Academic literature on the topic 'Terminal care Victoria'

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.

The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. We investigated documentation of the premorbid functional status, severity of illness, intensity of treatment, operative management and quality of end-of-life care in patients who died in a surgical unit, with a retrospective study of surgical mortality which was performed across three hospitals over a 23-month period in Victoria, Australia. Among 99 deceased patients in the study cohort, 68 had a surgical operation. Preoperative functional risk assessment by medical staff was infrequently documented in the medical notes (5%) compared with activities of daily living (69%) documented by nursing staff. Documented preoperative discussions regarding the risk of death were rarely and inconsistently done, but when done were extensive. Documented end-of-life care discussions were identified in 71%, but were frequently brief, inconsistent, and in 60% did not occur until 48 hours from death. In 35.4% of instances, documented discussions involved junior staff (registrars or residents), and 43.4% involved intensive care unit staff. Palliative or terminal care referrals also occurred late (1–2 days prior to death). Not-for-resuscitation orders were frequently changed when approaching the end of life. Overall, 57% of deceased patients had a documented opportunity for farewell with family. We conclude that discussions and documentation of end-of-life care practices could be improved and recommend that all surgical units undertake similar audits to ensure that end-of-life care discussions occur for high-risk and palliative care surgical patients and are documented appropriately.

The Australian species of the water beetle genus Hydraena Kugelann, 1794, are revised, based on the study of 7,654 specimens. The 29 previously named species are redescribed, and 56 new species are described. The species are placed in 24 species groups. High resolution digital images of all primary types are presented (online version in color), and geographic distributions are mapped. Male genitalia, representative female terminal abdominal segments and representative spermathecae are illustrated. Australian Hydraena are typically found in sandy/gravelly stream margins, often in association with streamside litter; some species are primarily pond dwelling, a few species are humicolous, and one species may be subterranean. The areas of endemicity and species richness coincide quite closely with the Bassian, Torresian, and Timorian biogeographic subregions. Eleven species are shared between the Bassian and Torresian subregions, and twelve are shared between the Torresian and Timorian subregions. Only one species, H. impercepta Zwick, is known to be found in both Australia and Papua New Guinea. One Australian species, H. ambiflagellata, is also known from New Zealand. New species of Hydraena are: H. affirmata (Queensland, Palmerston National Park, Learmouth Creek), H. ambiosina (Queensland, 7 km NE of Tolga), H. antaria (New South Wales, Bruxner Flora Reserve), H. appetita (New South Wales, 14 km W Delagate), H. arcta (Western Australia, Synnot Creek), H. ascensa (Queensland, Rocky Creek, Kennedy Hwy.), H. athertonica (Queensland, Davies Creek), H. australula (Western Australia, Synnot Creek), H. bidefensa (New South Wales, Bruxner Flora Reserve), H. biimpressa (Queensland, 19.5 km ESE Mareeba), H. capacis (New South Wales, Unumgar State Forest, near Grevillia), H. capetribensis (Queensland, Cape Tribulation area), H. converga (Northern Territory, Roderick Creek, Gregory National Park), H. cubista (Western Australia, Mining Camp, Mitchell Plateau), H. cultrata (New South Wales, Bruxner Flora Reserve), H. cunninghamensis (Queensland, Main Range National Park, Cunningham's Gap, Gap Creek), H. darwini (Northern Territory, Darwin), H. deliquesca (Queensland, 5 km E Wallaman Falls), H. disparamera (Queensland, Cape Hillsborough), H. dorrigoensis (New South Wales, Dorrigo National Park, Rosewood Creek, upstream from Coachwood Falls), H. ferethula (Northern Territory, Cooper Creek, 19 km E by S of Mt. Borradaile), H. finniganensis (Queensland, Gap Creek, 5 km ESE Mt. Finnigan), H. forticollis (Western Australia, 4 km W of King Cascade), H. fundaequalis (Victoria, Simpson Creek, 12 km SW Orbost), H. fundata (Queensland, Hann Tableland, 13 km WNW Mareeba), H. hypipamee (Queensland, Mt. Hypipamee National Park, 14 km SW Malanda), H. inancala (Queensland, Girraween National Park, Bald Rock Creek at "Under-ground Creek"), H. innuda (Western Australia, Mitchell Plateau, 16 mi. N Amax Camp), H. intraangulata (Queensland, Leo Creek Mine, McIlwrath Range, E of Coen), H. invicta (New South Wales, Sydney), H. kakadu (Northern Territory, Kakadu National Park, Gubara), H. larsoni (Queensland, Windsor Tablelands), H. latisoror (Queensland, Lamington National Park, stream at head of Moran's Falls), H. luminicollis (Queensland, Lamington National Park, stream at head of Moran's Falls), H. metzeni (Queensland, 15 km NE Mareeba), H. millerorum (Victoria, Traralgon Creek, 0.2 km N 'Hogg Bridge', 5.0 km NNW Balook), H. miniretia (Queensland, Mt. Hypipamee National Park, 14 km SW Malanda), H. mitchellensis (Western Australia, 4 km SbyW Mining Camp, Mitchell Plateau), H. monteithi (Queensland, Thornton Peak, 11 km NE Daintree), H. parciplumea (Northern Territory, McArthur River, 80 km SW of Borroloola), H. porchi (Victoria, Kangaroo Creek on Springhill Rd., 5.8 km E Glenlyon), H. pugillista (Queensland, 7 km N Mt. Spurgeon), H. queenslandica (Queensland, Laceys Creek, 10 km SE El Arish), H. reticuloides (Queensland, 3 km ENE of Mt. Tozer), H. reticulositis (Western Australia, Mining Camp, Mitchell Plateau), H. revelovela (Northern Territory, Kakadu National Park, GungurulLookout), H. spinissima (Queensland, Main Range National Park, Cunningham's Gap, Gap Creek), H. storeyi (Queensland, Cow Bay, N of Daintree River), H. tenuisella (Queensland, 3 km W of Batavia Downs), H. tenuisoror (Australian Capital Territory, Wombat Creek, 6 km NE of Piccadilly Circus), H. textila (Queensland, Laceys Creek, 10 km SE El Arish), H. tridisca (Queensland, Mt. Hemmant), H. triloba (Queensland, Mulgrave River, Goldsborough Road Crossing), H. wattsi (Northern Territory, Holmes Jungle, 11 km NE by E of Darwin), H. weiri (Western Australia, 14 km SbyE Kalumburu Mission), H. zwicki (Queensland, Clacherty Road, via Julatten).

