Journal articles on the topic 'Shoulder pain Victoria'

IntroductionPersistent musculoskeletal conditions can impact profoundly on younger people’s quality of life, psychological distress and capacity to work, as shown by previous research involving younger people with osteoarthritis. The personal impacts, in particular, work and parenting impacts, of other musculoskeletal conditions (such as persistent shoulder pain) on younger patient groups remain poorly understood. Furthermore, the personal financial burden associated with managing musculoskeletal conditions is rarely documented. This study aims to investigate well-being, work participation and productivity, shoulder-related parenting disability and out-of-pocket healthcare expenditure among younger people with shoulder pain and evaluate changes over 12 months.Methods and analysisOne hundred and fifty people aged 20–55 years with shoulder pain of more than 6 weeks’ duration (excluding those with recent history of fracture or dislocation) will be recruited for this cohort study. Participants will be recruited from three major public hospitals in Victoria, Australia, following screening of orthopaedic outpatient clinics lists and referrals. Participants will be asked to complete a baseline questionnaire and 2-week healthcare costs diary, with follow-up data collected at 12 months. Patient-reported outcomes will be collected, including health-related quality of life (HRQoL), shoulder pain and function, psychological distress, shoulder-related parenting disability and work productivity. Information on sociodemographics, employment, health services utilisation and shoulder-related healthcare expenditure will also be collected. Descriptive analysis of baseline data will provide a comprehensive snapshot of the personal burden of shoulder pain. Baseline HRQoL and psychological distress data will be compared with Australian population norms to provide context around well-being. Associations between sociodemographic factors and patient-reported outcomes will be evaluated using univariate and multivariate analyses. Changes in patient-reported outcomes from baseline to 12 months will be analysed using paired t-tests.Ethics and disseminationEthics approval has been obtained. The study findings will be submitted to peer-reviewed journals and presented at relevant scientific meetings.

Objective: To determine outcomes of intra-articular corticosteroids injection versus physiotherapy for the treatment of adhesive capsulitis using mean pain score on the visual analogue scale. Study Design: Comparative prospective study. Place and Duration of Study: Orthopedic outpatient department, Bahawal Victoria Hospital Bahawalpur from Jan to Jun 2021. Methodology: A total of 120 cases having adhesive capsulitis (frozen shoulder) were included in the study according to inclusion criteria. Non-probability consecutive sampling technique was used for the selection of cases. Patients were divided into two groups, group-A and group B, each containing 60 cases. Patients in group-A were given intra-articular steroid injection (2ml triamcinolone 40mg ± 2ml of bupivacaine). Patients in group B received ten sessions of physiotherapy by a welltrained physiotherapist under the supervision of an orthopaedic surgeon on alternate days. After six weeks, outcomes were measured in terms of pain score using a visual analogue pain scale. Results: Significant improvement was seen among patients in group-A with mean pain score from 7.32 ± 0.89 measured initially to 5.44 ± 1.37 measured after six weeks (p<0.001). No significant improvement was found among patients in group B with a mean pain score of 7.58 ± 0.94 measured initially to 7.12 ± 0.88 measured after six weeks (p>0.05). Conclusion: Significant improvement in pain relief can be achieved using intra-articular steroid injection administered in the shoulder as compared to supervised sessions of physiotherapy among patients with adhesive capsulitis.

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

ObjectivesTo investigate the impacts, on mental and physical health, of a mandatory shift to working from home during the COVID-19 pandemic.DesignCross sectional, online survey.SettingOnline survey was conducted from September 2020 to November 2020 in the general population.ParticipantsAustralian residents working from home for at least 2 days a week at some time in 2020 during the COVID-19 pandemic.Main outcome measuresDemographics, caring responsibilities, working from home arrangements, work-related technology, work–family interface, psychosocial and physical working conditions, and reported stress and musculoskeletal pain.Results924 Australians responded to the online questionnaire. Respondents were mostly women (75.5%) based in Victoria (83.7%) and employed in the education and training and healthcare sectors. Approximately 70% of respondents worked five or more days from home, with only 60% having a dedicated workstation in an uninterrupted space. Over 70% of all respondents reported experiencing musculoskeletal pain or discomfort. Gendered differences were observed; men reported higher levels of family to work conflict (3.16±1.52 to 2.94±1.59, p=0.031), and lower levels of recognition for their work (3.75±1.03 to 3.96±1.06, p=0.004), compared with women. For women, stress (2.94±0.92 to 2.66±0.88, p<0.001) and neck/shoulder pain (4.50±2.90 to 3.51±2.84, p<0.001) were higher than men and they also reported more concerns about their job security than men (3.01±1.33 to 2.78±1.40, p=0.043).ConclusionsPreliminary evidence from the current study suggests that working from home may impact employees’ physical and mental health, and that this impact is likely to be gendered. Although further analysis is required, these data provide insights into further research opportunities needed to assist employers in optimising working from home conditions and reduce the potential negative physical and mental health impacts on their employees.

Background: Assisted dying remains an emotive topic globally with a number of countries initiating legislation to allow individuals access to assisted dying measures. Victoria will become the first Australian state in over 13 years to pass Assisted Dying Legislation, set to come into effect in 2019. Objectives: This article sought to evaluate the impact of Victorian Assisted Dying Legislation via narrative view and case study presentation. Research design: Narrative review and case study. Participants and research context: case study. Ethical considerations: This legislation will provide eligible Victorian residents with the option to request access to assisted dying measures as a viable alternative to a potentially painful, protracted death. Findings: This legislation, while conservative and inclusive of many safeguards at present, will form the basis for further discussion and debate on assisted dying across Australia in time to come. Discussion: The passing of this legislation by the Victorian parliament was prolonged, emotive and divided not only the parliament but Australian society. Conclusion: Many advocates for this legislation proclaimed it was well overdue and will finally meet the needs of contemporary society. Protagonists claim that medical treatment should not provide a means of ending life, despite palliative care reportedly often failing to relieve the pain and suffering of individuals living with a terminal illness.

Family provision legislation was introduced in Victoria in 1906 to allow the court to order provision from the estate of a deceased person whose will did not make adequate provision for the proper maintenance and support of a person for whom the deceased had a moral duty to provide. The first version of the legislation allowed only widows and children to claim; it underwent little reform until 1997 when a major amendment to the Administration and Probate Act 1958 (Vic) removed the statutory list of eligible applicants, and replaced it with the jurisdictional question, ‘Did the deceased have a responsibility to provide?’ This in theory means that ‘anyone’ can make a claim, including those without a close family relationship with the deceased. This article examines a selection of judgments handed down under the new provisions, with the aim of showing the range of applicants who are now eligible to apply and examining the particular features of their relationship with the deceased that determined the success of their claims. This is in light of the current Victorian Law Reform Commission Inquiry into Succession Law that questions whether eligibility should be limited to certain types of relationship, and whether costs should continue to be paid out of the estate.

Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of six months. Detailed preoperative, intraoperative, and postoperative details of cases were recorded according to proforma. The postoperative pain and pain at days two and seven and at end of six months were recorded on a VAS scale. Results. Chronic pain at six-month followup was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7% of patients with preoperative pain developed chronic pain. Preemptive analgesia failed to show statistical significance in development of chronic pain (P=0.079). Nerve injury was present in 22 of cases; it was found that nerve injury significantly affected development of chronic pain (P=0.001). On multivariate analysis, it was found that development of chronic pain following hernia surgery was dependent upon factors like preoperative pain, type of anesthesia, nerve injury, postoperative local infiltration, postoperative complication, and most importantly the early postoperative pain. Conclusions. In the present study, we found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. Preemptive analgesia and operation under local anesthesia significantly affect pain. Intraoperative identification and preservation of all inguinal nerves are very important. Early diagnosis and management of chronic pain can remove suffering of the patient.

ObjectivesGreater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. Limited evidence exists for the effectiveness of exercise for GTPS. This study aimed to compare the effectiveness of isometric and isotonic exercise for individuals with GTPS.MethodsThis randomised controlled pilot trial recruited 30 participants with GTPS. Both programmes consisted of daily, progressive home exercise for 12 weeks with 8 individual physiotherapy sessions over the trial period. The primary outcome measure was the Victorian Institute of Sport Assessment-Gluteal (VISA-G) and secondary outcome measures included the Numeric Pain Rating Scale (0–10) and an 11-point Global Rating of Change Scale. Outcome measures were assessed at baseline, 4 and 12 weeks.ResultsTwenty-three participants completed the trial. After 12 weeks, mean VISA-G scores improved in both groups; 55–65 in the isometric group and 62–72 in the isotonic group. 55% of the isometric group and 58% of the isotonic group achieved a reduction in pain of at least 2 points (minimally clinically important difference (MCID)) on the Numeric Pain Rating Scale. 64% of the isometric group and 75% of the isotonic group had improved by at least 2 points (MCID) on the Global Rating of Change Scale.ConclusionIsometric and isotonic exercise programmes appear to be effective for individuals with GTPS and should be considered in the loading management of patients with this condition.

Introduction. Australian medical speciality colleges have adapted and integrated the CanMEDS Physician Competency Framework into their training programs. The role as manager is one of the competencies and is presently thought to receive little attention during training. The objective of our study was to investigate the perceptions of Australian junior doctors regarding their management skills and their perceived need for management education. Methods. In November and December 2011, 1376 junior doctors from eight Victorian metropolitan health services were invited via email to participate in this study. Participating junior doctors received a questionnaire regarding their self- perceived management skills and knowledge and a medical management training needs assessment. Results. The response rate of one of the health centres was too low (6%) and therefore insufficient for credible conclusions to be drawn. Of the other health services, 194 (16%) out of 1213 junior doctors responded to the survey. Overall, the junior doctors rated their perceived competency on a 1–5 Likert scale as moderate (mean 3.45; s.d. 0.42). Of the 194 residents who responded, 71.3% (n = 139) reported a need for management training. Discussion. The junior doctors of Victoria, Australia perceived their knowledge on medical management as moderate. The results of this study showed that there is a perceived need among junior doctors for more management training. This need seems to confirm that management skills are thought to be valuable in medical practice. Our study also suggests that before the development of specific interventions, there is a need for a gap analysis between the perceived and actual management skills desired in medical residents. The attention paid to the role ‘as manager’ should therefore be embedded in training of all junior doctors. What is known about the topic? The CanMEDS 2005 Framework describes the seven key competencies physicians should possess to meet the needs of patients and society, and was developed by The Royal College of Physicians and Surgeons of Canada. One of these competencies is the role as manager. Published studies have shown that medical residents have a need for education in healthcare management in basic and postgraduate medical training. What does this paper add? In this study we discovered that junior doctors in Victorian metropolitan health services have a moderate perception of their competencies as managers. Previous management experience influenced the perceived competence in a positive way. What are the implications for practitioners? We believe that it is necessary that junior doctors continue to build on existing opportunities to develop their management skills. In order to achieve this, awareness of the importance of management competencies and the possibilities to obtain management experience must be raised among junior doctors. Furthermore, they need to be given the opportunity to obtain experience.

Design: A retrospective study of 40 cases of Trigeminal Neuralgia who were treated surgically ( by MVD, micro-vasculardecompression). Place & Duration: Department of Neurosurgery Quaid-I-Azam Medical College/Bahawal Victoria Hospital Bahawalpur duringfour (4) year period from January 2003 to December 2006.These patients were resistant to medical treatment so MVD was performed. MethodsTotal number of patients is (40) forty. In 10 patients CT scan brain and especially for posterior fossa was performed before surgery to rule outany suspected tumour pathology. In the remaining 30 cases no MRI or CT scanning of brain was done before surgery and diagnosis ofTrigeminal Neuralgia was made on clinical grounds. Results: Posterior fossa was opened by standard right or left retro-mastoid approachdepending upon the side of pain. In 27 out of 40 cases the superior cerebellar artery (SCA) was the offending vessel. In 5 cases, only the veinwas the cause of pain. In 2 cases, vein and artery, both were the offending vessels. In 2 cases, only arachnoidal adhesions were the causeof pain. And in 4 cases, after opening the posterior fossa it was found that cause of pain is a tumour of trigeminal nerve (3 cases) or meningioma(1 case) of cerebellopontine angle. C o n c l u s i o n : From these operative findings of tumours in the posterior fossa in cases of TrigeminalNeuralgia, it is concluded that all the patients suffering from Trigeminal Neuralgia should be screened with MRI prior to surgery to rule out anytumour pathology as a cause of Trigeminal Neuralgia, so that proper preparations be made before surgical intervention.

The use of PRP (platelet-rich plasma) is beneficial and even more important in the future. The most common indications were tendon damage (77%), osteoarthritis (68%), muscle damage (57%) and cartilage damage (51%). It is a purified autologous blood product with a higher platelet concentration than whole blood. It is rich in various cytokines and growth factors and has been shown to initiate and enhance healing by stimulating cell migration, cell proliferation, angiogenesis, and matrix synthesis. In rotator cuff injury, PRP injection led to significant long-term pain relief but not in functional improvements. In Osteoarthritis, PRP injection is associated with long-term pain relief and function improvements. PRP injection has a better outcome in VAS (visual analog scale) and DASH (The Disabilities of the Arm, Shoulder and Hand) scores in elbow ulnar collateral ligament pathologies, including lateral elbow epicondylitis. In medial epicondylitis, a paucity of studies causing therapeutic modality for PRP has not yet been established. In acute muscle injury, PRP used has no differences in imaging, pain, ROM (range of motion), muscle strength, and muscle function. In Achilles Tendinopathy, PRP injection has been associated with improvement in VAS, but no difference in VISA-A (The Victorian Institute of Sports Assesment – Achilles Questionnaire) score. However, the majority of published literature is secondary and tertiary evidence. Future studies could provide important information about the optimal concentrations of growth factors, platelets and leukocytes required for the desired effect in many specific tissues, as well as the appropriate method of administration and timing of drug application.

Objective To determine whether the anteroposterior (AP) diameter of the patellar tendon in volleyball players is associated with a greater sensation of pain and decreased functionality. Material and Methods A descriptive, observational, cross-sectional study conducted on volleyball players. The scores on the Victorian Institute of Sport Assessment–Patella (VISA-P) scale were registered, together with the visual analogue scale (VAS) and the AP diameter of the patellar tendon, at 5 and at 10 mm distal to the inferior pole of the patella. The demographic, anthropometric and playing characteristics were registered and multiple linear regression models were constructed in order to analyze the relationship between the study variables. Results The final sample comprised 112 players. The AP diameter was greater in men and showed a positive significant association with the score on the VAS scale and a negative significant association with the VISA-P for both tendons after adjusting for the remaining variables. Conclusions The measurement of the AP diameter of the patellar tendon may be useful for the prevention of sports injuries in volleyball players as a greater tendon diameter is significantly associated with increased perceived pain and decreased functionality. Future studies should include a biomechanical analysis of jump and reception techniques.

They are taught what is called the hypothetical language for many of their best years – a language which was originally composed at a time when the country was in a very different state of civilisation to what it is at present, a state which has long since disappeared and been superseded. Many valuable maxims and noble thoughts which were at one time concealed in it have become current in their modern literature, and have been translated over and over again into the language now spoken. Surely then it would seem that the study of the original language should be confined to the few whose instincts led them naturally to pursue it.But the Erewhonians think differently; the store they set by this hypothetical language can hardly be believed; they will even give any one a maintenance for life if he attains a considerable proficiency in the study of it; nay, they will spend years in learning to translate some of their own good poetry into the hypothetical language – to do so with fluency being the mark of a scholar and a gentleman. Heaven forbid that I should be flippant, but it appeared to me to be a wanton waste of good human energy that men should spend years and years in the perfection of so barren an exercise, when their own civilisation presented problems by the hundred which cried aloud for solution and would have paid the solver handsomely; but people know their own affairs best.

From British debates over the 1832 New Poor Law to the near present, the notion of “desert” has long had a clear referent in discussions of social welfare policy. The designation “deserving poor” was reserved for those with legitimate grounds for not supporting themselves through paid employment. Invariably among them were the very young, the very old, and the mentally and physically very disabled—people who literally could not work for a living. Also included were various categories of people who, according to the varying conventions of the day, were socially excused from paid labor—widows in the Victorian era, students in the postwar era, and so on. Anyone who could and should work for a living but refused to do so was traditionally deemed to be among the “undeserving poor.” Those were the people whose “welfare dependency” has long been the target of welfare reformers, most recently Ronald Reagan and Margaret Thatcher, Bill Clinton and Tony Blair.

Background The Refugee Health Program (RHP) is a nurse-led community initiative, introduced in 2005 with the aim of responding to complex health issues of refugees arriving in Victoria, Australia. Little is known about refugee health nursing in the resettlement context and the impact of dedicated refugee healthcare. Aim To explore the experiences and perspectives of Refugee Health Nurses (RHNs), Refugee Health Managers (managers) and refugees, gaining insight into professional relationships and the complexities of offering a specialised refugee health service. Method A focused ethnographic approach incorporated semi-structured interviews with five RHNs, two managers and eight refugees, two focus groups with refugees and participant observation within the RHP during April 2017 to December 2017. Data collection was undertaken across two sites and interviews, focus groups and observations were transcribed and thematically analysed. Social constructionism asserts that the focus of enquiry should be on interaction, group processes and social practices. Emphasis is placed upon relationships between RHNs, managers and refugees, with knowledge viewed as relational and interactional. Results Professional relationships between RHNs and refugees are complex, with power oscillating between them. Contrary to discourses of ‘vulnerability’ of refugees, both RHNs and refugees demonstrated power in their relationships with each other. Nurses also suggested that these relationships were stressful and could lead to burnout. Key themes were developed: (1) nursing autonomy and gatekeeping; (2) vicarious trauma and burnout; and (3) refugee negotiation of care. Conclusions The balance of power is central to therapeutic relationships. In relationships between RHNs and refugees, power fluctuates as RHNs are exposed to vicarious trauma and symptoms of burnout, while refugees exercise agency by recognising benefits to specialised care. In developing effective therapeutic relationships between RHNs and refugees, attention should be paid to how care is delivered to protect RHNs from burnout while ensuring that refugees receive appropriate care.

Objective. To gain better understanding of the work-preparedness of new interns and identify areas where further training and education should be provided. Design. Surveys of new interns assessing self-reported confidence and preparedness for tasks commonly undertaken without direct supervision. The first survey was undertaken before the cohort had started work, the second once they had completed their second intern rotation. Setting. A large metropolitan Victorian health service. Participants. All interns starting in 2009 at Southern Health. Of the total 66 interns, 52 (84%) completed the first survey and 37 (56%) completed the second. Main outcome measure(s). Self-reported confidence and preparedness for common intern tasks. Results. The surveys identified tasks that interns undertake frequently, their preparedness for these and their confidence in completing them. Although most felt reasonably well prepared by their university training for many tasks they commonly undertake as interns, this was not the case for all tasks. In particular, they did not feel well prepared for the following: preoperative patient review, handover, fluid and medication management, patient admissions, assessment of unstable patients, communication with patients and families, and pain management. Conclusions. There are particular domains of work-readiness for interns that could be improved. For best results, the training of interns in these common tasks should be undertaken jointly by hospitals and universities to ensure smooth transition from medical student to intern. What is known about the topic?Transition from student to intern requires a range of skills and attributes. Previous publications have demonstrated a link between the number of times a procedural task has been completed by junior medical staff and confidence in completion. What does this paper add?This paper documents interns' own views about the tasks commonly undertaken during internship, and their views on how well they were prepared for these tasks by university training and organisational orientation. It considers non-procedural tasks (such as communication and escalation) as well as common intern procedures. It also documents the intern hopes and concerns regarding internship immediately pre-employment and after 20 weeks of employment. What are the implications for practitioners?Later-year university training experiences and organisational orientation planning should at least in part be geared by the requirements for work-readiness at intern level.

The Victorian Parliament has recently introduced a Bill which implements home detention as a sentencing option. Home detention is an intuitively appealing reform. The logic behind the proposal seems obvious. Prisons are expensive to run. There are too many offenders in prison. So let's take the cost out of prison by turning the homes of offenders into prisons: classic, user-pays, cost-shifting economics. The level of superficial appeal of the argument in favour of home detention is matched only by the depth of the fallacies underpinning some of the fundamental premises. The most basic of which is the assumption that offenders who are candidates for the new sanction should be in detention (of any kind) in the first place. Further, the narrow objective of reducing imprisonment is misguided. It should not be elevated to a cardinal sentencing objective—otherwise total success could be achieved by simply opening the prison gates. There are also other concerns about the appropriateness of home detention. The degree of pain it inflicts in many cases is questionable and it may also violate the principle that punishment should not be inflicted on the innocent. After examining the arguments for and against home detention, this article suggests the approach that should be adopted to achieve enlightened and meaningful sentencing reform.

Summary This article explores the creation of the Post Office medical service. Working for the Post Office was relatively well-paid and an increasing number of doctors were employed. Medical provision expanded with the introduction of non-contributory pensions from mid-century and developed into a comprehensive and nationwide service that was involved at all stages of employment, from initial recruitment through to receiving a pension. Post Office doctors assessed candidates’ fitness for work, checked on sick absences, provided free medicine and advice and visited workers’ homes. Doctors were responsible for determining whether or not a worker should be pensioned off on grounds of ill health. The career of the first Chief Medical Officer, Dr Waller Lewis, also illustrates the range of other areas in which the Post Office medical service became involved, including the clinical assessment and relief of sickness as well as identifying preventative measures to improve health outcomes.

Background: Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic’s role in the care of these patients. Aim: To describe the incidence and nature of cases attended by paramedics and the care provided where the reason for attendance was associated with a history of palliative care. Design: This is a retrospective cohort study. Setting/participants: Adult patients (aged >17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care or end of life were recorded in the patient care record. Secondary transfers including inter-hospital transport cases were excluded. Results: A total of 4348 cases met inclusion criteria. Median age was 74 years (interquartile range 64–83). The most common paramedic assessments were ‘respiratory’ (20.1%), ‘pain’ (15.8%) and ‘deceased’ (7.9%); 74.4% ( n = 3237) were transported, with the most common destination being a hospital (99.5%, n = 3221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic, morphine, fentanyl or methoxyflurane, and 356 (99.2%) were transported following analgesic administration. Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 h of the previous attendance. Conclusion: Paramedics have a significant role in caring for patients receiving palliative care. These results should inform the design of integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.

