier Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute; Unum Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute, Research Funding; Johnson & Johnson: Current holder of individual stocks in a privately-held company; Seattle Genetics: Research Funding. Badoux: Janssen: Honoraria; AbbVie: Honoraria, Other: Travel, Accommodations, Expenses. Tedeschi: Beigene: Honoraria, Speakers Bureau; AstraZeneca: Honoraria, Speakers Bureau; AbbVie: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau. Gonzalez-Barca: Kiowa: Consultancy, Speakers Bureau; Eusapharma: Consultancy; Janssen: Consultancy, Other: Travel, Accommodations, Expenses, Speakers Bureau; Takeda: Speakers Bureau; Roche: Other: Travel, Accommodations, Expenses; AbbVie: Other: Travel, Accommodations, Expenses, Speakers Bureau. Pagel: Pharmacyclics/AbbVie: Consultancy; Gilead: Consultancy; Actinium Pharmaceuticals: Consultancy; Kite, a Gilead Company: Consultancy; BeiGene: Consultancy; Epizyme: Consultancy; MEI Pharma: Consultancy; AstraZeneca: Consultancy; Incyte/MorphoSys: Consultancy. Jacobs: AstraZeneca: Consultancy, Speakers Bureau; Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding, Speakers Bureau; ADC Therapeutics: Consultancy; Adaptive Biotechnologies: Consultancy; MEI Pharma: Research Funding; TeneoBio: Research Funding; SecuraBio: Consultancy, Speakers Bureau; Verastem: Consultancy; TG Therapeutics: Research Funding, Speakers Bureau; Jannsen: Speakers Bureau; Genentech: Consultancy; AbbVie: Consultancy, Speakers Bureau. Szafer-Glusman: AbbVie: Current Employment, Other: Stock or other ownership. Zhou: AbbVie: Current Employment, Other: Stock and other ownership. Ninomoto: AbbVie: Current Employment, Other: Stock or other ownership. Dean: Pharmacyclics: Current Employment, Other: Stock or other ownership; AbbVie: Other: Stock Ownership. Tam: Pharmacyclics: Honoraria; BeiGene: Consultancy, Honoraria; Loxo: Consultancy; AbbVie: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Novartis: Honoraria. Wierda: Janssen: Research Funding; AstraZeneca: Research Funding; GSK/Novartis: Research Funding; Acerta Pharma Inc.: Research Funding; Karyopharm: Research Funding; Xencor: Research Funding; Oncternal Therapeutics, Inc.: Research Funding; Loxo Oncology, Inc.: Research Funding; Genentech: Research Funding; Sunesis: Research Funding; Miragen: Research Funding; Cyclacel: Research Funding; Pharmacyclics LLC, an AbbVie Company: Research Funding; Juno Therapeutics: Research Funding; Gilead Sciences: Research Funding; KITE Pharma: Research Funding; Genzyme Corporation: Consultancy; AbbVie: Research Funding. OffLabel Disclosure: Ibrutinib in combination with venetoclax is not approved in any indication.

<span>This article outlines the application of a particular model of content analysis (Henri, 1992; 1993) to the evaluation of an online discussion group. The discussion group was part of the learning environment for a subject of the Graduate Certificate in Higher Education offered by the Centre for Higher Education at Monash University, Australia. Henri's model focuses on the level of participation and interaction in the discussion group, as well analysing the content of the messages according to a cognitive view of learning. Overall, the analysis confirmed the success of the discussion group, and provided a useful conceptual lens with which to study the online environment.</span>

International debates surrounding the management of universities in Western states have focused heavily upon the implications of neo-liberalism and the economisation of knowledge at national and international levels. However, investigations at the institutional level reveal that programmes for the development of human capital, organisational reputation and service quality in education and research are encouraged through regimes of self-development, directed towards organisational objectives. This article utilises governmentality theory to explore the relationship between governance and subjectivity within the Australian higher education system. The governance of higher education, it will be argued, is enabled by mentalities of government which are dependent upon contemporary technologies, techniques for self-evaluation and career-planning, expertise about university labour, and—importantly—practices which engender an enterprising academic identity. To explore the utility of this analysis in contemporary Western liberal states, this study explores the construction of subjectivity implicit within Monash University’s Performance Development Online (PDO) technology. Embedded with “technologies of the self,” this performance management platform is positioned within Monash as a gateway which requires academics to reflect upon their careers and selves, encouraging the genesis of marketable identities. This article points to the utility of further research into the development of career in a changing academic environment.

Mental ill health among higher education students is a well-established problem; therefore, it is imperative to implement preventative approaches to support wellbeing. Blended and fully online education programmes widens access for mature or returning students; however, the psychological wellbeing of this sub-group of students is under-researched. Finally, evaluating wellbeing interventions that meet the needs of university students as well as accessible for online students is required. The aim of this study was to evaluate a brief, online and mindfulness-based intervention to assist the self-management of wellbeing and stress for both online and on-campus higher education students. The total sample included 427 participants (96% psychology students) at Monash University, Australia (n=283) and King’s College London (n=144), with 152 participants completing the whole study. Participants were allocated to a brief, self-guided, online and mindfulness-based intervention (over the course of one study period; n=297), or to a wait-list control group (n=148). Baseline and end of semester questionnaires included the 14-item Warwick-Edinburgh Mental Wellbeing Scale, 10-item Perceived Stress Scale and the 15-item Mindful Attention Awareness Scale. Regression modelling revealed the intervention condition accounted for up to 12% of the variability in change in student wellbeing, stress and mindfulness between the start and end of semester (when controlling for baseline). These findings support the implementation of a brief, online and asynchronous mindfulness-based intervention for supporting student mental health and psychological wellbeing. An on-going challenge in practice includes engaging and maintaining student engagement in wellbeing initiatives.

Study/Objective Evaluating the effectiveness of the Army Aboriginal Community Assistance Programs (AACAPs) from a military participant perspective provides the objective of this research. The study will identify areas of concern and provide guidance on current military policy, doctrine and protocol. Background Army Aboriginal Community Assistance Programs (AACAPs) represent a co-operative initiative between the Australian Army and Australian Government, that delivers complex support for Disaster Relief and Humanitarian Assistance (HA/DR) to improve the health and well-being of indigenous communities. Since 1997, the Army has conducted a number of AACAPs in remote Indigenous communities within continental Australia. No previous evaluations of these programs exist. Methods A ‘Quality Improvement’ study underpins this evaluation. Shewhart’s “Plan, Do, Study, Act” Model provides the guiding framework for the study. Allen’s Logic Model exemplifies the most appropriate framework to articulate the program needs and objectives, and to delineate the processes inherent in the program for this evaluation. The Center for Disease Control (CDC) evaluation model for public health programs, provides the evaluation standards to examine the delivery of health care to the deployed force in an austere environment. Part 1 of the study will be a desktop examination of current military policy, doctrine and protocol relating to AACAP. Part 2 will overlay personal experience from military participants in the AACAPs through a semi-structured interview, to enable deployed health personnel the opportunity to comment on their experiences. Analysis will comprise quantitative and qualitative method, specifically descriptive statistics and thematic analysis respectively. Army has approved all required governance, and ethics approval will be sought from Monash University. Results This is a proposed study, no results are available. Conclusion The benefit of this research will be gaining new knowledge with context of a humanitarian focused military task, through the lens of quality improvement to build capacity and enhance capability.

AbstractThe global online education sector has been rising rapidly, particularly during and after the events of 2020, and is becoming mainstream much sooner than expected. Despite this, research studies report higher levels of perceived isolation, difficulties with engagement, and higher attrition rates in online compared to equivalent on-campus programs. Reasons include restrictions to the type of institutional support accessible by online students, and the lack of comprehensiveness of orientation resources. This paper describes the collaborative efforts by a cross-faculty academic team, supported by a community of practice, to create a university-wide online orientation resource—the Monash Online Learning Hub (MOLH). The development of the MOLH involved multiple phases, including an analysis of current practice, resource design and content creation, formative evaluation by staff and students, and successful integration into the university’s mainstream student orientation platform for widescale implementation. The methods adopted were varied, and involved generating both qualitative and quantitative data across multiple phases of development from online education experts at the University, that culminated in the gradual building and refinement of the MOLH. Final outcomes, implications and lessons learned are also discussed in this paper.

IntroductionThe Pathway to Paramedicine Program offers secondary school students with an interest in the paramedic disciple a unique opportunity to gain insight into the profession and the training required. This study aimed to evaluate the secondary school students’ perspectives of the program.MethodsThis pilot intervention study with paper based survey included 14 secondary school students enrolled in the Pathway to Paramedicine Program at Monash University, Victoria. The evaluation survey consisted of a combination of Likert and free text questions.ResultsAll 13 Likert scale items received a median score of 4 (agree) or above. Ten items achieved a maximum median score of 5 (strongly agree). Nine items received a positive score of 4 or 5 from all students. Participants also indicated they gained insight into the disciple and confidence in their own skills. Fifty percent of Year 12 participants enrolled in paramedic degrees in 2014.ConclusionsThis study gave secondary school students valuable insight into paramedic practice and helped them make a decision about their future education and career paths. The results showed that the secondary school students had a tremendously positive perspective of the Pathway to Paramedic program, enjoyed and appreciated their interaction with paramedic student mentors and would recommend the program to others.