Embora já tenha mais de cinco anos de publicação, a obra objeto desta resenha, referenciada em epígrafe, se justifica por duas razões: uma editorial e outra de conteúdo. A primeira diz respeito a um programa da Editora Cortez, de São Paulo, de publicar, no Brasil, textos já publicados em outros países, sem traduzi-los, apenas negociando sua impressão no formato original – inclusive com as mesmas características físicas da edição estrangeira –, como é o caso da obra em tela. A segunda, relacionada à primeira, refere-se ao fato de ser muito pobre a bibliografia sobre a avaliação na Educação Infantil acessível aos educadores brasileiros da infância.Incorporada recentemente nos sistemas educacionais brasileiros1, a “Educação Infantil”2 e, mais recentemente ainda, o tema da avaliação da aprendizagem nela aplicada, estão 1Embora a Lei n.º 9.394, de 20 de dezembro de 1996 já tenha um quarto de século, sabemos que a produção de pesquisas sobre avaliação neste grau de ensino continua escassa, não só por sua complexidade, como porque a temática certamente ainda não conquistou prestígio na comunidade acadêmico-científica.2 Aqui registrada entre aspas, porque, embora seja esta a expressão consagrada na própria legislação e largamente disseminada na sociedade brasileira e estrangeira, parece que a denominação mais adequada seria “Educação da Infância”, já que o qualificativo “infantil” carrega consigo uma conotação histórico-sociológicaa merecer mais estudos e pesquisas para passarem a incorporar, respectivamente, as políticas e os programas de formação de educadores de infância e os currículos dirigidos para este segmento da Educação Básica.Avaliar, na Educação Infantil, é mais do que fazer verificações ou medir dimensões das performances estudantis. Aí, a avaliação é uma atividade indissociável das tarefas de ensino e das práticas de aprendizagem. Ela se constitui como uma atividade que deve ser desenvolvida ao longo de todo o processo do-discente em sala de aula. Consensualmente entre os pesquisadores do campo, independentemente de suas diferenças conceituais, a avaliação é uma ferramenta estratégica, seja para a verificação de objetivos e metas alcançadas (ou não) e, neste sentido, útil para a eventual correção de políticas, programas e planos educacionais – ou, no limite, até mesmo para sua eventual substituição –; seja, finalmente, para o desenvolvimento bio-psíquico-cognitivo-social dos pequenos.Ao contrário do que afirmam as teorias mais tradicionais, a avaliação não termina com a publicação dos resultados de determinado desempenho objeto da verificação levada a efeito, mas estende-se, na “pós-avaliação” para sua autoavaliação, em suma, para a meta-avaliação, no sentido de sua própria submissão aos processos que propõe e aplica nos outros” (pessoas e instituições). Aliás, a expressão “pós-avaliação” deve ser posta entre aspas porque a meta- avaliação faz parte intrínseca do próprio processo de avaliação educacional, não vindo, portanto, depois dele. O livro em tela, além de tratar conceptualmente da avaliação, oferecendo um repertório variado de reflexões e exemplos de experiências concretamente vividas em sala de aula, brinda o leitor com procedimentos e instrumentos meta-avaliados, para aplicação, com mais segurança, por educadores da infância que trabalham com crianças da faixa etária de 0 a 6 anos. Como de praxe em qualquer resenha, a(s) autora(s) e o(s) autor(es) da obra resenhada devem ser apresentados inicialmente. No caso da obra em tela, além dos autores – sobre as(os) quais se fala a seguir, registra-se uma “equipe de trabalho”, constituída por Mireia Crespo i Torres, Coral Saus i Raurrel, María Dilmé i Gualta e Montserrat Planas de Farners i Valentí, numa clara demonstração que se trata de uma obra de autoria, mais do que coletiva, mas, transindividual, porque “interdisciplinariza”, sintetiza e socializa teorias, práticas e propostas de uma equipe de pesquisadores (coautores) e de “aplicadores” (equipe de trabalho”).A primeira das autoras é Victoria Mir Costa, licenciada em Pedagogia, professora e diplomada em Atividades Infantis e Juvenis. Foi tutora de estágios, nas universidades de Girona negativa, como algo identificado com a imaturidade. Ora, a educação oferecida aos pequenos e às pequenas não pode ser “infantil”, na medida mesma de sua complexidade, mas, profunda e cientificamente consolidada, pois eles e elas são mais vulneráveis às influências adultas.e Central da Catalunha (UVic)). Ela tem formado uma boa dupla com María Teresa Gómez Masdevall, psicóloga especialista em educação da infância e de adolescentes e docente da Universidade de Sevilha. Por vários anos, ambas vêm sendo coautoras, como, por exemplo, nas obras Propuestas de intervención en el aula: técnicas para lograr um clima favorable en clase (1991) e Altas capacidades em niños y niñas: detección, identificación e integración en la escuela y en la família (2011) e Crecer en valores (2011), as duas primeiras na mesma editora do livro ora em resenha e a última na editora Sal Terrae. Os demais autores, Llorenç Carreras i Sureda (docente na educação Básica), Montserrat Valentí i Plantés (idem) e Anna Nadal i Farreras (formada em Letras e Filosofia pela Universidade de Barcelona) trabalham nas mesmas temáticas mencionadas em relação às duas primeiras autoras e vêm constituindo uma equipe de pesquisadores e docentes, com importantes obras teórico-práticas sobre a educação básica da Catalunha. Uma auto apresentação de Anna Nadal i Farreras sintetiza o espírito das equipes que produziram esta obra:Eu me defino como mãe, professora e cidadã. Eu sou apaixonada pelo meu trabalho. Tenho o privilégio de trabalhar pelo que mais gosto e com extraordinários companheiros de viagem (alunos, familiares e professores). Continuamos fiéis ao trabalho por uma escola inovadora, solidária, participativa, democrática, sensível à diversidade e que valoriza o zelo criativo das crianças. Uma escola alegre e animada onde todos somos atores, famílias, alunos e professores (https://educaciodema.cat/qui-es-qui/innovador/anna-maria-nadal-farreras, consultado em 20 de novembro de 2021).Evaluación y postevaluación en educación Infantil trata da avaliação que se debruça sobre o antes, o durante e o depois da vida do estudante pequeno em momentos determinados da verificação da aprendizagem na escola. Mesmo porque a proposta abriga-se numa concepção que privilegia a avaliação em processo, isto é, aquela que se dá ao longo e no próprio processo do-discente. De uma certa maneira, as autoras e os autores da obra se inscrevem no universo da chamada “avaliação formativa”, sem qualquer preocupação com comparações e classificações.Certamente, a avaliação sempre ocorreu, desde que o ser humano passou a analisar conscientemente suas escolhas, a partir de critérios e objetivos. Contudo, a avaliação foi compreendida inicialmente apenas para comparar e medir, sem tratar da valorização da pessoa como agente de sua própria aprendizagem – mediatizado pelo mundo, como dizia Paulo Freireem várias de suas obras – e de sua própria avaliação.Os autores deste livro deixam claro que a avaliação, de alguma forma, está destinada a evidenciar os equívocos dos avaliados em um determinado desempenho, mas, ao mesmo tempo, ela não pode deixar de demonstrar os avanços, fazendo-a instrumento de um projeto de alegria,de modo que as próprias educandas e os próprios educandos encontrem motivos e desejos reais para serem avaliados e passarem a avaliar as próprias dificuldades.Fica claro no texto que, na avaliação da aprendizagem, entrelaçam-se dois eixos: verificação da aprendizagem das(os) estudantes e levantamento, identificação e análise das práticas político-pedagógicas das professoras e dos professores. As autoras e o autor previnem: “A criança deve ser compreendida, aceita e amada por seus pais e professores” (p. 33). Nessa perspectiva, acentuam que o trabalho educativo deve fazer com que a(o) educanda(o) aceite a si mesmo, fazendo da avaliação um hábito que, desde a infância, fará a(o) menina(o) encontrar condições de refletir sobre seus problemas comuns, buscando o próprio aperfeiçoamento para melhor interferir e se inserir no mundo. Mais do que avaliar a capacidade cognitiva, afetiva, psicomotora etc. da(o) educanda(o), a obra destaca que é preciso levá-la(o) a contribuir consigo mesma(o) por meio do pensamento crítico, a fim de melhor situar-se nos coletivos, já que o ser humano é um ser que somente se plenifica pela vida em sociedade, intervindo na realidade de modo mais qualificado.A avaliação, demonstram as autoras e o autor, é um tema que requer objetividade, clareza, liberdade e criatividade, para que os que nela se envolvem sejam formados como sujeitos livres, criativos e capazes de se adaptarem às diferentes culturas e às novas tecnologias.Os professores, em sua maioria, têm uma imagem consolidada de avaliação no sentidode ela ser um instrumento que aprisiona os estudantes ao fracasso e, pela revelação deste fracasso, atentam contra sua autoestima, pois, na maioria dos casos, não lhes dão chance de participação do processo avaliativo, a não ser como objetos e, não, como sujeitos autônomos, críticos e responsáveis. Se a escola não trabalha a avaliação formativa, impedirá a formação de sujeitos capazes de “voar”. A avaliação é primordial, pois, mesmo nela, o professor é um facilitador da aprendizagem dos estudantes, na medida em que revela seus avanços e os desafios ainda não superados, mas que podem sê-lo, se bem desvendados na meta-avaliação.O livro evidencia um dos aspectos mais importantes da avaliação na educação para a infância e, por que não dizer do próprio processo educacional de crianças como um todo: a importância das atividades lúdicas, mesmo nos momentos formais da verificação das aprendizagens, sem falar que oferece um amplo e diversificado repertório de instrumentos de avaliação “empapados” de ludicidade. Nos instrumentos e exemplo oferecidos destaca-se, ainda, a oportunidade e a propriedade das expressões não orais, mais especificamente, das expressões corporais, certamente voltadas para a avaliação do desenvolvimento psicomotor das crianças, sem falar que a linguagem corporal acaba por se revelar como poderoso canal de comunicação.Como as autoras e o autor da obra tratam do insucesso do estudante e da estudante infantil? Tratam-nos como fracassados e fracassadas, que devem ser condenados e condenadas à exclusão do ambiente escolar? De modo algum: são reconhecidos e reconhecidas como seres capazes de aprender, na medida em que são considerados como protagonistas de sua própria avaliação. Nessa medida, cabe a nós leitores refletirmos sobre suas análises e propostas.Mais do que um texto de avaliação para a Educação Infantil, mais do que mais um livro na pobre literatura do campo, a obra é, também, um manual de didática, no bom sentido dos dois termos, com sugestões preciosas de atividades a serem desenvolvidas com crianças, sem falar na ampla e magnífica antologia de contos e de jogos, detalhadamente descritos e disponibilizados para os educadores e educadoras da infância. Certamente, por sua riqueza e profundidade, o livro não deve ser recomendado somente aos educadores da infância que trabalham profissionalmente nas instituições de Educação Infantil do País, mas a todos os educadores que lidam com crianças da primeira infância.

<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>