ObjectivesSurgical removal of the plantaris tendon can cure plantaris-associated Achilles tendinopathy, a condition in which Achilles and plantaris tendinopathy coexist. However, rare cases with plantaris tendinopathy alone are often misdiagnosed due to a normal Achilles tendon.Design and settingProspective case series study at one centre.ParticipantsTen consecutive patients (9 men and one woman, mean age 35 years, range 19–67) with plantaris tendon-related pain alone in altogether 13 tendons were included. All had had a long duration (median 10 months, range 3 months to 10 years) of pain symptoms on the medial side of the Achilles tendon mid-portion. Preoperative ultrasound showed thickened plantaris tendon but a normal Achilles tendon.InterventionsOperative treatment consisting of ultrasound-guided excision of the plantaris tendon.Primary and secondary outcome measuresScores from Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A)were taken preoperatively and postoperatively (median duration 10 months). Patient satisfaction and time until full return to sports activity level was asked by a questionnaire.ResultsThe VISA-A scores increased from 61 (range 45–81) preoperatively to 97 (range 94–100) postoperatively (p<0.01). Follow-up results at 10 months (range 7–72 months) on 9/10 patients showed full satisfaction and return to their preinjury sports or recreational activityConclusionThe plantaris tendon should be kept in mind when evaluating painful conditions in the Achilles tendon region, especially when no Achilles tendinopathy is present. Excision of the plantaris tendon via a minor surgical procedure in local anaesthesia results in a good outcome.

23 Background: The diagnosis and treatment of cancer often causes financial stress, partly by impacting on the ability to continue in paid employment. Our aim was to identify changes in work status 12 months after a diagnosis of breast cancer. Methods: An audit of the medical records of women who presented to the Western Health (Victoria, Australia) nurse led breast cancer Survivorship Clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at their review at SC 12 months later. Results: 111 records were reviewed. The mean age was 55 (range 28-82yrs). 84 of these women (76%) were 65 years of younger at the time of diagnosis. 46 of the 84 women ≤65 years were in paid employment at diagnosis (55%), and 38 (83%) were still working in some capacity at review in the SC. Of the 38 still working, 28 were working in the same capacity, 8 were working reduced hours, and 2 were working increased hours. Women who had axillary dissections were most likely to have changed work status. Financial stress was reported by 8/19 of women who stopped working or had changed work hours, including 9 no longer in paid employment and 10 with changed hours. 2/28 women working in the same capacity reported financial stress. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. Conclusions: A breast cancer diagnosis has the ability to influence a woman's work status one year after diagnosis. Health professionals should appreciate the potential work concerns and financial stresses continuing to affect their patients.

Background Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies. Hypothesis Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy. Study Design Randomized controlled clinical trial; Level of evidence, 2. Methods This study consisted of 27 patients (30 knees) in the study group and 23 patients (24 knees) in the control group. In the study group, patients were treated with 1500 impulses of extracorporeal shockwave at 14 KV (equivalent to 0.18 mJ/mm 2 energy flux density) to the affected knee at a single session. Patients in the control group were treated with conservative treatments including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise program, and the use of a knee strap. The evaluation parameters included pain score, Victorian Institute of Sports Assessment score, and ultrasonographic examination at 1, 3, 6, and 12 months and then once a year. Results At the 2- to 3-year follow-up, the overall results for the study group were 43% excellent, 47% good, 10% fair, and none poor. For the control group, the results were none excellent, 50% good, 25% fair, and 25% poor. The mean Victorian Institute of Sports Assessment scores were 42.57 ± 10.22 and 39.25 ± 10.85, respectively, before treatment (P = .129) and 92.0 ± 10.17 and 41.04 ± 10.96, respectively, after treatment (P < .001). Satisfactory results were observed in 90% of the study group versus 50% of the control group (P < .001). Recurrence of symptoms occurred in 13% of the study group and 50% of the control group (P = .014). Ultrasonographic examination showed a significant increase in the vascularity of the patellar tendon and a trend of reduction in the patellar tendon thickness after shockwave treatment compared with conservative treatments. However, no significant difference in the appearance, arrangement, and homogeneity of tendon fibers was noted between the 2 groups. There were no systemic or local complications or device-related problems. Conclusion Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.

Reference: de Vos RJ, van Veldhoven PLJ, Moen MH, Weir A, Tol JL. Autologous growth factor injections in chronic tendinopathy: a systematic review. Br Med Bull. 2010;95:63–77. Clinical Question: The authors of this systematic review evaluated the literature to critically consider the effects of growth factors delivered through autologous whole-blood and platelet-rich–plasma (PRP) injections in managing wrist-flexor and -extensor tendinopathies, plantar fasciopathy, and patellar tendinopathy. The primary question was, according to the published literature, is there sufficient evidence to support the use of growth factors delivered through autologous whole-blood and PRP injections for chronic tendinopathy? Data Sources: The authors performed a comprehensive, systematic literature search in October 2009 using PubMed, MEDLINE, EMBASE, CINAHL, and the Cochrane library without time limits. The following key words were used in different combinations: tendinopathy, tendinosis, tendinitis, tendons, tennis elbow, plantar fasciitis, platelet rich plasma, platelet transfusion, and autologous blood or injection. The search was limited to human studies in English. All bibliographies from the initial literature search were also viewed to identify additional relevant studies. Study Selection: Studies were eligible based on the following criteria: (1) Articles were suitable (inclusion criteria) if the participants had been clinically diagnosed as having chronic tendinopathy; (2) the design had to be a prospective clinical study, randomized controlled trial, nonrandomized clinical trial, or prospective case series; (3) a well-described intervention in the form of a growth factor injection with either PRP or autologous whole blood was used; and (4) the outcome was reported in terms of pain or function (or both). Data Extraction: All titles and abstracts were assessed by 2 researchers, and all relevant articles were obtained. Two researchers independently read the full text of each article to determine if it met the inclusion criteria. If opinions differed on suitability, a third reviewer was consulted to reach consensus. The data extracted included number of participants, study design, inclusion criteria, intervention, control group, primary outcome measures (pain using a visual analog or ordinal scale or function), time of follow-up, and outcomes for intervention and control group (percentage improvement) using a standardized data-extraction form. Function was evaluated in 9 of the 11 studies using (1) the Nirschl scale (elbow function) or the modified Mayo score for wrist flexors and extensors, (2) the Victorian Institute of Sports Assessment-Patella score, a validated outcome measure for patellar tendinopathy, or the Tegner score for patellar tendinopathy, and (3) the rearfoot score from the American Orthopaedic Foot and Ankle Scale for plantar fasciopathy. The Physiotherapy Evidence Database (PEDro) scale contains 11 items; items 2–11 receive 1 point each for a yes response. Reliability is sufficient (0.68) for the PEDro scale to be used to assess physiotherapy trials. A score of 6 or higher on the PEDro scale is considered a high-quality study; below 6 is considered a low-quality study. The PEDro score results determined the quality of the randomized controlled trial (RCT), nonrandomized clinical trial, or prospective case series (≥6 or &lt;6). A qualitative analysis was used with 5 levels of evidence (strong, moderate, limited, conflicting, or no evidence) to determine recommendations for the use of the intervention. The number of high-quality or low-quality RCT or nonrandomized clinical trial studies with consistent or inconsistent results determined the level of evidence (1–5). Main Results: Using the specific search criteria, the authors identified 418 potential sources. After screening of the title or abstract (or both), they excluded 405 sources, which left 13 studies. After viewing the full text, they excluded 2 additional sources (a case report and a study in which the outcome measure was remission of symptoms and not pain or function), leaving 11 studies for analysis. Six of the 11 studies were characterized by an observational, noncontrolled design; the remaining 5 studies were controlled clinical trials, 2 of which had proper randomization. The mean number of participants included in the studies was 40.5 (range = 20 to 100). Three of the studies were on “tennis elbow,” 1 on “golfer's elbow,” 1 on wrist extensor or flexor tendinopathy, 3 on plantar fasciopathy, and 3 on chronic patellar tendinopathy. Based on the information reported, there was no standardization of frequency or method of growth factor injection treatment or of preparation of the volume, and an optimal mixture was not described. Autologous whole-blood injections were used in 8 studies; in 5 studies, the autologous whole-blood injection was combined with a local anesthetic. In contrast, a local anesthetic was used in only 1 of the 3 PRP injection studies. The authors of the other 2 studies did not report whether a local anesthetic was used. The number of autologous whole-blood and PRP injections varied, ranging from 1 to 3. The centrifuging process was single or double for the PRP injections. In 2 studies, calcium was added to activate the platelets. A visual analogue or ordinal pain scale was used in 10 of the 11 studies. Function was evaluated in 9 of the 11 studies using (1) the Nirschl scale in 4 elbow studies or the modified Mayo score at baseline in 1 elbow study, (2) the Victorian Institute of Sports Assessment-Patella score for 1 study and the Tegner score for 2 of the patellar tendinopathy studies, and (3) the rearfoot score of the American Orthopaedic Foot and Ankle Scale for 1 plantar fasciopathy study. Only 1 study used an appropriate, disease-specific, validated tendinopathy measure (Victorian Institute of Sports Assessment-Patella). All intervention groups reported a significant improvement in pain or function score (or both), with a mean improvement of 66% over a mean follow-up of 9.4 months. The control groups in these studies also showed a mean improvement of 57%. None of the pain benefits among the intervention groups were greater than those for the control group at final follow-up. In 4 of the studies, the control group and the autologous growth factor injection group had similar results in pain or function or both, whereas in 2 studies, the control group had greater relief in pain than the injection group. Eleven studies were assessed using the PEDro scale. The PEDro scores for these studies ranged from 1 to 7, with an average score of 3.4. Only 3 studies had PEDro scores of ≥6 and were considered high quality. The 3 high-quality plantar fasciopathy studies used autologous growth factor injections but did not show a significant improvement over the control group. One of the studies that showed no beneficial effect for the autologous growth factor injections was compared with corticosteroids. Compared with other treatments, level 1 (strong) evidence demonstrated that autologous growth factor injections did not improve pain or function in plantar fasciopathy. The PRP injection results were based on 3 low-quality studies, 2 for the patellar tendon and 1 for the wrist flexors-extensors; level 3 (limited) evidence suggests that PRP injections improve pain or function. Conclusions: Strong evidence indicates that autologous growth factor injections do not improve plantar fasciopathy pain or function when combined with anesthetic agents or when compared with corticosteroid injections, dry needling, or exercise therapy treatments. Furthermore, limited evidence suggests that PRP injections are beneficial. Except for 2 high-quality RCT studies, the rest were methodologically flawed. Additional studies should be conducted using proper control groups, randomization, blinding, and validated disability outcome measures for pain and function. Until then, the results remain speculative because autologous whole-blood and PRP injection treatments are not standardized.

Background: Christmas Eye Disease (CED), also known as the “Albury-Wodonga syndrome” or “Harvester's Keratitis”, is a seasonal acute corneal ulceration syndrome, which is geographically limited to Australia, specifically in the south-west region of New South Wales (NSW) and north-east region of Victoria. The mechanism of injury is unknown, but the secretions from native beetles of the genus Orthoperus have been implicated. There remains a dearth of literature on CED, particularly with atypical disease presentations. We present the first reported case of CED in the upper Blue Mountains Region, presenting atypically with mild pain and foreign body sensation. We also aim to explore the possible entomological precipitants of the disease. Case Presentation: A 77-year-old man with a 1-day history of a mildly painful red eye was found to have acute corneal ulceration. He experienced mild discomfort in his right eye while asleep and woke the following morning with persistent blur, foreign body sensation, and photophobia. He had no history of ocular trauma or chemical exposure. He reported going for daily bushwalks in the upper Blue Mountains region but did not recall any exposure to environmental or entomological precipitants. Clinical Findings and Outcomes: Slit-lamp examination revealed a substantial corneal epithelial loss in the right eye with fluorescein staining, revealing a characteristic ‘green splash’ over 90% of the cornea. Other clinical findings included marked corneal edema, moderate conjunctival injection, mild palpebral swelling, and mild papillae. No anterior uveitis was observed, and the posterior segment examination was normal. There was a considerable reduction in his right visual acuity from baseline. He was empirically treated with 1% tropicamide ocular drops, 1% chloramphenicol ointment, and lubricant ocular drops. The bacterial and viral conjunctival swabs were unremarkable. Clinical progression was self-limiting, and complete resolution of the ulcer was achieved after one month. Conclusion: CED is a clinical diagnosis, and medical practitioners should be aware of atypical features, such as the absence of debilitating pain. Additionally, our case demonstrates that the geographic distribution of CED appears to be far more extensive than previously thought, thereby raising the possibility of disease manifestation in regions not commonly associated with it. Entomological precipitants of this condition remain circumstantial and warrant further validation.

IntroductionParamedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic’s role in the care of these patients. This study therefore aimed to describe the incidence and nature of cases attended by paramedics, the treatment provided, and the transport destination if transported, where the reason for attendance was associated with a history of palliative care.MethodsThis retrospective cohort study included all adult patients (aged > 17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care, dying or end of life were recorded in the patient care record. Secondary transfers were excluded. Descriptive statistics were used to analyse the sample. Categorical data are presented as frequencies and proportions, with comparisons made using the χ2 test.Results4,348 cases met inclusion criteria. Most patients were aged between 61–80 years (47.9%). The most common assessments recorded by paramedics were ‘respiratory’ (20.1%), ‘pain’ (15.8%), and ‘deceased’ (7.9%). 54.0% (n=2,346) received treatment from the paramedics, and 74.4% (n=3,237) were transported, with the most common destination a hospital (99.5%, n=3,221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic. Nausea and/or vomiting was documented in 15.6% (n=680) of cases attended. Antiemetics administered in these cases included metoclopramide (n=71, 10.4%), prochlorperazine (n=21, 3.1%), and ondansetron (n=9, 1.3%). Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 hours of the previous attendance.Discussion and conclusionParamedics may become involved in the care of patients receiving palliative care due to exacerbation of symptoms or a new health emergency. As such, the paramedic has a key role in managing symptoms or liaising with other members of the patient’s palliative care team to provide appropriate care. The results should inform integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.

The poorer health outcomes experienced by people with mental illness have led to new directions in policy for routine physical health screening of service users. By contrast, little attention has been paid to the physical health needs of consumers of alcohol and other drug (AOD) services, despite a similar disparity in physical health outcomes compared with the general population. The majority of people with problematic AOD use have comorbid mental illness, known as a dual diagnosis, likely to exacerbate their vulnerability to poor physical health. With the potential for physical health screening to improve health outcomes for AOD clients, a need exists for systematic identification and management of common health conditions. Within the current health service system, those with a dual diagnosis are more likely to have their physical health surveyed and responded to if they present for treatment in the mental health system. In this study, a physical health screening tool was administered to clients attending a community-based AOD service. The tool was administered by a counsellor during the initial phase of treatment, and referrals to health professionals were made as appropriate. Findings are discussed in terms of prevalence, types of problems identified and subsequent rates of referral. The results corroborate the known link between mental and physical ill health, and contribute to developing evidence that AOD clients present with equally concerning physical ill health to that of mental health clients and should equally be screened for such when presenting for AOD treatment.

Purpose – The purpose of this paper is to compare the quality of work-life experiences of workers in construction firms of differing sizes and explored the work conditions and circumstances that impact upon the work-life experiences of workers in small-to-medium sized enterprises (SMEs) in the Australian construction industry. Design/methodology/approach – Data were collected in two stages. First, data from a sub-set of construction industry workers were extracted from a large scale survey of workers in Victoria, Australia (the VicWAL survey). The survey measured work-life interference using the Australian Work and Life Index (AWALI). Next a subset of survey respondents was identified and interviewed to gain more detailed explanatory information and insight into work-life experiences. Findings – The survey results indicated that respondents who reported working for a construction firm with between 16 and 99 employees reported significantly higher AWALI scores (indicating high work-life interference) than workers in organisations employing 15 or less or more than 100 workers. The follow-up interviews revealed that workers in small construction organisations were managed directly and personally by the business owner/manager and able to access informal work-life supports that were provided on an “as needs” basis. In comparison workers in medium-sized firms perceived higher levels of work pressure and an expectation that work would be prioritised over family life. Research limitations/implications – The research shows that the findings of work-life balance research undertaken in large construction organisations cannot be generalised to SMEs. Organisation size should also be treated as an important variable in work-life balance research in construction. Practical implications – The research suggests that a better understanding of how workers in SME construction firms experience work-life balance is important in the design and development of work-life balance programs. In particular the challenges faced by workers as companies grow from SMEs require careful consideration and management. Originality/value – Previous research has focused on the work-life balance experiences of employees in large construction firms. Little was previously known about the experiences of workers in SME construction firms. The research provides new insight into the work-life experiences of construction workers in organisations of varying sizes.

Introduction Multimorbidity is increasing in prevalence, especially in low-income settings. Despite this, chronic conditions are often managed in isolation, potentially leading to burden-capacity imbalance and reduced treatment adherence. We aimed to explore, in a low-income population with common comorbidities, how the specific demands of multimorbidity affect burden and capacity as defined by the Cumulative Complexity Model. Materials and methods Qualitative interviews with thirteen rural community health centre patients in Victoria, Australia. Participants were aged between 47–72 years and reported 3–10 chronic conditions. We asked about perceived capacity and burden in managing health. The Theory of Patient Capacity was used to analyse capacity and Normalisation Process Theory to analyse burden. All data specifically associated with the experience of multimorbidity was extracted from each burden and capacity domain. Results The capacity domains of biography, resource mobilisation and work realisation were important in relation to multimorbidity. Conditions causing functional impairment (e.g. chronic pain, depression) interacted with physical, psychological and financial capacity, leading to biographical disruption and an inability to realise treatment and life work. Despite this, few people had a treatment plan for these conditions. Participants reported that multimorbidity affected all burden domains. Coherence and appraisal were especially challenging due to condition interactions, with clinicians providing little guidance. Discussion The capacity and burden deficits highlighted by participants were not associated with any specific diagnosis, but were due to condition interactions, coupled with the lack of health provider support to navigate interactions. Physical, psychological and financial capacities were inseparable, but rarely addressed or understood holistically. Understanding and managing condition and treatment interactions was a key burden task for patients but was often difficult, isolating and overwhelming. This suggests that clinicians should become more aware of linkages between conditions, and include generic, synergistic or cross-disciplinary approaches, to build capacity, reduce burden and encourage integrated chronic condition management.

Introduction Palpation tenderness is one of the clinical signs used in the diagnosis of patellar tendinopathy (PT). Despite the widespread use of pain pressure thresholds (PPTs) for assessment purposes, it is unknown whether other variables may influence the results of this test and its precision to discriminate between knees with and without PT. Objective To identify the discriminative accuracy of PPTs as a diagnostic test of PT in professional basketball players, used both in an isolated manner and in combination with other tests. Material and Methods An observational study with professional basketball players in which the main variable measured was the PPT, and the secondary variables were the Victorian Institute of Sport Assessment, Patellar tendon (VISA-P) questionnaire and the visual analogue scale (VAS). Age, weight and height were gathered as potential covariates. The receiver operating characteristic (ROC) curve was constructed with the data of the area under the ROC curve (AUC), used to determine the precision of the PPT applied on its own or combined with other secondary variables and covariates. Results In total, 146 patellar tendons of 73 players were analyzed. When analyzing the differences between the PPT of healthy tendons and those with PT, differences were found between the dominant leg and the non-dominant leg. Regarding the cut-off points, the most precise discrimination of a tendon with PT was 8.8 kg/cm2 for an isolated PPT test and 14% for its combination with the VAS. Conclusions This study shows the effectiveness of combining the data from the PPT and the VAS scores. Therefore, both tests should be used for the assessment of PT in professional basketball players, as this combination increases the discriminatory accuracy. Furthermore, these tests are easily applied in clinical practice.

Background:Multimorbidity (≥2 chronic conditions) escalates the risk of adverse health outcomes. However, its burden in people with osteoarthritis (OA) remains largely unknown.Objectives:To identify the clusters of patients with multimorbidity and associated factors in OA and non-OA populations and to estimate the risk of developing multimorbidity clusters after the index date (after diagnosis).Methods:The study used the Clinical Practice Research Datalink – a primary care database from the UK. Firstly, age, sex and practice matched OA and non-OA people aged 20+ were identified to explore patterns and associations of clusters of multimorbidity within each group. Non-OA controls were assigned with same index date as that of matched OA cases. Secondly, multimorbidity trajectories for 20 years after the index date were examined in people without any comorbidities at baseline in both OA and non-OA groups. Latent class analysis was used to identify clusters and latent class growth modelling was used for cluster trajectories. The associations between clusters and age, sex, body mass index (BMI), alcohol use, smoking habits at baseline were quantified through multinomial logistic regression.Results:In total, 47 long-term conditions were studied in 443,822 people (OA- 221922; non-OA- 221900), with a mean age of 62 years (standard deviation ± 13 years), and 58% being women. The prevalence of multimorbidity was 76.6% and 68.9% in the OA and non-OA groups, respectively. In the OA group five clusters were identified including relatively healthy (18%), ‘cardiovascular (CVD) and musculoskeletal (MSK)’ (12.3%), metabolic syndrome (28.2%), ‘pain and psychological (9.1%), and ‘musculoskeletal’ (32.4%). The non-OA group had similar patterns except that the ‘pain+ psychological’ cluster was replaced by ‘thyroid and psychological’. (Figure 1) Among people with OA, ‘CVD+MSK’ and metabolic syndrome clusters were strongly associated with obesity with a relative risk ratio (RRR) of 2.04 (95% CI 1.95-2.13) and 2.10 (95% CI 2.03-2.17), respectively. Women had four times higher risk of being in the ‘pain+ psychological’ cluster than men when compared to the gender ratio in the healthy cluster, (RRR 4.28; 95% CI 4.09-4.48). In the non-OA group, obesity was significantly associated with all the clusters.Figure 1: Posterior probability distribution of chronic conditions across the clusters in Osteoarthritis (OA, n=221922) and Non-Osteoarthritis (Non-OA, n=221900) group. COPD- Chronic Obstructive Pulmonary Disease; CVD- Cardiovascular; MSK- MusculoskeletalOA (n=24139) and non-OA (n=24144) groups had five and four multimorbidity trajectory clusters, respectively. Among the OA population, 2.7% had rapid onset of multimorbidity, 9.5% had gradual onset and 11.6% had slow onset, whereas among the non-OA population, there was no rapid onset cluster, 4.6% had gradual onset and 14.3% had slow onset of multimorbidity. (Figure 2)Figure 2: Clusters of multimorbidity trajectories after index date in OA (n=24139) and Non-OA (n=24144)Conclusion:Distinct identified groups in OA and non-OA suggests further research for possible biological linkage within each cluster. The rapid onset of multimorbidity in OA should be considered for chronic disease management.Supported by:Acknowledgments:We would like to thank the University of Nottingham, UK, Beijing Joint Care Foundation, China and Foundation for Research in Rheumatology (FOREUM) for supporting the study.Disclosure of Interests:Subhashisa Swain: None declared, Carol Coupland: None declared, Victoria Strauss: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Chang-Fu Kuo: None declared, Aliya Sarmanova: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium

Objectives To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population. Methods An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and subsequent consultation (item 116) and, for patients with multiple morbidities, initial management planning (item 132) and review (133). The analysis included 12 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, general medicine, geriatric medicine, haematology, immunology and allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). Main outcome measures were per-capita service use by medical speciality and by state and territory and ratio of subsequent consultations to initial consultations by medical speciality and by state and territory. Results There was marked variation in per-capita consultant physician service use across the states and territories, tending higher than average in New South Wales and Victoria, and lower than average in the Northern Territory. There was variation between and within specialties across states and territories in the ratio of subsequent consultations to initial consultations. Conclusion Significant per-capita variation in consultant physician utilisation is occurring across Australia. Future studies should explore the variation in greater detail to discern whether workforce issues, access or economic barriers to care, or the possibility of over- or under-servicing in certain geographic areas is leading to this variation. What is known about the topic? There are nearly 11million initial and subsequent consultant physician consultations billed to Medicare per year, incurring nearly A$850million in Medicare benefits. Little attention has been paid to per-capita variation in rates of consultant physician service use across states and territories. What does this paper add? There is marked variation in per-capita consultant physician service use across different states and territories both within and between specialties. What are the implications for practitioners? Variation in service use may be due to limitations in the healthcare workforce, access or economic barriers, or systematic over- or under-servicing. The clinical appropriateness of repeated follow-up consultations is unclear.

