Journal articles on the topic 'Tertiary Brighton Group, Victoria'

Importance COVID-19 mRNA vaccine-associated myocarditis has previously been described; however specific features in the adolescent population are currently not well understood. Objective To describe myocarditis adverse events following immunisation reported following any COVID-19 mRNA vaccines in the adolescent population in Victoria, Australia. Design Statewide, population-based study. Setting Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC) is the vaccine-safety service for Victoria, Australia. Participants All SAEFVIC reports of myocarditis and myopericarditis in 12–17-year-old COVID-19 mRNA vaccinees submitted between 22 February 2021 and 22 February 2022, as well as accompanying diagnostic investigation results where available, were assessed using Brighton Collaboration criteria for diagnostic certainty. Exposures Any mRNA COVID-19 vaccine. Main outcomes/Mmeasure Confirmed myocarditis as per Brighton Collaboration criteria (levels 1–3). Results Clinical review demonstrated definitive (Brighton level 1) or probable (level 2) diagnoses in 75 cases. Confirmed myocarditis reporting rates were 8.3 per 100 000 doses in this age group. Cases were predominantly male (n=62, 82.7%) and post dose 2 (n=61, 81.3%). Rates peaked in the 16–17-year-old age group and were higher in males than females (17.7 vs 3.9 per 100 000, p=<0.001). The most common presenting symptoms were chest pain, dyspnoea and palpitations. A large majority of cases who had a cardiac MRI had abnormalities (n=33, 91.7%). Females were more likely to have ongoing clinical symptoms at 1-month follow-up (p=0.02). Conclusion Accurate evaluation and confirmation of episodes of COVID-19 mRNA vaccine-associated myocarditis enabled understanding of clinical phenotypes in the adolescent age group. Any potential vaccination and safety surveillance policies needs to consider age and gender differences.

Background: Guillain-Barre syndrome (GBS) is the leading cause of acute flaccid paralysis in children. This study was aimed to compare the clinical spectrum and shortterm outcome of children with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) subtypes of GBS in children. Methods: The study was a prospective cohort study done in a tertiary neurology hospital for 3 years. Children under 18 years of age fulfilling the Brighton diagnostic criteria for GBS were enrolled in the study. Based on the nerve conduction study, patients were subclassified as AIDP, AMAN, AMSAN, and others. Finally, a comparison was done in children with AIDP and AMAN subtypes. Results: A total of 102 children have fulfilled the Brighton diagnostic criteria of GBS during that study period. Among them, 83 children were included in the final analysis as NCS findings suggestive of AIDP and AMAN were found in 29(28.43%) and 54(52.94%) of cases respectively. No patient died in this cohort and follow-up was done at 3 months after discharge. A comparison of clinical data between the two groups revealed similar clinical features in most of the cases. The mean age difference between the two groups was statistically significant and AIDP was found to be more frequent in the 1-5 years age group. There was a significant association between gastroenteritis and AMAN subtypes. On symptom analysis, pain and tingling sensation were found predominantly in AMAN subtypes. Children having AMAN variants developed respiratory distress more than AIDP. Assisted ventilation were needed in 14.45% of cases and the majority of them were from the AMAN group. The mean duration of hospital stay and the mean disability scores at three months after discharge were significantly higher in the AMAN group. Conclusions: AMAN was the commonest GBS subtypes in children. AIDP was more frequent in the younger age group. Children with AMAN appeared to have higher short-term morbidity and slower recovery than those with AIDP. Bang. J Neurosurgery 2022; 11(2): 94-100

Single, older women in the State of Victoria, Australia, have emerged as a group experiencing housing insecurity and being highly vulnerable to homelessness in their old age. A sizable demographic cohort, it is a group that could overwhelm the existing homelessness service system. One of the most surprising aspects of this trend is their propensity to be tertiary educated. Focus groups revealed ‘critical life events’ as significant, and a shared ‘control belief’ in the value of education. Given that education is a key means by which Australian governments seek to remedy homelessness, the entry of educated women into the homelessness population suggests policy needs to re-examine homelessness causation and explicitly apply a gender-lens.

Objectives: To find out the frequency of retinopathy in low birth weight infant presenting at tertiary care hospital, Bahawalpur. Study Design: Cross sectional study. Setting: Department of Ophthalmology, Bahawal Victoria Hospital, Bahawalpur. Period: From July 2018 to December 2018. Material & Methods: Neonatal eye examination was performed for ROP. Results: Total 78 neonates were recruited for present study and ROP was assessed. Mean gestational age of neonates was 32.54 ± 3.79 weeks. Mean weight was 1445.51 ± 517.373 grams. Out of 78 neonates, ROP was observed in 28 (36%) neonates. ROP was found in 27 (42.19%) neonates of premature group and in 1 (7.14%) neonates of at term group. ROP was found in 1 (3.23%), 5 (29.41%) and 22 (73.33%) neonates respectively in weight group 1500-2500 g, 1000-1500 g and <1000 g group. Male neonates were 35 (44.87%) and female neonates were 43 (55.13%). Development of ROP was not significantly (P = 0.248) associated with gender of the neonates. Statistically significant association between ROP and oxygen supplementation was observed with p value 0.021. Conclusion: Results showed higher number of patients with ROP. Association of development of ROP with gestation was highly significant. Oxygen supplementation and oxygen concentration was also associated with ROP. Findings also showed no effect of gender and duration of hospital stay on ROP.

The Torquay Sub-basin lies to the south of Port Phillip Bay in Victoria. It has two main tectonic elements; a Basin Deep area which is flanked to the southeast by the shallower Snail Terrace. It is bounded by the Otway Ranges to the northwest and shallow basement elsewhere. The stratigraphy of the area reflects the influence of two overlapping basins. The Lower Cretaceous section is equivalent to the Otway Group of the Otway Basin, whilst the Upper Cretaceous and Tertiary section is comparable with the Bass Basin stratigraphy.The Torquay Sub-basin apparently has all of the essential ingredients needed for successful hydrocarbon exploration. It has good reservoir-seal pairs, moderate structural deformation and probable source rocks in a deep kitchen. Four play types are recognised:Large Miocene age anticlines, similar to those in the Gippsland Basin, with an Eocene sandstone reservoir objective;The same reservoir in localised Oligocene anticlines associated with fault inversion;Possible Lower Cretaceous Eumeralla Formation sandstones in tilted fault blocks and faulted anticlines; andLower Cretaceous Crayfish Sub-group sandstones also in tilted fault block traps.Maturity modelling suggests that the Miocene anticlines post-date hydrocarbon generation. Poor reservoir potential and complex fault trap geometries downgrade the two Lower Cretaceous plays.The Oligocene play was tested by Wild Dog-1 which penetrated excellent Eocene age reservoir sands beneath a plastic shale seal, however, the well failed to encounter any hydrocarbons. Post-mortem analysis indicates the well tested a valid trap. The failure of the well is attributed to a lack of charge. Remaining exploration potential is limited to the deeper plays which have much greater risks associated with each play element.

Objectives: To assess the recurrence rate of breast cancer after modified radical mastectomy in cases of breast cancer at tertiary care hospital. Material and methods: Between the March 2020 to September 2020 (over the period of 6 months) total 110 women with breast cancer having age range 30-60 years were recruited from Department of Surgery, Bahawal Victoria Hospital Bahawalpur for this cross sectional study. Modified radical mastectomy was performed in all selected patients. At 6 months follow up, all the selected patients was again examined for recurrence of breast cancer. Results: Total 110 patients with breast cancer were recruited. Mean age of the patients was 43.56 ± 8.9 years. Recurrence of breast cancer was found in 25 (23%) cases. Total 11 (10%) patients belonged to age group <30 years followed by 13 (11.82%) patients to age group 30-40 years, 41 (37.27%) to age group 41-50 years and 45 (40.91%) patients to age group 51-60 years. Recurrence of breast cancer was noted in 2 (18.18%) patients, 3 (23.08%) patients, 10 (24.39%) patients and 10 (22.22%) patients respectively. Statistically insignificant association of recurrence with age group was noted with p value 0.9776. Conclusion: Results of this study showed a higher rate of recurrence of breast carcinoma after modified radical mastectomy. Most of the patients belonged to 5th decade of life. Parity, educational status and marital status showed no association with recurrence of breast cancer.

Background: Guillain Barre Syndrome (GBS) is an acute polyradiculopathy which is quite common in all ages. Objective: The aim of this study was to evaluate the clinical and electrophysiologicaspects of Guillain Barre Syndrome (GBS) in children. Methodology: This cross-sectional study was carried out in the Department of Neurophysiology of National Institute of Neurosciences and Hospital, Bangladesh from July 2016 to June 2018. Patients under 18 years of age fulfilling Brighton diagnostic criteria for GBS were included in this study. These patients were evaluated by detailed history, physical examination, and electrophysiological findings. Results: A total of 82 patients of GBS were enrolled in this study. The mean age was 12.93± 5.02 years (range 1 to<18 years). Most of the patients were male (64.6%) and from the middle-income group (70.73%). About Fourty eight percent of patients had a history of preceding illness among which gastrointestinal infection(24.3%) was the most common. Tingling and paresthesiaswas complained by 32.4% of patients as the first symptom. AMAN(61%) was the most common GBS variant followed by AIDP(26.8%). 9 (11%) patients needed ICU support among them AIDP was more frequent. Conclusion: AMAN is the most common variant among children in this population by electrophysiologic testing. Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 2-7

Aim: To determine the frequency of thrombocytopenia in hepatitis c patients presenting at tertiary care hospital. Methods: This cross sectional study was conducted at Department of Physiology in collaboration with Department of Medicine, Bahawal Victoria Hospital, Bahawalpur from March 2020 to September 2020 over the period of 6 months. Total 150 of hepatitis C, either male or female having age 20-60 years were included. Thrombocytopenia was assessed in selected patients. Results: In this study mean age of the patients was 44±12.38 years. Out of 150 patients of hepatitis C, thrombocytopenia was present in 48(32%) patients. In age group 20-40 years, thrombocytopenia was found in 14(26.92%) patients while in age group 41-60 years, thrombocytopenia was seen in 34(34.69%) patients. No statistically significant association of thrombocytopenia with age group was detected with p value 0.332. Male patients were 93(62%) and female patients were 57(38%). Thrombocytopenia was found in 30(32.26%) male patients and in 18(31.58%) female patients. Association of thrombocytopenia with gender was not statistically significant with p value 0.931. Conclusion: Results of present study revealed that higher proportion of hepatitis C patients found with thrombocytopenia. Most of the patients belonged to 4th and 5th decade. Higher number of male patients were victim of hepatitis C infection as compared to female patients. Most of the patients were obese. Higher number of patients were normotensive and non-diabetics. Keywords: Hepatitis C, thrombocytopenia, cirrhosis, hepatocellular carcinoma

Background: Fistula in ano is a common disease which has high recurrence rate and high fecal incontinence rate after surgery. We compared modified LIFT (Ligation of the intersphincteric fistula tract (LIFT) through lateral approach ) with cutting seton for transphincteric fistula. Aim: This study is aimed at which procedure is better with respect to postoperative complications Study design: It was a prospective comparative study. Methods: This was a prospective comparative study from 01-01-2019 to 30-06-2021 which was conducted on 50 patients who presented with transsphincteric fistula in ano (FIA) in surgical ward of Bahawal Victoria Hospital Bahawalpur. Patients were divided into two groups .Patients of Group A underwent modified lift procedure and patients of group B underwent cutting seton procedure. Data was collected on a proforma which included patients’ name ,age ,sex, age group, comorbid disease like diabetes mellitus ,chronic liver disease, cardiovascular disease and chronic renal failure, fistula tract involving less than 50% or more than 50% external sphincter ,procedure done, healing time of wound, complications like recurrence and incontinence. Patients were followed for 6 months for healing rate ,recurrence and incontinence. Data was analysed on spss 22 version Results: In Group A, complete healing (fistula closure without recurrence) was achieved in 20 patients (80%) out of 25. There was no case of anal incontinence after the procedure. 5 (20%) patients experienced recurrence in 6 months . In Group B, complete healing (fistula closure without recurrence) was achieved in 21 patients (84%), in 6 months follow up . 4(16%) patients were diagnosed as a case of anal incontinence. There were 4 (16%) patients with recurrence. Conclusion: Modified LIFT is better in terms of incontinence where as cutting seton is better in terms of recurrence.it is suggested that for high lying fistula modified LIFT is better procedure and for low lying fistula involving less than 50% sphincter cutting seton is better procedure.. Keywords: Modified LIFT (ligation of ineter sphincteric fistula tract) ,Cutting seton , transphincteric fistula.

Objective: To compare the patient outcome in severe COVID-19 pneumonia between the non-invasive ventilation and invasive mechanical ventilation. Study design: Prospective, observational study Study Setting and Duration: Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur from January 2021 to June 2021. Methodology: We analyzed 660 patients of severe covid pneumonia. Conscious proning was done in those requiring ≥ 21 L oxygen and oxygen saturation < 90%. We defined typical ARDS according to Berlin criteria. Atypical ARDS did not fulfill set criteria. We divided ARDS into 2 types i-e H and L type. We managed ARDS with either NIV, invasive mechanical ventilation or both. We used multiple regression analysis to predict ICU stay. Results: Out of 660 patients, 285 (43.18%) developed biPAP failure and were subsequently intubated. We observed 273 (41.4%) overall mortality, 175 (64.1%) in IMV and 98 (35.9%) in the NIV group (p<0.0001). invasive mechanical ventilation had statistically significant correlation with mortality and also predicted ICU stay. (p=< 0.001, OR 3.2, p=0.001). Conclusion: NIV therapy is superior to invasive mechanical ventilation in terms of ICU stay and outcome. Keywords: ARDS, coronavirus, COVID-19, non-invasive ventilation, mechanical ventilation, pneumonia

Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Materials and methods: A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a ‘bottom-up’, all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Results: There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) ( P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusions: Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of evidence: Not applicable for this multicentre audit.

Background: Ventilator associated pneumonia (VAP) complicates the course of 8-28% of patients receiving mechanical ventilation. Appropriate antimicrobial treatment significantly improves the outcome. Hence rapid identification of infected patients and accurate selection of antimicrobials are important clinical goals.Aims and Objectives: The present study was conducted with an aim to know the outcome of VAP and to identify pathogens, compare the bacteriological profile, duration of mechanical ventilation and length of hospitalization.Materials and Methods: Sixty patients who developed VAP during our study period of 2 years were included after meeting inclusion and exclusion criteria. Study was conducted in Victoria hospital and Bowring & Lady Curzon hospitals attached to Bangalore Medical College and Research institute.Results: Majority of patients were in the age group of 21-40 years. The occurrence of late VAP was 70 %. Klebsiella was the most common organism isolated in our study. Mortality was 13.3%. Average duration of intubation was 13.1±6.6days. Duration of hospital stay was 16.2±7.1 days.Conclusion: Our study concluded that occurrence of late VAP was more common than early VAP. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and length of hospitalisation. Above all utmost importance must be given to prevent VAP. Asian Journal of Medical Sciences Vol.8(5) 2017 75-79

BACKGROUND: The national hospital-acquired complications (HAC) system has been promoted as a method to identify health care errors that may be mitigated by clinical interventions. OBJECTIVES: To quantify the rate of HAC in multiday stay adults admitted to major hospitals. DESIGN: Retrospective observational analysis of 5-year (July 2014 – June 2019) administrative dataset abstracted from medical records. SETTING: All 47 hospitals with on-site intensive care units (ICUs) in the State of Victoria. PARTICIPANTS: All adults (aged ≥ 18 years) stratified into planned or unplanned, surgical or medical, ICU or other ward, and by hospital peer group (tertiary referral, metropolitan, regional). MAIN OUTCOME MEASURES: HAC rates in ICU compared with ward, and mixed-effects regression estimates of the association between HAC and i) risk of clinical deterioration, and ii) admission hospital site (intraclass correlation coefficient [ICC] > 0.3). RESULTS: 211 120 adult ICU separations with mean hospital mortality of 7.3% (95% CI, 7.2–7.4%) reported 110 132 (42.6%) HAC events (commonly, delirium, infection, arrhythmia and respiratory failure) in 62 945 records (29.8%). Higher HAC rates were reported in elective (cardiac [50.3%] and non-cardiac [40.6%]) surgical subgroups compared with emergency medical subgroup (23.9%), and in tertiary (35.4%) compared with non-tertiary (22.7%) hospitals. HAC was strongly associated with on-admission patient characteristics (P < 0.001), but was weakly associated with hospital site (ICC, 0.08; 95% CI, 0.05–0.11). CONCLUSIONS: Critically ill patients have a high burden of HAC events, which appear to be associated with patient admission characteristics. HAC may an indicator of hospital admission complexity rather than hospital-acquired complications.

Background: Ectopic pregnancy remains the most common cause of early pregnancy mortality, with management options differing according to clinical presentation and investigations. This audit aims to investigate the indications for medical and surgical management of ectopic pregnancy at a tertiary hospital network, in order to assess variances in practice and adherence to local hospital protocols. Methods: A retrospective audit of the management of women with a diagnosis of ectopic pregnancy was performed over 12 months from July 2018 to June 2019, at three hospitals in the largest healthcare network in Victoria, Australia. Information collected included patient demographics, risk factors for ectopic pregnancy, pathology and radiology results, documented indication for surgery, and any complications of treatment. A subgroup analysis of data was done to investigate changes and deficiency in management of ectopic pregnancy compared to local hospital protocol. Results: Over a 12-month period, 138 women were diagnosed with an ectopic pregnancy, of which 99 (72%) received surgical management and 39 (28%) received medical management. Four women within the medical group were excluded from analysis, one due to loss of follow-up and three patients who were diagnosed with nontubal ectopic pregnancies. About 94% (33/35) of women who received methotrexate were within hospital guidelines for medical management and 91% (32/35) were successfully managed without surgery. All women who received surgical management underwent a salpingectomy and 97% (96/99) had clear indications documented for surgery within local protocol. Conclusion: Overall, the majority of women with ectopic pregnancy were treated according to local guidelines. Expectant management and the option of salpingostomy as a surgical alternative could be considered in the local guidelines. The dissemination of this clinical audit data is aimed at continuing clinical governance and improvements in outcomes.

Six new species of oribatid mite belonging to the genus Crotonia are described from wet forests in Victoria, Australia. Crotonia alpina sp. nov., C. cornuta sp. nov. and C. victoriae sp. nov. belong to the Capistrata species-group, having the full complement of notogastral setae in the c series; whilst C. momitoi sp. nov., C. blacki sp. nov. and C. gadubanudi sp. nov. are members of the Cophinaria species-group, lacking setae c 2 . The fossil species Crotonia ramus (Womersley, 1957), also a member of the Cophinaria group, is redescribed from Tertiary Kauri pine resin (Agathis yallournensis). The new members of the Capistrata group share an unique combination of characters, including long flagelliform setae c 3 , shorter setiform c 2 and with setae c 3 the shortest of the c series; lateral strips of the notogastral shield ornamented with fields of tubercles; narrow, blunt bothridial auriculae and elongate parallel apophyses of setae h 2 projecting horizontally. The morphological homogeneity of this cluster of species is mirrored by the members of the Cophinaria species-group described herein which, together with C. pyemaireneri Colloff, 2009 and C. tasmanica Łochyńska, 2008 from Tasmania, plus C. jethurmerae Lee, 1985 from South Australia, share relatively well-developed setae d 2 , a porose notogastral shield with narrow lateral tuberculate strips; elongate, acute bothridial auriculae; long, flagelliform setae p 1 and relatively short apophyses of setae h 2 , divergent apically, and projecting posteriodorsally. The Victorian members of the Capistrata andCophinaria species-groups represent two homogeneous clusters of species associated with temperate rainforest refugia and wet sclerophyll forest in high-rainfall zones. An identification key is provided to the Australian species of Crotonia.