In 2017, Victoria became the first state in Australia to pass legislation permitting voluntary assisted dying. Under this law, only those people who are near the end of their lives may access voluntary assisted dying, and because many of these people require nursing care to manage the progression of their illness or their symptoms, it will invariably have an impact on nursing practice. The Victorian law includes a series of procedural steps as safeguards to ensure that the law operates as intended. To support people who choose voluntary assisted dying and to practice safely within boundaries of the law, nurses must be aware of these requirements and how they operate. However, there are often gaps in nurses’ legal knowledge. This was demonstrated in an article that aimed to inform nurses about the operation of Voluntary Assisted Dying Act 2017 (Vic) but contained several errors and misstatements of the law. Our article corrects these errors and discusses how the law is intended to be applied by revisiting the fictional case of Chloe – a woman with a terminal illness who is seeking voluntary assisted dying. As the Voluntary Assisted Dying Act 2017 (Vic) also protects nurses from liability if they act in accordance with its provisions, we conclude that sound knowledge and understanding of its operation support nurses to provide the safe, comprehensive and compassionate care their patients deserve at the end of life.

Abstract Background Each year, there are approximately 5,000 out-of-hospital cardiac arrests (OHCAs) in the state of Victoria, Australia (population 6.4 million, state healthcare budget AUD$2.9 billion / €1.8billion). Mortality from OHCA approaches ninety percent. High mortality rates and survivors not returning to work is likely to have an adverse effect on the Victorian economy but this has not been previously investigated. Purpose To model the economic impact of OHCA mortality and survivors not returning to work. Methods Data on all OHCAs transported by Ambulance Victoria from July 2017- June 2018 in Victoria, Australia was collected, including age, gender, survival to hospital, survival to discharge, and survival to 12 months. Cases were excluded if arrest was precipitated by trauma, exsanguination, overdose, terminal illness, hanging, SIDS, electrocution, sepsis, respiratory causes, drowning, or neurological causes. Pre-arrest employment status of patients was modelled using the Australian Bureau of Statistics Economic Security dataset, which provides contemporary employment rates for gender-matched five-year cohorts for Australians aged 15–79 years. For survivors to 12 months, pre-arrest and post-arrest work status were confirmed. Economic impact was then calculated to a five year horizon utilizing a Markov model with probabilistic sensitivity analysis. Results 4,934 arrests meeting the inclusion criteria were transported by Ambulance Victoria in twelve months, of whom 4,639 were determined to be cardiac arrests without any exclusion criteria as a precipitant. 695 patients survived to hospital (15.0%), and 325 to discharge (7.0%). At 12 months, 303 patients were alive (6.5% of overall cases, 93.2% of those discharged from hospital). Economic modelling of age and gender-matched data indicated that 1516 patients (35%) would have been employed pre-cardiac arrest, but only 216 survivors (4.7%) would be employed at five years post-arrest. Using Markov modelling incorporating estimated earnings and the pre-determined value of a statistical life, the annual economic burden of cardiac arrest approximated AUD$4 billion (€2.5 billion) at a five-year horizon. Conclusion The annual economic impact of cardiac arrest in Victoria, Australia is approximately AUD$4 billion (€2.5 billion) in a five-year horizon. As the annual Victorian state budget for all healthcare is AUD$2.93 billion (€1.8 billion), our data suggests that the economic impact of cardiac arrest is under-appreciated. Therefore, research in this area and providing state-of-the-art care for all cardiac arrest patients should be a healthcare priority. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): NHMRC/NHF Postgraduate Scholarship, RACP JJ Billings Scholarship

In this paper we explore the rise of anti-gambling apps in the context of the massive expansion of gambling in new spheres of life (online and offline) and an acceleration in strategies of anticipatory and individualised management of harm caused by gambling. These apps, and the techniques and forms of labour they demand, are examples of and a mechanism through which a mode of governance premised on ‘self-care’ and ‘self-control’ is articulated and put into practice. To support this argument, we explore two government initiatives in the Australian context. Quit Pokies, a mobile app project between the Moreland City Council, North East Primary Care Partnership and the Victorian Local Governance Association, is an example of an emerging service paradigm of ‘self-care’ that uses online and mobile platforms with geo-location to deliver real time health and support interventions. A similar mobile app, Gambling Terminator, was launched by the NSW government in late 2012. Both apps work on the premise that interrupting a gaming session through a trigger, described by Quit Pokies’ creator as a “tap on the shoulder” provides gamblers the opportunity to take a reflexive stance and cut short their gambling practice in the course of play. We critically examine these apps as self-disciplining techniques of contemporary neo-liberalism directed towards anticipating and reducing the personal harm and social risk associated with gambling. We analyse the material and discursive elements, and new forms of user labour, through which this consumable media is framed and assembled. We argue that understanding the role of these apps, and mobile media more generally, in generating new techniques and technologies of the self, is important for identifying emerging modes of governance and their implications at a time when gambling is going through an immense period of cultural normalisation in online and offline environments. The Australian context is particularly germane for the way gambling permeates everyday spaces of sociality and leisure, and the potential of gambling interventions to interrupt and re-configure these spaces and institute a new kind of subject-state relation. Gambling in Australia Though a global phenomenon, the growth and expansion of gambling manifests distinctly in Australia because of its long cultural and historical attachment to games of chance. Australians are among the biggest betters and losers in the world (Ziolkowski), mainly on Electronic Gaming Machines (EGM) or pokies. As of 