Underground gas storage is becoming increasingly important in Australia with the discovery of significant gas reserves, mostly in places distant from the expanding markets for gas.Gas has been stored in the offshore Barracouta Field since 1971 and storage projects are either being considered or underway in New South Wales, South Australia, Western Australia and the Northern Territory.Although not a great deal of attention has been paid to the legal, tax and administrative aspects of underground gas storage, the position is likely to change the more it becomes apparent that such storage is commercially and technically viable.The applicable legal regime will depend on the location of the storage. Offshore gas storage on the continental shelf beyond the coastal waters of a state is subject to Commonwealth jurisdiction. In state coastal waters, it is subject to state laws. Onshore, it is subject to the jurisdiction of the state or territory in which the storage occurs.Offshore beyond state coastal waters the Australian government has sovereign rights over the continental shelf for the purposes of exploring the continental shelf and exploiting its natural resources.There are a number of legal uncertainties which arise from gas storage which will be of concern to financiers as well as gas storers. With certain exceptions, there is doubt as to ownership of stored gas, and the right to inject and store gas. The right of withdrawal however would appear to fall under the right which normally exists under a production lease to 'mine' petroleum, or to conduct 'petroleum mining operations'. Except in Victoria, and to a significantly lesser extent South Australia, there is very little legislative guidance on the topic and related issues.The question whether stored gas is trading stock is the subject of Income Tax Ruling 2190 of 10 September 1985. This puts at rest, in practical terms, in any event, some of the doubts which existed as to the characterisation for income tax purposes of gas stored near the place of original extraction — the ruling concluded that 'reinjected processed gas should not be treated as trading stock for income tax purposes'.It is concluded that there is a good case for those Australian jurisdictions in which gas storage is occurring, or is about to occur, to provide legislation to eliminate the uncertainties.

The article reveals the experience of using a master class on academic vocal as a form of activation of the educational process in urban institutions of higher education in Ukraine. Since Ukrainian scholars have not identified theoretical works on the role of master classes in the educational process in the vocal sphere, the disclosure of experience, which is the purpose of our article, should update the development of methodological and methodical principles of research. It has been established that over the last decade the form of master classes has been increasingly used by domestic vocal teachers. The experience of their holding at the Mykola Lysenko Lviv National Academy of Music, the Institute of Arts of the Borys Hrinchenko Kyiv University and the Vasyl Stefanyk Precarpathian National University with the participation of leading foreign opera singers, most of whom are of Ukrainian origin, was summarized. All of them worked on master classes on a volunteer basis. In Lviv they were conducted by the professor from the Academy of Music (Norway), world-famous singer (tenor) Carlo Allemano, in Kyiv – world-famous opera singer (lyric-coloratura soprano) Victoria Lukianets from Vienna, in Ivano-Frankivsk – also world-famous opera singer (baritone) Pavlo Gunka (Great Britain), young singers, soloists of Polish opera theaters Iryna Zhytynska and Stanislav Kufliuk. In each case, the duration of master classes lasted from one to seven days, the number of participants was 4–30 people. A pre-studied program of 1–3 works (aria, solo songs, folk song) was chosen for the work. Some teachers paid more attention to technical problems in voice production, others – to the artistic image, associations, understanding of the works performed. The structure of the master classes included: 1) demonstration by a recognized singer-mentor of his skills and his understanding of the problem in a practical form; 2) involvement of the student in active activity on mastering of skill under the control of the expert; 3) publicity, ie the presence of a wide audience (teachers, students, journalists), who perceived the process of communication between the master and his wards, and who joined this process, asking questions and demanding explanations. The organizational and semantic aspects of the use of master classes in academic vocal in higher educational institutions in the field of art are in need of further consideration.

Acidification of non arable soils under long-term pasture presents a major agricultural problem in the high rainfall areas (≥600 mm/year) of central and southern New South Wales and north-eastern Victoria. Some of these soils were already strongly acid to depth before agriculture. Evidence suggests that persistence of pasture species tolerant of acidic soils is being affected adversely on a number of severely acidic soils. Acidification processes are well understood but the capacity for grazing enterprises to pay for amendment by lime application is a major constraint in long-term pasture areas. In addition, soil acidification is likely to have substantial off-site effects on water quantity and quality and as a result, on dryland salinity. However, there is a paucity of scientific evidence to link soil acidity and dryland salinity in this way. Production from a grazing enterprise can be maintained by selecting plants for tolerance of acidity, surface application of lime or a combination of both. Responses by subterranean clover, lucerne and perennial grass (mainly phalaris and cocksfoot)-based pastures to incorporated lime are reported, but there is limited evidence of responses to surface applied lime. The movement of the lime effect into the soil from surface application is suggested as a major factor in controlling lime responses by plants. There is a need for more confidence in the benefits of topdressed lime in non arable soils before producers are likely to adopt the practice. High subsurface acidity in many soils is a major limitation to the range of species that can be grown. In the longer term, the use of lime may remove constraints on the use of productive species such as lucerne. Other options for acidic soils where slope is less than 10% are for the grazing system to be modified or intensified, or for crop or horticultural production. Costs of lime could be justified through more profitable enterprises than traditional grazing operations. Low input systems based on native grasses are intrinsically appealing, however, this is only possible where a premium is paid for such produce (such as super fine wool). Forestry is an option where suitable land and infrastructure are present and should slow soil acidification and minimise off-site impacts. Land retirement may be a useful option for some parts of the landscape that contribute disproportionately to environmental problems. Private and government funded land retirement may have a role to play.

According to the headnote attached to the most recent decision under discussion, the litigation turned on the quantification of the total loss suffered by M as alleged holder of a right of habitatio after S as reputed owner of the farm revoked the verbal agreement between the parties entitling M to occupy the dwelling ad infinitum on condition that he renovates the dwelling to a habitable state. Notwithstanding the conviction of the judges involved, it is clear that at no stage were any of the requirements for the acquisition or vesting of a limited real right of habitatio complied with. No limited real right was registered against the farm and S as the alleged grantor of the limited real right was at no stage the owner of the property. He could not have been entitled to burden the property of another with such limited real right. A contractual arrangement between the parties, however, did exist granting the claimant an entitlement to occupy the dwelling. The initially friendly relations between the litigants soured abruptly in February 2013 when S evicted M from the farm because of a supposed blasphemous comment by M. This happened after the claimant had already invested significantly in the restoration and modernisation of the old dilapidated dwelling. “The plaintiff regarded this as a repudiation of the contract between him and the defendant, accepted it as such and left the farm, effectively halting the renovation project” (par 14 read with par 5.4 of the 2016-decision). His claim for compensation of the loss suffered was held by the court to be limited to the amounts reflected in the receipts representing the cost of building material when it was acquired. It is submitted that the court should also have taken note of the loss suffered as positive interest, because the claimant forfeited the calculated benefit of life-long free occupation in the restored dwelling. Because of the underlying agreement between the parties to the litigation, the patrimonial benefit that accrued to the estate of the owner of the farm due to the objective rules of accessio cannot be classified as actionable unjustified enrichment. The principles of unjustified enrichment do not apply – the resulting detriment or loss of M was cum causa and not sine causa. The remarks of the court pointing to unjustified enrichment do not convince. Damages should have been calculated to cover the loss in positive interest of the claimant and not merely his negative interest, ie the amounts paid for the building material used in the renovation. The court, however, held: “I’m satisfied that the plaintiff has adduced sufficient evidence to prove his claim for the costs of renovating the farmhouse on a balance of probabilities” (par 23). The last mentioned mode of quantification of the loss suffered would have been more in place where merely a delict was involved, as eg where the damaged motor vehicle should be repaired to the state it was in before the accident occurred. Had the judges in this case done a correct assessment of loss upon cancellation for breach of contract, it would have led to a respect of the rule of law and would not have been to the detriment of the claimant. The legal principles that should have been applied had already been clearly formulated more than a century ago: “The sufferer by such a breach should be placed in the position he would have occupied had the contract been performed, so far as that can be done by the payment of money, and without undue hardship to the defaulting party …” Victoria Falls & Transvaal Power Co Ltd v Consolidated Langlaagte Mines Ltd (1915 AD 1 22).

BackgroundImmune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but can result in toxicities, known as immune-related adverse events (irAEs), due to a hyperactivated immune system. ICI-related inflammatory arthritis has been described in literature, but herewith we introduce and characterize post-ICI activated osteoarthritis (ICI-aOA).MethodsWe conducted a multi-center, retrospective, observational study of patients with cancer treated with ICIs and diagnosed with ICI-aOA by a rheumatologist. ICI-aOA was defined by (1) an increase in non-inflammatory joint pain after ICI initiation, (2) in joints characteristically affected by osteoarthritis and (3) lack of inflammation on exam. Cases were graded using the CTCAE (Common Terminology Criteria for Adverse Events) V6.0 rubric for arthralgia. RECIST (Response evaluation criteria in solid tumors) V.1.1 (v.4.03) guidelines determined tumor response. Results were analyzed using Chi-squared tests of association and multivariate logistic regression.ResultsThirty-six patients had ICI-aOA with mean age at time of rheumatology presentation of 66 years (51–81yrs). Most patients had metastatic melanoma (10/36, 28%) and had received a PD1/PDL1 inhibitor monotherapy (31/36, 86%) with 5/36 (14%) combination therapy. Large joint involvement (hip/knee) was noted in 53% (19/36), small joints of hand 25% (9/36), and spine 14% (5/36). Two-thirds (24/36) suffered multiple joint involvement. Three of 36 (8%) had CTCAE grade 3, 14 (39%) grade 2 and 19 (53%) grade 1 manifestations. Symptom onset ranged from six days to 33.8 months with median of 5.2 months after ICI initiation; 5 patients suffered ICI-aOA after ICI cessation (0.6, 3.5, 4.4, 7.3 and 15.4 months after ICI cessation) (figure 1). Most common form of therapy was intra-articular corticosteroid injections only (15/36, 42%) followed by NSAIDs only (7/36, 20%) (figure 2). Twenty patients (56%) experienced other irAEs, with rheumatic and dermatologic being the most common. All three patients with high-grade ICI-aOA also had another irAE diagnosis at some point after ICI initiation.ConclusionsICI-aOA should be recognized as an adverse event of ICI immunotherapy. Early referral to a rheumatologist can facilitate the distinction between ICI induced inflammatory arthritis from post-ICI mechanical arthropathy, the latter of which can be managed with local therapy that will not compromise ICI efficacy.Ethics ApprovalCollection of patient data was approved by local Institutional Review Boards at respective institutions: Hospital for Special Surgery in New York (HSS IRB # 2017–1898), University of Chicago in Chicago, Illinois (IRB150837) and Austin Health in Melbourne, Victoria, Australia (HREC/18/Austin/102).Abstract 817 Figure 1Incidence of ICI-aOA (activated osteoarthritis after immune-checkpoint inhibitor) ranged from the first month after ICI initiation up until month 22 after ICI initiation, with most cases occurring in the first 6 months after start of ICI. Five of 36 patients experienced ICI-aOA after ICI cessation (0.6, 3.5, 4.4, 7.3 and 15.4 months after ICI cessation), corresponding to presentation after ICI initiation as follows: 2.0, 9.6, 19.1, 8.7 and 16.1 months after ICI initiation, respectively (as denoted in darker color). ICI: Immune-checkpoint inhibitor, NSAIDs: Non-steroidal anti-inflammatory drugs, DMARDs: Disease modifying anti-rheumatic drugsAbstract 817 Figure 2Therapeutic option most used was local or intra-articular corticosteroid therapy, followed by conservative management with physical therapy only then NSAIDs. Most patients experienced improvement in signs and symptoms with treatment. ICI: Immune-checkpoint inhibitor, NSAIDs: Non-steroidal anti-inflammatory drugs, DMARDs: Disease modifying anti-rheumatic drugs

Arab military expansion was a real challenge to the Byzantine Empire. The defeats sustained in wars with the Arabs, whom the Byzantines called sometimes Hagarenes to refer to Biblical Hagar, forced new method of war waging. That knowledge was taken predominantly directly from battlefield. The Arab menace increased during the reign of Leo VI the Wise (886-912). Albeit not a soldier himself, he took an attempt to reorganize the Byzantine army and navy. Although it did not bring an immediate effect, the Empire gradually be­gan to initiative. The situation changed for better during the reign of Constantine VII Porphyrogennetos (911-959) and Romanos I Lekapenos (919-959). A peace with the Bulgarians allowed to collect substantial forces on the eastern border of the empire. The weakening of the Abbasids gave way to the Hamdanid dynasty from northern Iraq and Syria to grow to the most serious Byzantine adversary in mid- 10th century, particularly during the reign of Sayf al-Dawla (945-967), who re­corded some remarkable victories over the Byzantine forces. In 955 Nikephoros II Phokas took over the post of domesticos of the East. Along with his brother Leo, Strategos of Cappadocia and John Tzimiskes, they were able to change the course of war, winning some battles in northern Syria. The struggle with the Muslims resulted in a number of military treatises, the most known of which were attributed to emperors Leo VI and Nikephoros II Pho­kas. Although it is not certain if they were written by them themselves, they were certainly created on their behalf. Among several treatises of Leo VI, the Tactica seems to be the most interest­ing. The work divided in 20 chapters was meant as a handbook for military com­manders. It discussed the organization of infantry, cavalry and navy, and their use in war, as well as that of sieges, ambushes etc. Much attention was paid to Arab logistics. Remarkably little, if any attention was paid to religious grounds as a rea­son for expansion. Not too surprisingly, much of the work was dedicated to the methods of efficient struggle against Muslims; the author correctly identified both strong and week sides of the Byzantine army. Some points clearly suggest a desire to take over certain elements of organization and war art from the adversary. Also the treatise by Nikephoros Phokas represents equally good value as Tactica. In this work we find a number of details regarding both military and non-military customs of the Arabs, which is not surprising, as the author was a military commander, experienced in battles against the Muslims. For this reason we should respect even more the military knowledge of Leo’s Tactica, if we remember that the author was not a professional soldier. Interestingly enough, with the notable exception of Nikephoros Phokas, the authors of other treatises added little to the information contained in Leo’s work. The reason for that was explicitly laid out by an anonymous author of still another treatise, Βιβλίον τακτικόν, who wrote that the chiefs knew so much about the raids on the lands of the Hagarenes that there was no use to discuss them in detail.

<p><strong>1. How can we maintain a sustainable private practice in the current political and economic climate?</strong></p><p>Eugene Allers</p><p><strong>2. SASOP Clinical guidelines, protocols and algorithms: Development of treatment guidelines for bipolar mood disorder and major depression</strong></p><p> Eugene Allers, Margaret Nair, Gerhard Grobler</p><p><strong>3. The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country</strong></p><p>U A Botha, P Oosthuien, L Koen, J A Joska, J Parker, N Horn</p><p><strong>4. Neurophysiology of emotion and senses - The interface between psyche and soma</strong></p><p>Eugene Allers</p><p><strong>5. Suicide prevention: From and beyond the psychiatrist's hands</strong></p><p>O Alonso Betanourt, M Morales Herrera</p><p><strong>6. Treatment of first-episod psychosis: Efficacy and toleabilty of a long-acting typical antipsychotic </strong></p><p>B Chiliza, R Schoeman, R Emsey, P Oosthuizen, L KOen, D Niehaus, S Hawkridge</p><p><strong>7. Treatment of attention deficit hyperactivity disorder in the young child</strong></p><p>Helen Clark</p><p><strong>8. Holistic/ Alternative treatment in psychiatry: The value of indigenous knowledge systems in cllaboration with moral, ethical and religious approaches in the military services</strong></p><p>J Dill</p><p><strong>9. Treating Schizophrenia: Have we got it wrong?</strong></p><p>Robin Emsley</p><p><strong>10.Terminal questions in the elderly</strong></p><p>Mike Ewart Smith</p><p><strong>11. Mental Health Policy development and implementation in Ghana, South Africa, Uganda and Zambia</strong></p><p>Alan J Flisher, Crick Lund, Michelle Frank, Arvin Bhana, Victor Doku, Natalie Drew, Fred N Kigozi, Martin Knapp, Mayeh Omar, Inge Petersen, Andrew Green andthe MHaPP Research Programme Consortium</p><p><strong>12. What indicators should be used to monitor progress in scaling uo services for people with mental disorders?</strong></p><p>Lancet Global Mental Health Group (Alan J Flisher, Dan Chisholm, Crick Lund, Vikram Patel, Shokhar Saxena, Graham Thornicroft, Mark Tomlinson)</p><p><strong>13. Does unipolar mania merit research in South Africa? A look at the literature</strong></p><p>Christoffel Grobler</p><p><strong>14. Revisiting the Cartesian duality of mind and body</strong></p><p>Oye Gureje</p><p><strong>15. Child and adolescent psychopharmacology: Current trends and complexities</strong></p><p>S M Hawkridge</p><p><strong>16. Integrating mental illness, suicide and religion</strong></p><p>Volker Hitzeroth</p><p><strong>17. Cost of acute inpatient mental health care in a 72-hour assessment uniy</strong></p><p>A B R Janse van Rensburg, W Jassat</p><p><strong>18. Management of Schizophrenia according to South African standard treatment guidelines</strong></p><p>A B R Janse van Rensburg</p><p><strong>19. Structural brain imaging in the clinical management of psychiatric illness</strong></p><p>F Y Jeenah</p><p><strong>20. ADHD: Change in symptoms from child to adulthood</strong></p><p>S A Jeeva, A Turgay</p><p><strong>21. HIV-Positive psychiatric patients in antiretrovirals</strong></p><p>G Jonsson, F Y Jeenah, M Y H Moosa</p><p><strong>22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape</strong></p><p>John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein</p><p><strong>23. Star'd - Critical review and treatment implications</strong></p><p>Andre Joubert</p><p><strong>24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session</strong></p><p>Andre Joubert</p><p><strong>25. My brain made me do it: How Neuroscience may change the insanity defence</strong></p><p>Sean Kaliski</p><p><strong>26. Child andadolescent mental health services in four African countries</strong></p><p>Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium</p><p><strong>27. Individualistic theories of risk behaviour</strong></p><p>Liezl Kramer, Volker Hitzeroth</p><p><strong>28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma?</strong></p><p>Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium</p><p><strong>29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital</strong></p><p>Carri Lewis, Christa Kruger</p><p><strong>30. Mental health and poverty: A systematic review of the research in low- and middle-income countries</strong></p><p>Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium</p><p><strong>31. The cost of scaling up mental health care in low- and middle-income countries</strong></p><p>Crick Lund, Dan Chishlom, Shekhar Saxena</p><p><strong>32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape</strong></p><p>P Milligan, J S Parker</p><p><strong>33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour</strong></p><p>D L Mkize</p><p><strong>34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005)</strong></p><p>N M Moola, N Khamker, J L Roos, P Rheeder</p><p><strong>35. One flew over Psychiatry nest</strong></p><p>Leverne Mountany</p><p><strong>36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry</strong></p><p>Margaret G Nair</p><p><strong>37. Developing the frameor of a postgraduate da programme in mental health</strong></p><p>R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay</p><p><strong>38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital</strong></p><p>J S Parker, P Milligan</p><p><strong>39. Task shifting: A practical strategy for scalingup mental health care in developing countries</strong></p><p>Vikram Patel</p><p><strong>40. Ethics: Informed consent and competency in the elderly</strong></p><p>Willie Pienaar</p><p><strong>41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search patient good</strong></p><p>Willie Pienaar</p><p><strong>42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country</strong></p><p>Duncan Ian Rodseth</p><p><strong>43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry</strong></p><p>Felix Potocnik</p><p><strong>44. Brain stimulation techniques - update on recent research</strong></p><p>P J Pretorius</p><p><strong>45. Holistic/Alternative treatments in psychiatry</strong></p><p>T Rangaka, J Dill</p><p><strong>46. Cognitive behaviour therapy and other brief interventions for management of substances</strong></p><p>Solomon Rataemane</p><p><strong>47. A Transtheoretical view of change</strong></p><p>Nathan P Rogerson</p><p><strong>48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period</strong></p><p>Deleyn Rema, Lindiwe Mthethwa, Christa Kruger</p><p><strong>49. Management of psychogenic and chronic pain - A novel approach</strong></p><p>M S Salduker</p><p><strong>50. Childhood ADHD and bipolar mood disorders: Differences and similarities</strong></p><p>L Scribante</p><p><strong>51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication</strong></p><p>Dinesh Singh, Karl Goodkin</p><p><strong>52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums</strong></p><p><strong></strong>Dan J Stein</p><p><strong>53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study</strong></p><p>Ugash Subramaney</p><p><strong>54. Canabis use in Psychiatric inpatients</strong></p><p><strong></strong>M Talatala, G M Nair, D L Mkize</p><p><strong>55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country</strong></p><p>H S Teh, P P Oosthuizen</p><p><strong>56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa</strong></p><p>Rita Thom</p><p><strong>57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital</strong></p><p>Ronel van der Westhuizen, Christa Kruger</p><p><strong>58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study</strong></p><p>Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein</p><p><strong>59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)?</strong></p><p>Werdie van Staden</p><p><strong>60. What every psychiatrist needs to know about scans</strong></p><p>Herman van Vuuren</p><p><strong>61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series</strong></p><p>Urvashi Vasant, Dinesh Singh</p><p><strong>62. Association between uetrine artery pulsatility index and antenatal maternal psychological stress</strong></p><p>Bavanisha Vythilingum, Lut Geerts, Annerine Roos, Sheila Faure, Dan J Stein</p><p><strong>63. Approaching the dual diagnosis dilemma</strong></p><p>Lize Weich</p><p><strong>64. Women's mental health: Onset of mood disturbance in midlife - Fact or fiction</strong></p><p>Denise White</p><p><strong>65. Failing or faking: Isses in the fiagnosis and treatment of adult ADHD</strong></p><p>Dora Wynchank</p>

Criminalisation theory scholars have examined important questions regarding what behaviours should be criminalised and why. More recently, greater attention has been paid to linking normative accounts with empirical and historicised analyses of criminalisation practices. Building on recent work on modalities of criminalisation as a methodological tool for contextual criminalisation research, this article introduces a second analytical approach for better understanding how criminal laws are made: processes of criminalisation. We discuss the findings of a pilot study of 143 criminal law statutes enacted in three Australian jurisdictions (New South Wales, Queensland, Victoria) from 2012–2017. We conclude that a processes approach supports a nuanced appreciation of the conditions under which criminal law statutes are produced, and facilitates scrutiny of whether legislative enactments are evidence-based and a product of meaningful consultation and genuine democratic participation in law-making.