290 Background: Ovarian cancer (OC) is a common, often fatal disease where 1/4 of cases are due to hereditary syndromes. Genetic screening of OC patients provides access to targeted treatments and screening recommendations. Patients are currently referred to a virtual, group, pre-counseling seminar, delivered by a Nurse Practitioner, where consent for germline genetic testing is obtained and results are delivered later by a Genetic Counsellor (GC). Previously, we found group pre-counseling to be an effective method to decrease wait times from diagnosis to test results. The purpose of this study was to evaluate the patient seminar experience using the previously validated, Genetic Counselling Outcome Scale (GCOS-24). BC Cancer- Victoria is a satellite of BC Cancer, providing tertiary cancer care to a population of ̃1.2 million. Methods: We completed a REB approved, prospective study recruiting patients referred to the group pre-counseling consenting seminar. The GCOS-24 was delivered electronically both pre (1) and post (2) attendance at the seminar, and 4 weeks post genetic counselling visit (3). Inclusion criteria included OC patients referred for germline BRCA testing between Jan 1, 2021, to Feb 28, 2022, > 18 years old who attended the group consenting seminar. Patients who could not communicate in English were excluded. Data was stored electronically via REDCap, a secure web-based platform. Results: Thirty-eight patients attended the seminar and 28 consented to participate and completed the first questionnaire. Twenty-five patients completed the second questionnaire and 21 completed the third. The average age was 67, with 80% high grade serous, 11% low grade, 6% clear cell and 3% endometrioid OC subtypes. Forty- nine percent of participants were from Victoria area, and 11% were 225+ km away. The average GCOS-24 score for pre seminar participants was 111, post seminar 121 and post GC’s appointment 124. Twelve (52%) patients scored minimum clinically important difference (MCID) increase between questionnaires 1 and 2, and 14 (67%) patients scored MCID increase between questionnaires 1 and 3. The questions reflecting the most improvement in average scores between questionnaires 1 and 3 were exploring knowledge and emotions. Conclusions: Virtual group pre-counseling sessions for OC patients are feasible and allow germline genetic testing access to a geographically diverse group of eligible patients. Mean GCO-24 score almost reached MCID between pre seminar and post seminar visit and did reach MCID between pre counselling and post GC visit. There was a general trend to improved scores as patients moved from counselling naïve to pre-counseling to completed GC appointment. Virtual pre-counseling seminars should be considered as high impact, resource light method of improving access to germline genetic counselling for OC patients.

Reconstructed thermal and structural histories derived from new AFTA Apatite Fission Track Analysis, vitrinite reflectance and (U-Th)/He apatite dating results from the Morum–1 well, Otway Basin, reveal that the Morum High is a mid-Tertiary inversion structure. Uplift and erosion commencing in the Late Paleocene to mid-Eocene (57–40 Ma) removed around 1,500 m of sedimentary section. The eroded section is attributed to the Paleocene- Eocene Wangerrip Group which is considered to have been deposited in a major depocentre in the vicinity of the present Morum High. This depocentre is interpreted to have been one of a number of transtensional basins developed at the margin of the Morum Sub-basin and adjacent to the Tartwaup Hinge Zone and Mussel Fault during the Early Tertiary. The Portland Trough in Victoria represents a similar depocentre in which over 1,500 m of Wangerrip Group section, mostly represented by deltaic sediments of the Early Eocene Dilwyn Formation, is still preserved.Quantification of the maximum paleotemperature profile in Morum–1 immediately prior to Late Paleocene to mid-Eocene inversion shows that the paleo-geothemal gradient at the time was between 21 and 31°C/km, similar to the present-day level of 29°C/km, demonstrating that there has been little change in basal heat flow since the Early Tertiary.Reconstruction of the thermal history at the Trumpet–1 location reveals no evidence for any periods of significant uplift and erosion, demonstrating the relative stability of this part of the Crayfish Platform since the Late Cretaceous.The thermal and burial histories at Morum–1 and Trumpet–1 have been used to calibrate a Temis2D hydrocarbon generation and migration model along seismic line 85-13, encompassing the Crayfish Platform, Morum High and Morum Sub-basin. The model shows the cessation of active hydrocarbon generation from Eumeralla Formation source rocks around the Morum High due to cooling at 45 Ma (within the range 57–40 Ma) resulting from uplift and erosion of a Wangerrip Group basin. There has been almost no hydrocarbon generation from the Eumeralla Formation beneath the Crayfish Platform.Migration of hydrocarbons generated from the Eumeralla Formation began in the Late Cretaceous in the Morum Sub-basin and is predicted to continue to the present day, with the potential for accumulations in suitably placed reservoirs within the Late Cretaceous package both within the Morum Sub-basin and at the southern margin of the Crayfish Platform.

ObjectivesThe effects of hypercapnia on regional cerebral oxygen saturation (rSO2) during surgery are unclear. We conducted a randomised controlled trial to investigate the relationship between mild hypercapnia and rSO2. We hypothesised that, compared with targeted normocapnia (TN), targeted mild hypercapnia (TMH) during major surgery would increase rSO2.DesignA prospective, randomised, controlled trial in adult participants undergoing elective major surgery.SettingA single tertiary centre in Heidelberg, Victoria, Australia.Participants40 participants were randomised to either a TMH or TN group (20 to each).InterventionsTMH (partial pressure of carbon dioxide in arterial blood, PaCO2, 45–55 mm Hg) or TN (PaCO235–40 mm Hg) was delivered via controlled ventilation throughout surgery.Primary and secondary outcome measuresThe primary endpoint was the absolute difference between the two groups in percentage change in rSO2from baseline to completion of surgery. Secondary endpoints included intraoperative pH, bicarbonate concentration, base excess, serum potassium concentration, incidence of postoperative delirium and length of stay (LOS) in hospital.ResultsThe absolute difference between the two groups in percentage change in rSO2from the baseline to the completion of surgery was 19.0% higher in both hemispheres with TMH (p<0.001). On both sides, the percentage change in rSO2was greater in the TMH group than the TN group throughout the duration of surgery. The difference between the groups became more noticeable over time. Furthermore, postoperative delirium was higher in the TN group (risk difference 0.3, 95% CI 0.1 to 0.5, p=0.02). LOS was similar between groups (5 days vs 5 days; p=0.99).ConclusionTMH was associated with a stable increase in rSO2from the baseline, while TN was associated with a decrease in rSO2in both hemispheres in patients undergoing major surgery. This resulted in a clear separation of percentage change in rSO2from the baseline between TMH and TN over time. Our findings provide the rationale for larger studies on TMH during surgery.Trial registration numberThe Australian New Zealand Clinical Trials Registry (ACTRN12616000320459).

To address workforce shortages, the Australian Government funded additional nursing and midwifery places in 2009 pre-registration courses. An existing deficit in midwifery clinical placements, combined with the need to secure additional clinical placements, contributed to a serious shortfall. In response, a unique collaboration between Midwifery Academics of Victoria (MIDAC), rural and metropolitan maternity managers (RMM and MMM) groups and Department of Health (DOH) Victoria was generated, in order to overcome difficulties experienced by maternity services in meeting the increased need. This group identified the large number of different clinical assessment tools required to be being completed by midwives supervising students as problematic. It was agreed that the development of a Common Assessment Tool (CAT) for use in clinical assessment across all pre-registration midwifery courses in Victoria had the potential to reduce workload associated with student assessments and, in doing so, release additional placements within each service. The CAT was developed in 2009 and implemented in 2010. The unique collaboration involved in the development of the CAT is a blueprint for future projects. The collaboration on this project provided a range of benefits and challenges, as well as unique opportunities for further collaborations involving industry, government, regulators and the tertiary sector. What is known about this topic? In response to current and predicted workforce shortages, the Australian Government funded additional midwifery places in pre-registration midwifery courses in 2009, creating the need for additional midwifery student clinical placements. Victorian midwifery service providers experienced difficulty in the supply of the additional placements requested, due to complex influences constraining clinical placement opportunities; one of these was the array of assessment tools being used by students on clinical placements. What does this paper add? A collaborative partnership between MIDAC, RMM and MMM groups, and the DOH identified a range of problems affecting the ability of midwifery services to increase clinical placements. The workload burden attached to the wide range of clinical assessment tools required to be completed by the supervising midwife for each placement was identified as the most urgent problem requiring resolution. The collaborative partnership approach facilitated the development of a CAT capable of meeting the needs of all key stakeholders. What are the implications for managers and policy makers? Using a collaborative partnership workshop approach, the development of a clear project focus where all participants understood the outcome required was achieved. This collaboration occurred at multiple levels with support from the DOH and was key to the success of the project. The approach strengthens problem solving in situations complicated by competing influences, a common occurrence in health service delivery, and where unilateral approaches have not or are unlikely to succeed.

BackgroundChronic tendinopathy is a significant burden in physically active populations. High-volume image-guided injection (HVIGI) proposes to strip away associated neovascularity, disrupt painful nerve ingrowth and facilitate rehabilitation.MethodsThe objective was to investigate the efficacy of HVIGI with and without steroid relative to placebo. The study design was a three-arm block randomised control trial in a tertiary rehabilitation centre. Sixty-two participants were recruited between 25 May 2016 and 5 March 2020. Participants were men aged 18–55 with, Achilles or patellar tendinopathy of at least 6-months chronicity who had not improved with conservative management including shockwave, Ultrasound (US) evidence of neovascularisation, tendon thickening and echogenic changes.Participants were randomly assigned to control (3ml subcutaneous 0.5% Bupivacaine) or HVIGI (10 ml 0.5% Bupivacaine and 30 ml normal saline US guided between tendon and underlying fatpad) or HVIGI with steroid (0.25 ml 100 mg/ml hydrocortisone). Clinicians and assessors were blinded. All participants were supervised through a pain-guided progressive loading programme for 6-months post injection. The primary outcome measures were the Victoria institute of sport assessments for Achilles and patellar tendinopathy (VISA-A and VISA-P) and visual analogue scale (VAS)-pain at 6-months.ResultsVISA improved by 22.8 ((95% CI) 10.4 to 35.3, effect size (ES) 1.51) in control (n=21), 18.6 (9.1 to 28.0, ES 1.31) in HVIGI (n=21) and 18.5 (3.4 to 33.6, ES 0.88) in HVIGI with steroid (n=20) groups. VAS-pain improved by 15 ((IQR) -38.75 to 8, ES 0.39) in control, 13 in HVIGI (-34.0 to 3.75, ES 0.47) and 27 (-38.0 to-1.0, ES 0.54) in HVIGI with steroid groups. Main effects for time were significant (p<0.001) but not group (p≥0.48) with no group-time interaction (p=0.71). One participant was lost to follow-up from each group for whom multiple imputation was used. No adverse events occurred.ConclusionsData does not demonstrate superiority of HVIGI over control injection. Pain-guided progressive loading remains the mainstay of treatment.

Purpose: The Families Defeating Diabetes intervention evaluated a postpartum healthy living program for women with recent gestational diabetes mellitus (GDM). Design: Randomized controlled trial. Setting: Tertiary centers in London, Calgary, and Victoria, Canada. Participants: Women with GDM and partners; 46% of eligible maternal participants agreed to participate. Intervention: Interventional (INT) participants received a healthy living seminar at 3 months; access to a walking group/Website; biweekly e-mails. Control (CON) participants received a contemporary postpartum diabetes prevention handout. Measures: Maternal, partner, and offspring demographics at baseline, 3, and 12 months. Analysis: Percentages of women losing ≥7% of postpartum weight were compared by χ2 testing; body habitus comparisons by analysis of covariance (ANCOVA); maternal A1C comparisons by unpaired t tests; participant outcome associations by Pearson correlation coefficients. Results: Maternal participants were 170 (89 INT and 81 CON) with 63 partners (30 INT and 33 CON); 103 (73 maternal; 30 partners) were lost to follow-up; 57% of maternal participants completed 12 months; 33% INT women (n = 50) lost ≥7% weight versus 25% CON women (n = 47), P = .43. Interventional participant results did not correlate with accession of study elements. Maternal completion was significantly associated with partner involvement, breastfeeding, higher income, and education. Paternal weights correlated significantly with maternal and offspring weights. Conclusion: Families Defeating Diabetes outcomes were not significantly different for INT maternal or paternal participants versus CON participants. Secondary outcomes of future value included statistically significant positive associations between paternal participation, socioeconomic indicators, and maternal study completion, significant correlations between maternal, paternal, and offspring weights as well as insights into study component engagement.

ObjectivesThe impact of a coronavirus disease (COVID-19)-specific professional development programme on the well-being of obstetrics and gynaecology (O&G) doctors in training (DiT) working during the pandemic.DesignA mixed-method evaluation of a single group pre–post test design study.SettingMelbourne, Australia between September 2020 and April 2021.Participants55 O&G DiT working across four healthcare sites of a major tertiary hospital in Victoria, Australia, were included in the programme.InterventionsThe delivery of a codesigned peer-to-peer programme, which identified and addressed the well-being goals of O&G DiT. Seven interactive workshops were run alongside the implementation of a number of participant-led wellness initiatives.Main outcome measuresRepeated-measures analysis of WHO Well-being Index (WHO-5) and Copenhagen Burnout Innovatory (CBI) scores across three time points during the programme. Multilevel generalised linear mixed-effects models with random intercept were fit to the data, both in the entire population (intention-to-treat) and restricted to those who attended the workshop (‘per-protocol’ analysis). Participatory experiences and programme learning were captured using the Most Significant Change (MSC) technique, which included inductive thematic analysis.ResultsWe demonstrated an overall 31.9% improvement in well-being scores (p=0.006). The MSC evaluation captured a shift in workplace culture as a result of the programme, with improvement across the domains of connection, caring, communication, confidence and cooperation.ConclusionsWe have successfully used a mixed-method approach to contextualise a productive programme to improve the well-being of COVID-19 front-line healthcare workers.

Introduction Cervical spinal cord injury (CSCI) is a significant medical and socioeconomic problem. In Victoria, Australia, there has been limited research into the incidence of CSCI. The Austin Hospital's Victorian Spinal Cord Injury Service (VSCIS) is a tertiary referral hospital that accepts referrals for surgical management and ongoing neurological rehabilitation for south eastern Australia. The aim of this study was to characterise the epidemiology of CSCI managed operatively at the VSCIS over the last decade, in order to help fashion public health campaigns. Methods This was a retrospective review of medical records from January 2000 to December 2009 of all patients who underwent surgical management of acute CSCI in the VSCIS catchment region. Patients treated non-operatively were excluded. Outcome measures included: demographics, mechanism of injury and associated factors (like alcohol) and patient neurological status. Results Men were much more likely to have CSCI than women, with a 4:1 ratio, and the highest incidence of CSCI for men was in their 20s (39%). The most common cause of CSCI was transport related (52%), followed by falls (23%) and water-related incidents (16%). Falls were more prevalent among those >50 years. Alcohol was associated in 22% of all CSCIs, including 42% of water-related injuries. Discussion Our retrospective epidemiological study identified at-risk groups presenting to our spinal injury service. Young males in their 20s were associated with an increased risk of transport-related accidents, water-related incidents in the summer months and accidents associated with alcohol. Another high risk group were men >50 years who suffer falls, both from standing and from greater heights. Public awareness campaigns should target these groups to lower incidence of CSCI.

Abstract A retrospective review of Candida bloodstream infections (BSI) in Australian hospitals between 1995 and 1998 was performed. Nine tertiary referral hospitals in the States of New South Wales, Victoria, South Australia and Queensland participated. Of all isolates, 56% were Candida albicans, 14% Candida parapsilosis, 13% Candida glabrata, 5% Candida krusei and 4.5% Candida tropicalis. There were significant differences in the distribution of species in different patient groups. Among surgical patients, 69% of candidaemia was due to C. albicans, whereas among medical patients the proportion was 52%, and in haematology patients 43% (P = 0.0012; Pearson χ2). BSI with C. krusei were almost exclusive to haematology patients and were the second leading cause of Candida infection in that group, accounting for 27% of infections. The temporal pattern of Candida isolates also revealed a relationship between the latter years of the study and a lower likelihood of infection with C. albicans. Logistic regression showed year of the study [P = 0.032; odds ratio (OR) 0.81; 95% confidence interval (CI) 0.67–0.98] and surgery (P = 0.005; OR 2.02; 95% CI 1.2–3.1) to be significant variables. The rate of candidaemia in Australian hospitals was similar to that reported for US hospitals at 0.1–0.27 per 1000 discharges. Since April 1998, the clinical database on the internet resource Mycology Online has invited submission of clinical details from cases of invasive mycoses from Australian clinicians. To date, descriptions of 43 patients with proven or presumptive mould infection have been entered on the database. Of these, the leading cause was infection with Aspergillus (n = 16), followed by Zygomycetes (n = 7), Fusarium (n = 5), Scedosporium (n = 5) and Exserohilum (n = 1). Although Aspergillus infections were the most frequent on the database, the variety of mould infections seen in this short time was surprising. A knowledge of local patterns of infection and antifungal susceptibility is useful in selecting empirical therapy and formulating prophylactic and pre-emptive strategies.

Abstract INTRODUCTION In management of patients post-autologous stem cell transplant (ASCT), there continues to be controversy regarding the benefit of granulocyte-colony stimulating factor (GCSF) given post-autologous stem cell transplantation on length of time to engraftment and rates of febrile neutropenia. We conducted a chart review on all patients who received autologous stem cell transplants with follow-up at two tertiary care centres, the Health Sciences Centre in St. John’s, Newfoundland, and Victoria General Hospital in Halifax, Nova Scotia from February 2001 to February 2006. METHODS Comparison was made between two groups, either receiving (Group A) or not receiving (Group B) planned GCSF (starting 5 days post ASCT) for engraftment purposes. Patients who were not intended to receive GCSF but later received it due to delayed engraftment or febrile neutropenia remained in the non-intervention arm for analysis. Patients were excluded who had CD34+ infusion doses of < 2.5 cells x 106/kg body weight as all these patients received planned GCSF to promote engraftment at both centers. Also, we excluded patients who were transferred from the treatment center (Halifax or St. John’s) to their referring center for post transplant care prior to engraftment as follow up data would not be available for these cases. Primary outcomes included time to neutrophil engraftment and days to hospital discharge. Secondary outcomes included episodes of febrile neutropenia, number of packed red cell and platelet transfusions, days to platelet engraftment and transplant related mortality. Comparison between groups of episodes of febrile neutropenia was performed using Fisher’s exact test and all other variables were analyzed using the unpaired t-test. RESULTS 215 patients were included, having received autologous stem cell transplants at the above centres from February 2001 to February 2006. There were no significant differences between the two groups in age, sex, or diagnoses. More patients in Group B received etoposide/melphalan conditioning whereas there were more treated with BEAM in group A. Mobilizing regimens also differed significantly, with more patients in the group B receiving GCSF alone. Median time to neutrophil engraftment differed between group A and group B (11 vs. 14 days respectively, p<0.0001). There was a higher incidence of febrile neutropenia in patients in group B (89%) compared with group A (76%, p<0.01). However, there was no significant difference between days to hospital discharge, platelet and packed red cell transfusions, or transplant related mortality. One distinct weakness of the study was in evaluating the duration of hospital stay as this was determined by date of final discharge post transplant and did not take into account delayed admissions or periods of discharge between recurrent admissions for transplant-related issues. CONCLUSION We observed a significant difference between the rate of febrile neutropenia and duration to neutrophil engraftment in those routinely receiving GCSF as part of post-transplant care vs. those who receive it either not at all or only for delayed engraftment. However, the clinical significance of these findings is unclear, particularly as the time to hospital discharge and the transfusion requirement was the same between the groups. Nonetheless, these results indicate a need for further study in this area, and suggest that more dedicated research into cost-effectiveness of the intervention may be useful.