2013, according to The World Count of Gaming Machine (Ziolkowski), there were 198,150 EGMs in the country, of which 197,274 were slot machines, with the rest being electronic table games of roulette, blackjack and poker. There are 118 persons per machine in Australia. New South Wales is the jurisdiction with most EGMs (95,799), followed by Queensland (46,680) and Victoria (28,758) (Ziolkowski). Gambling is significant in Australian cultural history and average Australian households spend at least some money on different forms of gambling, from pokies to scratch cards, every year (Worthington et al.). In 1985, long-time gambling researcher Geoffrey Caldwell stated thatAustralians seem to take a pride in the belief that we are a nation of gamblers. Thus we do not appear to be ashamed of our gambling instincts, habits and practices. Gambling is regarded by most Australians as a normal, everyday practice in contrast to the view that gambling is a sinful activity which weakens the moral fibre of the individual and the community. (Caldwell 18) The omnipresence of gambling opportunities in most Australian states has been further facilitated by the availability of online and mobile gambling and gambling-like spaces. Social casino apps, for instance, are widely popular in Australia. The slots social casino app Slotomania was the most downloaded product in the iTunes store in 2012 (Metherell). In response to the high rate of different forms of gambling in Australia, a range of disparate interest groups have identified the expansion of gambling as a concerning trend. Health researchers have pointed out that online gamblers have a higher risk of experiencing problems with gambling (at 30%) compared to 15% in offline bettors (Hastings). The incidence of gambling problems is also disproportionately high in specific vulnerable demographics, including university students (Cervini), young adults prone to substance abuse problems (Hayatbakhsh et al.), migrants (Tanasornnarong et al.; Scull & Woolcock; Ohtsuka & Ohtsuka), pensioners (Hing & Breen), female players (Lee), Aboriginal communities (Young et al.; McMillen & Donnelly) and individuals experiencing homelessness (Holsworth et al.). While there is general recognition of the personal and public health impacts of gambling in Australia, there is a contradiction in the approach to gambling at a governance level. On one hand, its expansion is promoted and even encouraged by the federal and state governments, as gambling is an enormous source of revenue, as evidenced, for example, by the construction of the new Crown casino in Barangaroo in Sydney (Markham & Young). Campaigns trying to limit the use of poker machines, which are associated with concerns over problem gambling and addiction, are deemed by the gambling lobby as un-Australian. Paradoxically, efforts to restrict gambling or control gambling winnings have also been described as un-Australian, such as in the Australian Taxation Office’s campaign against MONA’s founder, David Walsh, whose immense art collection was acquired with the funds from a gambling scheme (Global Mail). On the other hand, people experiencing problems with gambling are often categorised as addicts and the ultimate blame (and responsibility) is attributed to the individual. In Australia, attitudes towards people who are arguably addicted to gambling are different than those towards individuals afflicted by alcohol or drug abuse (Jean). While “Australians tend to be sympathetic towards people with alcohol and other drug addictions who seek help,” unless it is seen as one of the more socially acceptable forms of occasional, controlled gambling (such as sports betting, gambling on the Melbourne Cup or celebrating ANZAC Day with Two-Up), gambling is framed as an individual “problem” and “moral failing” (Jean). The expansion of gambling is the backdrop to another development in health care and public health discourse, which have for some time now been devoted to the ideal of what Lupton has called the “digitally engaged patient” (Lupton). Technologies are central to the delivery of this model of health service provision that puts the patient at the centre of, and responsible for, their own health and medical care. Lupton has pointed out how this discourse, while appearing new, is in fact the latest version of the 1970s emphasis on the ‘patient as consumer’, an idea given an extra injection by the massive development and availability of digital and interactive web-based and mobile platforms, many of these directed towards the provision of health and health-related information and services. What this means for patients is that, rather than relying solely on professional medical expertise and care, the patient is encouraged to take on some of this medical/health work to conduct practices of ‘self-care’ (Lupton). The Discourse of ‘Self-Management’ and ‘Self-Care’ The model of ‘self-care’ and ‘self-management’ by ‘empowering’ digital technology has now become a dominant discourse within health and medicine, and is increasingly deployed across a range of related sectors such as welfare services. In recent research conducted on homelessness and mobile media, for example, government department staff involved in the reform of welfare services referred to ‘self-management’ as the new service paradigm that underpins their digital reform strategy. Echoing ideas and language similar to the “digitally engaged patient”, customers of Centrelink, Medicare and other ‘human services’ are being encouraged (through planned strategic initiatives aimed at shifting targeted customer groups online) to transact with government services digitally and manage their own personal profiles and health information. One departmental staff member described this in terms of an “opportunity cost”, the savings in time otherwise spent standing in long queues in service centres (Humphry). Rather than view these examples as isolated incidents taking place within or across sectors or disciplines, these are better understood as features