Abstract Background Previous studies examining temporal variation in cardiovascular care have largely been limited to assessing weekend and after-hours effects whereby those presenting on the weekend or after-hours have a poorer outcome. However, emerging evidence suggests more complex patterns in patterns and outcomes may exist. Purpose We aimed to determine patterns of temporal variation in chest pain presentations and subsequent health-care quality and outcomes. Methods This was an observational, prospective-cohort study of adult patients aged 18 and over who were attended by emergency medical services for non-traumatic chest pain between 1 January 2015 and 30 June 2019 in Victoria, Australia. Major exclusion criteria included pre-hospital diagnosis of ST elevation myocardial infarction or an out of hospital cardiac arrest. The exposure variable was time of day and day of week stratified into 168 hourly time periods. The primary outcome measure was 30-day mortality. Results The study cohort comprised 196,365 ambulance attendances for acute non-traumatic chest pain; mean age 62.4 years (SD 18.3) and 99,497 (50.7%) females. Three temporal patterns were observed for chest pain presentations (Figure 1): (1) a diurnal pattern with a sharp increase in presentations from 8 am, peaking around midday, before decreasing into late evening with a nadir between 3–4 am, (2) a weekend effect where Saturday and Sunday had a relatively lower rate of presentations compared to during the week, and (3) a Monday – Sunday gradient where more presentations were likely earlier in the week, than later. Six patterns were identified across pre-hospital and hospital key performance indicators (KPI) (diurnal, in/after-hours, weekend effect, Monday – Sunday gradient, a peak period and morning vs afternoon/evening effect. Risk of 30-day mortality was associated with weekend presentation (OR 1.15, 95% CI 1.06–1.24, p=0.001) and morning presentation between midnight and midday (OR 1.17, 95% CI 1.09–1.25, p&lt;0.001) (Figure 2). Conclusion Chest pain presentations, care quality and outcomes demonstrate complex temporal variation beyond the already established weekend and after-hours effect. Such relationships should be considered during resource allocation and quality improvement programs in order to improve treatment quality across all days and times of the week. Funding Acknowledgement Type of funding sources: None.

Introduction: Achilles tendinopathy (AT) is a chronic musculoskeletal pathology best evaluated by ultrasound imaging. This cross-sectional study aimed at better understanding the relationship between musculoskeletal ultrasound biomarkers (MUBs) of Achilles tendon and localized pain, ankle flexibility, ankle strength, and functional abilities.Method: Forty-one participants with unilateral midportion chronic AT had their tendon images analyzed bilaterally in the longitudinal and transverse planes. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and Lower Extremity Functional Scale (LEFS) assessed pain and function, respectively, during standing and walking-related activities. Ankle flexibility was evaluated by weight-bearing lunge tests, while ankle isometric peak strength was measured using an instrumented dynamometer. Achilles tendon ultrasonographic images were analyzed using geometric (thickness), composition (echogenicity), and texture (homogeneity) MUBs. Discriminative validity was evaluated using paired Student's t-tests to compare MUBs between symptomatic and asymptomatic sides. Predictive validity was evaluated by computing the Pearson product-moment correlations coefficient between MUBs and pain, ankle flexibility, ankle strength, and function.Results: Significant differences were found in MUBs between the symptomatic and asymptomatic sides, confirming the discriminative validity of the selected MUBs. On the symptomatic side, thickness was found 29.9% higher (p &lt; 0.001), echogenicity 9.6% lower (p &lt; 0.001), and homogeneity 3.8% higher (p = 0.001) when compared with the asymptomatic side. However, predictive validity was scarcely confirmed, as most of the correlation coefficients were found negligible for the associations investigated between MUBs with localized pain, ankle flexibility, strength, and function. Only 14 statistically significant low to moderate associations were found, with negative and positive correlations ranging between −0.31 and −0.55 and between 0.34 and 0.54, respectively.Discussion: Musculoskeletal ultrasound biomarkers have a clinical utility in visualizing in vivo tendon integrity and diagnosing AT. MUBs should be valued as part of a comprehensive neuro-musculoskeletal assessment as they complement pain, flexibility, strength, and function measures. Altogether, they may inform the development and monitoring of a personalized rehabilitation treatment plan.

In Australia, the ageing population generate challenges, pressures and opportunities for both governmental and community organisations. Involvement in community choirs offers older people diverse benefits that increase with ongoing participation. The music directors/conductors (MD/C) of community choirs are pivotal in the success of ensembles. This paper forms part of our wider study into Well-being and ageing: community, diversity and the arts in Victoria, Australia and addresses the questions, how do music directors/conductors (MD/C) of community choirs understand working with older people? And, how do older choir members understand the role of their MD/C? We interviewed two MD/Cs and thematically analysed our data. We present our findings under two overarching themes that evolved from our data analysis: Understandings of working with older people in a choir and musical leadership in a community setting. We found that the MD/Cs are reflective practitioners who imbued their facilitation and conducting with enthusiasm, skill, knowledge and passion for musical engagement. Our research suggests that to ensure longevity of choirs and to recognise the contribution of MD/Cs, greater attention should be paid to the upskilling of future generations of MD/Cs.

AbstractPurpose This study sought to determine patterns of opioid use among workers with a compensated lower limb injury, factors associated with opioid use, and how opioid use is associated with time loss duration. Methods Claims and medication data were provided by the workers’ compensation regulator of Victoria, Australia, for claims lodged 2008–2018 from workers aged 15+ years with a lower limb injury. Descriptive statistics showed the number and prevalence of each opioid type (weak/strong) by demographic, claim and injury predictors. Binary and multinomial logistic regression determined the likelihood of any opioid use, and use of strong, weak or a combination of strong and weak opioids by predictors. Cox regression determined the effect of each opioid type on duration of time loss, controlling for predictors. Results There were 51,334 claims and of these 23.6% were dispensed opioids (9.2% for strong opioids only, 6.6% for weak opioids only and 7.8% for a combination). Weak opioids, on average, were dispensed 15 days earlier than strong opioids. Time loss claims and workers with fractures or hip injuries were most likely to be dispensed opioids. All opioids were associated with increased duration of time loss, with those dispensed both weak and strong opioids having the longest duration of time loss. Conclusions Any opioid use was associated with longer time loss duration, with increasing opioid strength having a greater effect. Review of pain management methods should be undertaken to reduce opioid use, which may have a positive impact on duration of time loss and long-term function.

Abstract Objective The aim of this study was to report the incidence and clinical course of a series of patients who were misdiagnosed with Bell’s palsy and were eventually proven to have occult neoplasms. Methods Two hundred forty patients with unilateral facial paralysis who were assessed at the facial nerve reanimation clinic, Victoria Hospital, London Health Science Centre, from 2008 through 2017 were reviewed. Persistent paralysis without recovery was the presenting complaint. Results Nine patients (3.8%) who were proven to have occult neoplasms initially presented with a diagnosis of Bell’s palsy. The mean diagnostic delay was 43.5 months. Four patients were proven to have skin cancers, 3 patients had parotid cancers, and 2 patients had facial nerve schwannomas as a final diagnosis. Initial magnetic resonance imaging (MRI) was performed in all 9 patients and 8 underwent a follow-up MRI. An occult tumor was identified upon review of the original MRI in one patient and at follow-up MRI in 8 patients. The mean time interval between the initial and follow-up imaging was 30.8 months. The disease status at most recent follow-up were no evidence of disease in 2 patients (22%) and alive with disease in 7 patients (78%). An irreversible, progressive pattern of facial paralysis combined with pain, multiple cranial neuropathies or history of skin cancer were predictable risk factors for occult tumors. Seven out of the 9 patients (77.8%) underwent at least one type of facial reanimation surgery, and the final subjective results by the surgeon were available for 5 patients. Three out of the 5 (60%) patients who were available for final subjective analysis were reported as Grade III according to the modified House-Brackmann scale. Conclusion Occult facial nerve neoplasm should be suspected in patients with progressive and irreversible facial paralysis but the diagnosis may only become evident with follow-up imaging. Facial reanimation surgery is a satisfactory option for these patients. Graphical abstract

IntroductionI work at a regional campus of La Trobe University, Australia. More precisely, I work at the Bendigo campus of La Trobe University. At Bendigo, we are often annoyed when referred to and addressed as ‘regional’ students and staff. Really, we should not be. After all, Bendigo campus is an outpost of La Trobe’s metropolitan base. It is funded, run, and directed from Bundoora (Melbourne). The word ‘regional’ simply describes the situation. A region is an “administrative division of a city or a district [… or …] a country” (Brown 2528). And the Latin etymology of region (regio, regere) includes “direction, line”, and “rule” (Kidd 208, 589). Just as the Bendigo campus of La Trobe is a satellite of the metropolitan campus, the town of Bendigo is an outpost of Melbourne. So, when we are addressed and interpellated (Althusser 48) as regional, it is a reminder of the ongoing fact that Australia is (still) a colony, an outpost of empire, a country organised on the colonial model. From central administrative hubs, spokes of communication, and transportation spread to the outposts. When Bendigo students and staff are addressed as regional, in a way we are also being addressed as colonial.In this article, the terms ‘region’ and ‘regional’ are deployed as inextricably associated with the Australian version of colonialism. In Australia, in the central metropolitan hubs, where the colonial project is at its most comprehensive, it is hard to see what remains, to see what has escaped that project. The aim of this article is to explore how different aspects of the country escape the totalising project of Australian colonialism. This exploration is undertaken primarily through a discussion of the ways in which some places on this continent remain not regional (and thus, not colonial) how they keep the metropolis at bay, and how they, thus, keep Europe at bay. This discussion includes a general overview of the Australian colonial project, particularly as it pertains to First Nations Peoples, their knowledge and philosophies, and the continent’s unique ecologies. Then the article becomes more speculative, imagining different ways of seeing and experiencing time and place in this country, ways of seeing the remains and refuges of pre-1788, not-regional, and not-colonial Australia. In these remains and refuges, there persist the flourishing and radical difference of this continent’s ecologies and, not surprisingly, the radical suitedness of tens of thousands of years of First Nations Peoples’ culture and thinking to that ecology, as Country. In what remains not regional, I argue, are answers to the question: How will we live here in the Anthropocene?A Totalising ProjectSince 1788, in the face of the ongoing presence and resistance of First Nations cultures, and the continent’s radically unique ecologies, the Australian colonial project has been to convert the continent into a region of Europe. As such, the imposed political, administrative, scientific, and economic institutions are largely European. This is also so, to a lesser extent, of social and cultural institutions. While the continent is not Europe geologically, the notion of the Anthropocene suggests that this is changing (Crutzen and Stoermer). This article does not resummarise the vast body of scholarship on the effects of colonisation, from genocide to missionary charity, to the creation of bureaucratic and comprador classes, and so on. Suffice to say that the different valences of colonisation—from outright malevolence to misguided benevolence–produce similar and common effects. As such, what we experience in metropolitan and regional Australia, is chillingly similar to what people experience in London. Chilling, because this experience demonstrates how the effects of the project tend towards the total.To clarify, when I use the name ‘Australia’ I understand it as the continent’s European name. When I use the term ‘Europe’ or ‘European’, I refer to both the European continent and to the reach and scope of the various colonial and imperial projects of European nations. I take this approach because I think it is necessary to recognise their global effects and loads. In Australia, this load has been evident and present for more than two centuries. On one hand, it is evident in the social, cultural, and political institutions that come with colonisation. On another, it is evident in the environmental impacts of colonisation: impacts that are severely compounded in Australia. In relation to this, there is vital, ongoing scholarship that explores the fact that, ecologically, Australia is a radically different place, and which discusses the ways in which European scientific, aesthetic, and agricultural assumptions, and the associated naturalised and generic understandings of ‘nature’, have grounded activities that have radically transformed the continent’s biosphere. To name but a few, Tim Flannery (Eaters, “Ecosystems”) and Stephen Pyne, respectively, examine the radical difference of this continent’s ecology, geology, climate, and fire regimes. Sylvia Hallam, Bill Gammage, and Bruce Pascoe (“Bolt”, Emu) explore the relationships of First Nations Peoples with that ecology, climate, and fire before 1788, and the European blindness to the complexity of these relationships. For instance, William Lines quotes the strikingly contradictory observations of the colonial surveyor, Thomas Mitchell, where the land is simultaneously “populous” and “without inhabitants” and “ready for the immediate reception of civilised man” and European pastoralism (Mitchell qtd. in Lines 71). Flannery (Eaters) and Tim Low (Feral, New) discuss the impacts of introduced agricultural practices, exotic animals, and plants. Tom Griffiths tells the story of ‘Improving’ and ‘Acclimatisation Societies’, whose explicit aims were to convert Australian lands into European lands (32–48). The notion of ‘keeping Europe at bay’ is a response to the colonial assumptions, practices, and impositions highlighted by these writers.The project of converting this continent and hundreds of First Nations Countries into a region of Europe, ‘Australia’, is, in ambition, a totalising one. From the strange flag-plantings, invocations and incantations claiming ownership and dominion, to legalistic conceptions such as terra nullius, the aim has been to speak, to declare, to interpellate the country as European. What is not European, must be made European. What cannot be made European is either (un)seen in a way which diminishes or denies its existence, or must be made not to exist. These are difficult things to do: to not see, to unsee, or to eradicate.One of the first acts of administrative division (direction and rule) in the Port Phillip colony (now known as Victoria) was that of designating four regional Aboriginal Protectorates. Edward Stone Parker was appointed Assistant Protector of Aborigines for the Loddon District, a district which persists today for many state and local government instrumentalities as the Loddon-Mallee region. In the 1840s, Parker experienced the difficulty described above, in attempting to ‘make European’ the Dja Dja Wurrung people. As part of Parker’s goal of Christianising Dja Dja Wurrung people, he sought to learn their language. Bain Attwood records his frustration:[Parker] remarked in July 1842. ‘For physical objects and their attributes, the language readily supplies equivalent terms, but for the metaphysical, so far I have been able to discover scarcely any’. A few years later Parker simply despaired that this work of translation could be undertaken. ‘What can be done’, he complained, ‘with a people whose language knows no such terms as holiness, justice, righteousness, sin, guilt, repentance, redemption, pardon, peace, and c., and to whose minds the ideas conveyed by those words are utterly foreign and inexplicable?’ (Attwood 125)The assumption here is that values and concepts that are ‘untranslatable’ into European understandings mark an absence of such value and concept. Such assumptions are evident in attempts to convince, cajole, or coerce First Nations Peoples into abandoning traditional cultural and custodial relationships with Country in favour of individual private property ownership. The desire to maintain relationships with Country are described by conservative political figures such as Tony Abbott as “lifestyle choices” (Medhora), effectively declaring them non-existent. In addition, processes designed to recognise First Nations relationships to Country are procedurally frustrated. Examples of this are the bizarre decisions made in 2018 and 2019 by Nigel Scullion, the then Indigenous Affairs Minister, to fund objections to land claims from funds designated to alleviate Indigenous disadvantage and to refuse to grant land rights claims even when procedural obstacles have been cleared (Allam). In Australia, given that First Nations social, cultural, and political life is seamlessly interwoven with the environment, ecology, the land–Country, and that the colonial project has always been, and still is, a totalising one, it is a project which aims to sever the connections to place of First Nations Peoples. Concomitantly, when the connections cannot be severed, the people must be either converted, dismissed, or erased.This project, no matter how brutal and relentless, however, has not achieved totality.What Remains Not Regional? If colonisation is a totalising project, and regional Australia stands as evidence of this project’s ongoing push, then what remains not regional, or untouched by the colonial? What escapes the administrative, the institutional, the ecological, the incantatory, and the interpellative reach of the regional? I think that despite this reach, there are such remains. The frustration, the anger, and antipathy of Parker, Abbott, and Scullion bear this out. Their project is unfinished and the resistance to it infuriates. I think that, in Australia, the different ways in which pre-1788 modes of life persist are modes of life which can be said to be ‘keeping Europe at bay’.In Reports from a Wild Country: Ethics for Decolonisation, Deborah Bird Rose compares Western/European conceptualisations of time, with those of the people living in the communities around the Victoria River in the Northern Territory. Rose describes Western constructions of time as characterised by disjunction (for example, the ‘birth’ of philosophy, the beginnings of Christianity) and by irreversible sequence (for example, concepts of telos, apocalypse, and progress). These constructions have become so naturalised as to carry a “seemingly commonsensical orientation toward the future” (15). Orientation, in an Australian society “built on destruction, enables regimes of violence to continue their work while claiming the moral ground of making a better future” (15). Such an orientation “enables us to turn our backs on the current social facts of pain, damage, destruction and despair which exist in the present, but which we will only acknowledge as our past” (17).In contrast to this ‘future vision’, Rose describes what she calls the ‘canonical’ time-space conceptualisation of the Victoria River people (55). Here, rather than a temporal extension into an empty future, orientation is towards living, peopled, and grounded origins, with the emphasis on the plural, rather than a single point of origin or disjunction:We here now, meaning we here in a shared present, are distinct from the people of the early days by the fact that they preceded us and made our lives possible. We are the ‘behind mob’—those who come after. The future is the domain of those who come after us. They are referred to as […] those ‘behind us’. (55)By way of illustration, when we walk into a sheep paddock, even if we are going somewhere (even the future), we are also irrevocably walking behind ancestors, predecessor ecologies, previous effects. The paddock, is how it is, after about 65,000 years of occupation, custodianship, and management, after European surveyors, squatters, frontier conflict and violence, the radical transformation of the country, the destruction of the systems that came before. Everything there, as Freya Mathews would put it, is of “the given” (“Becoming” 254, “Old” 127). We are coming up behind. That paddock is the past and present, and what happens next is irrevocably shaped by it. We cannot walk away from it.What remains not regional is there in front of us. Country, language, and knowledge remain in the sheep paddock, coexisting with everyone and everything else that everyone in this country follows (including the colonial and the regional). It is not gone. We have to learn how to see it.By the Fox or the Little EagleFigure 1: A Scatter of Sulphur-Crested Cockatoo Feathers at Wehla. Image Credit: Terry Eyssens.As a way of elaborating on this, I will tell you about a small, eight hectare, patch of land in Dja Dja Wurrung Country. Depending on the day, or the season, or your reason, it could take fifteen minutes to walk from one end to the other or it might take four hours, from the time you start walking, to the time when you get back to where you started. At this place, I found a scatter of White Cockatoo feathers (Sulphur-Crested Cockatoo—Cacatua galerita). There was no body, just the feathers, but it was clear that the Cockatoo had died, had been caught by something, for food. The scatter was beautiful. The feathers, their sulphur highlights, were lying on yellow-brown, creamy, dry grass. I dwelled on the scatter. I looked. I looked around. I walked around. I scanned the horizon and squinted at the sky. And I wondered, what happened.This small patch of land in Dja Dja Wurrung Country is in an area now known as Wehla. In the Dja Dja Wurrung and many other Victorian languages, ‘Wehla’ (and variants of this word) is a name for the Brushtail Possum (Trichosurus vulpecula). In the time I spend there/here, I see all kinds of animals. Of these, two are particularly involved in this story. One is the Fox (Vulpes vulpes), which I usually see just the back of, going away. They are never surprised. They know, or seem to know, where everyone is. They have a trot, a purposeful, cocky trot, whether they are going away because of me or whether they are going somewhere for their own good reasons. Another animal I see often is the Little Eagle (Hieraaetus morphnoides). It is a half to two-thirds the size of a Wedge-tailed Eagle (Aquila audax). It soars impressively. Sometimes I mistake a Little Eagle for a Wedge-tail, until I get a better look and realise that it is not quite that big. I am not sure where the Little Eagle’s nest is but it must be close by.I wondered about this scatter of White Cockatoo feathers. I wondered, was the scatter of White Cockatoo feathers by the Fox or by the Little Eagle? This could be just a cute thought experiment. But I think the question matters because it provokes thinking about what is regional and what remains not regional. The Fox is absolutely imperial. It is introduced and widespread. Low describes it as among Australia’s “greatest agent[s] of extinction” (124). It is part of the colonisation of this place, down to this small patch of land in Dja Dja Wurrung Country. Where the Fox is, colonisation, and everything that goes with it, remains, and maintains. So, that scatter of feathers could be a colonial, regional happening. Or maybe it is something that remains not regional, not colonial. Maybe the scatter is something that escapes the regional. The Little Eagles and the Cockatoos, who were here before colonisation, and their dance (a dance of death for the Cockatoo, a dance of life for the Little Eagle), is maybe something that remains not regional.But, so what if the scatter of White Cockatoo feathers, this few square metres of wind-blown matter, is not regional? Well, if it is ‘not regional’, then, if Australia is to become something other than a colony, we have to look for these things that are not regional, that are not colonial, that are not imperial. Maybe if we start with a scatter of White Cockatoo feathers that was by the Little Eagle, and then build outwards again, we might start to notice more things that are not regional, that still somehow escape. For example, the persistence of First Nations modes of land custodianship and First Nations understandings of time. Then, taking care not to fetishise First Nations philosophies and cultures, take the time and care to recognise the associations of all of those things with simply, the places themselves, like a patch of land in Dja Dja Wurrung Country, which is now known as Wehla. Instead of understanding that place as something that is just part of the former Aboriginal Protectorate of Loddon or of the Loddon Mallee region of Victoria, it is Wehla.The beginning of decolonisation is deregionalisation. Every time we recognise the not regional (which is hopefully, eventually, articulated in a more positive sense than ‘not regional’), and just say something like ‘Wehla’, we can start to keep Europe at bay. Europe’s done enough.seeing and SeeingChina Miéville’s The City and The City (2009) is set in a place, in which the citizens of two cities live. The cities, Besźel and Ul Qoma, occupy the same space, are culturally and politically different. Their relationship to each other is similar to that of border-sharing Cold War states. Citizens of the two cities are forbidden to interact with each other. This prohibition is radically policed. Even though the citizens of Besźel and Ul Qoma live in adjoining buildings, share roads, and walk the same streets, they are forbidden to see each other. The populations of each city grow up learning how to see what is permitted and to not see, or unsee, the forbidden other (14).I think that seeing a scatter of White Cockatoo feathers and wondering if it was by the Fox or by the Little Eagle is akin to the different practices of seeing and not seeing in Besźel and Ul Qoma. The scatter of feathers is regional and colonial and, equally, it is not. Two countries occupy the same space. Australia and a continent with its hundreds of Countries. What remains not regional is what is given and Seen as such. Understanding ourselves as walking behind everything that has gone before us enables this. As such, it is possible to see the scatter of White Cockatoo feathers as by the Fox, as happening in ‘regional Australia’, as thus characterised by around 200 years of carnage, where the success of one species comes at the expense of countless others. On the other hand, it is possible to See the feathers as by the Little Eagles, and as happening on a small patch of land in Dja Dja Wurrung Country, as a dance that has been happening for hundreds of thousands, if not millions, of years. It is a way of keeping Europe at bay.I think these Cockatoo feathers are a form of address. They are capable of interpellating something other than the regional, the colonial, and the imperial. A story of feathers, Foxes, and Little Eagles can remind us of our ‘behindness’, and evoke, and invoke, and exemplify ways of seeing and engaging with where we live that are tens of thousands of years old. This is both an act of the imagination and a practice of Seeing what is really there. When we learn to see the remains and refuges, the persistence of the not regional, we might also begin to learn how to live here in the Anthropocene. But, Anthropocene or no Anthropocene, we have to learn how to live here anyway.References Allam, Lorena. “Aboriginal Land Rights Claims Unresolved Despite All-Clear from Independent Review.” The Guardian 29 Mar. 2019. <https://www.theguardian.com/australia-news/2019/mar/29/aboriginal-land-rights-claims-unresolved-despite-all-clear-from-independent-review>.Althusser, Louis. “Ideology and Ideological State Apparatuses (Notes towards an Investigation).” On Ideology. Trans. Ben Brewster. London: Verso, [1971] 2008.Attwood, Bain. The Good Country: The Djadja Wurrung, the Settlers and the Protectors. Clayton: Monash UP, 2017.Brown, Lesley. The New Shorter Oxford English Dictionary: On Historical Principles: Volume 2. Oxford: Clarendon Press, 1993.Crutzen, Paul, J., and Eugene F. Stoermer. “The ‘Anthropocene’.” Global Change Newsletter 41 (May 2000): 17–18.Flannery, Timothy F. “The Fate of Empire in Low- and High-Energy Ecosystems.” Ecology and Empire: Environmental History of Settler Societies. Eds. Tom Griffiths and Libby Robin. Edinburgh: Keele UP, 1997. 46–59.———. The Future Eaters. Sydney: Reed New Holland, 1994.Gammage, Bill. The Biggest Estate on Earth: How Aborigines Made Australia. Sydney: Allen and Unwin, 2012.Griffiths, Tom. Forests of Ash. Cambridge: Cambridge UP, 2001.Hallam, Sylvia. Fire and Hearth: A Study of Aboriginal Usage and European Usurpation in South-Western Australia. Rev. ed. Crawley: U of Western Australia P, 2014.Kidd, D.A. Collins Gem Latin-English, English-Latin Dictionary. London: Collins, 1980.Lines, William. Taming the Great South Land: A History of the Conquest of Nature in Australia. Berkeley and Los Angeles: U of California P, 1991.Low, Tim. The New Nature: Winners and Losers in Wild Australia. Camberwell: Penguin Books, 2003.———. Feral Future: The Untold Story of Australia’s Exotic Invaders. Ringwood: Penguin Books, 1999.Mathews, Freya. “Becoming Native: An Ethos of Countermodernity II.” Worldviews: Environment, Culture, Religion 3 (1999): 243–71.———. “Letting the World Grow Old: An Ethos of Countermodernity.” Worldviews: Environment, Culture, Religion 3 (1999): 119–37.Medhora, Shalailah. “Remote Communities Are Lifestyle Choices, Says Tony Abbott.” The Guardian 10 Mar. 2015. <https://www.theguardian.com/australia-news/2015/mar/10/remote-communities-are-lifestyle-choices-says-tony-abbott>.Miéville, China. The City and the City. London: Pan MacMillan, 2009.Pascoe, Bruce. Dark Emu, Black Seeds: Agriculture or Accident? Broome: Magabala Books, 2014.———. “Andrew Bolt’s Disappointment.” Griffith Review 36 (Winter 2012): 226–33.Pyne, Stephen. Burning Bush: A Fire History of Australia. North Sydney: Allen and Unwin, 1992.Rose, Deborah Bird. Reports from a Wild Country: Ethics for Decolonisation. Sydney: U of New South Wales P, 2004.