Abstract Background: The diagnosis of VTE remains problematic in the emergency room. There are a number of algorithms, for both pulmonary embolism (PE) and deep venous thrombosis (DVT), that have been validated for use. These incorporate clinical assessment of pretest probability, D-Dimer measurement, and non-invasive diagnostic imaging. The purpose of this study was to evaluate adherence to the VTE diagnostic algorithms (according to Wells, Anderson et al.) at Victoria Hospital, London Ontario (a tertiary centre). Methods: The charts for all patients who presented with suspected DVT or PE during a two-month period were retrospectively reviewed. Patients were identified by those who had D-dimer testing or diagnostic imaging for VTE (D-dimers are only indicated for use in our hospital for the investigation of VTE). Patients were excluded if they were currently anticoagulated, pregnant, had upper limb DVT or were <18 years of age. All charts were reviewed by 3 persons to assign the Wells criteriae and to review the adherence to the recommended algorithms - determination was by consensus. Results: There were 289 patients included, 157 women and 132 men with an average age of 57. Of 289 patients included, 242 were investigated for PE with 6 events occurring, for an event rate of 2.5%. Forty-seven patients were investigated for DVT, with 4 events, for an event rate of 8.5%. The algorithms were seemingly correctly applied at superficial analysis in 64.4% of all patients and incorrectly applied in 20.8% of all patients. In 14.9% of patients, the algorithms were not followed to completion due to admission to hospital or an alternative diagnosis developing. Consultants correctly managed in 68.37% of cases and Residents in 59.8%. Although 71% of patients with suspected PE were seemingly managed according to algorithm - the vast majority of these patients had a low pretest probability (217) and were investigated with D-dimer only, which was negative. There were 25 patients in the moderate to high probability group and 17 were incorrectly managed with either unnecessary D-dimer assessments or a lack of leg imaging after non-diagnostic V/Q scans or CT scans. Eight patients in the low probability group had imaging despite negative D-dimer tests. With an event rate of only 2.5%, a disproportionately large number of patients were investigated for PE. Only 30% of patients with suspected DVT were managed correctly according to algorithm, 41% for “unlikely” and 7% “likely”. Of the 32 patients in the “unlikely” group, 9 patients had U/S performed despite negative D-dimer and 5 patients had U/S without D-dimer assessment. For the 15 patients who were “likely”, 6 had D-dimers performed upfront and 6 did not have D-dimers done after initial negative imaging. Overall, of 46 patients who had chest imaging for PE, 13 V/Q scans and 1 CT scan were done that were not indicated and 7 patients who should have been imaged were not. In the DVT group, 39 U/S were done and 10 of these were not indicated. Conclusions: The disproportionate amount of PE patients, and the overall low event rate for PE, suggest that D-dimers are being used indiscriminately as a screening test for the diagnosis of chest symptoms, an approach that has not been validated by studies. The algorithms for the diagnosis of DVT and PE are not being applied appropriately at our centre. The implications of this include the potential for missed diagnoses as well as the cost and potential clinical consequences of over investigation.

Abstract Aim: To compare patients with newly diagnosed multiple myeloma (NDMM) withbortezomib responsive and resistant disease (defined as <PR after 2 cycles) and assess the impact on clinical outcome particularly progression-free survival (PFS) and overall survival (OS). Method: Retrospective review of all patients identified with NDMM treated with upfront bortezomib in four tertiary centres in Victoria, Australia between 1st of January 2009 and 1st of March, 2016. Bortezomib responsiveness was defined as achievement of PR or better after completing 2 cycles of any bortezomib containing therapy (total eight doses of bortezomib). Prior radiotherapy was allowed. Data were analysed via log rank tests for PFS and OS using SAS (V9.4) software. Predictors of bortezomib resistance were assessed by chi-square analysis. Result: A total of 187 eligible patients were included (147bortezomib responsive and 40bortezomib resistant patients). Bortezomib resistance was associated with shorter median PFS, 27.4 (95%CI: 16.3, 30.8) vs 30.4 (95%CI: 23.4, 37.1) months (log-rank p= 0.047) with a median potential follow up of 27.4 vs 29.7 months in the resistant and responsive groups respectively. Estimated PFS at 12 months was 68.0% (95%CI: 50.3%, 80.5%) vs 88.3% (95%CI: 81.2%, 92.8%) and, at 24 months, 60.4% (95%CI: 41.7%, 74.7%) vs 60.0% (95%CI: 49.9%, 68.6%) in the resistant and responsive groups respectively, indicating non-constant hazard in the resistant group (see figure). Bortezomib resistance was not associated with higher ISS (ISS3 24% vs 15%, p=0.17), high riskcytogenetics (17p del ort(4;14)) (23% vs 23%, p= 0.99), MM sub-type (p= 0.63) or length ofbortezomib cycle (21 vs 35 day p= 0.56)). In responders (n=147), maintenance therapy was associated with improved PFS (p=0.021), and PFS at 24 months was, 70.7% (95%CI: 57.3%, 80.5%) vs 46.9% (32.0%, 60.5%) in those who received maintenance therapy and those who did not respectively. In non-responders (n=40) PFS at 24 months was 68.8% (95%CI: 35.7%, 87.3%) vs 54.9% (31.6%, 73.2%) in those patients who received maintenance therapy and those patients who did not respectively (p=0.84). Median OS has not been reached in either thebortezomib resistant or responsive groups however estimated OS at 24 months is 82.8% (95%CI: 62.8%, 92.7%) vs 89.5% (95%CI: 81.5%, 94.1%) in the resistant and responsive groups respectively. Conclusion: Bortezomib resistance is a poor prognostic factor and is associated with a shorter PFS. Consideration of early therapy change, maintenance therapy and/or referral for assessment for allograft in eligible patients appears to be warranted. Figure Figure. Disclosures No relevant conflicts of interest to declare.

Background:Treatment in Psoriatic Arthritis (PsA) has undergone a major revolution in recent years, with the development of new targets and molecules. Despite these advances, data from clinical practice demonstrating a change in management success are scarce.Objectives:To evaluate if the proportion of patients (pts) with PsA maintaining an acceptable medium-term control of the disease activity after starting a first biologic agent is increasing over time.Methods:Prospective cohort including 101 patients (pts) with PsA starting a 1st biologic (TNF inhibitor, anti-IL 17 inhibitor) in a tertiary hospital between 2002-2018. Demographic, clinical and laboratory data were collected at the beginning of treatment. Disease activity indexes (ASDAS for axPsA and DAPSA for pPsA) were collected before starting biologic, six and twelve months later (baseline, 6m and 12m visit, respectively). Low disease activity (LDA) was defined as ASDAS < 2.1 (axPsA) and DAPSA ≤14 (pPsA). Three groups were established according to biologic initiation date: period 1 (p1) (between 2002-2007), (p2) 2008-2013 and (p3) 2014-2018. Each period had a minimum follow-up of 1 year for every patient. For each interval, the percentage of pts achieving persistent (at both follow-up visits) LDA was determined, as a marker of acceptable medium-term control of the disease. All collected variables were compared between groups by ANOVA and Chi-Squared test.Results:Out of the 101 pts initiating biological therapy, 46 % were males and 57 % had peripheral PsA. At the biologic treatment start, mean ± SD age was 48.5 ± 12 years and disease duration was 9.9 ± 10 years. Biological therapies initiated included etanercept in 38 % of pts, infliximab in 24 %, adalimumab in 25 %, golimumab in 7 %, secukinumab in 3 % and certolizumab in 3 %.Stratified by time intervals, 36 (35.6%) pts started in p1, 36 (35.6%) in p2 and 29 (28.8%) in p3. Baseline characteristics of pts by periods are shown in Table 1. For patients in p3, compared to the previous intervals, a significant lower CRP (p=0.03) and ESR (p=0.004) were found at baseline, whereas there were no significant differences on baseline disease activity indices. Fifty-one (50%) pts achieved persistent-LDA after one year of starting biologic. Figure 1 reports the total number of patients that were in LDA in all the visits in the 1styear, stratified per period of time and predominant manifestation. A lower percentage of patients in LDA (33% in p1 vs, 67% in p2 vs 52% in p3, p = 0.02) was found in the first interval, in comparison to the most recent periods. The difference in response between p2 and p3 is mainly due to the group of patients with pPsA, whereas the improvement in the group of patients with axPsA remains constant in both periods.Table 1.Baseline patient’s characteristics by periods of timeFigure 1.Patients achieving persistent-LDA during the 1styear of biological therapy, stratified by period of time and by disease.* Statistically significant difference with respect to p1.Conclusion:The percentage of pts with PsA achieving LDA status after one year of initiating a biological therapy has substantially increased over time. A lower threshold of inflammation at biological therapy start and a broader spectrum of therapies might explain this better management on PsA.Disclosure of Interests:Diego Benavent: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Irene Monjo: None declared, Marta Novella-Navarro: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Chamaida Plasencia: None declared

Abstract Introduction: The introduction of direct oral anticoagulants (DOAC) has revolutionised the treatment of atrial fibrillation (AF) and venous thromboembolism (VTE). Previous clinical trials have demonstrated that DOACs are non-inferior to warfarin for treatment and prevention of VTE and at least as safe in terms of bleeding risk. However, there is limited data on real-world outcomes. We aim to evaluate the local real-world DOAC use with particular focus on safety and to specifically compare the safety outcomes of the warfarin era vs the DOAC era in the management of VTE. Method: Retrospective evaluation was performed with a total of 1696 patients reviewed including demographics and safety outcomes. Patients commenced or continuing on a DOAC for the treatment of AF and VTE at the Northern Hospital, a tertiary hospital in Victoria, Australia (September 2013 to September 2016, n=1079) were identified. A sub analysis was then performed comparing patients on DOAC for VTE indications to a separate retrospective local audit of VTE patients during the warfarin era (July 2011 to December 2012, n=617). For the purpose of the sub analysis, patients with active malignancy and thromboses other than deep vein thrombosis (DVT) and pulmonary embolus (PE) were excluded to maintain consistency with the warfarin era data. Results: A total of 1079 patients on DOAC with median age 70 years (range 17-96) were identified. The indications for DOAC were AF 61.4% (n=663), VTE treatment 30.5% (n=329) and VTE maintenance/prophylaxis 8.1% (n=87). The most commonly prescribed DOAC was rivaroxaban 60.8% (n=656) followed by apixaban 28.7% (n=310) and dabigatran 10.5% (n=113). Of these patients 29.7% (n=320) were on low dose anticoagulation. Forty episodes of clinically significant bleeding (ISTH-SCC score 3-4) (3.7%) were captured [Table 1]. The average HASBLED score of these patients was 2 and significant risk factors for bleeding included low dose anticoagulation, AF patients, concurrent antiplatelet use, prior bleeding and high falls risk. In terms of thrombotic complications, there were 12 episodes of thrombotic stroke (1.8%) despite DOAC use with risk factors including low dose anticoagulation (p=0.03), prior stroke (p=0.04) and high falls risk (p=0.03). Nine patients on DOACs for VTE (2.2%) reported recurrence including a patient with active malignancy. 374 patients on DOAC for VTE management were included in the sub-analysis comparison to the warfarin audit (n=617). Of the DOAC patients, 88.2% (n=330) were on rivaroxaban and 11.8% (n=44) were on apixaban - 31.8% (n=315) were on DOAC for acute VTE treatment and 6.0% (n=59) for maintenance or prophylaxis at time of data collection. There were more unprovoked VTE in the DOAC group (66.0% (n=208) vs 42.0% (n=259), p<0.001). The patient demographics are outlined in Table 2. Overall, there were 28 clinically significant bleeding (ISTH-SCC score 3-4) events in the warfarin group (4.5%) and 8 in the DOAC group (2.1%; p=0.05). The sites of bleeding were similar in both groups with gastrointestinal tract bleeding being the most common source. Forty-eight recurrent VTE events were captured - 39 occurred on warfarin (6.3%) and 9 while on DOAC (2.4%; p=0.005). Conclusion: This retrospective audit shows that our local safety outcomes are comparable to clinical trials. Low dose anticoagulation and high falls risk (a surrogate marker of frailty) were significant risk factors for both clinically significant bleeding and thrombotic stroke in the DOAC population. These patients are likely frailer with greater co-morbidities and have shared risk factors for bleeding and stroke, suggesting that for these high risk patients, low dose anticoagulation does not negate their risk of complications and careful prescribing and close monitoring remain essential. The sub-comparison between VTE patients on DOAC and warfarin found that patients on warfarin had a higher rate of VTE recurrence in comparison to patients on DOAC. This may reflect patients maintaining more time on therapeutic anticoagulation with the more predictable DOACs compared to warfarin patients who may have more time below therapeutic range. There may also be a selection bias as-high risk patients with co-morbidities and those not meeting criteria for DOACs continue to be prescribed warfarin in the DOAC era. This data is similar to recent real-life DOAC experience in the atrial fibrillation population. Table 1. Table 1. Disclosures No relevant conflicts of interest to declare.

Abstract Introduction While the role of cytarabine-based immunochemotherapy (ICT) and autologous stem cell transplantation (ASCT) in untreated younger patients with MCL is well established, the utility of 'more intense' approaches in older patients is uncertain. Despite a median age at presentation of 60 years or more there are few therapeutic trials focussing on older patients. With the development of targeted agents, the need to define the optimal ICT strategy for comparison is pressing. Methods The primary aim of this study was to compare the safety and efficacy of first line ICT based therapy in patients with MCL aged over 60 years. Treatment and outcome data were collected for patients treated between 2000-2015 across a combined health-care network servicing the south-eastern, south-western and central corridor of the Australian state of Victoria (catchment area >2 million patients encompassing four major academic tertiary referral centers). Eligible patients had MCL diagnosed according to WHO 2008 criteria, confirmed by either fluorescence in situ hybridization for t(11;14) translocation or immunohistochemistry for cyclin D1 expression. Only cases with adequate information, including baseline characteristics, treatment regimens and outcome, were included. Overall survival (OS) and progression free survival (PFS) were modelled using Cox regression. For ICT comparison, patients undergoing ASCT were censored at the time of transplant. Differences in hospitalization and transfusion were analyzed using the Mann-Whitney U test. Results 52 patients met inclusion criteria with a median age of 69 (range 60-91; M/F >3:1), of which 23 patients were >70 years. Most patients had advanced disease on staging, >1 extra-nodal site and an intermediate-high MIPI score. All received rituximab with initial therapy. Treatment regimens included: R-CHOP-like (31), alternating R-CHOP/R-DHAC (10), R-HyperCVAD/R-MA (7) and other (4). Eleven patients underwent ASCT. The median follow up for surviving patients was 40 months. Type of chemotherapy and up-front ASCT were the only variables influencing PFS and OS. Cytarabine-based ICT was associated with an improved median PFS (not reached vs 35 months, HR 0.27 [0.08-0.93], p=0.018) and OS (not reached vs 54 months, HR 0.28 [0.08-0.94], p=0.039) compared to R-CHOP-like regimens. Patients undergoing ASCT were younger (mostly < 70 years) and demonstrated improved median OS (not reached vs 46 months, HR 0.124 [0.017-0.921], p=0.041). No statistically significant difference in efficacy between R-HyperCVAD/R-MA and R-CHOP/R-DHAC could be determined due to low numbers. Both group of patients receiving cytarabine demonstrated durable response over time. However, those receiving R-HyperCVAD/R-MA experienced greater toxicity with increased hospitalisation: median 54 [31-72] v 20 [6-77] days, p=0.023 and transfusion requirements: median 13 [7-24] v 2 [0-5] red cell units, p=0.001; median 6 [2-15] v. 0 [0-1] platelet pools, p=0.001. Conclusion In older patients with previously untreated MCL, cytarabine-based ICT resulted in a significant improvement in OS, with a 72% reduction in the risk of death relative to CHOP-like therapy. Cytarabine-based ICT is highly efficacious and well tolerated and should serve as a benchmark with which to compare targeted therapies. ASCT should also be considered in selected older patients. Table Table. Disclosures Quach: Amgen: Membership on an entity's Board of Directors or advisory committees; Janssen Cilag: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Opat:Roche: Consultancy, Honoraria, Other: Provision of subsidised drugs, Research Funding.

Abstract Introduction Acute myeloid leukemia (AML) in older adults is a challenging clinical problem with a poor prognosis. Hypomethylating agents, such as azacitidine, improve survival in this population. (Oran B, Haematologica 2012) These treatments can be challenging to deliver, particularly in patients far from tertiary care centres. We examined whether residence outside of a major metropolitan area impacted referral patterns, treatments, and outcomes in a population-based cohort of AML patients over age 60 in British Columbia (BC), Canada. Methods Patients with ICD-10 diagnoses of AML were identified from the population based BC Cancer registry and BC Cancer pharmacy database. Diagnoses between 2010 and 2016 were included. Exclusion criteria included diagnosis age less than 60 years, any treatment outside BC, or APL. The diagnosis of AML was verified by chart review. Azacitidine was available at our institution in 2010, and is used primarily for patients with bone marrow blast counts below 30%. Patients were defined as having a hematologist/oncologist assessment if a provider with these credentials was listed in notes or pathology reports. Patients were defined as having received a treatment if it was dispensed at least once, with a date after AML diagnosis. Patients were defined as urban if they had a mailing address in a center of >/= 100,000 people, per the Statistics Canada definition, and rural if they had a mailing address elsewhere. Urban residences included greater Vancouver, Victoria and Kelowna, which comprise 71.5% of the population. (Statistics Canada, 2016 census) Between group differences were assessed by 2-tailed t-test or chi-square tests. Overall survival (OS) was assessed by Kaplan-Meier, with a log-rank test, and Cox regression. A p < 0.05 was significant. Results A total of 879 patients over age 60 with AML, excluding APL, were identified. Of these, 525 (60%) resided in urban areas vs 354 (40%) residing in rural areas. These groups were similar for median age at diagnosis (urban 75.9 years, rural 74.3 years, p = 0.067), adverse cytogenetic profile (urban 56%, rural 44%, p = 0.356), NPM1 positivity (urban 69%, rural 31%, p = 0.101) and FLT3 positivity (urban 76%, rural 24%, p = 0.052). Rural residents were less likely to have a documented hematologist/oncologist assessment (urban 84%, rural 65%, p < 0.001). Few patients overall received induction chemotherapy (151, 17%), with no difference between rural and urban residency (p = 0.524). Similarly, few patients underwent hematopoietic stem cell transplantation (38, 4%), with no difference with place of residence (p = 1.000). Median OS for patients treated with induction chemotherapy was 11.0 months (95% CI 9.0 - 13.1 mo). Median OS for patients treated with subcutaneous (SC) azacitidine was 7.1 months (95% CI 4.8 - 9.5 mo) vs 4.7 months (95% CI 3.3 - 6.1 mo) with SC cytarabine. With best supportive care, the median OS was 1.7 months (95% CI 1.5 - 1.9 mo). Median follow-up was 43.7 months (95% CI 39.2 - 48.2 mo), with 706 (97%) of patients deceased at last follow-up. Amongst the 728 patients who did not receive induction chemotherapy, 82 (11%) received SC cytarabine and 127 (17%) received SC azacitidine. Place of residence did not impact whether patients received SC cytarabine (urban 10%, rural 13%, p = 0.285). Rural residents were, however, less likely to receive SC azacitidine (urban 21%, rural 12%, p = 0.002). In patients not undergoing induction, rural residents had a worse OS by Kaplan-Meier analysis (p = 0.021), with a hazard ratio of 1.2 (95% CI 1.026 - 1.387, p = 0.022) on univariate Cox regression. Conclusions Older adults with a diagnosis of AML who reside in rural areas of BC are less likely to have a documented hematologist/oncologist assessment, and are less likely to receive SC azacitidine. This group also has a worsened OS, though the effect size is modest. There was no difference in rates of treatment with potentially curative regimens, although this approach applied to a minority of patients. We hypothesize that this difference may be partially due to the travel burdens placed on rural patients who receive SC azacitidine, which must be administered in a healthcare facility, unlike SC cytarabine. Less access to supportive care in rural areas is also likely a contributing factor. Policymakers should direct additional resources for rural oncologic healthcare delivery, and the importance of low burden drug formulations is AML should be emphasized. Disclosures No relevant conflicts of interest to declare.

Abstract Background Regular physical activity (PA) is associated with many health benefits during childhood, and tracks into desirable PA patterns and health profiles in adulthood. Interventions designed to support these behaviours among young children are critical. Family-based interventions focusing on parent-child activities together (i.e., co-activity) among preschool-aged children are warranted. Targeting parental support practices can increase the frequency of co-activity, however interventions must move beyond merely building intention and planning skills for successful maintenance. Interventions designed to increase co-activity habit strength may facilitate the sustainability and thus impact child PA. The purpose of this study is to compare the effects of three intervention conditions designed to increase child PA through co-activity: a standard education condition (information about benefits), a planning (action planning, coping planning) + education condition and a habit (context-dependent repetition from prompts and cues) + planning +education condition. Methods/design A longitudinal three-arm parallel design randomized trial will compare three conditions over six months. Families are eligible if they have at least one child between 3y and 5y that is not meeting 60mins/day of moderate to vigorous physical activity (MVPA). The primary outcome (child MVPA) is assessed via accelerometry at baseline, six weeks, three months and six months (primary endpoint). Intervention materials targeting co-activity are delivered post baseline assessment, with booster sessions at six weeks and three months. Parental co-activity habit, parent-child co-activity and other behavioural constructs are also assessed via questionnaire at all measurement occasions. As tertiary outcomes, parental PA is measured via accelerometry and co-activity is measured via a Bluetooth-enabled proximity feature. A total of 106 families have been recruited thus far from the Greater Victoria region. The study is ongoing with a minimum target of 150 families and an anticipated recruitment completion date of August 2022. Discussion This protocol describes the implementation of a randomized trial evaluating the effectiveness of a habit formation group compared with a planning group and an education only group to increase child PA through targeting parent-child co-activity. This information could prove useful in informing public health initiatives to promote PA among families with preschool-aged children. Trial registration This trial was prospectively registered on clinicaltrials.gov in February 2016, identifier NCT03055871.