<span>This paper describes research into multi-campus, video-on-demand at Monash University and its application to education. In education, video is used in a highly interactive way, for which traditional analog video tape is poorly equipped. During 1995, the Advanced Network System Performance Application Group and Monash's Department of Visual Arts recognised the potential of interactive video-on-demand and began a series of trials. The first used a small system located in the Visual Arts Library at Monash's Clayton campus. Academics, librarians and students were involved in evaluating the technology for teaching, research and study. This was followed by a larger, multi-campus trial, where video-on-demand was distributed from a central point on the Clayton campus to the main libraries at Monash's Clayton and Caulfield campuses using a high speed network. The trial is being extended to Monash's Berwick campus where interactive video-on-demand is being used as a research tool and to allow experimentation with more complex systems. This paper describes the outcomes, the difficulties, the potential for video-on-demand, and the factors that may affect its eventual uptake.</span>

Abstract Background Electronic communication is used in various populations to achieve health goals, but evidence in stroke is lacking. We pilot tested the feasibility and potential effectiveness of a novel personalised electronic self-management intervention to support person-centred goal attainment and secondary prevention after stroke. Methods A phase I, prospective, randomised controlled pilot trial (1:1 allocation) with assessor blinding, intention-to-treat analysis, and a process evaluation. Community-based survivors of stroke were recruited from participants in the Australian Stroke Clinical Registry (AuSCR) who had indicated their willingness to be contacted for research studies. Inclusion criteria include 1–2 years following hospital admission for stroke and living within 50 km of Monash University (Melbourne). Person-centred goals were set with facilitation by a clinician using a standardised template. The intervention group received electronic support messages aligned to their goals over 4 weeks. The control group received only 2–3 electronic administrative messages. Primary outcomes were study retention, goal attainment (assessed using Goal Attainment Scaling method) and satisfaction. Secondary outcomes were self-management (Health Education Impact Questionnaire: 8 domains), quality of life, mood and acceptability. Results Of 340 invitations sent from AuSCR, 73 responded, 68 were eligible and 57 (84%) completed the baseline assessment. At the goal-setting stage, 54/68 (79%) were randomised (median 16 months after stroke): 25 to intervention (median age 69 years; 40% female) and 29 to control (median age 68 years; 38% female). Forty-five (83%) participants completed the outcome follow-up assessment. At follow-up, goal attainment (mean GAS-T score ≥ 50) in the intervention group was achieved for goals related to function, participation and environment (control: environment only). Most intervention participants provided positive feedback and reported that the iVERVE messages were easy to understand (92%) and assisted them in achieving their goals (77%). We found preliminary evidence of non-significant improvements between the groups for most self-management domains (e.g. social integration and support: β coefficient 0.34; 95% CI − 0.14 to 0.83) and several quality-of-life domains in favour of the intervention group. Conclusion These findings support the need for further randomised effectiveness trials of the iVERVE program to be tested in people with new stroke. Trial registration ANZCTR, ACTRN12618001519246. Registered on 11 September 2018—retrospectively registered.

Abstract Background Subclinical heart failure (HF) is divided into Stage A and B (SAHF and SBHF) depending on structural or functional cardiac abnormalities. However, risk of HF progression is not solely dependent on echocardiographic abnormalities. Data on oxygen consumption (VO2) and other prognostic cardiopulmonary exercise test (CPET) markers in subclinical HF, particularly in the elderly, is lacking. VO2 may refine risk prediction and provide pathological insight in subclinical HF. Methods Asymptomatic individuals were recruited through primary care if they were ≥65 years with ≥1 non-ischaemic risk factor for HF. Clinical evaluation determined risk profile, biometrics and NT-proBNP. Treadmill CPET was undertaken with a modified Bruce protocol. Low V02 was defined as ≤20th percentile of age and gender specific VO2 in healthy individuals. SBHF defined as systolic (global longitudinal strain, GLS ≤16%), diastolic (E/e' ≥15, E/e' &gt;10 with left atrial enlargement or impaired relaxation with other changes or left ventricular (LV) hypertrophy (LV mass index &gt;95 g/m2 in women or &gt;115 g/m2 in men). Results Of the 91 included individuals (age 71±4 years, 53% female), 46 (51%) had SBHF, average NT-proBNP was 60pg/ml (26–99mg/ml) and did not differ by HF stage (59 [26–85] pg/ml vs. 60 [30–99] pg/ml for Stage A vs. B respectively, p=0.94). Average peak VO2 was 19.8 (16–22.6) ml/kg/min and was low in 71 (78%). VO2 did not differ by HF stage (19.9 [17.7–22.4] ml/kg/min vs. 19.7 [16–22.8] ml/kg/min for SAHF vs. SBHF respectively, p=0.62). NT-proBNP was significantly higher in those with abnormal VO2 (66 [34–110] pg/ml vs 31 [20–70] pg/ml, p=0.016). Within each HF stage, low VO2 was associated with higher NT-proBNP (Figure). Of those with NT-proBNP &gt;100pg/ml, 95% (22/23) had low VO2 compared with 72% of those ≤100pg/ml, p=0.02 (non-signifcant for 125pg/ml cut-off). No associations were found between SBHF or individual echo abnormalities and VO2. In logistic regression analysis NT-proBNP was a significant univariable predictor of low VO2 and remained significant after adjustment for other significant univariables (BMI) (OR 1.02 [95% CI 1.0001–1.03], p=0.048). Conclusion Low VO2 identifies a high-risk cardiac phenotype within subclinical HF stages, but is not necessarily associated with LV dysfunction. Levels of NT-proBNP beneath the cut-off used for HF exclusion may assist risk stratification in this population. NT-proBNP by VO2 in subclinical HF Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Dr E Potter is supported by a PhD Scholarship from Monash University, Melbourne, Australia

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Dr Kirsten Ellis has a creative and technical background and has experience in designing, developing and evaluating systems for people with unique requirements. A Senior Lecturer at the Department of Human Centred Computing (Monash University, Australia), her research interests include human–computer interaction and how technology can create a more inclusive society. She has developed multiple resources using a variety of technologies, including on the Nintendo DS lite, iPad, iPhone, Android and Microsoft’s Kinect. She is also involved with creating a variety of activities to engage everyone in STEM Making, no matter what their abilities are, ensuring it possible for everyone to get involved in the making process. The Biochemist spoke to Kirsten about her work and the importance of inclusive learning.

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(U Sydney, Australia; l.woodrow@edfac.usyd.edu.au), A model of adaptive language learning. The Modern Language Journal (Blackwell) 90.3 (2006), 297–319.07–256Yoshii, Makoto (Prefectural U Kumamoto, Japan; yoshii@pu-kumamoto.ac.jp), L1 and L2 glosses: Their effects on incidental vocabulary learning. Language Learning & Technology (University of Hawaii) 10.3 (2006), 85–101.07–257Yoshioka, Keiko (Leiden U, the Netherlands; k.yoshioka@let.leidenuniv.nl) & Eric Kellerman, Gestural introduction of ground reference in L2 narrative discourse. International Review of Applied Linguistics in Language Teaching (Walter de Gruyter) 44.2 (2006), 173–195.07–258Zyzik, Eve (Michigan State U, USA; zyzik@msu.edu), Transitivity alternations and sequence learning: Insights from L2 Spanish production data. Studies in Second Language Acquisition (Cambridge University Press) 28.3 (2006), 449–485.