IntroductionThe National School Chaplaincy and Student Welfare Program (NSCSWP) has been one of the most controversial Australian news topics in the past eight years. Newspaper representations of the NSCSWP have been prolific since the Program began in 2006/07. In my previous research into the NSCSWP, I found that initially the Program was well received. Following the High Court Challenge campaign, however, which began in late 2010, newspaper reports portrayed the NSCSWP in a predominantly negative light. These negative portrayals of the NSCSWP persisted in the lead up to the second High Court Challenge from 2013 until June 2014. During this time, newspaper representations portrayed the Program as an illegitimate form of counseling for state school students. However, I would argue that it was the newspaper representations of the NSCSWP that were in fact illegitimate. In this article, I contend that illegitimate representations of the NSCSWP became hegemonic because of a lack of evidence-based research conducted into the Program’s operation within state schools. Evidence-based research would have appropriately evaluated the Program’s progress and contributed to a legitimate and fair representation of chaplains in online newspapers. My analysis acknowledges the overwhelming prejudice against the NSCSWP. Whether chaplains were indeed a legitimate or illegitimate form of counseling is not my argument. My argument is that newspaper representations of the NSCSWP were illegitimate because news articles were presenting biased and incomplete information to the Australian community. Defining IllegitimacyIllegitimacy as a term has a long history dating back to early modern England, when it was commonly used to refer to children born out of wedlock (Pritchard 19). However, the definition of illegitimacy extends beyond this social phenomenon. Katie Pritchard states:The understanding of illegitimacy encompasses a kind of theoretical illegitimacy that is nothing to do with birth, referring to a kind of falseness or unsuitability that can be applied in many circumstances. (21)For this article, I will be using the term ‘illegitimate’ to describe how the newspaper representations of the NSCSWP were unsuitable because they were biased and lacked valuable information. Newspaper reports, which can be accessed online via the newspaper company’s website, include important authoritative voices. However, these voices expressed a certain opinion or concern, rather than delivering information that contributed to society’s understanding of the NSCSWP. Therefore, newspapers did not present legitimate facts, but instead a range of subjective opinions.The Illegitimacy of Newspaper ReportingThe ideological bias of newspapers has been recently examined regarding News Corp, the owner of national title The Australian, and many of the major Australian state newspapers: The Daily Telegraph; The Courier Mail, Herald Sun; The Advertiser; and Sunday Times. This organisation has recently been accused of showing bias in its newspaper articles (Meade). Meade quotes Mark Scott, the ABC Managing Director, who states:Given the aggressive editorial positioning of some of their mastheads and their willingness to adopt and pursue an editorial position, an ideological position and a market segmentation, you could argue that News Corporation newspapers have never been more assertive in exercising media power. (1)The market domination enjoyed by large organisations such as News Corp, and even Fairfax Media, leads to consistency in journalists’ writing on political, social, religious, and economic issues, which may predominate over the articles published by smaller newspapers. There is the concern that over time a particular point of view will be favoured. According to Mark Scott “a range of influential voices [is] essential to ensure a fair and open media” (Meade 1). Scott cites Rupert Murdoch who stated, back in 1967, that “freedom of the press mustn’t be one-sided just for a publisher to speak as he pleases, to try and bully the community” (Meade 1). Therefore, it has been acknowledged that a biased news article is illegitimate, and national news articles are to present facts, not the opinions of the newspaper.A Methodological Framework For this article I will utilise Norman Fairclough’s theory of Critical Discourse Analysis. Fairclough states:By ‘critical’ discourse analysis I mean discourse analysis which aims to systematically explore often opaque relationships of causality and determination between (a) discursive practices, events and texts and (b) wider social and cultural structures, relations and processes. (132-133)This method of analysis examines three assumptions: Existential, Propositional and Value. Existential assumptions make claims about what exists with regards to the problem, and refers to social phenomena such as globalisation or social cohesion (56). Propositional assumptions make predictions about what is or will be (55). Value assumptions simply evaluate things as good or bad, needed or not needed (57). These assumptions can be identified through analysis of the various direct quotes included within online newspaper articles.Direct quotations in newspaper articles available online often represent polarised views demonstrating whether people agree or disagree with the topic being discussed. The selection, or framing, of dominant voices within an article can be used to construct or re-present certain ideologies (Entman, 165). Entman explains that “we can define framing as the process of culling a few elements of perceived reality and assembling a narrative that highlights connections among them to promote a particular interpretation” (164). The framing of direct quotes within an article, therefore, assists the reader in identifying the article’s bias. The National School Chaplaincy and Student Welfare ProgramThe National School Chaplaincy Program was first established in 2006 by the Howard Government, and in 2011 Julia Gillard included secular youth workers, expanding it from 2012 to become the National School Chaplaincy and Student Welfare Program. According to the National School Chaplaincy and Student Welfare Guidelines, the Program aimed to “assist school communities to provide pastoral care and general spiritual, social and emotional comfort to all students, irrespective of their faith or beliefs” (6). Chaplaincy in Australia has been a predominantly Christian counseling service with Christianity being the most commonly practiced religion in Australia (Australian Bureau of Statistics). However, there have been chaplains representing other faiths such as Islam, Judaism and Buddhism (Australian Government 8). Chaplains were chosen by their respective schools and were partly funded by the Government to provide support to students and staff.State Newspaper Articles Online: Representations 2013-2014My sample of articles came from nine state newspapers with an online presence: The Sydney Morning Herald, Brisbane Courier Mail, Adelaide Advertiser, Melbourne Age, Northern Times, The Australian, The West Australian, The Daily Telegraph, and The Mercury. A total of 36 articles were collected, from the newspaper’s Website, for 2013 and 2014, and were divided into two categories.The two categories are Supportive (of the Program) and Unsupportive (of the Program). In 2013, two articles were supportive of the Program, whereas in 2014 there were four. In 2013 three articles were unsupportive of the Program, whereas in 2014 there were 27 unsupportive articles, representing the growing interest in the scheme in the final lead up to the High Court Challenge in 2014. An online newspaper article from 2013, which portrays the NSCSWP and in particular chaplains as illegitimate, is Call for Naked School Chaplain to Be Defrocked (Domjen). This article explains how an off-duty school chaplain was preaching naked in the main street of a country town in NSW. The NSW Teachers Federation President Maurie Mulheron, and Parents and Citizens Association publicity officer Rachael Sowden were quoted in this article. It is through their direct quotes that the illegitimacy of chaplaincy is framed. President Mulheron states:We believe the chaplaincy program is wrong and that money should be used for an increase in school-based counsellors. Obviously the right checks and balances are not in place. (1)When President Mulheron states “We” it is unclear to the reader as to whether he is referring to all NSW Teachers or the organisation’s administrators. The reader is left to make their own assumptions about whom he is referring to. The President also makes a value assumption that the money would be better spent on school-based counselors, thus expressing his own opinion that they are a better option. A propositional assumption is made when he claims that the “right checks and balances are not in place”, but is he basing his claim on this one incident or is there other research to support this assumption?Perhaps this naked chaplain appeared fine when the school hired him, perhaps he does not have a previous record of inappropriate behaviour, perhaps it was an isolated incident. The reader is not given any background information on this chaplain and is therefore meant to take the President’s assumptions as legitimate fact. Ms Sowden, representing the Parents’ and Citizens’ Association, also expresses the same assumptions and concerns. Ms Sowden states:We have great concerns about the chaplain scheme - many parents do. We are concerned about whether they go through the same processes as teachers in terms of working with children checks and their suitability to the position, and this case highlights that.Ms Sowden makes a propositional assumption that many parents and citizens are concerned about the Program. It would be interesting to know what the Parents and Citizens Association was doing about this, considering the choice to have a chaplain is a decision made by the school community? Ms Sowden also asks whether chaplains “go through the same processes as teachers in terms of working with children checks and their suitability to the position”. Chaplains do not go through the same process as teachers in their training as they have a different role in the school. However, chaplains do require a Certificate IV in Pastoral Care as well as a Working with Children Check because they are in close proximity to children, and are being paid for their school counseling service (Working with Children Check). Ms Sowden’s value assumption that chaplains are unsuitable for the position is based on her own limited understanding of their qualifications, which she admits to not knowing. In fact, to be appointed to represent parents and citizens and to even voice their concerns, but not know the qualifications of chaplains in her community, is an interesting area of ignorance.This article has been framed to evaluate the actions of all chaplains through the example of a publicly-naked chaplain, discussed without context in this article. The Program is portrayed as hiring unsuitable and thus illegitimate chaplains. However, the quotes are based on concerns and assumptions that are unfounded, and are fears presented as facts. Therefore the representation is illegitimate because it does not report any information that the public can use to better understand the NSCSWP, or even to understand the circumstances surrounding the chaplain who preached naked in the street. Another article from 2014, which represents chaplains as illegitimate, is Push to Divert Chaplain Cash to School Councillors (Paine). This article focuses on the comments of the Tasmanian Association of State School Organisations President Jenny Eddington, and the Australian Education Union President Angelo Gavrielatos. These dominant voices within the Tasmanian and Australian communities are chosen to express their opinion that the money once used for chaplains should now be used to fund psychologists in schools. AEU President Angelo Gavrielatos states: Apart from undermining our secular traditions, this additional funding should have been allocated to schools to better meet the educational needs of students with trained, specialist staff.Mr Gavrielatos makes a propositional assumption that chaplains are untrained staff and are thus illegitimate staff. However, chaplains are trained and specialise in providing counseling services. Thus, through his call for “trained, specialist staff” he aims to delegitimize the training of chaplains. Mr Gavrielatos also makes a value assumption when he claims that the funding put towards the NSCSWP undermines “our secular traditions”. “Secular traditions” is an existential assumption in positioning that Australians have secular traditions, and that these do not involve chaplaincy because the Australian Government is not supposed to support religion. The Australian Bureau of Statistics states:Enlightenment principles promoted a secular government, detached from the church, that encouraged tolerance and supported religious pluralism, including the right to practice no religion. By Federation, this diversity was enshrined in the Australian Constitution, which says that the Commonwealth shall not make any law for establishing any religion, or for imposing any religious observance, or for prohibiting the free exercise of any religion. (1)The funding of the Program was a contentious issue from the time of its inception; although it could be argued that it was the prerogative of the Government to support the practice of diverse cultural and religious beliefs by allowing schools to hire religious counselors of their choice. Given that not every student is Christian some would perhaps benefit from chaplains or counselors representing other faiths.These news articles have selected dominant voices to construct and promote an ideology of chaplains as an illegitimate resource for school communities. In these newspaper reports existential, propositional and value assumptions were expressed by dominant voices who expressed concern about the role and behaviour of chaplains in schools. However, research into the Program and its operation within each state may have avoided the representation of unfounded and illegitimate assumptions.Evidence-Based Research: Avoiding Illegitimacy Over the course of the Chaplaincy Program various resources, such as reports and journal articles attempted to provide evidence of how the NSCSWP was funded and operated within state schools.The Department of Education received frequent progress reports by state schools who hired chaplains, although this information was not made available to the public. However, in 2011 then Education Minister Peter Garrett released a discussion paper informing Australians about the current set up of the Program and how the community could have their say on the Program’s fulfillment from 2012-2014. The discussion paper was reported on by The Australian, which portrayed the Program as not catering to the needs of Australian youth because chaplains are predominantly Christian (Ferrari). The newspaper report focuses on the concerns of Australian communities regarding the funding, and qualifications of chaplains, and the cost of the Program. Thus, the Program appeared illegitimate and as though it could not cater to the Australian community’s expectations.Reports conducted by organisations external to the Education Department tried to examine schools communities’ expectations and experiences of the Program. One such report was written in 2009 by Dr Philip Hughes and Professor Margaret Sims from Edith Cowan University who aimed to examine how Australian schools evaluated the Program, and the role of chaplains, but their report excluded the state of NSW.Hughes and Sims state that chaplains’ “contribution was widely appreciated” by schools (6). This report attempted to provide a legitimate and independent account of the Program, however, the report was deemed biased by NSW Greens MLC, Dr John Kaye who remarked that the study was “deeply flawed” and lacked independence (Thielking & MacKenzie 1). According to critics, the study focussed on the positive benefits of chaplains, but the only benefit that was unique to them was that they were religious (The Greens). The study also neglected to report that Hughes was an employee of the Christian Research Association and that his background could impede his objectivity. In the same year, 2009, ACCESS ministries published a report titled: The value of chaplains in Victorian schools. The independent research conducted by Social Compass covers: “the value of chaplains; their social, spiritual and academic impacts; the difference made to the health, well being and quality of life of students; and the contributions made to strengthen communities” (2).This study promoted a positive view of chaplaincy within schools and tried to report on a portion of the community’s experiences with chaplains. However, it was limited in that it pertains only to Victorian schools and received very little media attention online. Even if this information were available online it would have only related to Victoria. Further research conducted into chaplaincy has been published in the Journal of Christian Education. This journal contains many articles on chaplaincy, but these are not easily available online as they require a subscription. The findings from these articles have not been published in newspaper articles online and have therefore not been made available to the general public. The Christian bias of the journal may have also contributed to its contents being neglected by news articles made available online, although they might have assisted in providing a more balanced representation of the NSCSWP.The extent of the research conducted into The National School Chaplaincy and Student Welfare Program has not been entirely delineated here, but these are some of the prominent resources. Nonetheless, the rigorous evaluation of the contribution of the NSCSWP was minimal, and the quality of its evaluation predominantly biased.Robert Slavin states that school program evaluations must “produce reliable, unbiased, and meaningful information on the strength of evidence behind each program” (1). Unfortunately, the research conducted into the Chaplaincy Program was not free from bias, consistent or properly designed in a way that legitimately evaluated the NSCSWP. According to Monica Thielking and David MacKenzie:The fact is that the provision of support services for students in Australian schools has never been subjected to serious research and evaluation, and any analysis is made more difficult by the fact that the various states and territories deploy somewhat different models. (1)Thus, the information on the Chaplaincy Program’s progress and the responsibilities of chaplains in schools was not comprehensive or accurate enough to be appropriately reported in newspapers available online. Therefore, newspaper articles used quotes and information based on a limited understanding of the Program, which in turn produced illegitimate representations of the NSCSWP.ConclusionNewspaper reports available online drew conclusions about the Program’s effectiveness, which had not been appropriately tested. If research had been made available to the public, or published within state-based media online, Australians would have had a more legitimate understanding of the Program’s operation within state education, even if that understanding could not have changed the High Court ruling.The Chaplaincy Program demonstrates how a lack of evidence-based research allows the media to construct illegitimate representations based on promoting the assumptions of dominant, and I would argue the loudest, voices, in society. The bias represented in a consistent approach adopted by newspapers owned by dominant media companies, is a factor in the re-presentation and promotion of certain ideologies. This was made evident by the fact that, in 2014, across nine state newspapers available online, 27 articles were unsupportive of the Program as opposed to only four articles that were supportive. Audiences need to be presented with facts rather than opinions, which are based on very little research. Hopefully newspaper reporting will change in the future to offer audiences a more legitimate representation of news events. ReferencesACCESS Ministries. The Value of Chaplains in Victorian Schools. NSW, 2009. Australian Bureau of Statistics. "Reflecting a Nation: Stories from the 2011 Census, 2012–2013." 2012. Australian Government. National School Chaplaincy Program: A Discussion Paper. Australia: Commonwealth of Australian, 2011. Chaplaincy Australia. "Training." n.d. Commonwealth of Australia. National School Chaplaincy and Student Welfare Program Guidelines. Australia: Australian Government, 2012. Domjen, Briana. “Call for Naked School Chaplain to Be Defrocked.” The Australian 3 Feb. 2013: 1.Entman, Robert. "Framing Bias: Media in the Distribution of Power." Journal of Communications 1 (2007): 163-73.Fairclough, Norman. Analysing Discourse: Textual Analysis for Social Research. London: Longman, 2003.Ferrari, Justine. "School Chaplains Not Representative." The Australian 12 Feb. 2011: 1.Hughes, Philip, and Margaret Sims. The Effectivess of Chaplaincy: As Provided by the National School Chaplaincy Association to Government Schools in Australia. Perth: Edith Cowan University, 2009.Meade, Amanda. "Mark Scott: News Corp Papers Never More Aggressive than Now." The Guardian 3 Oct. 2014: 1.Paine, Michelle. “Push to Divert Chaplain Cash to School Councillors.” The Mercury 21 Jun. 2014: 1.Pritchard, Katie. "Legitimacy, Illegitimacy and Sovereignty in Shakespeare’s British Plays." U of Manchester, 2011.Slavin, Robert. "Perspectives on Evidence-Based Research in Education: What Works? Issues in Synthesizing Educational Program Evaluations." Educational Researcher 37.1 (2008): 5-14. The Greens. "Chaplaincy Program Study 'Flawed and Biased': Conclusions Not Justified." n.d. Thielking, Monica, and David MacKenzie. “School Chaplains: Time to Look at the Evidence.” 2011. Working with Children Check. "Categories of Work." 2008.