of an emerging ‘discursive formation’ , a term Foucault used to describe the way in which particular institutions and/or the state establish a regime of truth, or an accepted social reality and which gives definition to a new historical episteme and subject: in this case that of the self-disciplined and “digitally engaged medical/health patient”. As Foucault explained, once this subject has become fully integrated into and across the social field, it is no longer easy to excavate, since it lies below the surface of articulation and is held together through everyday actions, habits and institutional routines and techniques that appear to be universal, necessary and/normal. The way in which this citizen subject becomes a universal model and norm, however, is not a straightforward or linear story and since we are in the midst of its rise, is not a story with a foretold conclusion. Nevertheless, across a range of different fields of governance: medicine; health and welfare, we can see signs of this emerging figure of the self-caring “digitally engaged patient” constituted from a range of different techniques and practices of self-governance. In Australia, this figure is at the centre of a concerted strategy of service digitisation involving a number of cross sector initiatives such as Australia’s National EHealth Strategy (2008), the National Digital Economy Strategy (2011) and the Australian Public Service Mobile Roadmap (2013). This figure of the self-caring “digitally engaged” patient, aligns well and is entirely compatible with neo-liberal formulations of the individual and the reduced role of the state as a provider of welfare and care. Berry refers to Foucault’s definition of neoliberalism as outlined in his lectures to the College de France as a “particular form of post-welfare state politics in which the state essentially outsources the responsibility of the ‘well-being' of the population” (65). In the case of gambling, the neoliberal defined state enables the wedding of two seemingly contradictory stances: promoting gambling as a major source of revenue and capitalisation on the one hand, and identifying and treating gambling addiction as an individual pursuit and potential risk on the other. Risk avoidance strategies are focused on particular groups of people who are targeted for self-treatment to avoid the harm of gambling addiction, which is similarly framed as individual rather than socially and systematically produced. What unites and makes possible this alignment of neoliberalism and the new “digitally engaged subject/patient” is first and foremost, the construction of a subject in a chronic state of ill health. This figure is positioned as terminal from the start. They are ‘sick’, a ‘patient’, an ‘addict’: in need of immediate and continuous treatment. Secondly, this neoliberal patient/addict is enabled (we could even go so far as to say ‘empowered’) by digital technology, especially smartphones and the apps available through these devices in the form of a myriad of applications for intervening and treating ones afflictions. These apps range fromself-tracking programs such as mood regulators through to social media interventions. Anti-Pokie Apps and the Neoliberal Gambler We now turn to two examples which illustrate this alignment between neoliberalism and the new “digitally engaged subject/patient” in relation to gambling. Anti-gambling apps function to both replace or ‘take the place’ of institutions and individuals actively involved in the treatment of problem gambling and re-engineer this service through the logics of ‘self-care’ and ‘self-management’. Here, we depart somewhat from Foucault’s model of disciplinary power summed up in the institution (with the prison exemplifying this disciplinary logic) and move towards Deleuze’s understanding of power as exerted by the State not through enclosures but through diffuse and rhizomatic information flows and technologies (Deleuze). At the same time, we retain Foucault’s attention to the role and agency of the user in this power-dynamic, identifiable in the technics of self-regulation and in his ideas on governmentality. We now turn to analyse these apps more closely, and explore the way in which these articulate and perform these disciplinary logics. The app Quit Pokies was a joint venture of the North East Primary Care Partnership, the Victorian Local Governance Association and the Moreland City Council, launched in early 2014. The idea of the rational, self-reflexive and agentic user is evident in the description of the app by app developer Susan Rennie who described it this way: What they need is for someone to tap them on the shoulder and tell them to get out of there… I thought the phone could be that tap on the shoulder. The “tap on the shoulder” feature uses geolocation and works by emitting a sound alert when the user enters a gaming venue. It also provides information about each user’s losses at that venue. This “tap on the shoulder” is both an alert and a reprimand from past gambling sessions. Through the Responsible Gambling Fund, the NSW government also launched an anti-pokie app in 2013, Gambling Terminator, including a similar feature. The app runs on Apple and Android smartphone platforms, and when a person is inside a gambling venue in New South Wales it: sends reminder messages that interrupt gaming-machine play and gives you a chance to re-think your choices. It also provides instant access to live phone and online counselling services which operate 24 hours a day, seven days a week. (Google Play Store) Yet an approach that tries to prevent harm by anticipating the harm that will come from gambling at the point of entering a venue, also eliminates the chance of potential negotiations and encounters a user might have during a visit to the pub and how this experience will unfold. It reduces the “tap on the shoulder”, which may involve a far wider set of interactions and affects, to a software operation and it frames the pub or the club (which under some conditions functions