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The learner's side of foreign language learning: where do styles, strategies, and tasks meet?International Review of Applied Linguistics for Language Teaching (Berlin, Germany), 41 (2003), 279–291.04–485Cziko, Gary A. (U. of Illinois at Urbana-Champaign, USA; Email: garycziko.net). Electronic tandem language learning (eTandem): a third approach to Second Language Learning for the 21st century. CALICO Journal (Texas, USA), 22, 1 (2004), 25–39.04–486DiFino, Sharon M. and Lombardino, Linda J. (U. of Florida, USA). Language learning disabilities: the ultimate foreign language challenge. Foreign Language Annals (Alexandria, VA, USA), 37, 3 (2004), 390–400.04–487Dubreil, Sebastien (U. of Notre Dame, Indiana, USA; Email: sdubreil@nd.edu), Herron, Carol and Cole, Steven B. An empirical investigation of whether authentic web sites facilitate intermediate-level French language students' ability to learn culture. CALICO Journal (Texas, USA), 22, 1 (2004), 41–61.04–488Duppenthaler, Peter M. (Tezukayama Gakuin U., Japan). Journal writing and the question of transfer of skills to other types of writing. JALT Journal (Tokyo, Japan), 26, 2 (2004), 172–188.04–489Egbert, Joy and Yang, Yu-Feng (Washington State U., USA; Email: jegbert@wsu.edu). Mediating the digital divide in CALL classrooms: promoting effective language tasks in limited technology contexts. ReCall (Cambridge, UK), 16, 2 (2004), 280–291.04–490Elder, Catherine (Monash U., Australia) and Manwaring, Diane. The relationship between metalinguistic knowledge and learning outcomes among undergraduate Students of Chinese. Language Awareness (Clevedon, UK), 13, 3 (2004), 145–162.04–491Ewald, Jennifer D. (Saint Joseph's U., USA; Email: jewald@sju.edu). A classroom forum on small group work: L2 learners see, and change, themselves. Language Awareness (Clevedon, UK), 13, 3 (2004), 163–179.04–492García, Paula (Northern Arizona U., USA; Email: pg4@dana.ucc.nau.edu). 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The expectations of the possible impact of ICT on teaching and learning have been huge, and over the past few decades ICT has played an increasingly important part in education all over the world. Educational technology has been high on the political agenda, significant achievements have been noted and a whole range of actors have benefited from public funding for a variety of projects trying to make use of educational technologies in education. Less attention has been given to research in field, and critical reflections have been rare. A main aim of this special issue of Seminar.net is to focus major changes and challenges after (more than) thirty years of ICT and learning in education. Research identifying dominating ideas within the field of educational technology has been highlighted, but also the leading providers of ideas and strategies and the extent to which these ideas have resulted in consistent and convincing arguments. This has involved efforts to identify the key actors and networks and what can be regarded as the main activities and milestones. Moreover, this is about how successful the policies of ICT in education have been and trying to provide a platform for future policies. This is a rather complex matter, and such analysis and reflections have usually not been given priority in the field of educational technology. Similar aims formed the basis for an international research seminar in Lillehammer in January 2018, and the initial initiative to opt for a special issue was put forward during this seminar. The plans were strongly supported by the 2018 network meeting of network 6 (Open Learning: Media, Environments and Cultures[1]) in the European Educational Research Association. The Lillehammer seminar included thirteen researchers from five different countries: Australia, USA, Germany, Scotland, Sweden and Norway. All five contributions published as research articles in the present issue of Seminar.net are based on presentations given at the seminar. The framework for the discussions was established by two keynote talks given by Neil Selwyn, Monash University, and Norm Friesen, Boise State University. Norm Friesen’s presentation has been developed into a research article included in this special issue. Neil Selwyns gave a thought-provoking keynote that so far still exists in a not published written draft. In this he briefly summarises some of his main viewpoints and arguments. Selwyn acknowledges that there are several interesting and insightful studies of education and technology, but he adds that the overall quality of research in this area has been understandably criticised over the past thirty years. He reflects on the need for education researchers to take care to resist falling into the trap of reaching polarized portrayals of digital technology in terms of either being good/bad, beneficial/harmful or descending into confirmatory roles of providing bland accounts of “what works and why”. He argues that we need research for the 2020s that explores the complexities, contradictions and inherently political nature of education and technology. According to Selwyn, we have to make sure that our work offers unbiased and disinterested alternatives to those who think that they already know the answers. This implies “to go beyond the digital”, and that the contemporary digital education might be better understood as entanglements of humanity, materiality and digitality. (This presentation is based on Selwyns not published draft.) In his article in this special issue, Norm Friesen begins by examining book culture - one which provides long-familiar demarcations of knowledge and ignorance, development and depravation that are starting to lose their force. Appealing to the notion of the longue durée, he then turns to the history and contemporaneity of the book in educational discourse. He considers what the changing educational significance of the book can tell us about change in education itself, and what this ongoing change might mean for us today. Friesen’s approach is based on seeing the book as an epochally and epistemologically foundational medium. The book’s physical nature, its typical contents, the habits and practices associated with its use, and the way that these are acquired, can thus be said to together constitute the paradigm for knowing. Rachel Shanks presents a reflective and reflexive account in relation to seven educational technology projects carried out, over the last ten years, in Scotland. The analysis is based on her own framework developed to understand why some of these educational technology projects were successful and why others were not. Her ambition is that this work can help to link practice back to research as well as indicating a way for lessons to be learnt in future educational technology projects. Shanks’ underlying assumption is that educational technology the last thirty years has not impacted the delivery of education that might have been predicted for it. Part of the lack of impact may relate to the introduction of new technologies through one-off educational technology projects which lack permanence and effective evaluation. Rensfeldt and Player-Koro examines major Swedish school digitalization curriculum reforms going back to the late 1960s. They examine how digitalization reforms are constituted discursively and materially in struggles over curricular knowledge content, preferred citizenship roles, and infrastructural investments and especially by relating curricular reforms to governance transformations. One recurrent strategy of reform is what they call the back to the future argument, where curricula address an ideal citizenship of future societies, politically used to support change. This movement has taken place partly through central, state-led or new monopolized technology governance and infrastructures and partly through decentralized forms of governing. Bjørgen and Fritze aim to shed light on the media practices considered by students as important and how their experiences correspond with the teachers' academic use of media. High expectations form the basis of their analysis, as exemplified by statements of the Norwegian Educational Quality Reform two decades ago. This implies that student-activating teaching methods by the use of digital technology might increase the scope of student-active learning. The authors have focused on a bachelor's course in Media Education, and based on data from interviews, a survey and activity logs in the students’ learning platform they conclude that students seem to prefer to study effectively, at the expense of activating teaching methods and of being active producers of learning. And although students are expected to be digitally competent, it should not be assumed that they master technology as expected in higher education. Haugsbakk and Nordkvelle address what they consider to be dominant arguments, discourses and issues related to the hegemonization of meaning formation in the field of educational technology. Their line of reasoning is based primarily on a case study of the leading journal in the field in Norway over the last fifteen years. Placing the journal’s policy at the forefront, the focus of their analysis is on the editorials. The main findings, based on issues of the journal over the first ten years, are that the editorials are in keeping with what may be regarded as the political priorities and the prevailing political discourses in the field. They contain relatively few, if any, critical perspectives and scant reference is made to the research articles and research area the journal claims to serve. [1] https://eera-ecer.de/networks/6-open-learning-media-environments-and-cultures/

Abstract Background The 2017 American Heart Association (AHA)/American College of Cardiology (ACC) hypertension guideline recommends a target blood pressure (BP) of <130/80 mmHg regardless of age, which is lower than previously recommended BP goals. Purpose We aimed to determine how much the updated classification for high BP would increase the overall prevalence of “hypertension” in an otherwise healthy elderly population. Additionally, we explored the cardiovascular disease (CVD) risk factor distribution in those newly classified “hypertensives” to determine whether the increased prevalence of hypertension was accompanied by an increase in other modifiable CVD risk factors. Methods We used baseline data from 19,114 participants (16,703 in Australia and 2,411 in the USA) aged ≥65 years who were enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) study between 2010 and 2014. Participants were classified as having hypertension using either: (a) pre-2017 thresholds (SBP ≥140 mmHg or mean DBP ≥90 mmHg and/or on anti-hypertensive) or (b) 2017 AHA/ACC guidelines (SBP ≥130 mmHg or DBP ≥80 mmHg and/or on anti-hypertensive). We assessed the presence of cardiovascular disease risk factors such as diabetes, hypercholesterolemia, smoking, obesity, reduced renal function among these hypertensive participants and also estimated their predicted risk over 10 years. Results Based on pre-2017 thresholds, 74% of the participants met the criteria for hypertension. Hypertension prevalence increased to 87% when the more stringent 2017 guideline was applied. 29% of this subset of newly classified hypertensive participants did not have any other identifiable traditional CVD risk factors. Further, a significantly lower 10-year predicted cardiovascular risk (22% versus 26%, p<0.001) among those newly classified hypertensive participants was observed in relation to those having hypertension based on pre-2017 guideline (Figure 1). Figure 1. 10-year predicted CVD risk among hyoertensive and newly classified hypertensive ASPREE participants by presence of CVD risk factor Conclusion As expected, the prevalence of hypertension increased among the healthy elderly when applying the new AHA-2017 guideline; however, the increased prevalence occurs despite lack of an accompanying increase in additional CVD risk factors or predicted 10-year risk. Our findings suggest an individualized approach is needed in evaluating high BP among the healthy elderly. Acknowledgement/Funding National Institute on Aging and the National Cancer Institute at NIH; NHMRC Australia, Monash University, Victorian Cancer Agency (Australia)