The continual (re)development associated with urban spaces results in the demand that heritage spaces be preserved. This raises a number of questions to be considered such as: which spaces will be preserved, what stories will be associated with these, and how will the embodied experience of these spaces be mediated? Since Foucault, it has been accepted that knowledge, power and truth are inextricably interwoven. There are no golden sands of freedom, there is no transcendent truth free from composing discourses. The construction of truth and history as discursive practice has a strong spatial component in museums. Objects are taken out of their original contexts, placed into knowledge regimes that delimit how these shall be known and then fixed in a stasis that regulates any change or flow in the meanings that might be constructed around these. Figure 1 - Skeleton of a middle age woman on display in the Dublinia MuseumThe body in the museum becomes either an object to be displayed or a nuisance to be excluded from contact with 'artefacts'. The picture above is of the skeleton of a middle age woman who died in Dublin hundreds of years ago and is now on display in the Dublinia Museum. Once the decision is made that this skeleton is no longer a body but an artefact it is placed behind glass so that the living bodies which come to view it may not 'interfere' with its discursive or physical existence. Once 'preserved' in this way, 'she' becomes an 'it', an object translated and removed from the everyday. In this case, the skeleton is placed within a scientific-medical discourse where the fact that it once belonged to an old woman who had worn away teeth tells us that she lived in a time when the people of Dublin had a poor diet. Similar undertakings are accepted practice in the Hyde Park Barracks Museum. All 'real' artefacts are kept behind glass, preserved in carefully controlled conditions that prevent human physical contact. Only replicas or reconstructions are available for everyday handling by the general public. In the example below, the item discussed was kept behind glass, a thing to be observed, revered, a relic to lend authority to the power-knowledge-truth regime of the Hyde Park Barracks Museum. Figure 2 - box containing a lock of Captain James Cook's hair and a rendition of his death scene in Hawaii on display at the Hyde Park Barracks MuseumSo 'precious' was this object that it was kept doubly removed, a small wooden casket within a timber and glass case behind the display panel of the museum. Figure 3 - closer view of box containing a lock of Captain James Cook's hair and a rendition of his death scene in Hawaii on display at the Hyde Park Barracks MuseumThis particular item contains a lock of Captain James Cook's hair and a rendition of his death scene in Hawaii. The case is made from the wood of the Resolution (his ship at the time of his death) and the entire item was a memento given to his widow upon the Resolution's return to Britain. This 'relic' is iconic of the approach adopted by the presentation of the Barracks as a museum. But what happens when the history being 'preserved' is the fabric of a built space? The spatial process of 'encasing', 'preserving' and physically removing 'artefacts' from everyday contact is an ongoing aspect of the presentation of the Barracks. In 1996, not long after I began my employ with the Barracks as part of an extended engagement with the embodied experience of cityspace, the curator decided that each guide should have their skills at presenting the Barracks in an appropriate light assessed. The result was that each guide was required to prepare and present a 'wall talk'. The 'wall talk' was literally that. Each guide was assigned a physical section of the museum to research and then discuss for ten minutes to an audience composed of other guides, the curator, the manager and education staff. The aims were to get each guide to re-assess their lecture presentation technique and to spread awareness amongst the guides that each physical section of the museum held its own unique part in the story of the Barracks. My assignment was a piece of wall on the second floor directly above the reception area. Deep into the persona I created so that I could 'pass' in this environment, I began by examining the wall. It was constructed of the convict made brick laid down in 1818 held together by Aboriginal midden material that dated back thousands of years, overlaid with whitewash applied in 1848 when the men moved out and the women moved in, the whitewash was overlaid with plaster held in place by cows hair in 1887 when the building was converted to a courts complex which was topped with remnants of wall paper that dated back to 1952 when the room was renovated as a Judge's chambers. On a section of the wall that had once been covered by this wallpaper was a pencil drawn outline of a pair of scissors, the name Max Fry and the date 1952 was written next to these. Both the floor and ceiling above and below the wall had sections that had been replaced when air conditioning was installed in the first incarnation of the building as a museum under the management of the Museum of Applied Arts and Sciences. A red builders' chalk mark showing where this was to installed remained even though the ducting had been removed in a later enactment of this museum space under the auspices of the Historic Houses Trust. In the rebated corner closest to this wall, out of sight to any but the closest inspection, there was a pencil drawing of a boxer shaping up to an unseen opponent. The skirting board was two inches higher than in the next room and of an Edwardian rather than a Victorian style. 'Ghosts' from zinc tiles were etched upon the ceiling and scratch marks from the iron beds used by the immigrant women remained upon the floors. I considered the wall carefully and even more carefully thought about the discourses of this institution, the personality of the curator and the predilections of the manager and other guides. If I was to continue 'passing', which story should I tell? How should it be told? What emphasis should be made and, most importantly of all, what must be elided? I considered raising the awareness that anthrax spores had been found in similar cow-hair reinforced plaster in the London Tube system but this somehow seemed irreverent. Starting with an statement about the mortar, Aboriginal land claims and how the entire Historic Houses Trust functioned to legitimate European seizure of Aboriginal land and that this was reflected by the way in which Aboriginal artefacts were ignored seemed equally inadvisable. Perhaps a discussion of the judge who inspired the boxer was in order. Rumour had it that he used to pay 'taxi-drivers' to join him in his rooms and engage in a little 'wrestling' and 'boxing'. This was reputedly such a physical activity that grunts, groans and cries of pain (?) were heard throughout the building. I could talk about the rats that had infested the ceilings above and below the room from the time that false ceilings were put in place during the renovation of the building into a courts complex and perhaps even display some of the 'artefacts' that had been stolen by the rats and hidden under the floor or in the ceiling space. A straight 'history' of the wall that simply discussed its physical composition would have 'passed', but that was perhaps more superficial than I felt the material warranted. Instead, set to a background audio tape of Tracey Chapman singing "Talking Bout a Revolution", a selection from Pink Floyd's The Wall and The Beatles Revolution 9, I told a story about the scissors. The scissors tale began by introducing Max Fry as a humble paperhanger working in the chambers of a powerful Judge in the 1950's. Oppressed, voiceless, the only impact he could make within the Barracks was to trace his scissors, sign his name, date it and then paper over this minor act of rebellion. For nearly thirty years his legacy remained hidden under the paper as judge after judge used the room to write the judgements that ordered the lives of those unfortunate enough to pass before them. In 1979 this legacy was unveiled but ignored, covered over by an air-conditioning system decreed necessary to preserve the artefacts displayed in the building. This oversight was rectified (so my story went) by the current generation of carers for the heritage of the building when the air conditioning was removed and the slice of social history and iniquitous power relations that Max Fry's rebellion illustrated was put on display for all to see. The talk was received well by all except for the chief guide who felt the music was distracting. He wanted me to do another wall some other time and 'get it right this time'. The curator was delighted and over-ruled the chief guide and the wall talks were over as far as I was concerned. A few months later, I was surprised to discover that on one of my 'time in lieu' breaks from the Barracks, that the wall had been encased in glass. The original scissors whose outline was traced upon the now preserved wall had been 'rescued' from Max's tool shed and hung behind the glass along with a picture of himself and some other of his tools. A story panel iterated a simplified version of the story I had told that elided any reference to class inequality or the powerlessness of his position. History's truth and permanence was now safely assured and no meddling fingers would ever again touch the pencilled scissored outline or smudge the bleary red chalk-line. The boxer, however, remains un-encased, a few hands-breadths from Max's sanitised and now unapproachable history, awaiting the right 'story' to bring it to prominence and preservation. Citation reference for this article MLA Style Darrell, Aaron. "Whose History?" M/C: A Journal of Media and Culture 5.2 (2002). [your date of access] < http://www.media-culture.org.au/0205/history.php>. Chicago Style Darrell, Aaron, "Whose History?" M/C: A Journal of Media and Culture 5, no. 2 (2002), < http://www.media-culture.org.au/0205/history.php> ([your date of access]). APA Style Darrell, Aaron. (2002) Whose History?. M/C: A Journal of Media and Culture 5(2). < http://www.media-culture.org.au/0205/history.php> ([your date of access]).

IntroductionIn regional Australia and New Zealand, museums and art galleries are increasingly becoming primary sites of cultural engagement. They are one of the key tourist attractions for regional towns and expected to generate much needed tourism revenue. In 2017 in New South Wales alone, there were three million visitors to regional galleries and museums (MGNSW 13). However, apart from those (partially) funded by local councils, they are often run on donations, good will, and the enthusiasm of volunteers. Regional museums and galleries provide some paid, and more unpaid, employment for ageing populations. While two-thirds of Australia’s population lives in capital cities, the remainder who live in regional towns are likely to be in the 60+ age cohort because people are choosing to retire away from the bustling, growing cities (ABS). At last count, there were about 3000 museums and galleries in Australia with about 80% of them located in regional areas (Scott). Over the last 40 years, this figure has tripled from the 1000 regional and provincial museums estimated by Peter Piggott in his 1975 report (24). According to a 2014 survey (Shaw and Davidson), New Zealand has about 470 museums and galleries and about 70% are located outside capital cities. The vast majority, 85%, have less than five, full-time paid staff, and more than half of these were run entirely by ageing volunteers. They are entrusted with managing the vast majority of the history and heritage collections of Australia and New Zealand. These ageing volunteers need a diverse range of skills and experience to care for and interpret collections. How do you find the time and budget for professional development for both paid staff and volunteers? Many professional development events are held in capital cities, which are often a significant distance from the regional museum—this adds substantially to the costs of attending and the time commitment required to get there. In addition, it is not uncommon for people working in regional museums to be responsible for everything—from security, collection management, conservation, research, interpretation and public programs to changing the light bulbs. While there are a large number of resources available online, following a manual is often more difficult than learning from other colleagues or learning in a more formal educational or vocational environment where you can receive timely feedback on your work. Further, a foundational level of prior knowledge and experience is often required to follow written instructions. This article will suggest some strategies for low cost professional development and networking. It involves planning, thinking strategically and forming partnerships with others in the region. It is time to harness the power of modern communications technology and use it as a tool for professional development. Some models of professional development in regional areas that have been implemented in the past will also be reviewed. The focus for this article is on training and professional development for workers in regional museums, heritage sites and keeping places. Regional art galleries have not been included because they tend to have separate regional networks and training opportunities. For example, there are professional development opportunities provided through the Art Galleries Association of Australia and their state branches. Regional galleries are also far more likely to have one or more paid staff members (Winkworth, “Fixing the Slums” 2). Regional Museums, Volunteers, and Social CapitalIt is widely accepted that regional museums and galleries enhance social capital and reduce social isolation (Kelly 32; Burton and Griffin 328). However, while working in a regional museum or gallery can help to build friendship networks, it can also be professionally isolating. How do you benchmark what you do against other places if you are two or more hours drive from those places? How do you learn from other colleagues if all your colleagues are also isolated by the ‘tyranny of distance’ and struggling with the same lack of access to training? In 2017 in New South Wales alone, there were 8,629 active volunteers working in regional museums and galleries giving almost five million hours, which Museums and Galleries NSW calculated was worth over $150 million per annum in unpaid labour (MGNSW 1). Providing training and professional development to this group is an investment in Australia’s social and cultural capital.Unlike other community-run groups, the museums and heritage places which have emerged in regional Australia and New Zealand are not part of a national or state branch network. Volunteers who work for the Red Cross, Scouts or Landcare benefit from being part of a national organisation which provides funding, support workers, a website, governance structure, marketing, political advocacy and training (Winkworth, “Let a Thousand Flowers” 11). In Australia and New Zealand, this role is undertaken by the Australian Museums and Galleries Association AMaGA (formerly Museums Australia) and Museums Aotearoa respectively. However, both of these groups operate at the macro policy level, for example organising annual conferences, publishing a journal and developing Indigenous policy frameworks, rather than the local, practical level. In 1995, due to their advocacy work, Landcare Australia received $500 million over five years from the federal government to fund 5000 Landcare groups, which are run by 120,000 volunteers (Oppenheimer 177). They argued successfully that the sustainable development of land resources started at the local level. What do we need to do to convince government of the need for sustainable development of our local and regional museum and heritage resources?Training for Volunteers Working in Regional Museums: The Current SituationAnother barrier to training for regional museum workers is the assumption that the 70:20:10 model of professional development should apply. That is, 70% of one’s professional development is done ‘on the job’ by completing tasks and problem-solving; 20% is achieved by learning from mentors, coaches and role models and 10% is learnt from attending conferences and symposia and enrolling in formal courses of study. However, this model pre-supposes that there are people in your workplace whom you can learn from and who can show you how to complete a task, and that you are not destroying or damaging a precious, unique object if you happen to make a mistake.Some museum volunteers come with skills in research, marketing, administration, customer service or photography, but very few come with specific museum skills like writing exhibition text, registering an acquisition or conserving artefacts. These skills need to be taught. As Kylie Winkworth has written, museum management now requires a [...] skills set, which is not so readily found in small communities, and which in many ways is less rewarding for the available volunteers, who may have left school at 15. We do not expect volunteer librarians to catalogue books, which are in any case of low intrinsic value, but we still expect volunteers in their 70s and 80s to catalogue irreplaceable heritage collections and meet ever more onerous museum standards. That so many volunteers manage to do this is extraordinary. (“Let a Thousand Flowers” 13)Workers in regional museums are constantly required to step outside their comfort zones and learn new skills with minimal professional support. While these challenging experiences can be very rewarding, they are also potentially damaging for our irreplaceable material cultural heritage.Training for museum professionals has been on the agenda of the International Council of Museums (ICOM) since 1947 (Boylan 62). However, until 1996, their work focused on recommending curricula for new museum professionals and did not include life-long learning and on-going professional development. ICOM’s International Committee for the Training of Personnel (ICTOP) and the ICOM Executive has responded to this in their new curricula—ICOM Curricula Guidelines for Professional Museum Development, but this does not address the difficulties staff or volunteers working in regional areas face in accessing training.In some parts of Australia, there are regional support and professional development programs in place. For example, in Queensland, there is the Museum Development Officer (MDO) network. However, because of the geographic size of the state and the spread of the museums, these five regionally based staff often have 60-80 museums or keeping places in their region needing support and so their time and expertise is spread very thinly. It is also predominantly a fee-for-service arrangement. That is, the museums have to pay for the MDO to come and deliver training. Usually this is done by the MDO working with a local museum to apply for a Regional Arts Development Fund (RADF) grant. In Victoria there is a roving curator program where eligible regional museums can apply to have a professional curator come and work with them for a few days to help the volunteers curate exhibitions. The roving curator can also provide advice on “develop[ing] high quality exhibitions for diverse audiences” via email, telephone and networking events. Tasmania operates a similar scheme but their two roving curators are available for up to 25 days of work each year with eligible museums, provided the local council makes a financial contribution. The New South Wales government supports the museum advisor program through which a museum professional will come to your museum for up to 20 days/year to give advice and hands-on training—provided your local council pays $7000, an amount that is matched by the state government—for this service. In 2010, in response to recommendations in the Dunn Report (2007), the Collections Council of Australia (CCA) established a pilot project with the City of Kalgoorlie-Boulder in Western Australia and $120,000 in funding from the Myer Foundation to trial the provision of a paid Collections Care Coordinator who would provide free training, expertise and support to local museums in the region. Tragically, CCA was de-funded by the Cultural Ministers Council the same year and the roll-out of a hub and spoke regional model was not supported by government due to the lack of an evidence base (Winkworth, “Let a Thousand Flowers” 18). An evaluation of the trial project would have tested a different model of regional training and added to the evidence base.All these state-based models (except the aborted Collections Care hub in Western Australia) require small regional museums to compete with each other for access to a museum professional and to successfully apply for funding, usually from their local council or state government. If they are successful, the training that is delivered is a one-off, as they are unlikely to get a second slice of the regional pie.An alternative to this competitive, fly-in fly-out, one-off model of professional development is to harness the technology and resources of local libraries and other cultural facilities in regional areas. This is what the Sydney Opera House Trust did in March 2019 to deliver their All about Women program of speakers via live streaming to 37 satellite sites throughout Australia and New Zealand.Harnessing Technology and Using Regional Library Infrastructure to Provide Training: ScenarioImagine the following scenario. It is a Monday morning in a regional library in Dubbo, New South Wales. Dubbo is 391 km or five hours drive by car from the nearest capital city (Sydney) and there are 50 regional museums within a 100 km radius. Ten people are gathered in a meeting room at the library watching a live stream of the keynote speakers who are presenting at their national museums conference. They are from five regional museums where they work as volunteers or part-time paid staff. They cannot afford to pay $2000, or more, to attend the conference, but they are happy to self-fund to drive for an hour or two to link up with other colleagues to listen to the presentations. They make notes and tweet in their questions using the conference twitter handle and hashtag. They have not been exposed to international speakers in the industry before and the ideas presented are fresh and stimulating. When the conference breaks for morning tea, they take a break too and get to know each other over a cuppa (provided free of charge by the library). Just as the networking sessions at conferences are vitally important for the delegates, they are even more important to address social isolation amongst this group. When they reconvene, they discuss their questions and agree to email the presenters with the questions that are unresolved. After the conference keynote sessions finish, the main conference (in the capital city) disperses into parallel sessions, which are no longer available via live stream.To make the two-hour drive more worthwhile and continue their professional development, they have arranged to hold a significance assessment workshop as well. Each museum worker has brought along photographs of one item in their collection that they want to do more research on. Some of them have also brought the object, if it is small and robust enough to travel. They have downloaded copies of Significance 2.0 and read it before they arrived. They started to write significance reports but could not fully understand how to apply some of the criteria. They cannot afford to pay for professional workshop facilitators, but they have arranged for the local studies librarian to give them an hour of free training on using the library’s resources (online and onsite) to do research on the local area and local families. They learn more about Trove, Papers Past and other research tools which are available online. This is hands-on and computer-based skills training using their own laptops/tablets or the ones provided by the library. After the training with the librarian, they break into two groups and read each other’s significance reports and make suggestions. The day finishes with a cuppa at 2.30pm giving them time to drive home before the sun sets. They agree to exchange email addresses so they can keep in touch. All the volunteers and staff who attended these sessions in regional areas feel energised after these meetings. They no longer feel so isolated and like they are working in the dark. They feel supported just knowing that there are other people who are struggling with the same issues and constraints as they are. They are sick of talking about the lack of budget, expertise, training and resources and want to do something with what they have.Bert (fictional name) decides that it is worth capitalising on this success. He emails the people who came to the session in Dubbo to ask them if they would like to do it again but focus on some different training needs. He asks them to choose two of the following three professional development options. First, they can choose to watch and discuss a recording of the keynote presentations from day two of the recent national conference. The conference organisers have uploaded digital recordings of the speakers’ presentations and the question time to the AMaGA website. This is an option for local libraries that do not have sufficient bandwidth to live stream video. The local library technician will help them cast the videos to a large screen. Second, they can each bring an object from their museum collection that they think needs conservation work. If the item is too fragile or big to move, they will bring digital photographs of it instead. Bert consulted their state-based museum and found some specialist conservators who have agreed to Skype or Facetime them in Dubbo free of charge, to give them expert advice about how to care for their objects, and most importantly, what not to do. The IT technician at Dubbo Library can set up their meeting room so that they can cast the Skype session onto a large smart screen TV. One week before the event, they will send a list of their objects and photographs of them to the conservator so that she can prepare, and they can make best use of her time. After this session, they will feel more confident about undertaking small cleaning and flattening treatments and know when they should not attempt a treatment themselves and need to call on the experts. Third, they could choose to have a training session with the council’s grants officer on writing grant applications. As he assesses grant applications, he can tell them what local councils look for in a successful grant application. He can also inform them about some of the grants that might be relevant to them. After the formal training, there will be an opportunity for them to exchange information about the grants they have applied for in the past—sometimes finding out what’s available can be difficult—and work in small groups to critique each other’s grant applications.The group chooses options two and three, as they want more practical skills development. They take a break in the middle of the day for lunch, which gives them the opportunity to exchange anecdotes from their volunteer work and listen to and support each other. They feel validated and affirmed. They have gained new skills and don’t feel so isolated. Before they leave, Alice agrees to get in touch with everyone to organise their next regional training day.Harnessing Technology and Using Regional Library Infrastructure to Provide Training: BenefitsThese scenarios need not be futuristic. The training needs are real, as is the desire to learn and the capacity of libraries to support regional groups. While funding for regional museums has stagnated or declined in recent years, libraries have been surging ahead. In August 2018, the New South Wales Government announced an “historic investment” of $60 million into all 370 public libraries that would “transform the way NSW’s public libraries deliver much-needed services, especially in regional areas” (Smith). Libraries are equipped and charged with the responsibility of enabling local community groups to make best use of their resources. Most state and national museum workers are keen to share their expertise with their regional colleagues: funding and distance are often the only barriers. These scenarios allow national conference keynote speakers to reach a much larger audience than the conference attendees. While this strategy might reduce the number of workers from regional areas who pay to attend conferences, the reality is that due to distance, other volunteer commitments, expense and family responsibilities, they probably would not attend anyway. Most regional museums and galleries and their staff might be asset-rich, but they are cash-poor, and the only way their workers get to attend conferences is if they win a bursary or grant. In 2005, Winkworth said: “the future for community museums is to locate them within local government as an integral part of the cultural, educational and economic infrastructure of the community, just like libraries and galleries” (“Fixing the Slums” 7). Fourteen years on, very little progress has been made in this direction. Those museums which have been integrated into the local council infrastructure, such as at Orange and Wagga Wagga in western New South Wales, are doing much better than those that are still stuck in ‘cultural poverty’ and trying to operate independently.However, the co-location and convergence of museums, libraries and archives is only successful if it is well managed. Helena Robinson has examined the impact on museum collection management and interpretation of five local government funded, converged collecting institutions in Australia and New Zealand and found that the process is complex and does not necessarily result in “optimal” cross-disciplinary expertise or best practice outcomes (14158).ConclusionRobinson’s research, however, did not consider community-based collecting institutions using regional libraries as sites for training and networking. By harnessing local library resources and making better use of existing communications technology it is possible to create regional hubs for professional development and collegiate support, which are not reliant on grants. If the current competitive, fly-in fly-out, self-funded model of providing professional development and support to regional museums continues, then the future for our cultural heritage collections and the dedicated volunteers who care for them is bleak. Alternatively, the scenarios I have described give regional museum workers agency to address their own professional development needs. This in no way removes the need for leadership, advocacy and coordination by national representative bodies such as AMaGA and Museums Aotearoa. If AMaGA partnered with the Australian Library and Information Association (ALIA) to stream their conference keynote sessions to strategically located regional libraries and used some of their annual funding from the Department of Communication and the Arts to pay for museum professionals to travel to some of those sites to deliver training, they would be investing in the nation’s social and cultural capital and addressing the professional development needs of regional museum workers. This would also increase the sustainability of our cultural heritage collections, which are valuable economic assets.ReferencesAustralian Bureau of Statistics. “2071.0—Census of Population and Housing: Reflecting Australia—Snapshot of Australia, 2016”. Canberra: Australian Bureau of Statistics, 2017. 17 Mar. 2019 <https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Snapshot%20of%20Australia,%202016~2>.Boylan, Patrick. “The Intangible Heritage: A Challenge and an Opportunity for Museums and Museum Professional Training.” International Journal of Intangible Heritage 1 (2006): 53–65.Burton, Christine, and Jane Griffin. “More than a Museum? Understanding How Small Museums Contribute to Social Capital in Regional Communities.” Asia Pacific Journal of Arts & Cultural Management 5.1 (2008): 314–32. 17 Mar. 2019 <http://apjacm.arts.unimelb.edu.au/article/view/32>.Dunn, Anne. The Dunn Report: A Report on the Concept of Regional Collections Jobs. Adelaide: Collections Council of Australia, 2007.ICOM Curricula Guidelines for Professional Museum Development. 2000. <http://museumstudies.si.edu/ICOM-ICTOP/comp.htm>.Kelly, Lynda. “Measuring the Impact of Museums on Their Communities: The Role of the 21st Century Museum.” New Roles and Issues of Museums INTERCOM Symposium (2006): 25–34. 17 Mar. 2019 <https://media.australianmuseum.net.au/media/dd/Uploads/Documents/9355/impact+paper+INTERCOM+2006.bb50ba1.pdf>.Museums and Galleries New South Wales (MGNSW). 2018 NSW Museums and Galleries Sector Census. Museums and Galleries of New South Wales. Data and Insights—Culture Counts. Sydney: MGNSW, 2019. 17 Mar. 2019 <https://mgnsw.org.au/wp-content/uploads/2019/02/2018-NSW-Museum-Gallery-Sector-Census.pdf>Oppenheimer, Melanie. Volunteering: Why We Can’t Survive without It. Sydney: U of New South Wales P, 2008.Pigott, Peter. Museums in Australia 1975. Report of the Committee of Inquiry on Museums and National Collections Including the Report of the Planning Committee on the Gallery of Aboriginal Australia. Canberra: Australian Government Printing Service, 1975. 17 Mar. 2019 <https://apo.org.au/node/35268>.Public Sector Commission, Western Australia. 70:20:10 Framework Learning Philosophy. Perth: Government of Western Australia, 2018. 17 Mar. 2019 <https://publicsector.wa.gov.au/centre-public-sector-excellence/about-centre/702010-framework>.Robinson, Helena. “‘A Lot of People Going That Extra Mile’: Professional Collaboration and Cross-Disciplinarity in Converged Collecting Institutions.” Museum Management and Curatorship 31 (2016): 141–58.Scott, Lee. National Operations Manager, Museums Australia, Personal Communication. 22 Oct. 2018.Shaw, Iain, and Lee Davidson, Museums Aotearoa 2014 Sector Survey Report. Wellington: Victoria U, 2014. 17 Mar. 2019 <http://www.museumsaotearoa.org.nz/sites/default/files/documents/museums_aotearoa_sector_survey_2014_report_-_final_draft_oct_2015.pdf>.Smith, Alexandra. “NSW Libraries to Benefit from $60 Million Boost.” Sydney Morning Herald 24 Aug. 2018. 17 Mar. 2019 <https://www.smh.com.au/politics/nsw/nsw-libraries-to-benefit-from-60-million-boost-20180823-p4zzdj.html>. Winkworth, Kylie. “Fixing the Slums of Australian Museums; or Sustaining Heritage Collections in Regional Australia.” Museums Australia Conference Paper. Canberra: Museums Australia, 2005. ———. “Let a Thousand Flowers Bloom: Museums in Regional Australia.” Understanding Museums—Australian Museums and Museology. Eds. Des Griffin and Leon Paroissien. Canberra: National Museum of Australia, 2011. 17 Mar. 2019 <https://nma.gov.au/research/understanding-museums/KWinkworth_2011.html>.