as hubs for socialization and community building) as dangerous places that should be avoided. This has the potential to lead to further stigmatisation of gamblers, their isolation and their exclusion from everyday spaces. Moreland Mayor, Councillor Tapinos captures the implicit framing of self-care as a private act in his explanation of the app as a method for problem gamblers to avoid being stigmatised by, for example, publicly attending group meetings. Yet, curiously, the app has the potential to create a new kind of public stigmatisation through potentially drawing other peoples’ attention to users’ gambling play (as the alarm is triggered) generating embarrassment and humiliation at being “caught out” in an act framed as aberrant and literally, “alarming”. Both Quit Pokies and Gambling Terminator require their users to perform ‘acts’ of physical and affective labour aimed at behaviour change and developing the skills of self-control. After downloading Quit Pokies on the iPhone and launching the app, the user is presented an initial request: “Before you set up this app. please write a list of the pokies venues that you regularly use because the app will ask you to identify these venues so it can send you alerts if you spend time in these locations. It will also use your set up location to identify other venues you might use so we recommend that you set up the App in the location where you spend most time. Congratulation on choosing Quit Pokies.”Self-performed processes include installation, setting up, updating the app software, programming in gambling venues to be detected by the smartphone’s inbuilt GPS, monitoring and responding to the program’s alerts and engaging in alternate “legitimate” forms of leisure such as going to the movies or the library, having coffee with a friend or browsing Facebook. These self-performed labours can be understood as ‘technologies of the self’, a term used by Foucault to describe the way in which social members are obliged to regulate and police their ‘selves’ through a range of different techniques. While Foucault traces the origins of ‘technologies of the self’ to the Greco-Roman texts with their emphasis on “care of oneself” as one of the duties of citizenry, he notes the shift to “self-knowledge” under Christianity around the 8th century, where it became bound up in ideals of self-renunciation and truth. Quit Pokies and Gambling Terminator may signal a recuperation of the ideal of self-care, over confession and disclosure. These apps institute a set of bodily activities and obligations directed to the user’s health and wellbeing, aided through activities of self-examination such as charting your recovery through a Recovery Diary and implementing a number of suggested “Strategies for Change” such as “writing a list” and “learning about ways to manage your money better”. Writing is central to the acts of self-examination. As Jeremy Prangnell, gambling counsellor from Mission Australia for Wollongong and Shellharbour regions explained the app is “like an electronic diary, which is a really common tool for people who are trying to change their behaviour” (Thompson). The labours required by users are also implicated in the functionality and performance of the platform itself suggesting the way in which ‘technologies of the self’ simultaneously function as a form of platform work: user labour that supports and sustains the operation of digital systems and is central to the performance and continuation of digital capitalism in general (Humphry, Demanding Media). In addition to the acts of labour performed on the self and platform, bodies are themselves potentially mobilised (and put into new circuits of consumption and production), as a result of triggers to nudge users away from gambling venues, towards a range of other cultural practices in alternative social spaces considered to be more legitimate.Conclusion Whether or not these technological interventions are effective or successful is yet to be tested. Indeed, the lack of recent activity in the community forums and preponderance of issues reported on installation and use suggests otherwise, pointing to a need for more empirical research into these developments. Regardless, what we’ve tried to identify is the way in which apps such as these embody a new kind of subject-state relation that emphasises self-control of gambling harm and hastens the divestment of institutional and social responsibility at a time when gambling is going through an immense period of expansion in many respects backed by and sanctioned by the state. Patterns of smartphone take up in the mainstream population and the rise of the so called ‘mobile only population’ (ACMA) provide support for this new subject and service paradigm and are often cited as the rationale for digital service reform (APSMR). Media convergence feeds into these dynamics: service delivery becomes the new frontier for the merging of previously separate media distribution systems (Dwyer). Letters, customer service centres, face-to-face meetings and web sites, are combined and in some instances replaced, with online and mobile media platforms, accessible from multiple and mobile devices. These changes are not, however, simply the migration of services to a digital medium with little effective change to the service itself. Health and medical services are re-invented through their technological re-assemblage, bringing into play new meanings, practices and negotiations among the state, industry and neoliberal subjects (in the case of problem gambling apps, a new subjectivity, the ‘neoliberal addict’). These new assemblages are as much about bringing forth a new kind of subject and mode of governance, as they are a solution to problem gambling. This figure of the self-treating “gambler addict” can be seen to be a template for, and prototype of, a more generalised and universalised self-governing citizen: one that no longer needs or makes demands on the state but who can help themselves and manage their own harm. Paradoxically, there is the potential for new risks and harms to the very same users that accompanies this shift: their outright exclusion as a result of deprivation from basic and assumed digital access and literacy, the further stigmatisation of gamblers, the elimination of opportunities for proximal support and their exclusion from everyday spaces. References Albarrán-Torres, César. “Gambling-Machines and the Automation of Desire.” Platform: Journal of Media and Communication 5.1 (2013). Australian Communications and Media Authority. “Australians Cut the Cord.” Research Snapshots. Sydney: ACMA (2013) Berry, David. Critical Theory and the Digital. Broadway, New York: Bloomsbury Academic, 2014 Berry, David. 