Introduction The exhibition of an artist’s work is traditionally accepted as representing the final stage of the creative process (Staniszewski). This article asks, however, whether this traditional view can be reassessed so that the curatorial practice of mounting an exhibition becomes, itself, a creative outcome feeding into work that may still be in progress, and that simultaneously operates as a learning and teaching tool. To provide a preliminary examination of the issue, we use a single case study approach, taking an example of practice currently used at an Australian university. In this program, internal and external students work together to develop and deliver an exhibition of their own work in progress. The exhibition space has a professional website (‘CQUniversity Noosa Exhibition Space’), many community members and the local media attend exhibition openings, and the exhibition (which runs for three to four weeks) becomes an outcome students can include in their curriculum vitae. This article reflects on the experiences, challenges, and outcomes that have been gained through this process over the past twelve months. Due to this time frame, the case study is exploratory and its findings are provisional. The case study is an appropriate method to explore a small sample of events (in this case exhibitions) as, following Merriam, it allows the construction of a richer picture of an under-examined phenomenon to be constructed. Although it is clear that this approach will not offer results which can be generalised, it can, nevertheless, assist in opening up a field for investigation and constructing a holistic account of a phenomenon (in this case, the exhibition space as authentic learning experience and productive teaching tool), for, as Merriam states, “much can be learned from a particular case” (51). Jennings adds that even the smallest case study is useful as it includes an “in-depth examination of the subject with which to confirm or contest received generalizations” (14). Donmoyer extends thoughts on this, suggesting that the single case study is extremely useful as the “restricted conception of generalizability … solely in terms of sampling and statistical significance is no longer defensible or functional” (45). Using the available student course feedback, anonymous end-of-term course evaluations, and other available information, this case study account offers an example of what Merriam terms a “narrative description” (51), which seeks to offer readers the opportunity to engage and “learn vicariously from an encounter with the case” (Merriam 51) in question. This may, we propose, be particularly productive for other educators since what is “learn[ed] in a particular case can be transferred to similar situations” (Merriam 51). Breaking Ground exhibition, CQUniversity Noosa Exhibition Space, 2014. Photo by Ulrike Sturm. Background The Graduate Certificate of Creative Industries (Creative Practice) (CQU ‘CB82’) was developed in 2011 to meet the national Australian Quality Framework agency’s Level 8 (Graduate Certificate) standards in terms of what is called in their policies, the “level” of learning. This states that, following the program, graduates from this level of program “will have advanced knowledge and skills for professional or highly skilled work and/or further learning … [and] will apply knowledge and skills to demonstrate autonomy, well-developed judgment, adaptability and responsibility as a practitioner or learner” (AQF). The program was first delivered in 2012 and, since then, has been offered both two and three terms a year, attracting small numbers of students each term, with an average of 8 to 12 students a term. To meet these requirements, such programs are sometimes developed to provide professional and work-integrated learning tasks and learning outcomes for students (Patrick et al., Smith et al.). In this case, professionally relevant and related tasks and outcomes formed the basis for the program, its learning tasks, and its assessment regime. To this end, each student enrolled in this program works on an individual, self-determined (but developed in association with the teaching team and with feedback from peers) creative/professional project that is planned, developed, and delivered across one term of study for full- time students and two terms for part- timers. In order to ensure the AQF-required professional-level outcomes, many projects are designed and/or developed in partnership with professional arts institutions and community bodies. Partnerships mobilised utilised in this way have included those with local, state, and national bodies, including the local arts community, festivals, and educational support programs, as well as private business and community organisations. Student interaction with curation occurs regularly at art schools, where graduate and other student shows are scheduled as a regular events on the calendar of most tertiary art schools (Al-Amri), and the curated exhibition as an outcome has a longstanding tradition in tertiary fine arts education (Webb, Brien, and Burr). Yet in these cases, it is ultimately the creative work on show that is the focus of the learning experience and assessment process, rather than any focus on engagement with the curatorial process itself (Dally et al.). When art schools do involve students in the curatorial process, the focus usually still remains on the students' creative work (Sullivan). Another interaction with curation is when students undertaking a tertiary-level course or program in museum, and/or curatorial practice are engaged in the process of developing, mounting, and/or critiquing curated activities. These programs are, however, very small in number in Australia, where they are only offered at postgraduate level, with the exception of an undergraduate program at the University of Canberra (‘215JA.2’). By adopting “the exhibition” as a component of the learning process rather than its end product, including documentation of students’ work in progress as exhibition pieces, and incorporating it into a more general creative industries focused program, we argue that the curatorial experience can become an interactive learning platform for students ranging from diverse creative disciplines. The Student Experience Students in the program under consideration in this case study come from a wide spectrum of the creative industries, including creative writing, film, multimedia, music, and visual arts. Each term, at least half of the enrolments are distance students. The decision to establish an on-campus exhibition space was an experimental strategy that sought to bring together students from different creative disciplines and diverse locations, and actively involve them in the exhibition development and curatorial process. As well as their individual project work, the students also bring differing levels of prior professional experience to the program, and exhibit a wide range of learning styles and approaches when developing and completing their creative works and exegetical reflections. To cater for the variations listed above, but still meet the program milestones and learning outcomes that must (under the program rules) remain consistent for each student, we employed a multi-disciplinary approach to teaching that included strategies informed by Gardner’s theory of multiple intelligences (Gardner, Frames of Mind), which proposed and defined seven intelligences, and repeatedly criticised what he identified as an over-reliance on linguistic and logical indices as identifiers of intelligence. He asserted that these were traditional indicators of high scores on most IQ measures or tests of achievement but were not representative of overall levels of intelligence. Gardner later reinforced that, “unless individuals take a very active role in what it is that they’re studying, unless they learn to ask questions, to do things hands on, to essentially re-create things in their own mind and transform them as is needed, the ideas just disappear” (Edutopia). In alignment with Gardner’s views, we have noted that students enrolled in the program demonstrate strengths in several key intelligence areas, particularly interpersonal, musical, body-kinaesthetic, and spacial/visual intelligences (see Gardner, ‘Multiple Intelligences’, 8–18). To cater for, and further develop, these strengths, and also for the external students who were unable to attend university-based workshop sessions, we developed a range of resources with various approaches to hands-on creative tasks that related to the projects students were completing that term. These resources included the usual scholarly articles, books, and textbooks but were also sourced from the print and online media, guest speaker presentations, and digital sites such as You Tube and TED Talks, and through student input into group discussions. The positive reception of these individual project-relevant resources is evidenced in the class online discussion forums, where consecutive groups of students have consistently reflected on the positive impact these resources have had on their individual creative projects: This has been a difficult week with many issues presenting. As part of our Free Writing exercise in class, we explored ‘brain dumping’ and wrote anything (no matter how ridiculous) down. The great thing I discovered after completing this task was that by allowing myself to not censor my thoughts by compiling a writing masterpiece, I was indeed “free” to express everything. …. … I understand that this may not have been the original intended goal of Free Writing – but it is something I would highly recommend external students to try and see if it works for you (Student 'A', week 5, term 1 2015, Moodle reflection point). I found our discussion about crowdfunding particularly interesting. ... I intend to look at this model for future exhibitions. I think it could be a great way for me to look into developing an exhibition of paintings alongside some more commercial collateral such as prints and cards (Student 'B', week 6, term 1 2015, Moodle reflection point). In class I specifically enjoyed the black out activity and found the online videos exceptional, inspiring and innovating. I really enjoyed this activity and it was something that I can take away and use within the classroom when educating (Student 'C', week 8, term 1 2015, Moodle reflection point). The application of Gardner’s principles and strategies dovetailed with our framework for assessing learning outcomes, where we were guided by Boud’s seven propositions for assessment reform in higher education, which aim to “set directions for change, designed to enhance learning achievements for all students and improve the quality of their experience” (26). Boud asserts that assessment has most effect when: it is used to engage students in productive learning; feedback is used to improve student learning; students and teachers become partners in learning and assessment; students are inducted