Introduction The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine preventable diseases and potential adverse events following immunisation (AEFI). PAEDS data is used to better understand these conditions, inform policy and practice under the National Immunisation Program, and enable rapid public health responses for certain conditions of public health importance. PAEDS enhances data available from other Australian surveillance systems by providing prospective, detailed clinical and laboratory information on children with selected conditions. This is the third annual PAEDS report, and presents surveillance data for 2016. Methods Specialist nurses screened hospital admissions, emergency department records, laboratory and other data, on a daily basis in 5 paediatric tertiary referral hospitals in New South Wales, Victoria, South Australia, Western Australia and Queensland to identify children with the conditions under surveillance. Retrospective data on some conditions was also captured by an additional hospital in the Northern Territory. Standardised protocols and case definitions were used across all sites. Conditions under surveillance in 2016 included acute flaccid paralysis (AFP) (a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal and invasive Group A streptococcus diseases. Most protocols restrict eligibility to hospitalisations; Emergency Department (ED) only presentations are also included for some conditions. Results In 2016, there were 673 cases identified across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach World Health Organization (WHO) reporting targets; identification of the leading infectious causes of acute encephalitis which included human parechovirus, influenza, enteroviruses, Mycoplasma pneumoniae, and bacterial meningo-encephalitis; demonstration of high influenza activity with vaccine effectiveness (VE) analysis demonstrating some protection offered through vaccination. All IS cases associated with vaccine receipt were reported to the relevant state health department. Varicella and herpes zoster case numbers increased from previous years associated with suboptimal vaccination in up to 40% of cases identified. Pertussis surveillance continued in 2016 with the addition of test negative controls captured for estimating vaccine effectiveness. Surveillance for invasive meningococcal disease showed predominance for serotype B in absence of immunisation, and new invasive group A streptococcus surveillance captured severe disease in children. Conclusions PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using hospital-based sentinel surveillance. Keywords: paediatric, surveillance, child, hospital, vaccine preventable diseases, adverse event following immunisation, acute flaccid paralysis, encephalitis, influenza, intussusception, pertussis, varicella zoster virus, meningococcal, group A streptococcus.

BACKGROUND: The National Institute on Aging and Alzheimer’s Association (NIA-AA) have proposed a new Research Framework: Towards a biological definition of Alzheimer’s disease, which uses a three-biomarker construct: Aß-amyloid, tau and neurodegeneration AT(N), to generate a biomarker based definition of Alzheimer’s disease. OBJECTIVES: To stratify AIBL participants using the new NIA-AA Research Framework using cerebrospinal fluid (CSF) biomarkers. To evaluate the clinical and cognitive profiles of the different groups resultant from the AT(N) stratification. To compare the findings to those that result from stratification using two-biomarker construct criteria (AT and/or A(N)). DESIGN: Individuals were classified as being positive or negative for each of the A, T, and (N) categories and then assigned to the appropriate AT(N) combinatorial group: A-T-(N)-; A+T-(N)-; A+T+(N)-; A+T-(N)+; A+T+(N)+; A-T+(N)-; A-T-(N)+; A-T+(N)+. In line with the NIA-AA research framework, these eight AT(N) groups were then collapsed into four main groups of interest (normal AD biomarkers, AD pathologic change, AD and non-AD pathologic change) and the respective clinical and cognitive trajectories over 4.5 years for each group were assessed. In two sensitivity analyses the methods were replicated after assigning individuals to four groups based on being positive or negative for AT biomarkers as well as A(N) biomarkers. SETTING: Two study centers in Melbourne (Victoria) and Perth (Western Australia), Australia recruited MCI individuals and individuals with AD from primary care physicians or tertiary memory disorder clinics. Cognitively healthy, elderly NCs were recruited through advertisement or via spouses of participants in the study. PARTICIPANTS: One-hundred and forty NC, 33 MCI participants, and 27 participants with AD from the AIBL study who had undergone CSF evaluation using Elecsys® assays. INTERVENTION (if any): Not applicable. MEASUREMENTS: Three CSF biomarkers, namely amyloid β1-42, phosphorylated tau181, and total tau, were measured to provide the AT(N) classifications. Clinical and cognitive trajectories were evaluated using the AIBL Preclinical Alzheimer Cognitive Composite (AIBL-PACC), a verbal episodic memory composite, an executive function composite, California Verbal Learning Test – Second Edition; Long-Delay Free Recall, Mini-Mental State Examination, and Clinical Dementia Rating Sum of Boxes scores. RESULTS: Thirty-eight percent of the elderly NCs had no evidence of abnormal AD biomarkers, whereas 33% had biomarker levels consistent with AD or AD pathologic change, and 29% had evidence of non-AD biomarker change. Among NC participants, those with biomarker evidence of AD pathology tended to perform worse on cognitive outcome assessments than other biomarker groups. Approximately three in four participants with MCI or AD had biomarker levels consistent with the research framework’s definition of AD or AD pathologic change. For MCI participants, a decrease in AIBL-PACC scores was observed with increasing abnormal biomarkers; and increased abnormal biomarkers were also associated with increased rates of decline across some cognitive measures. CONCLUSIONS: Increasing biomarker abnormality appears to be associated with worse cognitive trajectories. The implementation of biomarker classifications could help better characterize prognosis in clinical practice and identify those at-risk individuals more likely to clinically progress, for their inclusion in future therapeutic trials.

This article explores how fat women protesting challenges norms of womanhood, the place of women in society, and who has the power to have their say in public spaces. We use the term fat as a political reclamation; Fat Studies scholars and fat activists prefer the term fat, over the normative term “overweight” and the pathologising term “obese/obesity” (Lee and Pausé para 3). Who is and who isn’t fat, we suggest, is best left to self-determination, although it is generally accepted by fat activists that the term is most appropriately adopted by individuals who are unable to buy clothes in any store they choose. Using a tweet from conservative commentator Ann Coulter as a leaping-off point, we examine the narratives around women in the public sphere and explore how fat bodies might transgress further the norms set by society. The public representations of women in politics and protest are then are set in the context of ‘activist wisdom’ (Maddison and Scalmer) from two sides of the globe. Activist wisdom gives preference to the lived knowledge and experience of activists as tools to understand social movements. It seeks to draw theoretical implications from the practical actions of those on the ground. In centring the experiences of ourselves and other activists, we hope to expand existing understandings of body politics, gender, and political power in this piece. It is important in researching social movements to look both at the representations of protest and protestors in all forms of media as this is the ‘public face’ of movements, but also to examine the reflections of the individuals who collectively put their weight behind bringing social change.A few days after the 45th President of the United States was elected, people around the world spilled into the streets and participated in protests; precursors to the Women’s March which would take place the following January. Pictures of such marches were shared via social media, demonstrating the worldwide protest against the racism, misogyny, and overall oppressiveness, of the newly elected leader. Not everyone was supportive of these protests though; one such conservative commentator, Ann Coulter, shared this tweet: Image1: A tweet from Ann Coulter; the tweet contains a picture of a group of protestors, holding signs protesting Trump, white supremacy, and for the rights of immigrants. In front of the group, holding a megaphone is a woman. Below the picture, the text reads, “Without fat girls, there would be no protests”.Coulter continued on with two more tweets, sharing pictures of other girls protesting and suggesting that the protestors needed a diet programme. Kivan Bay (“Without Fat Girls”) suggested that perhaps Coulter was implying that skinny girls do not have time to protest because they are too busy doing skinny girl things, like buying jackets or trying on sweaters. Or perhaps Coulter was arguing that fat girls are too visible, too loud, and too big, to be taken seriously in their protests. These tweets provide a point of illustration for how fat women protesting challenge norms of womanhood, the place of women in society, and who has the power to have their say in public spaces While Coulter’s tweet was most likely intended as a hostile personal attack on political grounds, we find it useful in its foregrounding of gender, bodies and protest which we consider in this article, beginning with a review of fat girls’ role in social justice movements.Across the world, we can point to fat women who engage in activism related to body politics and more. Australian fat filmmaker and activist Kelli Jean Drinkwater makes documentaries, such as Aquaporko! and Nothing to Lose, that queer fat embodiment and confronts body norms. Newly elected Ontario MPP Jill Andrew has been fighting for equal rights for queer people and fat people in Canada for decades. Nigerian Latasha Ngwube founded About That Curvy Life, Africa’s leading body positive and empowerment site, and has organised plus-size fashion show events at Heineken Lagos Fashion and Design Week in Nigeria in 2016 and the Glitz Africa Fashion Week in Ghana in 2017. Fat women have been putting their bodies on the line for the rights of others to live, work, and love. American Heather Heyer was protesting the hate that white nationalists represent and the danger they posed to her friends, family, and neighbours when she died at a rally in Charlottesville, North Carolina in late 2017 (Caron). When Heyer was killed by one of those white nationalists, they declared that she was fat, and therefore her body size was lauded loudly as justification for her death (Bay, “How Nazis Use”; Spangler).Fat women protesting is not new. For example, the Fat Underground was a group of “radical fat feminist women”, who split off from the more conservative NAAFA (National Association to Aid Fat Americans) in the 1970s (Simic 18). The group educated the public about weight science, harassed weight-loss companies, and disrupted academic seminars on obesity. The Fat Underground made their first public appearance at a Women’s Equality Day in Los Angeles, taking over the stage at the public event to accuse the medical profession of murdering Cass Elliot, the lead singer of the folk music group, The Mamas and the Papas (Dean and Buss). In 1973, the Fat Underground produced the Fat Liberation Manifesto. This Manifesto began by declaring that they believed “that fat people are full entitled to human respect and recognition” (Freespirit and Aldebaran 341).Women have long been disavowed, or discouraged, from participating in the public sphere (Ginzberg; van Acker) or seen as “intruders or outsiders to the tough world of politics” (van Acker 118). The feminist slogan the personal is political was intended to shed light on the role that women needed to play in the public spheres of education, employment, and government (Caha 22). Across the world, the acceptance of women within the public sphere has been varied due to cultural, political, and religious, preferences and restrictions (Agenda Feminist Media Collective). Limited acceptance of women in the public sphere has historically been granted by those ‘anointed’ by a male family member or patron (Fountaine 47).Anti-feminists are quick to disavow women being in public spaces, preferring to assign them the role as helpmeet to male political elite. As Schlafly (in Rowland 30) notes: “A Positive Woman cannot defeat a man in a wrestling or boxing match, but she can motivate him, inspire him, encourage him, teach him, restrain him, reward him, and have power over him that he can never achieve over her with all his muscle.” This idea of women working behind the scenes has been very strong in New Zealand where the ‘sternly worded’ letter is favoured over street protest. An acceptable route for women’s activism was working within existing political institutions (Grey), with activity being ‘hidden’ inside government offices such as the Ministry of Women’s Affairs (Schuster, 23). But women’s movement organisations that engage in even the mildest form of disruptive protest are decried (Grey; van Acker).One way women have been accepted into public space is as the moral guardians or change agents of the entire political realm (Bliss; Ginzberg; van Acker; Ledwith). From the early suffrage movements both political actors and media representations highlighted women were more principled and conciliatory than men, and in many cases had a moral compass based on restraint. Cartoons showed women in the suffrage movement ‘sweeping up’ and ‘cleaning house’ (Sheppard 123). Groups like the Women’s Christian Temperance Union were celebrated for protesting against the demon drink and anti-pornography campaigners like Patricia Bartlett were seen as acceptable voices of moral reason (Moynihan). And as Cunnison and Stageman (in Ledwith 193) note, women bring a “culture of femininity to trade unions … an alternative culture, derived from the particularity of their lives as women and experiences of caring and subordination”. This role of moral guardian often derived from women as ‘mothers’, responsible for the physical and moral well-being of the nation.The body itself has been a sight of protest for women including fights for bodily autonomy in their medical decisions, reproductive justice, and to live lives free from physical and sexual abuse, have long been met with criticisms of being unladylike or inappropriate. Early examples decried in NZ include the women’s clothing movement which formed part of the suffrage movement. In the second half of the 20th century it was the freedom trash can protests that started the myth of ‘women burning their bras’ which defied acceptable feminine norms (Sawer and Grey). Recent examples of women protesting for body rights include #MeToo and Time’s Up. Both movements protest the lack of bodily autonomy women can assert when men believe they are entitled to women’s bodies for their entertainment, enjoyment, and pleasure. And both movements have received considerable backlash by those who suggest it is a witch hunt that might ensnare otherwise innocent men, or those who are worried that the real victims are white men who are being left behind (see Garber; Haussegger). Women who advocate for bodily autonomy, including access to contraception and abortion, are often held up as morally irresponsible. As Archdeacon Bullock (cited in Smyth 55) asserted, “A woman should pay for her fun.”Many individuals believe that the stigma and discrimination fat people face are the consequences they sow from their own behaviours (Crandall 892); that fat people are fat because they have made poor decisions, being too indulgent with food and too lazy to exercise (Crandall 883). Therefore, fat people, like women, should have to pay for their fun. Fat women find themselves at this intersection, and are often judged more harshly for their weight than fat men (Tiggemann and Rothblum). Examining Coulter’s tweet with this perspective in mind, it can easily be read as an attempt to put fat girl protestors back into their place. It can also be read as a warning. Don’t go making too much noise or you may be labelled as fat. Presenting troublesome women as fat has a long history within political art and depictions. Marianne (the symbol of the French Republic) was depicted as fat and ugly; she also reinforced an anti-suffragist position (Chenut 441). These images are effective because of our societal views on fatness (Kyrölä). Fatness is undesirable, unworthy of love and attention, and a representation of poor character, lack of willpower, and an absence of discipline (Murray 14; Pausé, “Rebel Heart” para 1).Fat women who protest transgress rules around body size, gender norms, and the appropriate place for women in society. Take as an example the experiences of one of the authors of this piece, Sandra Grey, who was thrust in to political limelight nationally with the Campaign for MMP (Grey and Fitzsimmons) and when elected as the President of the New Zealand Tertiary Education Union in 2011. Sandra is a trade union activist who breaches too many norms set for the “good woman protestor,” as well as the norms for being a “good fat woman”. She looms large on a stage – literally – and holds enough power in public protest to make a crowd of 7,000 people “jump to left”, chant, sing, and march. In response, some perceive Sandra less as a tactical and strategic leader of the union movement, and more as the “jolly fat woman” who entertains, MCs, and leads public events. Though even in this role, she has been criticised for being too loud, too much, too big.These criticisms are loudest when Sandra is alongside other fat female bodies. When posting on social media photos with fellow trade union members the comments often note the need of the group to “go on a diet”. The collective fatness also brings comments about “not wanting to fuck any of that group of fat cows”. There is something politically and socially dangerous about fat women en masse. This was behind the responses to Sandra’s first public appearance as the President of TEU when one of the male union members remarked “Clearly you have to be a fat dyke to run this union.” The four top elected and appointed positions in the TEU have been women for eight years now and both their fatness and perceived sexuality present as a threat in a once male-dominated space. Even when not numerically dominant, unions are public spaces dominated by a “masculine culture … underpinned by the undervaluation of ‘women’s worth’ and notions of womanhood ‘defined in domesticity’” (Cockburn in Kirton 273-4). Sandra’s experiences in public space show that the derision and methods of putting fat girls back in their place varies dependent on whether the challenge to power is posed by a single fat body with positional power and a group of fat bodies with collective power.Fat Girls Are the FutureOn the other side of the world, Tara Vilhjálmsdóttir is protesting to change the law in Iceland. Tara believes that fat people should be protected against discrimination in public and private settings. Using social media such as Facebook and Instagram, Tara takes her message, and her activism, to her thousands of followers (Keller, 434; Pausé, “Rebel Heart”). And through mainstream media, she pushes back on fatphobia rhetoric and applies pressure on the government to classify weight as a protected status under the law.After a lifetime of living “under the oppression of diet culture,” Tara began her activism in 2010 (Vilhjálmsdóttir). She had suffered real harm from diet culture, developing an eating disorder as a teen and being told through her treatment for it that her fears as a fat woman – that she had no future, that fat people experienced discrimination and stigma – were unfounded. But Tara’s lived experiences demonstrated fat stigma and discrimination were real.In 2012, she co-founded the Icelandic Association for Body Respect, which promotes body positivity and fights weight stigma in Iceland. The group uses a mixture of real life and online tools; organising petitions, running campaigns against the Icelandic version of The Biggest Loser, and campaigning for weight to be a protected class in the Icelandic constitution. The Association has increased the visibility of the dangers of diet culture and the harm of fat stigma. They laid the groundwork that led to changing the human rights policy for the city of Reykjavík; fat people cannot be discriminated against in employment settings within government jobs. As the city is one of the largest employers in the country, this was a large step forward for fat rights.Tara does receive her fair share of hate messages; she’s shared that she’s amazed at the lengths people will go to misunderstand what she is saying (Vilhjálmsdóttir). “This isn’t about hurt feelings; I’m not insulted [by fat stigma]. It’s about [fat stigma] affecting the livelihood of fat people and the structural discrimination they face” (Vilhjálmsdóttir). She collects the hateful comments she receives online through screenshots and shares them in an album on her page. She believes it is important to keep a repository to demonstrate to others that the hatred towards fat people is real. But the hate she receives only fuels her work more. As does the encouragement she receives from people, both in Iceland and abroad. And she is not alone; fat activists across the world are using Web 2.0 tools to change the conversation around fatness and demand civil rights for fat people (Pausé, “Rebel Heart”; Pausé, “Live to Tell").Using Web 2.0 tools as a way to protest and engage in activism is an example of oppositional technologics; a “political praxis of resistance being woven into low-tech, amateur, hybrid, alternative subcultural feminist networks” (Garrison 151). Fat activists use social media to engage in anti-assimilationist activism and build communities of practice online in ways that would not be possible in real life (Pausé, “Express Yourself” 1). This is especially useful for those whose protests sit at the intersections of oppressions (Keller 435; Pausé, “Rebel Heart” para 19). Online protests have the ability to travel the globe quickly, providing opportunities for connections between protests and spreading protests across the globe, such as SlutWalks in 2011-2012 (Schuster 19). And online spaces open up unlimited venues for women to participate more freely in protest than other forms (Harris 479; Schuster 16; Garrison 162).Whether online or offline, women are represented as dangerous in the political sphere when they act without male champions breaching norms of femininity, when their involvement challenges the role of woman as moral guardians, and when they make the body the site of protest. Women must ‘do politics’ politely, with utmost control, and of course caringly; that is they must play their ‘designated roles’. Whether or not you fit the gendered norms of political life affects how your protest is perceived through the media (van Acker). Coulter’s tweet loudly proclaimed that the fat ‘girls’ protesting the election of the 45th President of the United States were unworthy, out of control, and not worthy of attention (ironic, then, as her tweet caused considerable conversation about protest, fatness, and the reasons not to like the President-Elect). What the Coulter tweet demonstrates is that fat women are perceived as doubly-problematic in public space, both as fat and as women. They do not do politics in a way that is befitting womanhood – they are too visible and loud; they are not moral guardians of conservative values; and, their bodies challenge masculine power.ReferencesAgenda Feminist Media Collective. “Women in Society: Public Debate.” Agenda: Empowering Women for Gender Equity 10 (1991): 31-44.Bay, Kivan. “How Nazis Use Fat to Excuse Violence.” Medium, 7 Feb. 2018. 1 May 2018 <https://medium.com/@kivabay/how-nazis-use-fat-to-excuse-violence-b7da7d18fea8>.———. “Without Fat Girls, There Would Be No Protests.” Bullshit.ist, 13 Nov. 2016. 16 May 2018 <https://bullshit.ist/without-fat-girls-there-would-be-no-protests-e66690de539a>.Bliss, Katherine Elaine. Compromised Positions: Prostitution, Public Health, and Gender Politics in Revolutionary Mexico City. Penn State Press, 2010.Caha, Omer. Women and Civil Society in Turkey: Women’s Movements in a Muslim Society. London: Ashgate, 2013.Caron, Christina. “Heather Heyer, Charlottesville Victim, Is Recalled as ‘a Strong Woman’.” New York Times, 13 Aug. 2017. 1 May 2018 <https://www.nytimes.com/2017/08/13/us/heather-heyer-charlottesville-victim.html>.Chenut, Helen. “Anti-Feminist Caricature in France: Politics, Satire and Public Opinion, 1890-1914.” Modern & Contemporary France 20.4 (2012): 437-452.Crandall, Christian S. "Prejudice against Fat People: Ideology and Self-Interest." Journal of Personality and Social Psychology 66.5 (1994): 882-894.Damousi, Joy. “Representations of the Body and Sexuality in Communist Iconography, 1920-1955.” Australian Feminist Studies 12.25 (1997): 59-75.Dean, Marge, and Shirl Buss. “Fat Underground.” YouTube, 11 Aug. 2016 [1975]. 1 May 2018 <https://youtu.be/UPYRZCXjoRo>.Fountaine, Susan. “Women, Politics and the Media: The 1999 New Zealand General Election.” PhD thesis. Palmerston North, NZ: Massey University, 2002.Freespirit, Judy, and Aldebaran. “Fat Liberation Manifesto November 1973.” The Fat Studies Reader. Eds. Esther Rothblum and Sondra Solovay. New York: NYU P, 2009. 341-342.Garber, Megan. “The Selective Empathy of #MeToo Backlash.” The Atlantic, 11 Feb 2018. 5 Apr. 2018 <https://www.theatlantic.com/entertainment/archive/2018/02/the-selective-empathy-of-metoo-backlash/553022/>.Garrison, Edith. “US Feminism – Grrrl Style! Youth (Sub)Cultures and the Technologics of the Third Wave.” Feminist Studies 26.1 (2000): 141-170.Garvey, Nicola. “Violence against Women: Beyond Gender Neutrality.” Looking Back, Moving Forward: The Janus Women’s Convention 2005. Ed. Dale Spender. Masterton: Janus Trust, 2005. 114-120.Ginzberg, Lori D. Women and the Work of Benevolence: Morality, Politics, and Class in the Nineteenth-Century United States. Yale UP, 1992.Grey, Sandra. “Women, Politics, and Protest: Rethinking Women's Liberation Activism in New Zealand.” Rethinking Women and Politics: New Zealand and Comparative Perspectives. Eds. John Leslie, Elizabeth McLeay, and Kate McMillan. Victoria UP, 2009. 34-61.———, and Matthew Fitzsimons. “Defending Democracy: ‘Keep MMP’ and the 2011 Electoral Referendum.” Kicking the Tyres: The New Zealand General Election and Electoral Referendum of 2011. Eds. Jon Johansson and Stephen Levine. Victoria UP, 2012. 285-304.———, and Marian Sawer, eds. Women’s Movements: Flourishing or in Abeyance? London: Routledge, 2008.Harris, Anita. “Mind the Gap: Attitudes and Emergent Feminist Politics since the Third Wave.” Australian Feminist Studies 25.66 (2010): 475-484.Haussegger, Virginia. “#MeToo: Beware the Brewing Whiff of Backlash.” Sydney Morning Herald, 7 Mar. 2018. 1 Apr. 2018 <https://www.smh.com.au/national/metoo-beware-the-brewing-whiff-of-backlash-20180306-p4z33s.html>.Keller, Jessalynn. “Virtual Feminisms.” Information, Communication and Society 15.3(2011): 429-447.Kirston, Gill. “From ‘a Woman’s Place Is in Her Union’ to ‘Strong Unions Need Women’: Changing Gender Discourses, Policies and Realities in the Union Movement.” Labour & Industry: A Journal of the Social and Economic Relations of Work 27.4 (2017): 270-283.Kyrölä, Katariina. The Weight of Images. London: Routledge, 2014.Ledwith, Sue. “Gender Politics in Trade Unions: The Representation of Women between Exclusion and Inclusion.” European Review of Labour and Research 18.2 (2012): 185-199.Lyndsey, Susan. Women, Politics, and the Media: The 1999 New Zealand General Election. Dissertation. Massey University, 2002.Maddison, Sarah, and Sean Scalmer. Activist Wisdom: Practical Knowledge and Creative Tension in Social Movements. Sydney: UNSW P, 2006. Moynihan, Carolyn. A Stand for Decency: Patricia Bartlett & the Society for Promotion of Community Standards, 1970-1995. Wellington: The Society, 1995.Murray, Samantha. "Pathologizing 'Fatness': Medical Authority and Popular Culture." Sociology of Sport Journal 25.1 (2008): 7-21.Pausé, Cat. “Live to Tell: Coming Out as Fat.” Somatechnics 21 (2012): 42-56.———. “Express Yourself: Fat Activism in the Web 2.0 Age.” The Politics of Size: Perspectives from the Fat-Acceptance Movement. Ed. Ragen Chastain. Praeger, 2015. 1-8.———. “Rebel Heart: Performing Fatness Wrong Online.” M/C Journal 18.3 (2015).Rowland, Robyn, ed. Women Who Do and Women Who Don’t Join the Women’s Movement. London: Routledge, 1984.Schuster, Julia. “Invisible Feminists? Social Media and Young Women’s Political Participation.” Political Science 65.1 (2013): 8-24.Sheppard, Alice. "Suffrage Art and Feminism." Hypatia 5.2 (1990): 122-136.Simic, Zora. “Fat as a Feminist Issue: A History.” Fat Sex: New Directions in Theory and Activism. Eds. Helen Hester and Caroline Walters. London: Ashgate, 2015. 15-36.Spangler, Todd. “White-Supremacist Site Daily Stormer Booted by Hosting Provider.” Variety, 13 Aug. 2017. 1 May 2018 <https://variety.com/2017/digital/news/daily-stormer-heather-heyer-white-supremacist-neo-nazi-hosting-provider-1202526544/>.Smyth, Helen. Rocking the Cradle: Contraception, Sex, and Politics in New Zealand. Steele Roberts, 2000.Tiggemann, Marika, and Esther D. Rothblum. "Gender Differences in Social Consequences of Perceived Overweight in the United States and Australia." Sex Roles 18.1-2 (1988): 75-86.Van Acker, Elizabeth. “Media Representations of Women Politicians in Australia and New Zealand: High Expectations, Hostility or Stardom.” Policy and Society 22.1 (2003): 116-136.Vilhjálmsdóttir, Tara. Personal interview. 1 June 2018.