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This chapter argues that Oscar Wilde’s The Importance of Being Earnest, described by its author as an ‘amusing thing with lots of fun and wit’, contains an explosive undercurrent of social critique. The funniest of Wilde’s plays, Earnest satirizes the subterfuge (‘Bunburying’) demanded of sexual heretics in Victorian society, where marginal identities and desires were excluded, suppressed, or in Wilde’s case, brutally penalized. Conrad investigates Wilde’s ambivalent attitude to direct revolutionary action such as the Fenian dynamite campaign of 1881-85 and French anarchist activities of the 1890s, attending particularly to the 1884 bomb explosion in the cloakroom at Victoria Station, the ‘terminus’ where Miss Prism left the infant Jack Worthing in a handbag containing her three-decker novel. As Conrad argues, ‘texts, bodies, and bombs all meet at Victoria Station’, and Wilde, as an Irishman and a homosexual, could himself be seen as ‘a potential bomb right at the terminus of Victorian society’.

This chapter considers objects as displayed in museums, architecture, and consumer goods. It unwraps the meanings of a Japanese suit of armour in the Tower of London, and then moves on to discuss the hybrid architecture and design of the Chhatrapati Shivaji Terminus, known in the West as the Victoria Terminus in Mumbai. In a final example, the case of football and soccer evokes debates on globalization and the global condition.

Abstract The Third Reich rode a wave of ‘lightning’ military victories in 1939 and 1940 that made the regime look stronger than ever. Despite continuing victories into 1941 against the Soviet Union, those in charge of armaments and munitions told Hitler to his face, in late November, that the war could ‘no longer be won militarily’. Thereafter, the dictator became determined to find a victory that would give him the necessary political leverage to seek peace. Yet he grew more ambitious and determined to find space up to the Ural Mountains for the ‘colonial land’ of his dreams. Victory escaped Hitler’s grasp in the vicious war that ensued, particularly in the east. The fighting provided the context for massive human rights abuses and the Holocaust. Although the Wehrmacht reached the distant Caucasus Mountains in mid-1942, already by early the next year the tide had turned with the defeat at Stalingrad. Despite some grumblings, the German people, mobilized into a fighting ‘community of the people’ on the Home Front remained remarkably faithful to the cause. Nor did the armed forces turn on their leaders, apart from the small number of plotters in July 1944. The end came, not so much by Germany’s ‘self-destruction’, as through the determination and concerted efforts of the world’s remaining great powers, who together resolutely waged war, at enormous cost in blood and treasure, to terminate the Third Reich and to discredit the ideas of which it was a product.

The city is humanity’s most enduring symbol of power. States and empires rise and fall, armies conquer and collapse, ideologies come and go, but the world’s great cities endure. If there is a force that can vanquish a city, it is natural, not artificial. Ancient cities that anchored early states in Southwest, South, and East Asia fell victim to climate change as deserts encroached on their hinterlands. Modern cities on low ground at the water’s edge would not survive the sea-level rise that could accompany sustained global warming. But no political upheaval or economic breakdown would end the life of a major city—not even destruction by atomic bombs. Hiroshima and Nagasaki were rebuilt because the advantages and opportunities offered by their sites and situations were unaltered by the catastrophes that struck them. Silk route terminal Chang’an morphed into Xian and Tenochtitlan became Mexico City because their locational benefits, sites, and regional networks outlasted their violent transitions. Not for nothing is Rome known as the Eternal City. With the maturation of the modern state came the notion of the “capital” city, focus of its administrative system and emblematic of its power. Cities had always dominated their hinterlands, but now their power radiated far afield. From Athens to Amsterdam and from Madrid to Moscow, these national capitals became imperial headquarters that launched colonial campaigns near and far. London was synonymous with this early wave of globalization, but Paris also lay at the heart of a global network of power and influence. In these capitals, cityscapes substantiated national achievements through elaborate palaces, columned government buildings, decorative triumphal arches, spacious parade routes, and commemorative statuary. Museums bulging with treasure attested further to the primacy of the culture, leading one observer, long ago but memorably, to designate such centers as “primate” cities (Jefferson, 1939). The trappings of this primacy reappeared in the architecture of colonial headquarters from Dakar to Delhi and from Luanda to Lima, incongruous Greco- Roman-Victorian-Iberian imprints on administrative offices, railroad stations, post offices, even prisons half a world away from Europe. More than ever before, the city in the global periphery was the locus of authority and transculturation.