into the assessment practices of higher education; assessment and learning are placed at the centre of subject and program design; assessment and learning is a focus for staff and institutional development; and, assessment provides inclusive and trustworthy representation of student achievement. These propositions were integral to the design of learning outcomes for the exhibition. Teachers worked with students, individually and as a group, to build their capacity to curate the exhibition, and this included such things as the design and administration of invitations, and also the physical placement of works within the exhibition space. In this way, teachers and students became partners in the process of assessment. The final exhibition, as a learning outcome, meant that students were engaged in productive learning that placed both assessment and knowledge at the centre of subject and project design. It is a collation of creative pieces that embodies the class, as a whole; however, each piece also represents the skills and creativity of individual students and, in this way, are is a trustworthy representations of student achievement. While we aimed to employ all seven recommendations, our main focus was on ensuring that the exhibition, as an authentic learning experience, was productive and that the students were engaged as responsible and accountable co-facilitators of it. These factors are particularly relevant as almost all the students were either currently working, or planning to work, in their chosen creative field, where the work would necessarily involve both publication, performance, and/or exhibition of their artwork plus collaborative practice across disciplinary boundaries to make this happen (Brien). For this reason, we provided exhibition-related coursework tasks that we hoped were engaging and that also represented an authentic learning outcome for the students. Student Curatorship In this context, the opportunity to exhibit their own works-in-progress provided an authentic reason, with a deadline, for students to both work, and reflect, on their creative projects. The documentation of each student’s creative process was showcased as a stand-alone exhibition piece within the display. These exhibits not only served not only to highlight the different learning styles of each student, but also proved to inspire creativity and skill development. They also provided a working model whereby students (and potential enrollees) could view other students’ work and creative processes from inception to fully-realised project outcomes. The sample online reflections quoted above not only highlight the effectiveness of the online content delivery, but this engagement with the online forum also allowed remote students to comment on each other’s projects as well as to and respond to issues they were encountering in their project planning and development and creative practice. It was essential that this level of peer engagement was fostered for the curatorial project to be viable, as both internal and external students are involved in designing the invitation, catalogue, labels, and design of the space, while on-campus students hang and label work according to the group’s directions. Distance students send in items. This is a key point of this experiment: the process of curating an exhibition of work from diverse creative fields, and from students located thousands of kilometres apart, as a way of bringing cohesion to a diverse cohort of students. That cohesiveness provided an opportunity for authentic learning to occur because it was in relation to a task that each student apparently understood as personally, academically, and professionally relevant. This was supported by the anonymous course evaluation comments, which were overwhelmingly positive about the exhibition process – there were no negative comments regarding this aspect of the program, and over 60 per cent of the class supplied these evaluations. This also met a considerable point of anxiety in the current university environment whereby actively engaging students in online learning interactions is a continuing issue (Dixon, Dixon, and Axmann). A key question is: what relevance does this curatorial process have for a student whose field is not visual art, but, for instance, music, film, or writing? By displaying documentation of work in progress, this process connects students of all disciplines with an audience. For example, one student in 2014 who was a singer/songwriter, had her song available to be played on a laptop, alongside photographs of the studio when she was recording her song with her band. In conjunction with this, the cover artwork for her CD, together with the actual CD and CD cover, were framed and exhibited. Another student, who was also a musician but who was completing a music history project, sent in pages of the music transcriptions he had been working on during the course. This manuscript was bound and exhibited in a way that prompted some audience members to commented that it was like an artist’s book as well as a collection of data. Both of these students lived over 1,000 kilometres from the campus where the exhibition was held, but they were able to share with us as teaching staff, as well as with other students who were involved in the physical setting up of the exhibition, exactly how they envisaged their work being displayed. The feedback from both of these students was that this experience gave them a strong connection to the program. They described how, despite the issue of distance, they had had the opportunity to participate in a professional event that they were very keen to include on their curricula vitae. Another aspect of students actively participating in the curation of an exhibition which features work from diverse disciplines is that these students get a true sense of the collaborative interconnectedness of the disciplines of the creative industries (Brien). By way of example, the exhibit of the singer/songwriter referred to above involved not only the student and her band, but also the photographer who took the photographs, and the artist who designed the CD cover. Students collaboratively decided how this material was handled in the exhibition catalogue – all these names were included and their roles described. Breaking Ground exhibition, CQUniversity Noosa Exhibition Space, 2014. Photo by Ulrike Sturm. Outcomes and Conclusion We believe that the curation of an exhibition and the delivery of its constituent components raises student awareness that they are, as creatives, part of a network of industries, developing in them a genuine understanding of the way the creating industries works as a profession outside the academic setting. It is in this sense that this curatorial task is an authentic learning experience. In fact, what was initially perceived as a significant challenge—, that is, exhibiting work in progress from diverse creative fields—, has become a strength of the curatorial project. In reflecting on the experiences and outcomes that have occurred through the implementation of this example of curatorial practice, both as a learning tool and as a creative outcome in its own right, a key positive indicator for this approach is the high level of student satisfaction with the course, as recorded in the formal, anonymous university student evaluations (with 60–100 per cent of these completed for each term, when the university benchmark is 50 per cent completion), and the high level of professional outcomes achieved post-completion. The university evaluation scores have been in the top (4.5–5/.5) range for satisfaction over the program’s eight terms of delivery since 2012. Particularly in relation to subsequent professional outcomes, anecdotal feedback has been that the curatorial process served as an authentic and engaged learning experience because it equipped the students, now graduates, of the program with not only knowledge about how exhibitions work, but also a genuine understanding of the web of connections between the diverse creative arts and industries. Indeed, a number of students have submitted proposals to exhibit professionally in the space after graduation, again providing anecdotal feedback that the experience they gained through our model has had a sustaining impact on their creative practice. While the focus of this activity has been on creative learning for the students, it has also provided an interesting and engaging teaching experience for us as the program’s staff. We will continue to gather evidence relating to our model, and, with the next iteration of the exhibition project, a more detailed comparative analysis will be attempted. At this stage, with ethics approval, we plan to run an anonymous survey with all students involved in this activity, to develop questions for a focus group discussion with graduates. We are also in the process of contacting alumni of the program regarding professional outcomes to map these one, two, and five years after graduation. We will also keep a record of what percentage of students apply to exhibit in the space after graduation, as this will also be an additional marker of how professional and useful they perceive the experience to be. In conclusion, it can be stated that the 100 per cent pass rate and 0 per cent attrition rate from the program since its inception, coupled with a high level (over 60 per cent) of student progression to further post-graduate study in the creative industries, has not been detrimentally affected by this curatorial experiment, and has encouraged staff to continue with this approach. References Al-Amri, Mohammed. “Assessment Techniques Practiced in Teaching Art at Sultan Qaboos University in Oman.” International Journal of Education through Art 7.3 (2011): 267–282. AQF Levels. Australian Qualifications Framework website. 18 June 2015 ‹http://www.aqf.edu.au/aqf/in-detail/aqf-levels/›. Boud, D. Student Assessment for Learning in and after Courses: Final Report for Senior Fellowship. Sydney: Australian Learning and Teaching Council, 2010. 