04–573 Akker, Evelien (Nijmegen U., The Netherlands; Email: e.akker@nici.kun.nl) and Cutler, Anne. Prosodic cues to semantic structure in native and non-native listening. Bilingualism: Language and Cognition (Cambridge, UK), 6, 2 (2003), 81–96.04–574 Allen, Heather W. (University of Pittsburgh) and Herron, Carol A. mixed-methodology investigation of the linguistic and affective outcomes of summer study abroad. Foreign Language Annals (New York, USA), 36, 3 (2003), 370–385.04–575 Barcroft, Joe (Washington U., MO, USA; Email: barcroft@artsci.wustl.edu). Effects of questions about word meaning during L2 Spanish lexical learning. The Modern Language Journal (Madison, WI, USA), 87, 4 (2003), 546–561.04–576 Boehlke, Olaf (Creighton U., USA; Email: bohlke@creighton.edu). A comparison of student participation levels by group size and language stages during chatroom and face-to-face discussions in German. Calico Journal (Texas, USA), 21, 1 (2003), 67–87.04–577 Brandford, Verna and Wilson, Rebecca (Institute of Education, U. of London). Using PowerPoint to develop pupils' oral skills in modern foreign languages. Francophonie (London, UK), 28 (2003), 18–24.04–578 Brouwer, Catherine E. (U. of Southern Denmark, Denmark; Email: rineke@language.sdu.dk). Word searches in NNS-NS interaction: opportunities for language learning?The Modern Language Journal (Madison, WI, USA), 87, 4 (2003), 534–545.04–579 Carr, Jo (Queensland U. of Technology, Australia; Email: j.carr@qut.edu.au). Why boys into languages won't go: the problematic gender agenda in languages education. Babel, (Adelaide, Australia), 37, 2 (2002), 4–9.04–580 Chalhoub-Deville, Micheline (U. of Iowa, USA; Email: m-chalhoub-deville@uiowa.edu). Second language interaction: current perspectives and future trends. Language Testing (London, UK), 20, 4 (2003), 369–383.04–581 Chan, Victoria, Spratt, Mary and Humphreys, Gillian (Hong Kong Polytechnic U., Hong Kong). Autonomous language learning: Hong Kong tertiary students' attitudes and behaviours. Evaluation and Research in Education (Clevedon, UK), 16, 1 (2002), 1–16.04–582 Dam Jensen, Eva and Vinther, Thora (University of Copenhagen, Denmark; Email: dam@hum.ku.dk.). Exact repetition as input enhancement in second language acquisition. Language Learning (University of Michigan, USA), 53, 3 (2003), 373–428.04–583 De Carlo, Maddalena (Université de Cassino, Italy). Affectivité et acquisition du langage. [Affectivity and Language Acquisition.] Études de linguistique appliquée (Paris, France), 13, 1 (2003), 275–290.04–584 Derwing, Tracey M. (Alberta U., Canada) and Rossiter, Marian J. The effects of pronunciation instruction on the accuracy, fluency and complexity of L2 accented speech. Applied Language Learning (Monterey, CA, USA), 13, 1 (2003), 1–18.04–585 Dykstra-Pruim, Pennylyn (Calvin College, MI, USA). L2 acquisition of German plurals: how students form them and textbooks teach them. Die Unterrichtspraxis (Cherry Hill, NJ, USA), 36, 1 (2003), 43–55.04–586 Eckman, Fred (University of Wisconsin, USA; Email: eckman@uwm.edu), Elreyes, Abdullah and Iverson, Gregory. Some principles of second language phonology. Second Language Research (London, UK), 19, 3 (2003), 169–208.04–587 Egbert, Joy (Washington State U., USA; Email: jegbert@wsu.edu). A study of flow theory in the foreign language classroom. The Modern Language Journal (Madison, WI, USA), 87, 4 (2003), 499–518.04–588 Ehrman, Madeline (Foreign Service Institute, US Dept of State, Washington DC, USA; Email: ehrmann@aol.com) and Leaver, Betty Lou. Cognitive styles in the service of language learning. System, 31, 3 (2003), (Oxford), 393–415.04–589 Felser, Claudia (U. of Essex, UK; Email: felsec@essex.ac.uk), Roberts, Leah, Gross, Rebecca and Marinis, Theodore. The processing of ambiguous sentences by first and second language learners of English. Applied Psycholinguistics (Cambridge, UK), 24, 3 (2003), 453–490.04–590 Gass, Susan (Michigan State University, USA; Email: gass@msu.edu) and Svetics, Ildikó. Differential effects of attention. Language Learning (Michigan, USA), 53, 3 (2003), 497–545.04–591 Griffiths, Carol (Auckland Institute of Studies, Auckland, New Zealand; Email: carolg@ais.ac.nz). Patterns of language learning strategy use. System, (Oxford, UK), 31, 3 (2003), 367–383.04–592 Hertel, Tammy J. (Department of World Languages and Cultures, Juniata College, USA; Email: hertel@juniata.edu) Lexical and discourse factors in the second language acquisition of Spanish word order. Second Language Research (London, England), 19, 4 (2003), 273–304.04–593 Hertel, Tammy J. (Juniata College). Using an e-mail exchange to promote cultural learning. Foreign Language Annals (New York, USA), 36, 3 (2003), 386–396.04–594 Hu, Chieh-Fang (Taipei Municipal Teachers College, Taiwan; Email: cfhu@mail1.tmtc.edu.tw). Phonological memory, phonological awareness and foreign language word learning. Language Learning (University of Michigan, USA), 53, 3 (2003), 429–462.04–595 Izumi, Shinichi (Sophia University, Japan; Email: s-izumi@sophia.ac.jp). Processing difficulty in comprehension and production of relative clauses by learners of English as a second language. Language Learning (Michigan, USA), 53, 2 (2003), 285–323.04–596 Jones, Linda, J. (U. of Arkansas, USA; Email: lcjones@uark.edu). Supporting listening comprehension and vocabulary acquisition with multimedia annotation: the students' voice. Calico Journal (San Marcos Tex. USA), 21, 1 (2003), 41–65.04–597 Jung, Euen Hyuk (Sarah) (Yonsei U., South Korea; Email: jungehs@hotmail.com). The role of discourse signaling cues in second language listening comprehension. The Modern Language Journal (Madison, WI, USA), 87, 4 (2003), 562–577.04–598 Knutson, Sonja (Memorial U., Newfoundland, Canada). Experiential learning in second-language classrooms. TESL Canada Journal (Burnaby, B.C., Canada), 20, 2 (2003), 53–64.04–599 Littlemore, Jeannette (U. of Birmingham, UK). The communicative effectiveness of different types of communication strategy. System, (Oxford, UK), 31, 3 (2003), 331–34704–600 McCollum, Daniel L. (Pennsylvania State U., USA). Utilizing non-cognitive predictors of foreign language achievement. Applied Language Learning (Monterey, CA, USA), 13, 1 (2003), 19–32.04–601 Morris, Frank (University of Miami, USA; Email: fmorris@miami.edu.) and Tarone, Elaine. Impact of classroom dynamics on the effectiveness of recasts in second language acquisition. Language Learning (University of Michigan, USA), 53, 2 (2003), 325–368.04–602 Ntirampeba, Pascal (Université de Montréal, Québec, Canada). La progression en didactique du texte argumentatif écrit. [Progressive approach to written argumentative text.] Révue Canadienne de Linguistique Appliquée, 6, 2 (2003), 159–169.04–603 Parkinson, Brian, Benson, Cathy and Jenkins, Michael (U. of Edinburgh, Scotland, UK). Learner diary research with ‘Cambridge' examination candidates. Edinburgh Working Papers in Applied Linguistics (Edinburgh, Scotland, UK), 12 (2003), 45–63.04–604 Pérez, Luisa, C. (Emporia State U., USA; Email: perezlui@emporia.edu). Foreign language productivity in synchronous versus asynchronous computer-mediated communication. Calico Journal (Texas, USA), 21, 1 (2003), 89–104.04–605 Pulido, Diana (Washington State University, USA; Email: dpulido@wsu.edu.). Modeling the role of second language proficiency and topic familiarity in second language incidental vocabulary acquisition through reading. Language Learning (University of Michigan, USA), 53, 2 (2003), 233–284.04–606 Sasaki, Yoshinori (Ochanomizu U., Japan) and Hayakawa, Harumi. Does a quiz facilitate or spoil language learning? Instructional effects of lesson review quizzes. Applied Language Learning (Monterey, CA, USA), 13, 1 (2003), 33–56.04–607 Seus-Walker, Katia (IUT-Université de Toulouse III, France). Pour développer l'autonomie des apprenants. [Developing learner autonomy.] Les Cahiers de l'APLIUT, XXII, 2 (2003), 43–58.04–608 Sparks, Richard L. (College of Mount St. Joseph, Cincinnati, Ohio) Philips, Lois and Javorsky, James. College students classified as having learning disabilities and attention deficit hyperactivity disorder and the foreign language requirement. Foreign Language Annals (New York, USA), 36, 3 (2003), 325–337.04–609 Stotz, Daniel and Meuter, Tessa (Zürcher Hochschule Winterthur, Switzerland; Email: daniel.stotz@zhwin.ch). Embedded English: integrating content and language learning in a Swiss primary school project. Bulletin suisse de linguistique appliquée (Neuchâtel, Switzerland), 77 (2003), 83–101.04–610 Takeuchi, Osamu (Kansai U., Osaka, Japan; Email: takeuchi@ipcku.kansai-u.ac.jp). What can we learn from good foreign language learners? A qualitative study in the Japanese foreign language context. System, (Oxford, UK), 31, 3 (2003), 385–392.04–611 Vandergrift, Larry (University of Ottawa, Canada; Email: lvdgrift@uottawa.ca). Orchestrating strategy use: toward a model of the skilled second language listener. Language Learning (University of Michigan, USA), 53, 3 (2003), 463–496.04–612 Vann, Roberta J. (Iowa State U., USA) and Fairbairn, Shelley B. Linking our worlds: a collaborative academic literacy project. TESOL Journal (Alexandria, VA, USA), 12, 3 (2003), 11–16.04–613 Verspoor, Marjolijn and Lowie, Wander (University of Groningen, The Netherlands). Making sense of polysemous words. Language Learning (University of Michigan, USA), 53, 3 (2003), 547–586.04–614 Weldon, A. and Trautmann, G. (U. of North Carolina-Asheville, USA). Spanish and service-learning: pedagogy and praxis. Hispania (Ann Arbor, USA), 86, 3 (2003), 574–585.04–615 Wen, W. P. (Xiangtan U., Hunan, P.R. of China lw@xtu.edu.com) and Clément, R. A Chinese conceptualisation of willingness to communicate in ESL. Language, Culture and Curriculum, (Clevedon, UK) 16, 1 (2003), 18–38.04–616 Yeh, Yuli and Wang, Chai-wei. (National Tsing Hua U., Taiwan; Email: ylyeh@mx.nthu.edu.tw). Effects of multimedia vocabulary annotations and learning styles on vocabulary learning. Calico Journal (Texas, USA), 21, 1 (2003), 131–144.04–617 Yuet Hung Chan, C. (City U. of Hong Kong; Email: ctcych@cityu.edu.hk). Cultural content and reading proficiency: a comparison of mainland Chinese and Hong Kong learners of English. Language, Culture and Curriculum, (Clevedon, UK) 16, 1 (2003), 60–69.04–618 Zsiga, Elizabeth (Georgetown University, USA; Email: zsigae@georgetown.edu). Articulatory timing in a second language – evidence from Russian and English. Studies in Second Language Acquisition (New York, USA), 25, 3 (2003), 399–432.04–619 Zughoul, Muhammed Raji and Abdul-Fattah, Hussein (Yarmouk U., Jordan). Translational collocational strategies of Arab learners of English: a study in lexical semantics. Babel (Amsterdam, The Netherlands), 49, 1 (2003), 59–81.