Introduction: The Creative Arts and Regional Well-BeingThe relationship between regionalism, well-being, and the creative arts has enjoined significant attention from community activists, commercial entrepreneurs, policy analysts, artists, and researchers over recent years (Australia Council for the Arts, “Living Culture”; Australia Council for the Arts, “The Arts in Regional Australia;” Drummond, Keane, and West; Elg; Warren, and West; Woodward, Bremner, and Cahalan). Underpinning most of the activity and research in this area is the understanding (occasionally bordering on an un-critical presumption) that the creative arts make a positive contribution to regional well-being. Commenting on the Live. Love. Life. creative-arts wellness festival in Daylesford, Victoria, Mary-Anne Thomas (Member of Parliament for the state seat of Macedon) stated that the festival will “reinforce Daylesford and the Macedon Ranges’ status as one of the nation’s leading wellness destinations” (Elg). For Thomas, it would appear that the linkage of the creative arts to regional well-being is never in doubt; which is to say, always already available for reinforcement. According to university-based researchers Margaret Woodward, Craig Bremner, and Anthony Cahalan, writing in a more scholarly and critical register, “there is a growing body of research which shows that thriving creative industries and cultural activities are crucial for the health and vitality of a region and its communities” (3). Qualifying this, they add that: “Achieving high levels of community well being through thriving creative activity is not however without its challenges in regional Australia” (3). Similarly, Rozaline Drummond, Jondi Keane, and Patrick West present their work as a test of the efficacy of the creative arts in aiding regional well-being: The opportunity to work collaboratively with a community like the one at Lake Bolac [Victoria] provided an occasion to gauge our discerning and initiating skills within creative-arts research and to test the argument that the combination of our different approaches adds to community and individual well-being. Our approach is informed by Gilles Deleuze’s ethical proposition that the health of a community is directly influenced by the richness of the composition of its parts. (n.p.)Deleuzean philosophy aside, quantitative data indicates that people in regional Australia are increasingly optimistic about the positive impact of the creative arts on their well-being. In 2016, 57% believed the arts impacted their sense of well-being and happiness, up from 52% in 2013 (Australia Council for the Arts, “The Arts in Regional Australia”). Given this article’s emphasis on place and well-being in relation to located creative-arts production, it is worth citing another dataset from the same Australia Council for the Arts publication, which details the “Location of Professional Artists”:There continues to be a concentration of artists in urban areas. Three quarters (74%) live in cities, compared to two thirds of the Australian population. This urban concentration […] may in part be related to concentration of cultural infrastructure in cities.1 in 6 Australian artists live in regional cities or towns (16%) and around 1 in 10 live in rural, remote or very remote areas (11%). (n.p.)Regional artists are a minority voice in the Australian creative arts. But the ways in which a minority voice is constructed, and the (potential) impact a minoritarian position has within the wider debate about regional well-being and the creative arts, requires careful unpacking. Ironically, creative artists themselves have been relatively neglected actors in this space. Working with Tony Birch’s short story, “The Red House”, as a neglected text of regionalism, this article exposes oversights in current understandings of the connection between well-being and regionalism. The Voice of the Regional Artist and “Resistant Speech” It is important to recognise that the “concentration of artists in urban areas” may sometimes lead to situations where non-regional artists, in the undoubtedly well-meaning pursuit of regional well-being, drown out the voices of regional artists in regional places (Australia Council for the Arts, “The Arts in Regional Australia”). Drummond, Keane, and West, all city-based artists, show sensitivity to this problem in their observation that: “It is not for the artists to presume that they can empower a [regional] community.” Certainly, regional artists and communities should take the lead in the development of regional well-being through the creative arts. The problem of (not) speaking for the other is, however, not so easily dealt with (Spivak). While urban artists might adopt the strategy of consciously allowing regional artists a voice, making such allowance could itself be viewed as a play of privilege and power by the city-based practitioner, resourced by their greater “concentration of cultural infrastructure” (Australia Council for the Arts, “The Arts in Regional Australia”). It is notoriously difficult to give the slip to the relatively invisible operations of entitlement. Furthermore, even if the regional artist is given a voice, there are many different ways of being heard or not heard. Gayatri Chakravorty Spivak’s distinction between “speaking” and “talking” is useful here. Discussing “Can the Subaltern Speak?” in an interview with Bulan Lahiri, Spivak notes that: “It was not about talking. It was about: when the subaltern speaks there is not enough infrastructure for people to recognise it as resistant speech. That’s what it means.” In this crucial move, Spivak refines understanding of the issues at stake around the minoritarian position of regional artists. It is not enough for regional artists merely to “talk”; rather, they must be heard with the full impact of “resistant speech” (Lahiri). Obviously, what Spivak means by the “infrastructure” of “resistant speech” differs from the meaning the word “infrastructure” has in the Australia Council for the Arts publication referred to above, which employs the term as part of a governmental and technocratic discourse (“The Arts in Regional Australia”). The distance separating these two usages of “infrastructure” indicates the difference between the quantitative and the qualitative. Working with Spivak, this article’s focus is on the gap or failing in the infrastructure of qualitative research that has led to the relative neglect of Tony Birch’s short story “The Red House” as a significant text of regionalism. The Australia Council for the Arts, with its quantitative and empirical methodology, would not count Birch as a regional writer (to the best of the author’s knowledge, Birch lives and works in Melbourne). Its definition of a regional artist undermines the possibilities of a qualitative research infrastructure. However, recognizing the powerful regional concerns within a text by a primarily city-based writer like Birch is a key move, not only in expanding the definition of who counts as a minoritarian regional writer, but in giving voice to the “resistant speech” of women and children, subalterns on Spivak’s terms, within the regional-urban flux (Lahiri). The aim of this article is to give voice to Tony Birch as a regional writer, at least insofar as he is the author of “The Red House”, while also addressing the issue of well-being (as linked to the curse of domestic violence), through attention to Birch’s artistic re-creation of regionalism. In this way, working with Spivak’s reference to “infrastructure,” the aim is to nurture the growth of a research infrastructure open to a more productive engagement with regionalism, which begins by nuancing the definition of regional. It is not that regional artists, defined either by their demography or (as with Birch) by their creative concerns, are not “talking” rather, what they are saying is not being recognised in Spivak’s strong sense of “speaking”. Indeed, the very fact that Birch is not a regional writer in an empirical sense, and that, as will be explored later in this article, “The Red House” is not even primarily set in a regional location, has at least one important consequence. Potentially, it increases the value of Birch’s short story to an engagement with regionalism, given that “The Red House” unfolds regionalism as a concept always already in productive dialogue with other frameworks of place (such as the urban and the international). To the extent that Birch is a city-based writer of regionalism, and thus on the (urban) margin of the (regional) margin, he enlivens an exquisite position of minoritarian power. Furthermore, “The Red House” contains a diversity of acute insights into the nexus of regionalism and well-being that, to date, critics have overlooked. “The Red House” and the Well-Being of Places Comparatively little scholarly attention has been paid to creative work that itself dramatises and interrogates the issue of regional well-being. Tony Birch’s short story “The Red House” (2006), from his collection of linked stories (which is sometimes referred to as a novel) Shadowboxing, is a particularly interesting candidate to fill this gap in the literature, given how delicately it ranges across, and problematises, the division between the urban and the regional.“The Red House” is the opening story of Shadowboxing. Covering a period of close to a decade, loosely overlapping with the 1960s, and set in different parts of Victoria and Melbourne, it is told in the voice of Michael, who recounts the story of a peripatetic family under stress and struggling to survive. The first sentence reads: “We moved to the red house in the winter after my younger sister, May, died of meningitis” (1). The first page also establishes the place-based coordinates of the story: “In the weeks following our move from Clunes back to Fitzroy, our new house was almost submerged by a rising flood” (1). Birch’s interrogation of regionalism will henceforth operate largely along the Clunes-Fitzroy axis. Fitzroy is an inner-city suburb of Melbourne while Clunes is a small regional town (present population: approximately 2000) about 140 kilometres north-west of Melbourne (Clunes). A flashback section of three pages or so, early on in the story, fills in the events leading up to the return to Melbourne after May’s death in Clunes. Apart from this, the story has a linear structure. The various spatial shifts of “The Red House”, both within Melbourne and between Clunes and Melbourne, are all triggered by threats against, or the pursuit of, multiple modes of well-being. The first move reflects the promise of a fresh romantic union: “It was only after he [Michael’s father] had met my mother and moved with her to my [maternal] grandmother’s house over in Carlton that he had left Fitzroy for the first time in his life” (4–5). This move from Fitzroy to Carlton is followed by a much bigger one: Carlton to Clunes. Implicated in this move are at least two modes of well-being: “The eventual move to the bush had come on the advice of a doctor at the public hospital. He said that the fresh air would help my dad recover from [his] asthma” (5); however, “My grandmother told me years later that the move did not really have all that much to do with his asthma. It was the drink” (5). The context is the husband’s assault of “his six months’ pregnant wife” with “a straight right on the end of her nose” (5). The decision to move to Clunes is made by Michael’s mother: “He fought with her so much that my mother eventually decided that she would have to move away from her mother’s house, for both their sakes. Clunes was a drastic move. But it worked, for a time […]. They appeared happy” (6). This part of “The Red House” unpacks the complexities of how well-being and (physical and mental) health are linked in a social matrix; a physical ailment (asthma) elides an addiction to alcohol, until a doctor’s discourse (validated by the authority of a medical establishment) is subverted by the subalternate voice of Michael’s grandmother. This passage also dramatises the abject scenario of a victim (Michael’s mother) attending to the well-being of her persecutor (Michael’s father) by moving to Clunes “for both their sakes” (6).Subsequently, May is born in Clunes, “a ‘special baby’. She was magical even…” (6). Indeed, “My father’s habit of explosive anger melted before May. He was truly besotted with her” (6). Just before what would have been her second birthday, May dies. “My father wanted to bring May back to Melbourne for burial, but my mother stood up to him and demanded that she be buried in the town where she was born” (6). This is the most powerful enduring connection of Michael’s family to regional Clunes. Significantly, well-being (in the sense of survival and the rebuilding of happiness after the tragic death of a daughter) is dispersed differently, through place, by mother and father, along gendered lines. While the mother wants her daughter’s birthplace and place of death to coincide, the father wants to possess his daughter, almost as if she were an object, by returning her to the city for burial. (Space restrictions preclude further exploration here of the many issues raised by May’s death, including those around the gendered nexus between well-being [happiness] and the proximity or otherwise to a child’s burial place.) After May’s death, Michael’s father’s behaviour deteriorates once more. The domestic violence continues: “It was difficult for my mother to find anything safe to say to him […]. She tried to talk about May with him several times, but he either responded with silence, or swore and yelled at her uncontrollably. He also found his way back to the pubs” (7). The decision to return to Melbourne is made by Michael’s father, against his wife’s wishes: And then one night after he had walked in from the pub he sat down at the table and just said to her, ‘Fuck all this fresh-air bullshit, we’re going back to Melbourne.’ She tried persuading him to stay, talked about his job and my school, but he would not listen. He got sick of her talking and slammed a fist into his heavy palm. ‘We’re fucken going. That’s it. We’re going.’ And that was it.She looked across the table that night and saw once again the man she had married six years earlier, the man who she had deceived herself had faded and eventually disappeared with the move away from the city. (7)In this passage, well-being (even if only imagined rather than real) is explicitly linked to place. Shortly afterwards, the family moves into the red house, where they will remain. The flashback section of the text has already sketched out the chain of events that leads to the return to the city, while also commenting on the agency Michael’s mother exercises in dealing with what, to her, is an unwelcome situation: “Mum […] had argued against coming back to the city. She sensed the looming danger in my father moving back both to his old streets and his old habits. But on realising that she had no real say in the matter, she was determined to ensure that she at least have some say in the house she was moving into” (4). Specifically, Michael’s mother turns her Fitzroy house into the regional house left behind in Clunes. Under her influence, “It wasn’t long before the inside of the house came to life and began to resemble the old place at Clunes” (11). Again: she brings a portrait of May, along with assorted baby belongings, into the Fitzroy house, keeping this secret from her husband. Thus, Michael’s mother infiltrates regional place into urban place as a strategy of (subalternate) well-being. In summary, “The Red House” unpacks well-being as an expansive category shaped by domestic violence, in a negative sense, but also more positively by the actuality or promise of happiness. It also interrogates the fine-grained links between well-being in its incarnations as medical and emotional health. At the same time, it maps the rise and fall of well-being against a human geography of regional and urban places, refusing any simplistic connection of place to well-being (more faintly, there is even the problematising presence of international place, in the character of the Italian landlord, Mr Carboni, and the reference to “the local Italian community [2]). Thus, the text’s regionalism suggests a strategic model, reliant on human intervention in the (re-)creation of place; this is most evident in Michael’s mother’s actions. “The Red House” rewards interpretation as a text of how regional place (Clunes) is re-made in urban place (Fitzroy) through the rehabilitation of a house in the interests of well-being. Well-Being and Domestic Violence across Places It is hard to imagine a greater threat to the well-being of women and children than domestic violence. This makes it all the more surprising that “The Red House” is one of relatively few texts (to the author’s knowledge) to offer a detailed outline of the territory of well-being, in its many forms stretching from the health-based to the emotional, while also including a direct and unflinching consideration of domestic violence. (One cognate text is Kathryn Heyman’s novel The Breaking, which merges medical disability and domestic violence within a broader consideration of regional well-being.) Even more unusual is the way Birch’s story of well-being and domestic violence is mapped in relation to regional and non-regional places. “The Red House” is rare and valuable for its triangulation of well-being, domestic violence, and place; above all, in its refusal to resort to any comforting notion that regional places have essential qualities that make them necessarily better for well-being than the experience of cities. This is perhaps the meaning of the colour of the red house, a colour Michael’s father hates. According to a local know-all, Emu Bailey, the red was originally a form of protest by Ettie Rogers, “‘some sort of communist’” (10). “‘Most everyone around here back then was DLP [Democratic Labour Party]. Still is, some of them. Ettie wasn’t in agreement with the others in the street, so she let them know all about it. Redone it every summer too, the same colour, red’” (10). When Michael’s mother responds to her husband’s injunction to re-paint the house “‘any colour but that fucken red’” (13) by preparing to re-paint it, subversively, “a deep red splash of colour” (19) it is not difficult to discern a silent protest, passed down from woman to woman, against the domestic violence suffered by Michael and his mother. Indeed, Birch comes very close to describing the red of the house as blood-like, labelling it “a rich congealed red” (2). “Congealed” is often used to describe blood. In this way, through a colour that evokes the body, a house becomes a visible and metaphorical protest against the bodily violence (but also emotional and mental torment) that is domestic violence. As Meg Mundell argues, “the body is integral to how literary sense of place is produced” (8). This bodily, coloured protest folds back into the special sort of place the Fitzroy home becomes. If Michael’s mother cannot keep living in Clunes, she can at least paint her city house red. Perhaps attesting to the success of this female protest, there is, towards the end of “The Red House”, a fascinating moment when, as if influenced by the domestic circumstances of transplanted place (from regional Clunes) created by Michael’s mother, domestic violence threatens, but is thwarted. Michael’s mother has just told her husband that she is going to have another baby: “He spun around and moved towards her. I thought that maybe he was going to hit her. But he didn’t. He stopped in front of her. They were toe to toe” (17). Place and (pregnant) body, in an intensified combination (or even, to riff on Spivak’s terminology, as an “infrastructure”), allow the subaltern to “speak” against her oppression. Conclusion: Re-Defining Regionalism through the Literary Creative Arts Tony Birch’s “The Red House” re-creates the regional as something other than a pre-determined place. Regionalism is “activated,” in a strategic mode, within the flux of the urban and the regional. This is particularly evident in the actions of Michael’s mother. She preserves her well-being (located in Clunes, as it were, where her daughter is buried) even after she is forced by her husband to return to Melbourne (the place she left to escape from his domestic violence). The picture of May acts as a talisman of well-being (aptly, given Clunes is described by Michael as “a town where old superstitions held sway over logic” [6]), which Michael’s mother smuggles from regional Clunes into her Melbourne house. “The Red House” is thus a vital literary rejoinder to the conceptualisation of well-being, and regional areas employed by government bodies and commercial entities, which instrumentalizes a binary opposition of the regional/non-regional. By extension, it contests the naïve linkage of regional place to well-being through a nuanced investigation into the complex links between place (regional, urban, even international) and multi-faceted well-being. Birch’s story is a valuable, fine-grained creative analysis of well-being (extending from happiness, comfort and security through to what might be called the “ill-being” of domestic violence), which is matched to an equally fine-grained engagement with multiple modalities of place. It challenges the reader to creatively re-think how regionalism and well-being might align. References Australia Council for the Arts. “Living Culture: First Nations Arts Participation and Wellbeing.” Sydney: Australia Council for the Arts, 2017. 10 Mar. 2019 <https://www.australiacouncil.gov.au/research/living-culture/>.———. “The Arts in Regional Australia: A Research Summary.” Sydney: Australia Council for the Arts, 2017. 10 Mar. 2019 <https://www.australiacouncil.gov.au/research/regional-arts-summary/>.Birch, Tony. “The Red House.” Shadowboxing. Melbourne: Scribe, 2006. 1–19. Clunes, Victoria. Wikipedia. <https://en.wikipedia.org/wiki/Clunes,_Victoria>.Drummond, Rozalind, Jondi Keane, and Patrick West. “Zones of Practice: Embodiment and Creative Arts Research.” M/C Journal 15.4 (2012). 1 Mar. 2019 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/528>.Elg, Hayley. “New Wellness Festival for Daylesford.” The Advocate 22 Jan. 2018. 1 Mar. 2019 <https://www.hepburnadvocate.com.au/story/5182322/the-live-love-life-festival-is-coming-to-daylesford-this-november/>.Heyman, Kathryn. “When I First Wrote about Domestic Violence, No One Talked about It. Now the Shame has Lifted.” The Guardian. 21 May 2017. 10 Mar. 2019 <https://www.theguardian.com/books/2017/may/21/when-i-first-wrote-about-domestic-violence-no-one-talked-about-it-now-the-shame-has-lifted>.Lahiri, Bulan. “In Conversation: Speaking to Spivak.” The Hindu 5 Feb. 2011. 1 Mar. 2019 <https://www.thehindu.com/books/In-Conversation-Speaking-to-Spivak/article15130635.ece>.Mundell, Meg. “Crafting ‘Literary Sense of Place’: The Generative Work of Literary Place-Making.” JASAL: Journal of the Association for the Study of Australian Literature 18.1 (2018): 1–17. 10 Mar. 2019 <https://openjournals.library.sydney.edu.au/index.php/JASAL/article/view/12375>.Spivak, Gayatri Chakravorty. “Can the Subaltern Speak?” Colonial Discourse and Post-Colonial Theory: A Reader. New York: Harvester Wheatsheaf, 1993: 66–111. Warren, Brad, and Patrick West. “From Ecological Creativity to an Ecology of Well-Being: ‘Flows & Catchments’ as a Case Study of NVivo.” Landscapes: The Journal of the International Centre for Landscape and Language 5.2 (2013): 1–15. 1 Mar. 2019 <https://ro.ecu.edu.au/landscapes/vol5/iss2/21/>.Woodward, Margaret, Craig Bremner, and Anthony Cahalan. “Defining the Geography of Creativity in a Regional Australian University.” Proceedings of the 2012 Australian Council of University Art and Design Schools (ACUADS) Conference: Region and Isolation: The Changing Function of Art & Design Education within Diasporic Cultures and Borderless Communities. Australian Council of University Art and Design Schools (ACUADS) Conference 2012. Perth: Australian Council of University Art and Design Schools (ACUADS), 2012: 1–13. 1 Mar. 2019 <https://acuads.com.au/conference/article/defining-the-geography-of-creativity-in-a-regional-australian-university/>.