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IntroductionIn July 1997, the Mackay campus of Central Queensland University hosted a conference with the theme Regional Australia: Visions of Mackay. It was the first academic conference to be held at the young campus, and its aim was to provide an opportunity for academics, business people, government officials, and other interested parties to discuss their visions for the development of Mackay, a regional community of 75,000 people situated on the Central Queensland coast (Danaher). I delivered a presentation at that conference and authored a chapter in the book that emerged from its proceedings. The chapter entitled “Mackay Online” explored the potential impact that the Internet could have on the Mackay region, particularly in the areas of regional business, education, health, and entertainment (Pace). Two decades later, how does the reality compare with that vision?Broadband BluesAt the time of the Visions of Mackay conference, public commercial use of the Internet was in its infancy. Many Internet services and technologies that users take for granted today were uncommon or non-existent then. Examples include online video, video-conferencing, Voice over Internet Protocol (VoIP), blogs, social media, peer-to-peer file sharing, payment gateways, content management systems, wireless data communications, smartphones, mobile applications, and tablet computers. In 1997, most users connected to the Internet using slow dial-up modems with speeds ranging from 28.8 Kbps to 33.6 Kbps. 56 Kbps modems had just become available. Lamenting these slow data transmission speeds, I looked forward to a time when widespread availability of high-bandwidth networks would allow the Internet’s services to “expand to include electronic commerce, home entertainment and desktop video-conferencing” (Pace 103). Although that future eventually arrived, I incorrectly anticipated how it would arrive.In 1997, Optus and Telstra were engaged in the rollout of hybrid fibre coaxial (HFC) networks in Sydney, Melbourne, and Brisbane for the Optus Vision and Foxtel pay TV services (Meredith). These HFC networks had a large amount of unused bandwidth, which both Telstra and Optus planned to use to provide broadband Internet services. Telstra's Big Pond Cable broadband service was already available to approximately one million households in Sydney and Melbourne (Taylor), and Optus was considering extending its cable network into regional Australia through partnerships with smaller regional telecommunications companies (Lewis). These promising developments seemed to point the way forward to a future high-bandwidth network, but that was not the case. A short time after the Visions of Mackay conference, Telstra and Optus ceased the rollout of their HFC networks in response to the invention of Asynchronous Digital Subscriber Line (ADSL), a technology that increases the bandwidth of copper wire and enables Internet connections of up to 6 Mbps over the existing phone network. ADSL was significantly faster than a dial-up service, it was broadly available to homes and businesses across the country, and it did not require enormous investment in infrastructure. However, ADSL could not offer speeds anywhere near the 27 Mbps of the HFC networks. When it came to broadband provision, Australia seemed destined to continue playing catch-up with the rest of the world. According to data from the Organisation for Economic Cooperation and Development (OECD), in 2009 Australia ranked 18th in the world for broadband penetration, with 24.1 percent of Australians having a fixed-line broadband subscription. Statistics like these eventually prompted the federal government to commit to the deployment of a National Broadband Network (NBN). In 2009, the Kevin Rudd Government announced that the NBN would combine fibre-to-the-premises (FTTP), fixed wireless, and satellite technologies to deliver Internet speeds of up to 100 Mbps to 90 percent of Australian homes, schools, and workplaces (Rudd).The rollout of the NBN in Mackay commenced in 2013 and continued, suburb by suburb, until its completion in 2017 (Frost, “Mackay”; Garvey). The rollout was anything but smooth. After a change of government in 2013, the NBN was redesigned to reduce costs. A mixed copper/optical technology known as fibre-to-the-node (FTTN) replaced FTTP as the preferred approach for providing most NBN connections. The resulting connection speeds were significantly slower than the 100 Mbps that was originally proposed. Many Mackay premises could only achieve a maximum speed of 40 Mbps, which led to some overcharging by Internet service providers, and subsequent compensation for failing to deliver services they had promised (“Optus”). Some Mackay residents even complained that their new NBN connections were slower than their former ADSL connections. NBN Co representatives claimed that the problems were due to “service providers not buying enough space in the network to provide the service they had promised to customers” (“Telcos”). Unsurprisingly, the number of complaints about the NBN that were lodged with the Telecommunications Industry Ombudsman skyrocketed during the last six months of 2017. Queensland complaints increased by approximately 40 percent when compared with the same period during the previous year (“Qld”).Despite the challenges presented by infrastructure limitations, the rollout of the NBN was a boost for the Mackay region. For some rural residents, it meant having reliable Internet access for the first time. Frost, for example, reports on the experiences of a Mackay couple who could not get an ADSL service at their rural home because it was too far away from the nearest telephone exchange. Unreliable 3G mobile broadband was the only option for operating their air-conditioning business. All of that changed with the arrival of the NBN. “It’s so fast we can run a number of things at the same time”, the couple reported (“NBN”).Networking the NationOne factor that contributed to the uptake of Internet services in the Mackay region after the Visions of Mackay conference was the Australian Government’s Networking the Nation (NTN) program. When the national telecommunications carrier Telstra was partially privatised in 1997, and further sold in 1999, proceeds from the sale were used to fund an ambitious communications infrastructure program named Networking the Nation (Department of Communications, Information Technology and the Arts). The program funded projects that improved the availability, accessibility, affordability, and use of communications facilities and services throughout regional Australia. Eligibility for funding was limited to not-for-profit organisations, including local councils, regional development organisations, community groups, local government associations, and state and territory governments.In 1998, the Mackay region received $930,000 in Networking the Nation funding for Mackay Regionlink, a project that aimed to provide equitable community access to online services, skills development for local residents, an affordable online presence for local business and community organisations, and increased external awareness of the Mackay region (Jewell et al.). One element of the project was a training program that provided basic Internet skills to 2,168 people across the region over a period of two years. A second element of the project involved the establishment of 20 public Internet access centres in locations throughout the region, such as libraries, community centres, and tourist information centres. The centres provided free Internet access to users and encouraged local participation and skill development. More than 9,200 users were recorded in these centres during the first year of the project, and the facilities remained active until 2006. A third element of the project was a regional web portal that provided a free easily-updated online presence for community organisations. The project aimed to have every business and community group in the Mackay region represented on the website, with hosting fees for the business web pages funding its ongoing operation and development. More than 6,000 organisations were listed on the site, and the project remained financially viable until 2005.The availability, affordability and use of communications facilities and services in Mackay increased significantly during the period of the Regionlink project. Changes in technology, services, markets, competition, and many other factors contributed to this increase, so it is difficult to ascertain the extent to which Mackay Regionlink fostered those outcomes. However, the large number of people who participated in the Regionlink training program and made use of the public Internet access centres, suggests that the project had a positive influence on digital literacy in the Mackay region.The Impact on BusinessThe Internet has transformed regional business for both consumers and business owners alike since the Visions of Mackay conference. When Mackay residents made a purchase in 1997, their choice of suppliers was limited to a few local businesses. Today they can shop online in a global market. Security concerns were initially a major obstacle to the growth of electronic commerce. Consumers were slow to adopt the Internet as a place for doing business, fearing that their credit card details would be vulnerable to hackers once they were placed online. After observing the efforts that finance and software companies were making to eliminate those obstacles, I anticipated that it would only be a matter of time before online transactions became commonplace:Consumers seeking a particular product will be able to quickly find the names of suitable suppliers around the world, compare their prices, and place an order with the one that can deliver the product at the cheapest price. (Pace 106)This expectation was soon fulfilled by the arrival of online payment systems such as PayPal in 1998, and online shopping services such as eBay in 1997. eBay is a global online auction and shopping website where individuals and businesses buy and sell goods and services worldwide. The eBay service is free to use for buyers, but sellers are charged modest fees when they make a sale. It exemplifies the notion of “friction-free capitalism” articulated by Gates (157).In 1997, regional Australian business owners were largely sceptical about the potential benefits the Internet could bring to their businesses. Only 11 percent of Australian businesses had some form of web presence, and less than 35 percent of those early adopters felt that their website was significant to their business (Department of Industry, Science and Tourism). Anticipating the significant opportunities that the Internet offered Mackay businesses to compete in new markets, I recommended that they work “towards the goal of providing products and services that meet the needs of international consumers as well as local ones” (107). In the two decades that have passed since that time, many Mackay businesses have been doing just that. One prime example is Big on Shoes (bigonshoes.com.au), a retailer of ladies’ shoes from sizes five to fifteen (Plane). Big on Shoes has physical shopfronts in Mackay and Moranbah, an online store that has been operating since 2009, and more than 12,000 followers on Facebook. This speciality store caters for women who have traditionally been unable to find shoes in their size. As the store’s customer base has grown within Australia and internationally, an unexpected transgender market has also emerged. In 2018 Big on Shoes was one of 30 regional businesses featured in the first Facebook and Instagram Annual Gift Guide, and it continues to build on its strengths (Cureton).The Impact on HealthThe growth of the Internet has improved the availability of specialist health services for people in the Mackay region. Traditionally, access to surgical services in Mackay has been much