IntroductionMusicians and critics regard Australian jazz as vibrant and creative (Shand; Chessher; Rechniewski). From its tentative beginnings in the early twentieth century (Whiteoak), jazz has become a major aspect of Australia’s music and performance. Due to the large distances separating cities and towns, its development has been influenced by geographical isolation (Nikolsky; Chessher; Clare; Johnson; Stevens; McGuiness). While major cities have been the central hubs, it is increasingly acknowledged that regional centres also provide avenues for jazz performance (Curtis).This article discusses findings relating to transient musical populations shaped by geographical conditions, venue issues that are peculiar to the Northern region, and finally the challenges of cultural and parochial mindsets that North Queensland jazz musicians encounter in performance.Cairns and MackayCairns and Mackay are regional centres on the coast of Queensland, Australia. Cairns – population 156,901 in 2016 (ABS) – is a world famous tourist destination situated on the doorstep of the Great Barrier Reef (Thorp). Mackay – population 114,969 in 2016 (ABS) – is a lesser-known community with an economy largely underpinned by the sugar cane and coal mining industries (Rolfe et al. 138). Both communities lie North of the capital city Brisbane – Mackay in the heart of Central Queensland, and Cairns as the unofficial capital of Far North Queensland. Mackay and Cairns were selected for this study, not on representational grounds, but because they provide an opportunity to learn through case studies. Stake notes that “potential for learning is a different and sometimes superior criterion to representativeness,” adding, “that may mean taking the one most accessible or the one we can spend the most time with (451).”Musically, both regional centres have a number of venues that promote live music, however, only Cairns has a dedicated jazz club, the Cairns Jazz Club (CJC). Each has a community convention centre that brings high-calibre touring musicians to the region, including jazz musicians.Mackay is home to the Central Queensland Conservatorium of Music (CQCM) a part of the Central Queensland University that has offered conservatoire-style degree programs in jazz, contemporary music and theatre for over twenty-five years. Cairns does not have any providers of tertiary jazz qualifications.MethodologySemi-structured in-depth interviews were conducted with twenty-two significant individuals associated with the jazz communities in Mackay and Cairns over a twelve-month period from 2015 to 2016. Twelve of the interviewees were living in Cairns at the time, and ten were living in Mackay. The selection of interviewees was influenced by personal knowledge of key individuals, historical records located at the CQCM, and from a study by (Mitchell), who identified important figures in the Cairns jazz scene. The study participants included members of professional jazz ensembles, dedicated jazz audience members and jazz educators. None of the participants who were interviewed relied solely on the performance of jazz as their main occupation. All of the musicians combined teaching duties with music-making in several genres including rock, jazz, Latin and funk, as well as work in the recording and producing of recorded music. Combining the performance of jazz and commercial musical styles is a common and often crucial part of being a musician in a regional centre due to the low demand for any one specific genre (Luckman et al. 630). The interview data that was gathered during the study’s data collection phase was analysed for themes using the grounded theory research method (Charmaz). The following sections will discuss three areas of findings relating to some of the unique North Queensland influences that have impacted the development and sustainability of the two regional jazz communities.Transient Musical PopulationsThe prospect of living in North Queensland is an alluring proposition for many people. According to the participants in this study, the combination of work and a tropical lifestyle attracts people from all over the country to Cairns and Mackay, but this influx is matched by a high population turnover. Many musicians who move into the region soon move away again. High population turnover is a characteristic of several Northern regional centres such as the city of Darwin (Luckman, Gibson and Lea 12). The high growth and high population turnover in Cairns, in particular, was one of the highest in the country between 2006 and 2011 (ABS). The study participants in both regions believed that the transient nature of the local population is detrimental to the development and sustainability of the jazz communities. One participant described the situation in Cairns this way: “The tropics sort of lure them up there, tease them with all of the beauty and nature, and then spit them out when they realise it’s not what they imagined (interviewee 1, 24 Aug. 2016).” Looking more broadly to other coastal regional areas of Australia, there is evidence of the counter-urban flow of professionals and artists seeking out a region’s “natural and cultural environment” (Gibson 339). On the far North coast of New South Wales, Gibson examined how the climate, natural surroundings and cultural charms attracted city dwellers to that region (337). Similarly, most of the participants in this study mentioned lifestyle choices such as raising a family and living in the tropics as reasons to move to Cairns or Mackay. The prospect of working in the tourism and hospitality industry was found to be another common reason for musicians to move to Cairns in particular. In contrast to some studies (Salazar; Conradson and Latham) where it was found that the middle- to upper-classes formed the majority of lifestyle migrants, the migrating musicians identified by this study were mostly low-income earners seeking a combination of music work and other types of employment outside the music industry. There have been studies that have explored and critically reviewed the theoretical frameworks behind lifestyle migration (Benson and Osbaldiston) including the examination of issues and the motivation to ‘lifestyle migrate’. What is interesting in this current study is the focus of discussion on the post-migration effects. Study participants believe that most of the musicians who move into their region leave soon afterwards because of their disillusionment with the local music industry. Despite the lure of musical jobs through the tourism and hospitality industry, local musicians in Cairns tend to believe there is less work than imagined. Pub rock duos and DJs have taken most of the performance opportunities, which makes it hard for new musicians to compete.The study also reveals that Cairns jazz musicians consider it more difficult to find and collaborate with quality newcomers. This may be attributed to the smaller jazz communities’ demand for players of specific instruments. One participant explained, “There’s another bass player that just moved here, but he only plays by ear, so when people want to play charts and new songs, he can’t do it so it's hard finding the right guys up here at times (interviewee 2, 23 Aug. 2016).” Cairns and Mackay participants agreed that the difficulty of finding and retaining quality musicians in the region impacted on the ability of certain groups to be sustainable. One participant added, “It’s such a small pool of musicians, at the moment, I've got a new project ready to go and I've got two percussionists, but I need a bass player, but there is no bass player that I'm willing to work with (interviewee 3, 24 Aug. 2016).” The same participant has been fortunate over the years, performing with a different local group whose members have permanently stayed in the Cairns region, however, forging new musical pathways and new groups seemed challenging due to the lack of musical skills in some of the potential musicians.In Mackay, the study revealed a smaller influx of new musicians to the region, and study participants experienced the same difficulties forming groups and retaining members as their Cairns counterparts. One participant, who found it difficult to run a Big Band as well as a smaller jazz ensemble because of the transient population, claimed that many local musicians were lured to metropolitan centres for university or work.Study participants in both Northern centres appeared to have developed a tolerance and adaptability for their regional challenges. While this article does not aim to suggest a solution to the issues they described, one interesting finding that emerged in both Cairns and Mackay was the musicians’ ability to minimise some of the effects of the transient population. Some musicians found that it was more manageable to sustain a band by forming smaller groups such as duos, trios and quartets. An example was observed in Mackay, where one participant’s Big Band was a standard seventeen-piece group. The loss of players was a constant source of anxiety for the performers. Changing to a smaller ensemble produced a sense of sustainability that satisfied the group. In Cairns, one participant found that if the core musicians in the group (bass, drums and vocals) were permanent local residents, they could manage to use musicians passing through the region, which had minimal impact on the running of the group. For example, the Latin band will have different horn players sit in from time to time. When those performers leave, the impact on the group is minimal because the rhythm section is comprised of long-term Cairns residents.Venue Conditions Heat UpAt the Cape York Hotel in Cairns, musicians and audience members claimed that it was uncomfortable to perform or attend Sunday afternoon jazz gigs during the Cairns summer due to the high temperatures and non air-conditioned venues. This impact of the physical environment on the service process in a venue was first modelled and coined the ‘Servicescape’ by Bitner (57). The framework, which includes physical dimensions like temperature, noise, space/function and signage, has also been further investigated in other literature (Minor et al.; Kubacki; Turley and Fugate). This model is relevant to this study because it clearly affects the musician’s ability to perform music in the Northern climate and attract audiences. One of the regular musicians at the Cape York Hotel commented: So you’re thinking, ‘Well, I’m starting to create something here, people are starting to show up’, but then you see it just dwindling away and then you get two or three weeks of hideously hot weather, and then like last Sunday, by the time I went on in the first set, my shirt was sticking to me like tissue paper… I set up a gig, a three-hour gig with my trio, and if it’s air conditioned you’re likely to get people but if it’s like the Cape York, which is not air conditioned, and you’re out in the beer garden with a tin roof over the top with big fans, it’s hideous‘. (Interviewee 4, 24 Aug. 2016)The availability of venues that offer live jazz is limited in both regions. The issue was twofold: firstly, the limited availability of a larger venue to cater for the ensembles was deemed problematic; and secondly, the venue manager needed to pay for the services of the club, which contributed to its running costs. In Cairns, the Cape York Hotel has provided the local CJC with an outdoor beer garden as a venue for their regular Sunday performances since 2015. The president of the CJC commented on the struggle for the club to find a suitable venue for their musicians and patrons. The club has had residencies in multiple venues over the last thirty years with varying success. It appears that the club has had to endure these conditions in order to provide their musicians and audiences an outlet for jazz performance. This dedication to their art form and sense of resilience appears to be a regular theme for these Northern jazz musicians.Minor et al. (7) recommended that live music organisers needed to consider offering different physical environments for different events (7). For example, a venue that caters for a swing band might include a dance floor for potential dancers or if a venue catered for a sit down jazz show, the venue might like to choose the best acoustic environment to best support the sound of the ensemble. The research showed that customers have different reasons for attending events, and in relation to the Cape York Hotel, the majority of the customers were the CJC members who simply wanted to enjoy their jazz club performances in an air conditioned environment with optimal acoustics as the priority. Although not ideal, the majority of the CJC members still attended during the summer months and endured the high temperatures due to a lack of venue suitability.Parochial MindsetsOne of the challenging issues faced by many of the participants in both regions was the perceived cultural divide between jazz aficionados and general patrons at many venues. While larger centres in Australia have enjoyed an international reputation as creative hubs for jazz such as Melbourne and Sydney (Shand), the majority of participants in this study believed that a significant portion of the general public is quite parochial in their views on various musical styles including jazz. Coined the ‘bogan factor’, one participant explained, “I call it the bogan factor. Do you think that's an academic term? It is now” (interviewee 5, 17 Feb. 2016). They also commented on dominant cultural choices of residents in these regions: “It's North Queensland, it's a sport orientated, 4WD dominated place. Culturally they are the main things that people are attracted to” (interviewee 5, 17 Feb. 2016). These cultural preferences appear to affect the performance opportunities for the participants in Cairns and Mackay.Waitt and Gibson explored how the Wollongong region was chosen as an area for investigation to see if city size mattered for creativity and creativity-led regeneration (1224). With the ‘Creative Class’ framework in mind (Florida), the researchers found that Wollongong’s primarily blue-collar industrial identity was a complex mixture of cultural pursuits including the arts, sport and working class ideals (Waitt and Gibson 1241). This finding is consistent with the comments of study participants from Cairns and Mackay who believed that the identities of their regions were strongly influenced by sport and industries like mining and farming. One Mackay participant added, “I think our culture, in itself, would need to change to turn more people to jazz. I can’t see that happening. That’s Australia. You’re fighting against 200 years of sport” (interviewee 6, 12 Feb. 2016). Performing in Mackay or Cairns in venues that attract various demographics can make it difficult for musicians playing jazz. A Cairns participant added, “As Ingrid James once told me, ‘It's North Queensland, you’ve got an audience of tradesman, they don't get it’. It's silly to think it's going to ever change” (interviewee 7, 26 Aug. 2016). One Mackay participant believed that the lack of appreciation for jazz in regional areas was largely due to a lack of exposure to the art form. Most people grow up listening to other styles of music in their households.Another participant made the point that regardless of the region’s cultural and leisure-time preferences, if a jazz band is playing in a football club, you must expect it to be unpopular. Many of the research participants emphasised that playing in a suitable venue is paramount for developing a consistent and attentive audience. Choosing a venue that values and promotes the style of jazz music that the musicians are performing could help to attract more jazz fans and therefore build a sustainable jazz community.Refreshingly, this study revealed that musicians in both regions showed considerable resilience in dealing with the issue of parochial mindsets, and they have implemented methods to help educate their audiences. The audience plays a significant part in the development and future of a jazz community (Becker; Martin). For the Central Queensland Conservatorium of Music in Mackay, part of the ethos of the institution is to provide music performance and educational opportunities to the region. One of the lecturers who made a significant contribution to the design of the ensemble program had a clear vision to combine jazz and popular music styles in order to connect with a regional audience. He explained, “The popular music strand of the jazz program and what we called the commercial ensembles was very much birthed out of that concept of creating a connection with the community and making us more accessible in the shortest amount of time, which then enabled us to expose people to jazz” (interviewee 8, 20 Mar. 2016).In a similar vein, several Cairns musicians commented on how they engaged with their audiences through education. Some musicians attempted to converse with the patrons on the comparative elements of jazz and non-jazz styles, which helped to instil some appreciation in patrons with little jazz knowledge. One participant cited that although not all patrons were interested in an education at a pub, some became regular attendees and showed greater appreciation for the different jazz styles. These findings align with other studies (Radbourne and Arthurs; Kubacki; Kubacki et al.), who found that audiences tend to return to arts organizations or events more regularly if they feel connected to the experience (Kubacki et al. 409).ConclusionThe Cairns and Mackay jazz musicians who were interviewed in this study revealed some innovative approaches for sustaining their art form in North Queensland. The participants discussed creative solutions for minimising the influence of a transient musician population as well as overcoming some of the parochial mindsets in the community through education. The North Queensland summer months proved to be a struggle for musicians and audience members alike in Cairns in particular, but resilience and commitment to the music and the social network of jazz performers seemed to override this obstacle. Although this article presents just a subset of the findings from a study of the development and sustainability of the jazz communities in Mackay and Cairns, it opens the way for further investigation into the unique issues faced. Deeper understanding of these issues could contribute to the ongoing development and sustainability of jazz communities in regional Australia.ReferencesAustralian Bureau of Statistics. "Mackay (Statistical Area 2), Cairns (R) (Statistical Local Area), Census 2016." Canberra: Australian Bureau of Statistics.———. "Perspectives on Regional Australia: Population Growth and Turnover in Local Government Areas (Lgas), 2006-2011." Canberra: Australian Bureau of Statistics.Becker, H. Art Worlds. Berkeley, CA: University of California Press, 1982.Benson, Michaela, and Nick Osbaldiston. "Toward a Critical Sociology of Lifestyle Migration: Reconceptualizing Migration and the Search for a Better Way of Life." The Sociological Review 64.3 (2016): 407-23.Bitner, Mary Jo. "Servicescapes: The Impact of Physical Surroundings on Customers and Employees." The Journal of Marketing (1992): 57-71. Charmaz, K. Constructing Grounded Theory. 2nd ed. Thousand Oaks, California: Sage, 2014. Chessher, A. "Australian Jazz Musician-Educators: An Exploration of Experts' Approaches to Teaching Jazz." Sydney: University of Sydney, 2009. Clare, J. Bodgie Dada and the Cult of Cool: Jazz in Australia since the 1940s. Sydney: University of New South Wales Press, 1995. Conradson, David, and Alan Latham. "Transnational Urbanism: Attending to Everyday Practices and Mobilities." Journal of Ethnic and Migration Studies 31.2 (2005): 227-33. Curtis, Rebecca Anne. "Australia's Capital of Jazz? The (Re)creation of Place, Music and Community at the Wangaratta Jazz Festival." Australian Geographer 41.1 (2010): 101-16. Florida, Richard. The Rise of the Creative Class: And How It’s Transforming Work, Leisure, Community and Everyday Life. Melbourne, Victoria: Pluto Press Australia, 2003. Gibson, Chris. "Migration, Music and Social Relations on the NSW Far North Coast." Transformations 2 (2002): 1-15. ———. "Rural Transformation and Cultural Industries: Popular Music on the New South Wales Far North Coast." Australian Geographical Studies 40.3 (2002): 337-56. Johnson, Bruce. The Inaudible Music: Jazz, Gender and Australian Modernity. Strawberry Hills, NSW: Currency Press, 2000. Kubacki, Krzysztof. "Jazz Musicians: Creating Service Experience in Live Performance." International Journal of Contemporary Hospitality Management 20.4 (2008): 401- 13. ———, et al. "Comparing Nightclub Customers’ Preferences in Existing and Emerging Markets." International Journal of Hospitality Management 26.4 (2007): 957-73. Luckman, S., et al. "Life in a Northern (Australian) Town: Darwin's Mercurial Music Scene." Continuum: Journal of Media & Cultural Studies 22.5 (2008): 623-37. ———, Chris Gibson, and Tess Lea. "Mosquitoes in the Mix: How Transferable Is Creative City Thinking?" Singapore Journal of Tropical Geography 30.1 (2009): 70-85. Martin, Peter J. "The Jazz Community as an Art World: A Sociological Perspective." Jazz Research Journal 2.1 (2005): 5-13. McGuiness, Lucian. "A Case for Ethnographic Enquiry in Australian Jazz." Sydney: University of Sydney, 2010.Minor, Michael S., et al. "Rock On! An Elementary Model of Customer Satisfaction with Musical Performances." Journal of Services Marketing 18.1 (2004): 7-18. Mitchell, A. "Jazz on the Far North Queensland Resort Circuit: A Musician's Perspective." Proceedings of the History & Future of Jazz in the Asia-Pacific Region. Eds. P. Hayward and G. Hodges. Vol. 1. Hamilton Island, Australia: Central Queensland Conservatorium of Music, 2004. Nikolsky, T. "The Development of the Australian Jazz Real Book." Melbourne: RMIT University, 2012. Radbourne, Jennifer, and Andy Arthurs. "Adapting Musicology for Commercial Outcomes." 9th International Conference on Arts and Cultural Management (AIMAC 2007), 2007.Rechniewski, Peter. The Permanent Underground: Australian Contemporary Jazz in the New Millennium. Platform Papers 16. Redfern, NSW: Currency House, 2008. Rolfe, John, et al. "Lessons from the Social and Economic Impacts of the Mining Boom in the Bowen Basin 2004-2006." Australasian Journal of Regional Studies 13.2 (2007): 134-53. Salazar, Noel B. "Migrating Imaginaries of a Better Life … until Paradise Finds You." Understanding Lifestyle Migration. Springer, 2014. 119-38. Shand, J. Jazz: The Australian Accent. Sydney: UNSW Press, 2009.Stake, Robert E. "Qualitative Case Studies." The Sage Handbook of Qualitative Research. Eds. Norman K. Denzin and Yvonna S. Lincoln. 3rd ed. Thousand Oaks, CA: Sage, 2005. 443-66. Stevens, Timothy. "The Red Onion Jazz Band at the 1963 Australian Jazz Convention." Musicology Australia 24.1 (2001): 35-61. Thorp, Justine. "Tourism in Cairns: Image and Product." Journal of Australian Studies 31.91 (2007): 107-13. Turley, L., and D. Fugate. "The Multidimensional Nature of Service Facilities." Journal of Services Marketing 6.3 (1992): 37-45. Waitt, G., and C. Gibson. "Creative Small Cities: Rethinking the Creative Economy in Place." Urban Studies 46.5-6 (2009): 1223-46. Whiteoak, J. "'Jazzing’ and Australia's First Jazz Band." Popular Music 13.3 (1994): 279-95.