IntroductionBallarat’s Theatre Royal was the first permanent theatre built in inland Australia. Upon opening in 1858, it was acclaimed as having “the handsomest theatrical exterior in the colony” (Star, “Editorial” 7 Dec. 1889) and later acknowledged as “the grandest playhouse in all Australia” (Spielvogel, Papers Vol. 1 160). Born of Gold Rush optimism, the Royal was loved by many, yet the over-arching story of its ill-fated existence has failed to surface, in any coherent fashion, in official history. This article takes some first steps toward retrieving lost knowledge from fragmented archival records, and piecing together the story of why this purpose-built theatre ceased operation within a twenty-year period. A short history of the venue will be provided, to develop context. It will be argued that while a combination of factors, most of which were symptomatic of unfortunate timing, destroyed the longevity of the Royal, the principal problem was one of stigmatisation. This was an era in which the societal pressure to visibly conform to conservative values was intense and competition in the pursuit of profits was fierce.The cultural silence that befell the story of the Royal, after its demise, is explicable in relation to history being written by the victors and a loss of spokespeople since that time. As theatre arts historiographer McConachie (131) highlights, “Theatres, like places for worship and spectator sports, hold memories of the past in addition to providing a practical and cognitive framework for performance events in the present.” When that place, “a bounded area denoted by human agency and memory” (131), is lost in time, so too may be the socio-cultural lessons from the period, if not actively recalled and reconsidered. The purpose of this article is to present the beginning of an investigation into the disjointed narrative of Ballarat’s Theatre Royal. Its ultimate failure demonstrates how dominant community based entertainment became in Ballarat from the 1860s onwards, effectively crushing prospects for mid-range professional theatre. There is value in considering the evolution of the theatre’s lifespan and its possible legacy effects. The connection between historical consciousness and the performing arts culture of by-gone days offers potential to reveal specks of cross-relevance for regional Australian theatrical offerings today.In the BeginningThe proliferation of entertainment venues in Ballarat East during the 1850s was a consequence of the initial discovery of surface alluvial gold and the ongoing success of deep-lead mining activities in the immediate area. This attracted extraordinary numbers of people from all over the world who hoped to strike it rich. Given the tough nature of life on the early gold diggings, most disposable income was spent on evening entertainment. As a result, numerous venues sprang into operation to cater for demand. All were either canvas tents or makeshift wooden structures: vibrant in socio-cultural activity, however humble the presentation values. It is widely agreed (Withers, Bate and Brereton) that noteworthy improvements occurred from 1856 onwards in the artistry of the performers, audience tastes, the quality of theatrical structures and living standards in general. Residents began to make their exit from flood and fire prone Ballarat East, moving to Ballarat West. The Royal was the first substantial entertainment venture to be established in this new, affluent, government surveyed township area. Although the initial idea was to draw in some of the patronage which had flourished in Ballarat East, Brereton (14) believed “There can be no doubt that it was [primarily] intended to attract those with good taste and culture”. This article will contend that how society defined ‘good taste’ turned out to be problematic for the Royal.The tumultuous mid-1850s have attracted extensive academic and popular attention, primarily because they were colourful and politically significant times. The period thereafter has attracted little scholarly interest, unless tied to the history of surviving organisations. Four significant structures designed to incorporate theatrical entertainment were erected and opened in Ballarat from 1858 onwards: The Royal was swiftly followed by the Mechanics Institute 1859, Alfred Hall 1867 and Academy of Music 1874-75. As philosopher Albert Borgmann (41) highlighted, the erection of “magnificent settings in which the public could gather and enjoy itself” was the dominant urban aspiration for cultural consumption in the nineteenth century. Men of influence in Victorian cities believed strongly in progress and grand investments as a conscious demonstration of power, combined with Puritan vales, teetotalism and aggressive self-assertiveness (Briggs 287-88). At the ceremonial laying of the foundation stone for the Royal on 20 January 1858, eminent tragedian, Gustavos Brooke, announced “… may there be raised a superstructure perfect in all its parts, and honourable to the builder.” He proclaimed the memorial bottle to be “a lasting memento of the greatness of Ballarat in erecting such a theatre” and philosophised that “the stage not only refines the manners, but it is the best teacher of morals, for it is the truest and most intelligible picture of life. It stamps the image of virtue on the mind …” (Star, “Laying” 21 Jan. 1858). These initial aspirations seem somewhat ambitious when viewed with the benefit of hindsight. Ballarat’s Theatre Royal opened in December 1858, ironically with Jerrold’s comedy ‘Time Works Wonders’. The large auditorium holding around 1500 people “was crowded to overflowing and was considered altogether brilliant in its newness and beauty” by all in attendance (Star, “Local and General” 30 Dec. 1858). Generous descriptions abound of how splendid it was, in architectural terms, but also in relation to scenery, decorations and all appointments. Underneath the theatre were two shops, four bars, elegant dining rooms, a kitchen and 24 bedrooms. A large saloon was planned to be attached soon-after. The overall cost of the build was estimated at a substantial 10,000 pounds.The First Act: 1858-1864In the early years, the Royal was deemed a success. The pleasure-seeking public of Ballarat came en masse and the glory days seemed like they might continue unabated. By the early 1860s, Ballarat was known as a great theatrical centre for performing arts, its population was famous both nationally and internationally for an appreciation of good acting, and the Royal was considered the home of the best dramatic art in Ballarat (Withers 260). Like other theatres of the 1850s diggings, it had its own resident company of actors, musicians, scenic artists and backstage crew. Numerous acclaimed performers came to visit and these were prosperous and happy times for the Royal’s lively theatrical community. As early as 1859, however, there was evident rivalry between the Royal and the Mechanics Institute, as suggested on numerous occasions in the Ballarat Star. As a multi-purpose venue for education and the betterment of the working classes, the latter venue had the distinct advantage of holding the moral high ground. Over time this competition increased as audiences decreased. As people shifted to family-focussed entertainments, these absorbed their time and attention. The transformation of a transient population into a township of families ultimately suffocated prospects for professional entertainment in Ballarat. Consumer interest turned to the growth of strong amateur societies with the establishment of the Welsh Eisteddfod 1863; Harmonic Society 1864; Bell Ringers’ Club 1866 and Glee and Madrigal Union 1867 (Brereton 38). By 1863, the Royal was reported to have “scanty patronage” and Proprietor Symonds was in financial trouble (Star, “News and Notes” 15 Sep. 1864). It was announced that the theatre would open for the last time on Saturday, 29 October 1864 (Australasian). On that same date, the Royal was purchased by Rowlands & Lewis, the cordial makers. They promptly on-sold it to the Ballarat Temperance League, who soon discovered that there was a contract in place with Bouchier, the previous owner, who still held the hotel next door, stating that “all proprietors … were bound to keep it open as a theatre” (Withers 260-61). Having invested immense energy into the quest to purchase it, the Temperance League backed out of the deal. Prominent Hotelier Walter Craig bought it for less than 3,000 pounds. It is possible that this stymied effort to quell the distribution of liquor in the heart of the city evoked the ire of the Protestant community, who were on a dedicated mission “to attack widespread drunkenness, profligacy, licentiousness and agnosticism,” and forming an interdenominational Bible and Tract Society in 1866 (Bate 176). This caused a segment of the population to consider the Royal a ‘lost cause’ and steer clear of it, advising ‘respectable’ families to do the same, and so the stigma grew. Social solidarity of this type had significant impact in an era in which people openly demonstrated their morality by way of unified public actions.The Second Act: 1865-1868The Royal closed for renovations until May 1865. Of the various alterations made to the interior and its fittings, the most telling was the effort to separate the ladies from the ‘town women’, presumably to reassure ‘respectable’ female patrons. To this end, a ladies’ retiring room was added, in a position convenient to the dress circle. The architectural rejuvenation of the Royal was cited as an illustration of great progress in Sturt Street (Ballarat Star, “News and Notes” 27 May 1865). Soon after, the Royal hosted the Italian Opera Company.However, by 1866 there was speculation that the Royal may be converted into a dry goods store. References to what sort of impression the failing of theatre would convey to the “old folks at home” in relation to “progress in civilisation'' and "social habits" indicated the distress of loyal theatre-goers. Impassioned pleas were written to the press to help preserve the “Temple of Thespus” for the legitimate use for which it was intended (Ballarat Star, “Messenger” and “Letters to the Editor” 30 Aug. 1866). By late 1867, a third venue materialised. The Alfred Hall was built for the reception of Ballarat’s first Royal visitor, the Duke of Edinburgh. On the night prior to the grand day at the Alfred, following a private dinner at Craig’s Hotel, Prince Alfred was led by an escorted torchlight procession to a gala performance at Craig’s very own Theatre Royal. The Prince’s arrival caused a sensation that completely disrupted the show (Spielvogel, Papers Vol. 1 165). While visiting Ballarat, the Prince laid the stone for the new Temperance Hall (Bate 159). This would not have been required had the League secured the Royal for their use three years earlier.Thereafter, the Royal was unable to reach the heights of what Brereton (15) calls the “Golden Age of Ballarat Theatre” from 1855 to 1865. Notably, the Mechanics Institute also experienced financial constraints during the 1860s and these challenges were magnified during the 1870s (Hazelwood 89). The late sixties saw the Royal reduced to the ‘ordinary’ in terms of the calibre of productions (Brereton 15). Having done his best to improve the physical attributes and prestige of the venue, Craig may have realised he was up against a growing stigma and considerable competition. He sold the Royal to R.S. Mitchell for 5,500 pounds in 1868.Another New Owner: 1869-1873For the Saturday performance of Richard III in 1869, under the new Proprietor, it was reported that “From pit to gallery every seat was full” and for many it was standing room only (Ballarat Star, “Theatre Royal” 1 Feb. 1869). Later that year, Othello attracted people with “a critical appreciation of histrionic matters” (Ballarat Star, “News and Notes” 19 July 1869). The situation appeared briefly promising. Unfortunately, larger economic factors were soon at play. During 1869, Ballarat went ‘mad’ with mine share gambling. In 1870 the economic bubble burst, and hundreds of people in Ballarat were financially ruined. Over the next ten years the population fell from 60,000 to less than 40,000 (Spielvogel, Papers Vol. 3 39). The last surviving theatre in Ballarat East, the much-loved Charles Napier, put on its final show in September 1869 (Brereton 15). By 1870 the Royal was referred to as a “second-class theatre” and was said to be such bad repute that “it would be most difficult to draw respectable classes” (Ballarat Star, “News and Notes” 17 Jan. 1870). It seems the remaining theatre patrons from the East swung over to support the Royal, which wasn’t necessarily in the best interests of its reputation. During this same period, family-oriented crowds of “the pleasure-seeking public of Ballarat” were attending events at the newly fashionable Alfred Hall (Ballarat Courier, “Theatre Royal” June 1870). There were occasional high points still to come for the Royal. In 1872, opera drew a crowded house “even to the last night of the season” which according to the press, “gave proof, if proof were wanting, that the people of Ballarat not only appreciate, but are willing to patronise to the full any high-class entertainment” (Ballarat Courier, “Theatre Royal” 26 Aug. 1872). The difficulty, however, lay in the deterioration of the Royal’s reputation. It had developed negative connotations among local temperance and morality movements, along with their extensive family, friendship and business networks. Regarding collective consumption, sociologist John Urry wrote “for those engaged in the collective tourist gaze … congregation is paramount” (140). Applying this socio-cultural principle to the behaviour of Victorian theatre-going audiences of the 1870s, it was compelling for audiences to move with the masses and support popular events at the fresh Alfred Hall rather than the fading Royal. Large crowds jostling for elbow room was perceived as the hallmark of a successful event back then, as is most often the case now.The Third Act: 1874-1878An additional complication faced by the Royal was the long-term effect of the application of straw across the ceiling. Acoustics were initially poor, and straw was intended to rectify the problem. This caused the venue to develop a reputation for being stuffy and led to the further indignity of the Royal suffering an infestation of fleas (Jenkins 22); a misfortune which caused some to label it “The Royal Bug House” (Reid 117). Considering how much food was thrown at the stage in this era, it is not surprising that rotten debris attracted insects. In 1873, the Royal closed for another round of renovations. The interior was redesigned, and the front demolished and rebuilt. This was primarily to create retail store frontage to supplement income (Reid 117). It was reported that the best theatrical frontage in Australasia was lost, and in its place was “a modestly handsome elevation” for which all play-goers of Ballarat should be thankful, as the miracle required of the rebuild was that of “exorcising the foul smells from the old theatre and making it bright and pretty and sweet” (Ballarat Star, “News and Notes” 26 Jan. 1874). The effort at rejuvenation seemed effective for a period. A “large and respectable audience” turned out to see the Fakir of Oolu, master of the weird, mystical, and strange. The magician’s show “was received with cheers from all parts of the house, and is certainly a very attractive novelty” (Ballarat Courier, “Theatre Royal” 29 Mar. 1875). That same day, the Combination Star Company gave a concert at the Mechanics Institute. Indicating the competitive tussle, the press stated: “The attendance, however, doubtless owing to attractions elsewhere, was only moderately large” (Courier, “Concert at the Mechanics’” 29 Mar. 1875). In the early 1870s, there had been calls from sectors of society for a new venue to be built in Ballarat, consistent with its status. The developer and proprietor, Sir William Clarke, intended to offer a “higher class” of entertainment for up to 1700 people, superior to the “broad farces” at the Royal (Freund n.p.) In 1875, the Academy of Music opened, at a cost of twelve thousand pounds, just one block away from the Royal.As the decade of decreasing population wore on, it is intriguing to consider an unprecedented “riotous” incident in 1877. Levity's Original Royal Marionettes opened at the Royal with ‘Beauty and the Beast’ to calamitous response. The Company Managers, Wittington & Lovell made clear that the performance had scarcely commenced when the “storm” arose and they believed “the assault to be premeditated” (Wittington and Lovell in Argus, “The Riot” 6 Apr. 1877). Paid thuggery, with the intent of spooking regular patrons, was the implication. They pointed out that “It is evident that the ringleaders of the riot came into the theatre ready armed with every variety of missiles calculated to get a good hit at the figures and scenery, and thereby create a disturbance.” The mob assaulted the stage with “head-breaking” lemonade bottles, causing costly damage, then chased the frightened puppeteers down Sturt Street (Mount Alexander Mail, “Items of News” 4 Apr. 1877). The following night’s performance, by contrast, was perfectly calm (Ballarat Star, “News and Notes” 7 Apr. 1877). Just three months later, Webb’s Royal Marionette pantomimes appeared at the Mechanics’ Institute. The press wrote “this is not to be confounded, with the exhibition which created something like a riot at the Theatre Royal last Easter” (Ballarat Star, “News and Notes” 5 July 1877).The final performance at the Royal was the American Rockerfellers’ Minstrel Company. The last newspaper references to the Royal were placed in the context of other “treats in store” at The Academy of Music, and forthcoming offerings at the Mechanics Institute (Star, “Advertising” 3 July 1878). The Royal had experienced three re-openings and a series of short-term managements, often ending in loss or even bankruptcy. When it wound up, investors were left to cover the losses, while the owner was forced to find more profitable uses for the building (Freund n.p.). At face value, it seemed that four performing arts venues was one too many for Ballarat audiences to support. By August 1878 the Royal’s two shop fronts were up for lease. Thereafter, the building was given over entirely to retail drapery sales (Withers 260). ReflectionsThe Royal was erected, at enormous expense, in a moment of unbridled optimism, after several popular theatres in Ballarat East had burned to the ground. Ultimately the timing for such a lavish investment was poor. It suffered an inflexible old-fashioned structure, high overheads, ongoing staffing costs, changing demographics, economic crisis, increased competition, decreased population, the growth of local community-based theatre, temperance agitation and the impact of negative rumour and hear-say.The struggles endured by the various owners and managers of, and investors in, the Royal reflected broader changes within the larger community. The tension between the fixed nature of the place and the fluid needs of the public was problematic. Shifting demographics meant the Royal was negatively affected by conservative values, altered tastes and competing entertainment options. Built in the 1850s, it was sound, but structurally rigid, dated and polluted with the bacterial irritations of the times. “Resident professional companies could not compete with those touring from Melbourne” by whom it was considered “… hard to use and did not satisfy the needs of touring companies who required facilities equivalent to those in the metropolitan theatres” (Freund n.p.). Meanwhile, the prevalence of fund-raising concerts, created by charitable groups and member based community organisations, detracted from people’s interest in supporting professional performances. After-all, amateur concerts enabled families to “embrace the values of British middle class morality” (Doggett 295) at a safe distance from grog shops and saloons. Children aged 5-14 constituted only ten percent of the Ballarat population in 1857, but by 1871 settler families had created a population in which school aged children comprised twenty-five of the whole (Bate 146). This had significant ramifications for the type of theatrical entertainments required. By the late sixties, as many as 2000 children would perform at a time, and therefore entrance fees were able to be kept at affordable levels for extended family members. Just one year after the demise of the Royal, a new secular improvement society became active, holding amateur events and expanding over time to become what we now know as the Royal South Street Society. This showed that the appetite for home-grown entertainment was indeed sizeable. It was a function that the Royal was unable to service, despite several ardent attempts. Conclusion The greatest misfortune of the Royal was that it became stigmatised, from the mid 1860s onwards. In an era when people were either attempting to be pure of manners or were considered socially undesirable, it was hard for a cultural venue to survive which occupied the commercial middle ground, as the Royal did. It is also conceivable that the Royal was ‘framed’, by one or two of its competitor venues, or their allies, just one year before its closure. The Theatre Royal’s negative stigma as a venue for rough and intemperate human remnants of early Ballarat East had proven insurmountable. The Royal’s awkward position between high-class entrepreneurial culture and wholesome family-based community values, both of which were considered tasteful, left it out-of-step with the times and vulnerable to the judgement of those with either vested interests or social commitments elsewhere. This had long-term resonance for the subsequent development of entertainment options within Ballarat, placing the pendulum of favour either on elite theatre or accessible community based entertainments. The cultural middle-ground was sparse. The eventual loss of the building, the physical place of so much dramatic energy and emotion, as fondly recalled by Withers (260), inevitably contributed to the Royal fading from intergenerational memory. The telling of the ‘real story’ behind the rise and fall of the Ballarat Theatre Royal requires further exploration. If contemporary cultural industries are genuinely concerned “with the re-presentation of the supposed history and culture of a place”, as Urry believed (154), then untold stories such as that of Ballarat’s Theatre Royal require scholarly attention. This article represents the first attempt to examine its troubled history in a holistic fashion and locate it within a context ripe for cultural analysis.ReferencesBate, Weston. Lucky City: The First Generation at Ballarat 1851–1901. Carlton South: Melbourne UP, 1978.Brereton, Roslyn. Entertainment and Recreation on the Victorian Goldfields in the 1850s. BA (Honours) Thesis. 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