more limited than in metropolitan areas because of the shortage of specialists willing to practise in regional areas (Green). In 2003, a senior informant from the Royal Australasian College of Surgeons bluntly described the Central Queensland region from Mackay to Gladstone as “a black hole in terms of surgery” (Birrell et al. 15). In 1997 I anticipated that, although the Internet would never completely replace a visit to a local doctor or hospital, it would provide tools that improve the availability of specialist medical services for people living in regional areas. Using these tools, doctors would be able to “analyse medical images captured from patients living in remote locations” and “diagnose patients at a distance” (Pace 108).These expectations have been realised in the form of Queensland Health’s Telehealth initiative, which permits medical specialists in Brisbane and Townsville to conduct consultations with patients at the Mackay Base Hospital using video-conference technology. Telehealth reduces the need for patients to travel for specialist advice, and it provides health professionals with access to peer support. Averill (7), for example, reports on the experience of a breast cancer patient at the Mackay Base Hospital who was able to participate in a drug trial with a Townsville oncologist through the Telehealth network. Mackay health professionals organised the patient’s scans, administered blood tests, and checked her lymph nodes, blood pressure and weight. Townsville health professionals then used this information to advise the Mackay team about her ongoing treatment. The patient expressed appreciation that the service allowed her to avoid the lengthy round-trip to Townsville. Prior to being offered the Telehealth option, she had refused to participate in the trial because “the trip was just too much of a stumbling block” (Averill 7).The Impact on Media and EntertainmentThe field of media and entertainment is another aspect of regional life that has been reshaped by the Internet since the Visions of Mackay conference. Most of these changes have been equally apparent in both regional and metropolitan areas. Over the past decade, the way individuals consume media has been transformed by new online services offering user-generated video, video-on-demand, and catch-up TV. These developments were among the changes I anticipated in 1997:The convergence of television and the Internet will stimulate the creation of new services such as video-on-demand. Today television is a synchronous media—programs are usually viewed while they are being broadcast. When high-quality video can be transmitted over the information superhighway, users will be able to watch what they want, when and where they like. […] Newly released movies will continue to be rented, but probably not from stores. Instead, consumers will shop on the information superhighway for movies that can be delivered on demand.In the mid-2000s, free online video-sharing services such as YouTube and Vimeo began to emerge. These websites allow users to freely upload, view, share, comment on, and curate online videos. Subscription-based streaming services such as Netflix and Amazon Prime have also become increasingly popular since that time. These services offer online streaming of a library of films and television programs for a fee of less than 20 dollars per month. Computers, smart TVs, Blu-ray players, game consoles, mobile phones, tablets, and other devices provide a multitude of ways of accessing streaming services. Some of these devices cost less than 100 dollars, while higher-end electronic devices include the capability as a bundled feature. Netflix became available in Mackay at the time of its Australian launch in 2015. The growth of streaming services greatly reduced the demand for video rental shops in the region, and all closed down as a result. The last remaining video rental store in Mackay closed its doors in 2018 after trading for 26 years (“Last”).Some of the most dramatic transformations that have occurred the field of media and entertainment were not anticipated in 1997. The rise of mobile technology, including wireless data communications, smartphones, mobile applications, and tablet computers, was largely unforeseen at that time. Some Internet luminaries such as Vinton Cerf expected that mobile access to the Internet via laptop computers would become commonplace (Lange), but this view did not encompass the evolution of smartphones, and it was not widely held. Similarly, the rise of social media services and the impact they have had on the way people share content and communicate was generally unexpected. In some respects, these phenomena resemble the Black Swan events described by Nassim Nicholas Taleb (xvii)—surprising events with a major effect that are often inappropriately rationalised after the fact. They remind us of how difficult it is to predict the future media landscape by extrapolating from things we know, while failing to take into consideration what we do not know.The Challenge for MackayIn 1997, when exploring the potential impact that the Internet could have on the Mackay region, I identified a special challenge that the community faced if it wanted to be competitive in this new environment:The region has traditionally prospered from industries that control physical resources such as coal, sugar and tourism, but over the last two decades there has been a global ‘shift away from physical assets and towards information as the principal driver of wealth creation’ (Petre and Harrington 1996). The risk for Mackay is that its residents may be inclined to believe that wealth can only be created by means of industries that control physical assets. The community must realise that its value-added information is at least as precious as its abundant natural resources. (110)The Mackay region has not responded well to this challenge, as evidenced by measures such as the Knowledge City Index (KCI), a collection of six indicators that assess how well a city is positioned to grow and advance in today’s technology-driven, knowledge-based economy. A 2017 study used the KCI to conduct a comparative analysis of 25 Australian cities (Pratchett, Hu, Walsh, and Tuli). Mackay rated reasonably well in the areas of Income and Digital Access. But the city’s ratings were “very limited across all the other measures of the KCI”: Knowledge Capacity, Knowledge Mobility, Knowledge Industries and Smart Work (44).The need to be competitive in a technology-driven, knowledge-based economy is likely to become even more pressing in the years ahead. The 2017 World Energy Outlook Report estimated that China’s coal use is likely to have peaked in 2013 amid a rapid shift toward renewable energy, which means that demand for Mackay’s coal will continue to decline (International Energy Agency). The sugar industry is in crisis, finding itself unable to diversify its revenue base or increase production enough to offset falling global sugar prices (Rynne). The region’s biggest tourism drawcard, the Great Barrier Reef, continues to be degraded by mass coral bleaching events and ongoing threats posed by climate change and poor water quality (Great Barrier Reef Marine Park Authority). All of these developments have disturbing implications for Mackay’s regional economy and its reliance on coal, sugar, and tourism. Diversifying the local economy through the introduction of new knowledge industries would be one way of preparing the Mackay region for the impact of new technologies and the economic challenges that lie ahead.ReferencesAverill, Zizi. “Webcam Consultations.” Daily Mercury 22 Nov. 2018: 7.Birrell, Bob, Lesleyanne Hawthorne, and Virginia Rapson. The Outlook for Surgical Services in Australasia. Melbourne: Monash University Centre for Population and Urban Research, 2003.Cureton, Aidan. “Big Shoes, Big Ideas.” Daily Mercury 8 Dec. 2018: 12.Danaher, Geoff. Ed. Visions of Mackay: Conference Papers. Rockhampton: Central Queensland UP, 1998.Department of Communications, Information Technology and the Arts. Networking the Nation: Evaluation of Outcomes and Impacts. Canberra: Australian Government, 2005.Department of Industry, Science and Tourism. Electronic Commerce in Australia. Canberra: Australian Government, 1998.Frost, Pamela. “Mackay Is Up with Switch to Speed to NBN.” Daily Mercury 15 Aug. 2013: 8.———. “NBN Boost to Business.” Daily Mercury 29 Oct. 2013: 3.Gates, Bill. The Road Ahead. New York: Viking Penguin, 1995.Garvey, Cas. “NBN Rollout Hit, Miss in Mackay.” Daily Mercury 11 Jul. 2017: 6.Great Barrier Reef Marine Park Authority. Reef Blueprint: Great Barrier Reef Blueprint for Resilience. Townsville: Great Barrier Reef Marine Park Authority, 2017.Green, Anthony. “Surgical Services and Referrals in Rural and Remote Australia.” Medical Journal of Australia 177.2 (2002): 110–11.International Energy Agency. World Energy Outlook 2017. France: IEA Publications, 2017.Jewell, Roderick, Mary O’Flynn, Fiorella De Cindio, and Margaret Cameron. “RCM and MRL—A Reflection on Two Approaches to Constructing Communication Memory.” Constructing and Sharing Memory: Community Informatics, Identity and Empowerment. Eds. Larry Stillman and Graeme Johanson. Newcastle: Cambridge Scholars Publishing, 2007. 73–86.Lange, Larry. “The Internet: Where’s It All Going?” Information Week 17 Jul. 1995: 30.“Last Man Standing Shuts Doors after 26 Years of Trade.” Daily Mercury 28 Aug. 2018: 7.Lewis, Steve. “Optus Plans to Share Cost Burden.” Australian Financial Review 22 May 1997: 26.Meredith, Helen. “Time Short for Cable Modem.” Australian Financial Review 10 Apr. 1997: 42Nassim Nicholas Taleb. The Black Swan: The Impact of the Highly Improbable. New York: Random House, 2007.“Optus Offers Comp for Slow NBN.” Daily Mercury 10 Nov. 2017: 15.Organisation for Economic Cooperation and Development. “Fixed Broadband Subscriptions.” OECD Data, n.d. <https://data.oecd.org/broadband/fixed-broadband-subscriptions.htm>.Pace, Steven. “Mackay Online.” Visions of Mackay: Conference Papers. Ed. Geoff Danaher. Rockhampton: Central Queensland University Press, 1998. 111–19.Petre, Daniel and David Harrington. The Clever Country? Australia’s Digital Future. Sydney: Lansdown Publishing, 1996.Plane, Melanie. “A Shoe-In for Big Success.” Daily Mercury 9 Sep. 2017: 6.Pratchett, Lawrence, Richard Hu, Michael Walsh, and Sajeda Tuli. The Knowledge City Index: A Tale of 25 Cities in Australia. Canberra: University of Canberra neXus Research Centre, 2017.“Qld Customers NB-uN Happy Complaints about NBN Service Double in 12 Months.” Daily Mercury 17 Apr. 2018: 1.Rudd, Kevin. “Media Release: New National Broadband Network.” Parliament of Australia Press Release, 7 Apr. 2009 <https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:"media/pressrel/PS8T6">.Rynne, David. “Revitalising the Sugar Industry.” Sugar Policy Insights Feb. 2019: 2–3.Taylor, Emma. “A Dip in the Pond.” Sydney Morning Herald 16 Aug. 1997: 12.“Telcos and NBN Co in a Crisis.” Daily Mercury 27 Jul. 2017: 6.