Introduction I am a transmigrant who has moved back and forth between the West and the Rest. I was born and raised in a Muslim family in a predominantly Muslim country, Bangladesh, but I spent several years of my childhood in Pakistan. After my marriage, I lived in the United States for a year and a half, the Middle East for 5 years, Australia for three years, back to the Middle East for another 5 years, then, finally, in Australia for the last 12 years. I speak Bengali (my mother tongue), Urdu (which I learnt in Pakistan), a bit of Arabic (learnt in the Middle East); but English has always been my medium of instruction. So where is home? Is it my place of origin, the Muslim umma, or my land of settlement? Or is it my ‘root’ or my ‘route’ (Blunt and Dowling)? Blunt and Dowling (199) observe that the lives of transmigrants are often interpreted in terms of their ‘roots’ and ‘routes’, which are two frameworks for thinking about home, homeland and diaspora. Whereas ‘roots’ might imply an original homeland from which people have scattered, and to which they might seek to return, ‘routes’ focuses on mobile, multiple and transcultural geographies of home. However, both ‘roots’ and ‘routes’ are attached to emotion and identity, and both invoke a sense of place, belonging or alienation that is intrinsically tied to a sense of self (Blunt and Dowling 196-219). In this paper, I equate home with my root (place of birth) and route (transnational homing) within the context of the ‘diaspora and belonging’. First I define the diaspora and possible criteria of belonging. Next I describe my transnational homing within the framework of diaspora and belonging. Finally, I consider how Australia can be a ‘home’ for me and other Muslim Australians. The Diaspora and Belonging Blunt and Dowling (199) define diaspora as “scattering of people over space and transnational connections between people and the places”. Cohen emphasised the ethno-cultural aspects of the diaspora setting; that is, how migrants identify and position themselves in other nations in terms of their (different) ethnic and cultural orientation. Hall argues that the diasporic subjects form a cultural identity through transformation and difference. Speaking of the Hindu diaspora in the UK and Caribbean, Vertovec (21-23) contends that the migrants’ contact with their original ‘home’ or diaspora depends on four factors: migration processes and factors of settlement, cultural composition, structural and political power, and community development. With regard to the first factor, migration processes and factors of settlement, Vertovec explains that if the migrants are political or economic refugees, or on a temporary visa, they are likely to live in a ‘myth of return’. In the cultural composition context, Vertovec argues that religion, language, region of origin, caste, and degree of cultural homogenisation are factors in which migrants are bound to their homeland. Concerning the social structure and political power issue, Vertovec suggests that the extent and nature of racial and ethnic pluralism or social stigma, class composition, degree of institutionalised racism, involvement in party politics (or active citizenship) determine migrants’ connection to their new or old home. Finally, community development, including membership in organisations (political, union, religious, cultural, leisure), leadership qualities, and ethnic convergence or conflict (trends towards intra-communal or inter-ethnic/inter-religious co-operation) would also affect the migrants’ sense of belonging. Using these scholarly ideas as triggers, I will examine my home and belonging over the last few decades. My Home In an initial stage of my transmigrant history, my home was my root (place of birth, Dhaka, Bangladesh). Subsequently, my routes (settlement in different countries) reshaped my homes. In all respects, the ethno-cultural factors have played a big part in my definition of ‘home’. But on some occasions my ethnic identification has been overridden by my religious identification and vice versa. By ethnic identity, I mean my language (mother tongue) and my connection to my people (Bangladeshi). By my religious identity, I mean my Muslim religion, and my spiritual connection to the umma, a Muslim nation transcending all boundaries. Umma refers to the Muslim identity and unity within a larger Muslim group across national boundaries. The only thing the members of the umma have in common is their Islamic belief (Spencer and Wollman 169-170). In my childhood my father, a banker, was relocated to Karachi, Pakistan (then West Pakistan). Although I lived in Pakistan for much of my childhood, I have never considered it to be my home, even though it is predominantly a Muslim country. In this case, my home was my root (Bangladesh) where my grandparents and extended family lived. Every year I used to visit my grandparents who resided in a small town in Bangladesh (then East Pakistan). Thus my connection with my home was sustained through my extended family, ethnic traditions, language (Bengali/Bangla), and the occasional visits to the landscape of Bangladesh. Smith (9-11) notes that people build their connection or identity to their homeland through their historic land, common historical memories, myths, symbols and traditions. Though Pakistan and Bangladesh had common histories, their traditions of language, dress and ethnic culture were very different. For example, the celebration of the Bengali New Year (Pohela Baishakh), folk dance, folk music and folk tales, drama, poetry, lyrics of poets Rabindranath Tagore (Rabindra Sangeet) and Nazrul Islam (Nazrul Geeti) are distinct in the cultural heritage of Bangladesh. Special musical instruments such as the banshi (a bamboo flute), dhol (drums), ektara (a single-stringed instrument) and dotara (a four-stringed instrument) are unique to Bangladeshi culture. The Bangladeshi cuisine (rice and freshwater fish) is also different from Pakistan where people mainly eat flat round bread (roti) and meat (gosh). However, my bonding factor to Bangladesh was my relatives, particularly my grandparents as they made me feel one of ‘us’. Their affection for me was irreplaceable. The train journey from Dhaka (capital city) to their town, Noakhali, was captivating. The hustle and bustle at the train station and the lush green paddy fields along the train journey reminded me that this was my ‘home’. Though I spoke the official language (Urdu) in Pakistan and had a few Pakistani friends in Karachi, they could never replace my feelings for my friends, extended relatives and cousins who lived in Bangladesh. I could not relate to the landscape or dry weather of Pakistan. More importantly, some Pakistani women (our neighbours) were critical of my mother’s traditional dress (saree), and described it as revealing because it showed a bit of her back. They took pride in their traditional dress (shalwar, kameez, dopatta), which they considered to be more covered and ‘Islamic’. So, because of our traditional dress (saree) and perhaps other differences, we were regarded as the ‘Other’. In 1970 my father was relocated back to Dhaka, Bangladesh, and I was glad to go home. It should be noted that both Pakistan and Bangladesh were separated from India in 1947 – first as one nation; then, in 1971, Bangladesh became independent from Pakistan. The conflict between Bangladesh (then East Pakistan) and Pakistan (then West Pakistan) originated for economic and political reasons. At this time I was a high school student and witnessed acts of genocide committed by the Pakistani regime against the Bangladeshis (March-December 1971). My memories of these acts are vivid and still very painful. After my marriage, I moved from Bangladesh to the United States. In this instance, my new route (Austin, Texas, USA), as it happened, did not become my home. Here the ethno-cultural and Islamic cultural factors took precedence. I spoke the English language, made some American friends, and studied history at the University of Texas. I appreciated the warm friendship extended to me in the US, but experienced a degree of culture shock. I did not appreciate the pub life, alcohol consumption, and what I perceived to be the lack of family bonds (children moving out at the age of 18, families only meeting occasionally on birthdays and Christmas). Furthermore, I could not relate to de facto relationships and acceptance of sex before marriage. However, to me ‘home’ meant a family orientation and living in close contact with family. Besides the cultural divide, my husband and I were living in the US on student visas and, as Vertovec (21-23) noted, temporary visa status can deter people from their sense of belonging to the host country. In retrospect I can see that we lived in the ‘myth of return’. However, our next move for a better life was not to our root (Bangladesh), but another route to the Muslim world of Dhahran in Saudi Arabia. My husband moved to Dhahran not because it was a Muslim world but because it gave him better economic opportunities. However, I thought this new destination would become my home – the home that was coined by Anderson as the imagined nation, or my Muslim umma. Anderson argues that the imagined communities are “to be distinguished, not by their falsity/genuineness, but by the style in which they are imagined” (6; Wood 61). Hall (122) asserts: identity is actually formed through unconscious processes over time, rather than being innate in consciousness at birth. There is always something ‘imaginary’ or fantasized about its unity. It always remains incomplete, is always ‘in process’, always ‘being formed’. As discussed above, when I had returned home to Bangladesh from Pakistan – both Muslim countries – my primary connection to my home country was my ethnic identity, language and traditions. My ethnic identity overshadowed the religious identity. But when I moved to Saudi Arabia, where my ethnic identity differed from that of the mainstream Arabs and Bedouin/nomadic Arabs, my connection to this new land was through my Islamic cultural and religious identity. Admittedly, this connection to the umma was more psychological than physical, but I was now in close proximity to Mecca, and to my home of Dhaka, Bangladesh. Mecca is an important city in Saudi Arabia for Muslims because it is the holy city of Islam, the home to the Ka’aba (the religious centre of Islam), and the birthplace of Prophet Muhammad [Peace Be Upon Him]. It is also the destination of the Hajj, one of the five pillars of Islamic faith. Therefore, Mecca is home to significant events in Islamic history, as well as being an important present day centre for the Islamic faith. We lived in Dhahran, Saudi Arabia for 5 years. Though it was a 2.5 hours flight away, I treasured Mecca’s proximity and regarded Dhahran as my second and spiritual home. Saudi Arabia had a restricted lifestyle for women, but I liked it because it was a Muslim country that gave me the opportunity to perform umrah Hajj (pilgrimage). However, Saudi Arabia did not allow citizenship to expatriates. Saudi Arabia’s government was keen to protect the status quo and did not want to compromise its cultural values or standard of living by allowing foreigners to become a permanent part of society. In exceptional circumstances only, the King granted citizenship to a foreigner for outstanding service to the state over a number of years. Children of foreigners born in Saudi Arabia did not have rights of local citizenship; they automatically assumed the nationality of their parents. If it was available, Saudi citizenship would assure expatriates a secure and permanent living in Saudi Arabia; as it was, there was a fear among the non-Saudis that they would have to leave the country once their job contract expired. Under the circumstances, though my spiritual connection to Mecca was strong, my husband was convinced that Saudi Arabia did not provide any job security. So, in 1987 when Australia offered migration to highly skilled people, my husband decided to migrate to Australia for a better and more secure economic life. I agreed to his decision, but quite reluctantly because we were again moving to a non-Muslim part of the world, which would be culturally different and far away from my original homeland (Bangladesh). In Australia, we lived first in Brisbane, then Adelaide, and after three years we took our Australian citizenship. At that stage I loved the Barossa Valley and Victor Harbour in South Australia, and the Gold Coast and Sunshine Coast in Queensland, but did not feel at home in Australia. We bought a house in Adelaide and I was a full time home-maker but was always apprehensive that my children (two boys) would lose their culture in this non-Muslim world. In 1990 we once again moved back to the Muslim world, this time to Muscat, Sultanate of Oman. My connection to this route was again spiritual. I valued the fact that we would live in a Muslim country and our children would be brought up in a Muslim environment. But my husband’s move was purely financial as he got a lucrative job offer in Muscat. We had another son in Oman. We enjoyed the luxurious lifestyle provided by my husband’s workplace and the service provided by the housemaid. I loved the beaches and freedom to drive my car, and I appreciated the friendly Omani people. I also enjoyed our frequent trips (4 hours flight) to my root, Dhaka, Bangladesh. So our children were raised within our ethnic and Islamic culture, remained close to my root (family in Dhaka), though they attended a British school in Muscat. But by the time I started considering Oman to be my second home, we had to leave once again for a place that could provide us with a more secure future. Oman was like Saudi Arabia; it employed expatriates only on a contract basis, and did not give them citizenship (not even fellow Muslims). So after 5 years it was time to move back to Australia. It was with great reluctance that I moved with my husband to Brisbane in 1995 because once again we were to face a different cultural context. As mentioned earlier, we lived in Brisbane in the late 1980s; I liked the weather, the landscape, but did not consider it home for cultural reasons. Our boys started attending expensive private schools and we bought a house in a prestigious Western suburb in Brisbane. Soon after arriving I started my tertiary education at the University of Queensland, and finished an MA in Historical Studies in Indian History in 1998. Still Australia was not my home. I kept thinking that we would return to my previous routes or the ‘imagined’ homeland somewhere in the Middle East, in close proximity to my root (Bangladesh), where we could remain economically secure in a Muslim country. But gradually I began to feel that Australia was becoming my ‘home’. I had gradually become involved in professional and community activities (with university colleagues, the Bangladeshi community and Muslim women’s organisations), and in retrospect I could see that this was an early stage of my ‘self-actualisation’ (Maslow). Through my involvement with diverse people, I felt emotionally connected with the concerns, hopes and dreams of my Muslim-Australian friends. Subsequently, I also felt connected with my mainstream Australian friends whose emotions and fears (9/11 incident, Bali bombing and 7/7 tragedy) were similar to mine. In late 1998 I started my PhD studies on the immigration history of Australia, with a particular focus on the historical settlement of Muslims in Australia. This entailed retrieving archival files and interviewing people, mostly Muslims and some mainstream Australians, and enquiring into relevant migration issues. I also became more active in community issues, and was not constrained by my circumstances. By circumstances, I mean that even though I belonged to a patriarchally structured Muslim family, where my husband was the main breadwinner, main decision-maker, my independence and research activities (entailing frequent interstate trips for data collection, and public speaking) were not frowned upon or forbidden (Khan 14-15); fortunately, my husband appreciated my passion for research and gave me his trust and support. This, along with the Muslim community’s support (interviews), and the wider community’s recognition (for example, the publication of my letters in Australian newspapers, interviews on radio and television) enabled me to develop my self-esteem and built up my bicultural identity as a Muslim in a predominantly Christian country and as a Bangladeshi-Australian. In 2005, for the sake of a better job opportunity, my husband moved to the UK, but this time I asserted that I would not move again. I felt that here in Australia (now in Perth) I had a job, an identity and a home. This time my husband was able to secure a good job back in Australia and was only away for a year. I no longer dream of finding a home in the Middle East. Through my bicultural identity here in Australia I feel connected to the wider community and to the Muslim umma. However, my attachment to the umma has become ambivalent. I feel proud of my Australian-Muslim identity but I am concerned about the jihadi ideology of militant Muslims. By jihadi ideology, I mean the extremist ideology of the al-Qaeda terrorist group (Farrar 2007). The Muslim umma now incorporates both moderate and radical Muslims. The radical Muslims (though only a tiny minority of 1.4 billion Muslims worldwide) pose a threat to their moderate counterparts as well as to non-Muslims. In the UK, some second- and third-generation Muslims identify themselves with the umma rather than their parents’ homelands or their country of birth (Husain). It should not be a matter of concern if these young Muslims adopt a ‘pure’ Muslim identity, providing at the same time they are loyal to their country of residence. But when they resort to terrorism with their ‘pure’ Muslim identity (e.g., the 7/7 London bombers) they defame my religion Islam, and undermine my spiritual connection to the umma. As a 1st generation immigrant, the defining criteria of my ‘homeliness’ in Australia are my ethno-cultural and religious identity (which includes my family), my active citizenship, and my community development/contribution through my research work – all of which allow me a sense of efficacy in my life. My ethnic and religious identities generally co-exist equally, but when I see some Muslims kill my fellow Australians (such as the Bali bombings in 2002 and 2005) my Australian identity takes precedence. I feel for the victims and condemn the perpetrators. On the other hand, when I see politics play a role over the human rights issues (e.g., the Tampa incident), my religious identity begs me to comment on it (see Kabir, Muslims in Australia 295-305). Problematising ‘Home’ for Muslim Australians In the European context, Grillo (863) and Werbner (904), and in the Australian context, Kabir (Muslims in Australia) and Poynting and Mason, have identified the diversity within Islam (national, ethnic, religious etc). Werbner (904) notes that in spite of the “wishful talk of the emergence of a ‘British Islam’, even today there are Pakistani, Bangladeshi and Arab mosques, as well as Turkish and Shia’a mosques”; thus British Muslims retain their separate identities. Similarly, in Australia, the existence of separate mosques for the Bangladeshi, Pakistani, Arab and Shia’a peoples indicates that Australian Muslims have also kept their ethnic identities discrete (Saeed 64-77). However, in times of crisis, such as the Salman Rushdie affair in 1989, and the 1990-1991 Gulf crises, both British and Australian Muslims were quick to unite and express their Islamic identity by way of resistance (Kabir, Muslims in Australia 160-162; Poynting and Mason 68-70). In both British and Australian contexts, I argue that a peaceful rally or resistance is indicative of active citizenship of Muslims as it reveals their sense of belonging (also Werbner 905). So when a transmigrant Muslim wants to make a peaceful demonstration, the Western world should be encouraged, not threatened – as long as the transmigrant’s allegiances lie also with the host country. In the European context, Grillo (868) writes: when I asked Mehmet if he was planning to stay in Germany he answered without hesitation: ‘Yes, of course’. And then, after a little break, he added ‘as long as we can live here as Muslims’. In this context, I support Mehmet’s desire to live as a Muslim in a non-Muslim world as long as this is peaceful. Paradoxically, living a Muslim life through ijtihad can be either socially progressive or destructive. The Canadian Muslim feminist Irshad Manji relies on ijtihad, but so does Osama bin Laden! Manji emphasises that ijtihad can be, on the one hand, the adaptation of Islam using independent reasoning, hybridity and the contesting of ‘traditional’ family values (c.f. Doogue and Kirkwood 275-276, 314); and, on the other, ijtihad can take the form of conservative, patriarchal and militant Islamic values. The al-Qaeda terrorist Osama bin Laden espouses the jihadi ideology of Sayyid Qutb (1906-1966), an Egyptian who early in his career might have been described as a Muslim modernist who believed that Islam and Western secular ideals could be reconciled. But he discarded that idea after going to the US in 1948-50; there he was treated as ‘different’ and that treatment turned him against the West. He came back to Egypt and embraced a much more rigid and militaristic form of Islam (Esposito 136). Other scholars, such as Cesari, have identified a third orientation – a ‘secularised Islam’, which stresses general beliefs in the values of Islam and an Islamic identity, without too much concern for practices. Grillo (871) observed Islam in the West emphasised diversity. He stressed that, “some [Muslims were] more quietest, some more secular, some more clamorous, some more negotiatory”, while some were exclusively characterised by Islamic identity, such as wearing the burqa (elaborate veils), hijabs (headscarves), beards by men and total abstinence from drinking alcohol. So Mehmet, cited above, could be living a Muslim life within the spectrum of these possibilities, ranging from an integrating mode to a strict, militant Muslim manner. In the UK context, Zubaida (96) contends that marginalised, culturally-impoverished youth are the people for whom radical, militant Islamism may have an appeal, though it must be noted that the 7/7 bombers belonged to affluent families (O’Sullivan 14; Husain). In Australia, Muslim Australians are facing three challenges. First, the Muslim unemployment rate: it was three times higher than the national total in 1996 and 2001 (Kabir, Muslims in Australia 266-278; Kabir, “What Does It Mean” 63). Second, some spiritual leaders have used extreme rhetoric to appeal to marginalised youth; in January 2007, the Australian-born imam of Lebanese background, Sheikh Feiz Mohammad, was alleged to have employed a DVD format to urge children to kill the enemies of Islam and to have praised martyrs with a violent interpretation of jihad (Chulov 2). Third, the proposed citizenship test has the potential to make new migrants’ – particularly Muslims’ – settlement in Australia stressful (Kabir, “What Does It Mean” 62-79); in May 2007, fuelled by perceptions that some migrants – especially Muslims – were not integrating quickly enough, the Howard government introduced a citizenship test bill that proposes to test applicants on their English language skills and knowledge of Australian history and ‘values’. I contend that being able to demonstrate knowledge of history and having English language skills is no guarantee that a migrant will be a good citizen. Through my transmigrant history, I have learnt that developing a bond with a new place takes time, acceptance and a gradual change of identity, which are less likely to happen when facing assimilationist constraints. I spoke English and studied history in the United States, but I did not consider it my home. I did not speak the Arabic language, and did not study Middle Eastern history while I was in the Middle East, but I felt connected to it for cultural and religious reasons. Through my knowledge of history and English language proficiency I did not make Australia my home when I first migrated to Australia. Australia became my home when I started interacting with other Australians, which was made possible by having the time at my disposal and by fortunate circumstances, which included a fairly high level of efficacy and affluence. If I had been rejected because of my lack of knowledge of ‘Australian values’, or had encountered discrimination in the job market, I would have been much less willing to embrace my host country and call it home. I believe a stringent citizenship test is more likely to alienate would-be citizens than to induce their adoption of values and loyalty to their new home. Conclusion Blunt (5) observes that current studies of home often investigate mobile geographies of dwelling and how it shapes one’s identity and belonging. Such geographies of home negotiate from the domestic to the global context, thus mobilising the home beyond a fixed, bounded and confining location. Similarly, in this paper I have discussed how my mobile geography, from the domestic (root) to global (route), has shaped my identity. Though I received a degree of culture shock in the United States, loved the Middle East, and was at first quite resistant to the idea of making Australia my second home, the confidence I acquired in residing in these ‘several homes’ were cumulative and eventually enabled me to regard Australia as my ‘home’. I loved the Middle East, but I did not pursue an active involvement with the Arab community because I was a busy mother. Also I lacked the communication skill (fluency in Arabic) with the local residents who lived outside the expatriates’ campus. I am no longer a cultural freak. I am no longer the same Bangladeshi woman who saw her ethnic and Islamic culture as superior to all other cultures. I have learnt to appreciate Australian values, such as tolerance, ‘a fair go’ and multiculturalism (see Kabir, “What Does It Mean” 62-79). My bicultural identity is my strength. With my ethnic and religious identity, I can relate to the concerns of the Muslim community and other Australian ethnic and religious minorities. And with my Australian identity I have developed ‘a voice’ to pursue active citizenship. Thus my biculturalism has enabled me to retain and merge my former home with my present and permanent home of Australia. References Anderson, Benedict. Imagined Communities: Reflections on the Origin and Spread of Nationalism. London, New York: Verso, 1983. Australian Bureau of Statistics: Census of Housing and Population, 1996 and 2001. Blunt, Alison. Domicile and Diaspora: Anglo-Indian Women and the Spatial Politics of Home. Oxford: Blackwell, 2005. Blunt, Alison, and Robyn Dowling. Home. London and New York: Routledge, 2006. Cesari, Jocelyne. “Muslim Minorities in Europe: The Silent Revolution.” In John L. Esposito and Burgat, eds., Modernising Islam: Religion in the Public Sphere in Europe and the Middle East. London: Hurst, 2003. 251-269. Chulov, Martin. “Treatment Has Sheik Wary of Returning Home.” Weekend Australian 6-7 Jan. 2007: 2. Cohen, Robin. Global Diasporas: An Introduction. Seattle: University of Washington, 1997. Doogue, Geraldine, and Peter Kirkwood. Tomorrow’s Islam: Uniting Old-Age Beliefs and a Modern World. Sydney: ABC Books, 2005. Esposito, John. The Islamic Threat: Myth or Reality? 3rd ed. New York, Oxford: Oxford UP, 1999. Farrar, Max. “When the Bombs Go Off: Rethinking and Managing Diversity Strategies in Leeds, UK.” International Journal of Diversity in Organisations, Communities and Nations 6.5 (2007): 63-68. Grillo, Ralph. “Islam and Transnationalism.” Journal of Ethnic and Migration Studies 30.5 (Sep. 2004): 861-878. Hall, Stuart. Polity Reader in Cultural Theory. Cambridge: Polity Press, 1994. Huntington, Samuel, P. The Clash of Civilisation and the Remaking of World Order. London: Touchstone, 1998. Husain, Ed. The Islamist: Why I Joined Radical Islam in Britain, What I Saw inside and Why I Left. London: Penguin, 2007. Kabir, Nahid. Muslims in Australia: Immigration, Race Relations and Cultural History. London: Kegan Paul, 2005. ———. “What Does It Mean to Be Un-Australian: Views of Australian Muslim Students in 2006.” People and Place 15.1 (2007): 62-79. Khan, Shahnaz. Aversion and Desire: Negotiating Muslim Female Identity in the Diaspora. Toronto: Women’s Press, 2002. Manji, Irshad. The Trouble with Islam Today. Canada:Vintage, 2005. Maslow, Abraham. Motivation and Personality. New York: Harper, 1954. O’Sullivan, J. “The Real British Disease.” Quadrant (Jan.-Feb. 2006): 14-20. Poynting, Scott, and Victoria Mason. “The Resistible Rise of Islamophobia: Anti-Muslim Racism in the UK and Australia before 11 September 2001.” Journal of Sociology 43.1 (2007): 61-86. Saeed, Abdallah. Islam in Australia. Sydney: Allen and Unwin, 2003. Smith, Anthony D. National Identity. Harmondsworth: Penguin, 1991. Spencer, Philip, and Howard Wollman. Nationalism: A Critical Introduction. London: Sage, 2002. Vertovec, Stevens. The Hindu Diaspora: Comparative Patterns. London: Routledge. 2000. Werbner, Pnina, “Theorising Complex Diasporas: Purity and Hybridity in the South Asian Public Sphere in Britain.” Journal of Ethnic and Migration Studies 30.5 (2004): 895-911. Wood, Dennis. “The Diaspora, Community and the Vagrant Space.” In Cynthia Vanden Driesen and Ralph Crane, eds., Diaspora: The Australasian Experience. New Delhi: Prestige, 2005. 59-64. Zubaida, Sami. “Islam in Europe: Unity or Diversity.” Critical Quarterly 45.1-2 (2003): 88-98. Citation reference for this article MLA Style Kabir, Nahid. "Why I Call Australia ‘Home’?: A Transmigrant’s Perspective." M/C Journal 10.4 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0708/15-kabir.php>. APA Style Kabir, N. (Aug. 2007) "Why I Call Australia ‘Home’?: A Transmigrant’s Perspective," M/C Journal, 10(4). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0708/15-kabir.php>.