Introduction As the country with the fifth largest population in the world, Indonesia is a massive potential market for mobile technology adoption and development. Despite an annual per capita income of only $1,280 USD (World Bank), there are 63 million mobile phone users in Indonesia (Suhartono, sec. 1.7) and it is predicted to reach 80 million in 2007 (Jakarta Post 1). Mobile phones are not only a symbol of Indonesian modernity (Barendregt 5), but like other communication technology can become a platform through which to explore socio-political issues (Winner 28). In this article we explore the role mobile phone technology in contemporary forms of social, intimate, and sexual relationships in Indonesia. We argue that new forms of expression and relations are facilitated by the particular features of mobile technology. We discuss two cases from contemporary Indonesia: a mobile dating service (BEDD) and mobile phone pornography. For each case study, we first discuss the socio-political background in Indonesia, then describe the technological affordances of the mobile phone which facilitate dating and pornography, and finally give examples of how the mobile phone is effecting change in dating and pornographic practices. This study is placed at a time when social relations, intimacy, and sexuality in Indonesia have become central public issues. Since the end of the New Order whilst many people have embraced the new freedoms of reformasi and democratization, there is also a high degree of social anxiety, tension and uncertainty (Juliastuti 139-40). These social changes and desires have played out in the formations of new and exciting modes of creativity, solidarity, and sociality (Heryanto and Hadiz 262) and equally violence, terror and criminality (Heryanto and Hadiz 256). The diverse and plural nature of Indonesian society is alive with a myriad of people and activities, and it is into this diverse social body that the mobile phone has become a central and prominent feature of interaction. The focus of our study is dating and pornography as mediated by the mobile phone; however, we do not suggest that these are new experiences in Indonesia. Rather over the last decade social, intimate, and sexual relationships have all been undergoing change and their motivations can be traced to a variety of sources including the factors of globalization, democratization and modernization. Throughout Asia “new media have become a crucial site for constituting new Asian sexual identities and communities” (Berry, Martin, and Yue 13) as people are connecting through new communication technologies. In this article we suggest that mobile phone technology opens new possibilities and introduces new channels, dynamics, and intensities of social interaction. Mobile phones are particularly powerful communication tools because of their mobility, accessibility, and convergence (Ling 16-19; Ito 14-15; Katz and Aakhus 303). These characteristics of mobile phones do not in and of themselves bring about any particular changes in dating and pornography, but they may facilitate changes already underway (Barendegt 7-9; Barker 9). Mobile Dating Background The majority of Indonesians in the 1960s and 1970s had arranged marriages (Smith-Hefner 443). Education reform during the 70s and 80s encouraged more women to attain an education which in turn led to the delaying of marriage and the changing of courtship practices (Smith-Hefner 450). “Compared to previous generations, [younger Indonesians] are freer to mix with the opposite sex and to choose their own marriage,” (Utomo 225). Modern courtship in Java is characterized by “self-initiated romance” and dating (Smith-Hefner 451). Mobile technology is beginning to play a role in initiating romance between young Indonesians. Technology One mobile matching or dating service available in Indonesia is called BEDD (www.bedd.com). BEDD is a free software for mobile phones in which users fill out a profile about themselves and can meet BEDD members who are within 20-30 feet using a Bluetooth connection on their mobile devices. BEDD members’ phones automatically exchange profile information so that users can easily meet new people who match their profile requests. BEDD calls itself mobile social networking community; “BEDD is a new Bluetooth enabled mobile social medium that allows people to meet, interact and communicate in a new way by letting their mobile phones do all the work as they go throughout their day.” As part of a larger project on mobile social networking (Humphreys 6), a field study was conducted of BEDD users in Jakarta, Indonesia and Singapore (where BEDD is based) in early 2006. In-depth interviews and open-ended user surveys were conducted with users, BEDD’s CEO and strategic partners in order to understand the social uses and effects BEDD. The majority of BEDD members (which topped 100,000 in January 2006) are in Indonesia thanks to a partnership with Nokia where BEDD came pre-installed on several phone models. In management interviews, both BEDD and Nokia explained that they partnered because both companies want to help “build community”. They felt that Bluetooth technology such as BEDD could be used to help youth meet new people and keep in touch with old friends. Examples One of BEDD’s functions is to help lower barriers to social interaction in public spaces. By sharing profile information and allowing for free text messaging, BEDD can facilitate conversations between BEDD members. According to users, mediating the initial conversation also helps to alleviate social anxiety, which often accompanies meeting new people. While social mingling and hanging out between Jakarta teenagers is a relatively common practice, one user said that BEDD provides a new and fun way to meet and flirt. In a society that must balance between an “idealized morality” and an increasingly sexualized popular culture (Utomo 226), BEDD provides a modern mode of self-initiated matchmaking. While BEDD was originally intended to aid in the matchmaking process of dating, it has been appropriated into everyday life in Indonesia because of its interpretive flexibility (Pinch & Bjiker 27). Though BEDD is certainly used to meet “beautiful girls” (according to one Indonesian male user), it is also commonly used to text message old friends. One member said he uses BEDD to text his friends in class when the lecture gets boring. BEDD appears to be a helpful modern communication tool when people are physically proximate but cannot easily talk to one another. BEDD can become a covert way to exchange messages with people nearby for free. Another potential explanation for BEDD’s increasing popularity is its ability to allow users to have private conversations in public space. Bennett notes that courtship in private spaces is seen as dangerous because it may lead to sexual impropriety (154). Dating and courtship in public spaces are seen as safer, particularly for conserving the reputation young Indonesian women. Therefore Bluetooth connections via mobile technologies can be a tool to make private social connections between young men and women “safer”. Bluetooth communication via mobile phones has also become prevalent in more conservative Muslim societies (Sullivan, par. 7; Braude, par. 3). There are, however, safety concerns about meeting strangers in public spaces. When asked, “What advice would you give a first time BEDD user?” one respondent answered, “harus bisa mnilai seseorang krn itu sangat penting, kita mnilai seseorang bukan cuma dari luarnya” (translated: be careful in evaluating (new) people, and don’t ever judge the book by its cover”). Nevertheless, only one person participating in this study mentioned this concern. To some degree meeting someone in a public may be safer than meeting someone in an online environment. Not only are there other people around in public spaces to physically observe, but co-location means there may be some accountability for how BEDD members present themselves. The development and adoption of matchmaking services such as BEDD suggests that the role of the mobile phone in Indonesia is not just to communicate with friends and family but to act as a modern social networking tool as well. For young Indonesians BEDD can facilitate the transfer of social information so as to encourage the development of new social ties. That said, there is still debate about exactly whom BEDD is connecting and for what purposes. On one hand, BEDD could help build community in Indonesia. One the other hand, because of its privacy it could become a tool for more promiscuous activities (Bennett 154-5). There are user profiles to suggest that people are using BEDD for both purposes. For example, note what four young women in Jakarta wrote in the BEDD profiles: Personal Description Looking For I am a good prayer, recite the holy book, love saving (money), love cycling… and a bit narcist. Meaning of life Ordinary gurl, good student, single, Owen lover, and the rest is up to you to judge. Phrenz ?! Peace?! Wondeful life! I am talkative, have no patience but so sweet. I am so girly, narcist, shy and love cute guys. Check my fs (Friendster) account if you’re so curious. Well, I am just an ordinary girl tho. Anybody who wants to know me. A boy friend would be welcomed. Play Station addict—can’t live without it! I am a rebel, love rock, love hiphop, naughty, if you want proof dial 081********* phrenz n cute guyz As these profiles suggest, the technology can be used to send different kinds of messages. The mobile phone and the BEDD software merely facilitate the process of social exchange, but what Indonesians use it for is up to them. Thus BEDD and the mobile phone become tools through which Indonesians can explore their identities. BEDD can be used in a variety of social and communicative contexts to allow users to explore their modern, social freedoms. Mobile Pornography Background Mobile phone pornography builds on a long tradition of pornography and sexually explicit material in Indonesia through the use of a new technology for an old art and product. Indonesia has a rich sexual history with a documented and prevalent sex industry (Suryakusuma 115). Lesmana suggests that the country has a tenuous pornographic industry prone to censorship and nationalist politics intent on its destruction. Since the end of the New Order and opening of press freedoms there has been a proliferation in published material including a mushrooming of tabloids, men’s magazines such as FHM, Maxim and Playboy, which are often regarded as pornographic. This is attributed to the decline of the power of the bureaucracy and government and the new role of capital in the formation of culture (Chua 16). There is a parallel pornography industry, however, that is more amateur, local, and homemade (Barker 6). It is into this range of material that mobile phone pornography falls. Amongst the myriad forms of pornography and sexually explicit material available in Indonesia, the mobile phone in recent years has emerged as a new platform for production, distribution, and consumption. This section will not deal with the ethics of representation nor engage with the debate about definitions and the rights and wrongs of pornography. Instead what will be shown is how the mobile phone can be and has been used as an instrument/medium for the production and consumption of pornography within contemporary social relationships. Technology There are several technological features of the mobile phone that make pornography possible. As has already been noted the mobile phone has had a large adoption rate in Indonesia, and increasingly these phones come equipped with cameras and the ability to send data via MMS and Bluetooth. Coupled with the mobility of the phone, the convergence of technology in the mobile phone makes it possible for pornography to be produced and consumed in a different way than what has been possible before. It is only recently that the mobile phone has been marketed as a video camera with the release of the Nokia N90; however, quality and recording time are severely limited. Still, the mobile phone is a convenient and at-hand tool for the production and consumption of individually made, local, and non-professional pieces of porn, sex and sexuality. It is impossible to know how many such films are in circulation. A number of websites that offer these films for downloads host between 50 and 100 clips in .3gp file format, with probably more in actual circulation. At the very least, this is a tenfold increase in number compared to the recent emergence of non-professional VCD films (Barker 3). This must in part be attributed to the advantages that the mobile phone has over standard video cameras including cost, mobility, convergence, and the absence of intervening data processing and disc production. Examples There are various examples of mobile pornography in Indonesia. These range from the pornographic text message sent between lovers to the mobile phone video of explicit sexual acts (Barendregt 14-5). The mobile phone affords privacy for the production and exchange of pornographic messages and media. Because mobile devices are individually owned, however, pornographic material found on mobile phones can be directly tied to the individual owners. For example, police in Kotabaru inspected the phones of high school students in search of pornographic materials and arrested those individuals on whose phones it was found (Barendregt 18). Mobile phone pornography became a national political issue in 2006 when an explicit one-minute clip of a singer and an Indonesian politician became public. Videoed in 2004, the clip shows Maria Eva, a 27 year-old dangdut singer (see Browne, 25-6) and Yahya Zaini, a married 42 year-old who was head of religious affairs for the Golkar political party. Their three-year affair ended in 2005, but the film did not become public until 2006. It spread like wildfire between phones and across the internet, however, and put an otherwise secret relationship into the limelight. These types of affairs and relationships were common knowledge to people through gossip, exposes such as Jakarta Undercover (Emka 93-108) and stories in tabloids; yet this culture of adultery and prostitution continued and remained anonymous because of bureaucratic control of evidence and information (Suryakusuma 115). In this case, however, the filming of Maria Eva once public proves the identities of those involved and their infidelity. As a result of the scandal it was further revealed that Maria Eva had been forced by Yayha Zaini and his wife to have an abortion, deepening the moral crisis. Yahya Zaini later resigned as his party’s head of Religious Affairs (Asmarani, sec. 1-2), due to what was called the country’s “first real sex scandal” (Naughton, par. 2). As these examples show, there are definite risks and consequences involved in the production of mobile pornography. Even messages/media that are meant to be shared between two consenting individuals can eventually make their way into the public mobile realm and have serious consequences for those involved. Mobile video and photography does, however, represent a potential new check on the Indonesian bureaucratic elite which has not been previously available by other means such as a watchdog media. “The role of the press as a control mechanism is practically nonexistent [in Jakarta], which in effect protects corruption, nepotism, financial manipulation, social injustice, and repression, as well as the murky sexual life of the bureaucratic power elite,” (Suryakusuma 117). Thus while originally a mobile video may have been created for personal pleasure, through its mass dissemination via new media it can become a means of sousveillance (Mann, Nolan and Wellman 332-3) whereby the control of surveillance is flipped to reveal the often hidden abuses of power by officials. Whilst the debates over pornography in Indonesia tend to focus on the moral aspects of it, the broader social impacts of technology on relationships are often ignored. Issues related to power relations or even media as cultural expression are often disregarded as moral judgments cast a heavy shadow over discussions of locally produced Indonesian mobile pornography. It is possible to move beyond the moral critique of pornographic media to explore the social significance of its proliferation as a cultural product. Conclusion In these two case studies we have tried to show how the mobile phone in Indonesia has become a mode of interaction but also a platform through which to explore other current issues and debates related to dating, sexuality and media. Since 1998 and the fall of the New Order, Indonesia has been struggling with blending old and new, a desire of change and nostalgia for past, and popular desire for a “New Indonesia” (Heryanto, sec. Post-1998). Cultural products within Indonesia have played an important role in exploring these issues. The mobile phone in Indonesia is not just a technology, but also a product in and through which these desires are played out. Changes in dating and pornography practices have been occurring in Indonesia for some time. As people use mobile technology to produce, communicate, and consume, the device becomes intricately related to identity struggle and cultural production within Indonesia. It is important to keep in mind, however, that while mobile technology adoption within Indonesia is growing, it is still limited to a particular subset of the population. As has been previously observed (Barendregt 3), it is wealthier, young people in urban areas who are most intensely involved in mobile technology. As handset prices decrease and availability in rural areas increases, however, no longer will mobile technology be so demographically confined in Indonesia. The convergent technology of the mobile phone opens many possibilities for creative adoption and usage. As a communication device it allows for the creation, sharing, and viewing of messages. Therefore, the technology itself facilitates social connections and networking. As demonstrated in the cases of dating and pornography, the mobile phone is both a tool for meeting new people and disseminating sexual messages/media because it is a networked technology. The mobile phone is not fundamentally changing dating and pornography practices, but it is accelerating social and cultural trends already underway in Indonesia by facilitating the exchange and dissemination of messages and media. As these case studies show, what kinds of messages Indonesians choose to create and share are up to them. The same device can be used for relatively innocuous behavior as well as more controversial behavior. With increased adoption in Indonesia, the mobile will continue to be a lens through which to further explore modern socio-political issues. 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"Modernity and the Mobile Phone: Exploring Tensions about Dating and Sex in Indonesia." M/C Journal 10.1 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0703/06-humphreys-barker.php>. APA Style Humphreys, L., and T. Barker. (Mar. 2007) "Modernity and the Mobile Phone: Exploring Tensions about Dating and Sex in Indonesia," M/C Journal, 10(1). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0703/06-humphreys-barker.php>.