While the term “visual literacy” has grown in popularity in the last 50 years, its meaning remains nebulous. It is described variously as: a vehicle for aesthetic appreciation, a means of defence against visual manipulation, a sorting mechanism for an increasingly data-saturated age, and a prerequisite to civic inclusion (Fransecky 23; Messaris 181; McTigue and Flowers 580). Scholars have written extensively about the first three subjects but there has been less research on how visual literacy frames civic life and how it might help the public as a tool to address disadvantage and assist in removing social and cultural barriers. This article examines a forerunner to visual literacy in the push to create an international symbol language born out of popular education movements, a project that fell short of its goals but still left a considerable impression on graphic media. This article, then, presents an analysis of visual literacy campaigns in the early postwar era. These campaigns did not attempt to invent a symbolic language but posited that images themselves served as a universal language in which students could receive training. Of particular interest is how the concept of visual literacy has been mobilised as a pedagogical tool in design, digital humanities and in broader civic education initiatives promoted by Third Space institutions. Behind the creation of new visual literacy curricula is the idea that images can help anchor a world community, supplementing textual communication. Figure 1: Visual Literacy Yearbook. Montebello Unified School District, USA, 1973. Shedding Light: Origins of the Visual Literacy Frame The term “visual literacy” came to the fore in the early 1970s on the heels of mass literacy campaigns. The educators, creatives and media theorists who first advocated for visual learning linked this aim to literacy, an unassailable goal, to promote a more radical curricular overhaul. They challenged a system that had hitherto only acknowledged a very limited pathway towards academic success; pushing “language and mathematics”, courses “referred to as solids (something substantial) as contrasted with liquids or gases (courses with little or no substance)” (Eisner 92). This was deemed “a parochial view of both human ability and the possibilities of education” that did not acknowledge multiple forms of intelligence (Gardner). This change not only integrated elements of mass culture that had been rejected in education, notably film and graphic arts, but also encouraged the critique of images as a form of good citizenship, assuming that visually literate arbiters could call out media misrepresentations and manipulative political advertising (Messaris, “Visual Test”). This movement was, in many ways, reactive to new forms of mass media that began to replace newspapers as key forms of civic participation. Unlike simple literacy (being able to decipher letters as a mnemonic system), visual literacy involves imputing meanings to images where meanings are less fixed, yet still with embedded cultural signifiers. Visual literacy promised to extend enlightenment metaphors of sight (as in the German Aufklärung) and illumination (as in the French Lumières) to help citizens understand an increasingly complex marketplace of images. The move towards visual literacy was not so much a shift towards images (and away from books and oration) but an affirmation of the need to critically investigate the visual sphere. It introduced doubt to previously upheld hierarchies of perception. Sight, to Kant the “noblest of the senses” (158), was no longer the sense “least affected” by the surrounding world but an input centre that was equally manipulable. In Kant’s view of societal development, the “cosmopolitan” held the key to pacifying bellicose states and ensuring global prosperity and tranquillity. The process of developing a cosmopolitan ideology rests, according to Kant, on the gradual elimination of war and “the education of young people in intellectual and moral culture” (188-89). Transforming disparate societies into “a universal cosmopolitan existence” that would “at last be realised as the matrix within which all the original capacities of the human race may develop” and would take well-funded educational institutions and, potentially, a new framework for imparting knowledge (Kant 51). To some, the world of the visual presented a baseline for shared experience. Figure 2: Exhibition by the Gesellschafts- und Wirtschaftsmuseum in Vienna, photograph c. 1927. An International Picture Language The quest to find a mutually intelligible language that could “bridge worlds” and solder together all of humankind goes back to the late nineteenth century and the Esperanto movement of Ludwig Zamenhof (Schor 59). The expression of this ideal in the world of the visual picked up steam in the interwar years with designers and editors like Fritz Kahn, Gerd Arntz, and Otto and Marie Neurath. Their work transposing complex ideas into graphic form has been rediscovered as an antecedent to modern infographics, but the symbols they deployed were not to merely explain, but also help education and build international fellowship unbounded by spoken language. The Neuraths in particular are celebrated for their international picture language or Isotypes. These pictograms (sometimes viewed as proto-emojis) can be used to represent data without text. Taken together they are an “intemporal, hieroglyphic language” that Neutrath hoped would unite working-class people the world over (Lee 159). The Neuraths’ work was done in the explicit service of visual education with a popular socialist agenda and incubated in the social sphere of Red Vienna at the Gesellschafts- und Wirtschaftsmuseum (Social and Economic Museum) where Otto served as Director. The Wirtschaftsmuseum was an experiment in popular education, with multiple branches and late opening hours to accommodate the “the working man [who] has time to see a museum only at night” (Neurath 72-73). The Isotype contained universalist aspirations for the “making of a world language, or a helping picture language—[that] will give support to international developments generally” and “educate by the eye” (Neurath 13). Figure 3: Gerd Arntz Isotype Images. (Source: University of Reading.) The Isotype was widely adopted in the postwar era in pre-packaged sets of symbols used in graphic design and wayfinding systems for buildings and transportation networks, but with the socialism of the Neuraths’ peeled away, leaving only the system of logos that we are familiar with from airport washrooms, charts, and public transport maps. Much of the uptake in this symbol language could be traced to increased mobility and tourism, particularly in countries that did not make use of a Roman alphabet. The 1964 Olympics in Tokyo helped pave the way when organisers, fearful of jumbling too many scripts together, opted instead for black and white icons to represent the program of sports that summer. The new focus on the visual was both technologically mediated—cheaper printing and broadcast technologies made the diffusion of image increasingly possible—but also ideologically supported by a growing emphasis on projects that transcended linguistic, ethnic, and national borders. The Olympic symbols gradually morphed into Letraset icons, and, later, symbols in the Unicode Standard, which are the basis for today’s emojis. Wordless signs helped facilitate interconnectedness, but only in the most literal sense; their application was limited primarily to sports mega-events, highway maps, and “brand building”, and they never fulfilled their role as an educational language “to give the different nations a common outlook” (Neurath 18). Universally understood icons, particularly in the form of emojis, point to a rise in visual communication but they have fallen short as a cosmopolitan project, supporting neither the globalisation of Kantian ethics nor the transnational socialism of the Neuraths. Figure 4: Symbols in use. Women's bathroom. 1964 Tokyo Olympics. (Source: The official report of the Organizing Committee.) Counter Education By mid-century, the optimism of a universal symbol language seemed dated, and focus shifted from distillation to discernment. New educational programs presented ways to study images, increasingly reproducible with new technologies, as a language in and of themselves. These methods had their roots in the fin-de-siècle educational reforms of John Dewey, Helen Parkhurst, and Maria Montessori. As early as the 1920s, progressive educators were using highly visual magazines, like National Geographic, as the basis for lesson planning, with the hopes that they would “expose students to edifying and culturally enriching reading” and “develop a more catholic taste or sensibility, representing an important cosmopolitan value” (Hawkins 45). The rise in imagery from previously inaccessible regions helped pupils to see themselves in relation to the larger world (although this connection always came with the presumed superiority of the reader). “Pictorial education in public schools” taught readers—through images—to accept a broader world but, too often, they saw photographs as a “straightforward transcription of the real world” (Hawkins 57). The images of cultures and events presented in Life and National Geographic for the purposes of education and enrichment were now the subject of greater analysis in the classroom, not just as “windows into new worlds” but as cultural products in and of themselves. The emerging visual curriculum aimed to do more than just teach with previously excluded modes (photography, film and comics); it would investigate how images presented and mediated the world. This gained wider appeal with new analytical writing on film, like Raymond Spottiswoode's Grammar of the Film (1950) which sought to formulate the grammatical rules of visual communication (Messaris 181), influenced by semiotics and structural linguistics; the emphasis on grammar can also be seen in far earlier writings on design systems such as Owen Jones’s 1856 The Grammar of Ornament, which also advocated for new, universalising methods in design education (Sloboda 228). The inventorying impulse is on display in books like Donis A. Dondis’s A Primer of Visual Literacy (1973), a text that meditates on visual perception but also functions as an introduction to line and form in the applied arts, picking up where the Bauhaus left off. Dondis enumerates the “syntactical guidelines” of the applied arts with illustrations that are in keeping with 1920s books by Kandinsky and Klee and analyse pictorial elements. However, at the end of the book she shifts focus with two chapters that examine “messaging” and visual literacy explicitly. Dondis predicts that “an intellectual, trained ability to make and understand visual messages is becoming a vital necessity to involvement with communication. It is quite likely that visual literacy will be one of the fundamental measures of education in the last third of our century” (33) and she presses for more programs that incorporate the exploration and analysis of images in tertiary education. Figure 5: Ideal spatial environment for the Blueprint charts, 1970. (Image: Inventory Press.) Visual literacy in education arrived in earnest with a wave of publications in the mid-1970s. They offered ways for students to understand media processes and for teachers to use visual culture as an entry point into complex social and scientific subject matter, tapping into the “visual consciousness of the ‘television generation’” (Fransecky 5). Visual culture was often seen as inherently democratising, a break from stuffiness, the “artificialities of civilisation”, and the “archaic structures” that set sensorial perception apart from scholarship (Dworkin 131-132). Many radical university projects and community education initiatives of the 1960s made use of new media in novel ways: from Maurice Stein and Larry Miller’s fold-out posters accompanying Blueprint for Counter Education (1970) to Emory Douglas’s graphics for The Black Panther newspaper. Blueprint’s text- and image-dense wall charts were made via assemblage and they were imagined less as charts and more as a “matrix of resources” that could be used—and added to—by youth to undertake their own counter education (Cronin 53). These experiments in visual learning helped to break down old hierarchies in education, but their aim was influenced more by countercultural notions of disruption than the universal ideals of cosmopolitanism. From Image as Text to City as Text For a brief period in the 1970s, thinkers like Marshall McLuhan (McLuhan et al., Massage) and artists like Bruno Munari (Tanchis and Munari) collaborated fruitfully with graphic designers to create books that mixed text and image in novel ways. Using new compositional methods, they broke apart traditional printing lock-ups to superimpose photographs, twist text, and bend narrative frames. The most famous work from this era is, undoubtedly, The Medium Is the Massage (1967), McLuhan’s team-up with graphic designer Quentin Fiore, but it was followed by dozens of other books intended to communicate theory and scientific ideas with popularising graphics. Following in the footsteps of McLuhan, many of these texts sought not just to explain an issue but to self-consciously reference their own method of information delivery. These works set the precedent for visual aids (and, to a lesser extent, audio) that launched a diverse, non-hierarchical discourse that was nonetheless bound to tactile artefacts. In 1977, McLuhan helped develop a media textbook for secondary school students called City as Classroom: Understanding Language and Media. It is notable for its direct address style and its focus on investigating spaces outside of the classroom (provocatively, a section on the third page begins with “Should all schools be closed?”). The book follows with a fine-grained analysis of advertising forms in which students are asked to first bring advertisements into class for analysis and later to go out into the city to explore “a man-made environment, a huge warehouse of information, a vast resource to be mined free of charge” (McLuhan et al., City 149). As a document City as Classroom is critical of existing teaching methods, in line with the radical “in the streets” pedagogy of its day. McLuhan’s theories proved particularly salient for the counter education movement, in part because they tapped into a healthy scepticism of advertisers and other image-makers. They also dovetailed with growing discontent with the ad-strew visual environment of cities in the 1970s. Budgets for advertising had mushroomed in the1960s and outdoor advertising “cluttered” cities with billboards and neon, generating “fierce intensities and new hybrid energies” that threatened to throw off the visual equilibrium (McLuhan 74). Visual literacy curricula brought in experiential learning focussed on the legibility of the cities, mapping, and the visualisation of urban issues with social justice implications. The Detroit Geographical Expedition and Institute (DGEI), a “collective endeavour of community research and education” that arose in the aftermath of the 1967 uprisings, is the most storied of the groups that suffused the collection of spatial data with community engagement and organising (Warren et al. 61). The following decades would see a tamed approach to visual literacy that, while still pressing for critical reading, did not upend traditional methods of educational delivery. Figure 6: Beginning a College Program-Assisting Teachers to Develop Visual Literacy Approaches in Public School Classrooms. 1977. ERIC. Searching for Civic Education The visual literacy initiatives formed in the early 1970s both affirmed existing civil society institutions while also asserting the need to better inform the public. Most of the campaigns were sponsored by universities, major libraries, and international groups such as UNESCO, which published its “Declaration on Media Education” in 1982. They noted that “participation” was “essential to the working of a pluralistic and representative democracy” and the “public—users, citizens, individuals, groups ... were too systematically overlooked”. Here, the public is conceived as both “targets of the information and communication process” and users who “should have the last word”. To that end their “continuing education” should be ensured (Study 18). Programs consisted primarily of cognitive “see-scan-analyse” techniques (Little et al.) for younger students but some also sought to bring visual analysis to adult learners via continuing education (often through museums eager to engage more diverse audiences) and more radical popular education programs sponsored by community groups. By the mid-80s, scores of modules had been built around the comprehension of visual media and had become standard educational fare across North America, Australasia, and to a lesser extent, Europe. There was an increasing awareness of the role of data and image presentation in decision-making, as evidenced by the surprising commercial success of Edward Tufte’s 1982 book, The Visual Display of Quantitative Information. Visual literacy—or at least image analysis—was now enmeshed in teaching practice and needed little active advocacy. Scholarly interest in the subject went into a brief period of hibernation in the 1980s and early 1990s, only to be reborn with the arrival of new media distribution technologies (CD-ROMs and then the internet) in classrooms and the widespread availability of digital imaging technology starting in the late 1990s; companies like Adobe distributed free and reduced-fee licences to schools and launched extensive teacher training programs. Visual literacy was reanimated but primarily within a circumscribed academic field of education and data visualisation. Figure 7: Visual Literacy; What Research Says to the Teacher, 1975. National Education Association. USA. Part of the shifting frame of visual literacy has to do with institutional imperatives, particularly in places where austerity measures forced strange alliances between disciplines. What had been a project in alternative education morphed into an uncontested part of the curriculum and a dependable budget line. This shift was already forecasted in 1972 by Harun Farocki who, writing in Filmkritik, noted that funding for new film schools would be difficult to obtain but money might be found for “training in media education … a discipline that could persuade ministers of education, that would at the same time turn the budget restrictions into an advantage, and that would match the functions of art schools” (98). Nearly 50 years later educators are still using media education (rebranded as visual or media literacy) to make the case for fine arts and humanities education. While earlier iterations of visual literacy education were often too reliant on the idea of cracking the “code” of images, they did promote ways of learning that were a deep departure from the rote methods of previous generations. Next-gen curricula frame visual literacy as largely supplemental—a resource, but not a program. By the end of the 20th century, visual literacy had changed from a scholarly interest to a standard resource in the “teacher’s toolkit”, entering into school programs and influencing museum education, corporate training, and the development of public-oriented media (Literacy). An appreciation of image culture was seen as key to creating empathetic global citizens, but its scope was increasingly limited. With rising austerity in the education sector (a shift that preceded the 2008 recession by decades in some countries), art educators, museum enrichment staff, and design researchers need to make a case for why their disciplines were relevant in pedagogical models that are increasingly aimed at “skills-based” and “job ready” teaching. Arts educators worked hard to insert their fields into learning goals for secondary students as visual literacy, with the hope that “literacy” would carry the weight of an educational imperative and not a supplementary field of study. Conclusion For nearly a century, educational initiatives have sought to inculcate a cosmopolitan perspective with a variety of teaching materials and pedagogical reference points. Symbolic languages, like the Isotype, looked to unite disparate people with shared visual forms; while educational initiatives aimed to train the eyes of students to make them more discerning citizens. The term ‘visual literacy’ emerged in the 1960s and has since been deployed in programs with a wide variety of goals. Countercultural initiatives saw it as a prerequisite for popular education from the ground up, but, in the years since, it has been formalised and brought into more staid curricula, often as a sort of shorthand for learning from media and pictures. The grand cosmopolitan vision of a complete ‘visual language’ has been scaled back considerably, but still exists in trace amounts. Processes of globalisation require images to universalise experiences, commodities, and more for people without shared languages. Emoji alphabets and globalese (brands and consumer messaging that are “visual-linguistic” amalgams “increasingly detached from any specific ethnolinguistic group or locality”) are a testament to a mediatised banal cosmopolitanism (Jaworski 231). In this sense, becoming “fluent” in global design vernacular means familiarity with firms and products, an understanding that is aesthetic, not critical. It is very much the beneficiaries of globalisation—both state and commercial actors—who have been able to harness increasingly image-based technologies for their benefit. To take a humorous but nonetheless consequential example, Spanish culinary boosters were able to successfully lobby for a paella emoji (Miller) rather than having a food symbol from a less wealthy country such as a Senegalese jollof or a Morrocan tagine. This trend has gone even further as new forms of visual communication are increasingly streamlined and managed by for-profit media platforms. The ubiquity of these forms of communication and their global reach has made visual literacy more important than ever but it has also fundamentally shifted the endeavour from a graphic sorting practice to a critical piece of social infrastructure that has tremendous political ramifications. Visual literacy campaigns hold out the promise of educating students in an image-based system with the potential to transcend linguistic and cultural boundaries. This cosmopolitan political project has not yet been realised, as the visual literacy frame has drifted into specialised silos of art, design, and digital humanities education. It can help bridge the “incomplete connections” of an increasingly globalised world (Calhoun 112), but it does not have a program in and of itself. Rather, an evolving visual literacy curriculum might be seen as a litmus test for how we imagine the role of images in the world. References Brown, Neil. “The Myth of Visual Literacy.” Australian Art Education 13.2 (1989): 28-32. Calhoun, Craig. “Cosmopolitanism in the Modern Social Imaginary.” Daedalus 137.3 (2008): 105–114. Cronin, Paul. “Recovering and Rendering Vital Blueprint for Counter Education at the California Institute for the Arts.” Blueprint for Counter Education. Inventory Press, 2016. 36-58. Dondis, Donis A. A Primer of Visual Literacy. MIT P, 1973. Dworkin, M.S. “Toward an Image Curriculum: Some Questions and Cautions.” Journal of Aesthetic Education 4.2 (1970): 129–132. Eisner, Elliot. Cognition and Curriculum: A Basis for Deciding What to Teach. Longmans, 1982. Farocki, Harun. “Film Courses in Art Schools.” Trans. Ted Fendt. Grey Room 79 (Apr. 2020): 96–99. Fransecky, Roger B. Visual Literacy: A Way to Learn—A Way to Teach. Association for Educational Communications and Technology, 1972. Gardner, Howard. Frames Of Mind. Basic Books, 1983. Hawkins, Stephanie L. “Training the ‘I’ to See: Progressive Education, Visual Literacy, and National Geographic Membership.” American Iconographic. U of Virginia P, 2010. 28–61. Jaworski, Adam. “Globalese: A New Visual-Linguistic Register.” Social Semiotics 25.2 (2015): 217-35. Kant, Immanuel. Anthropology from a Pragmatic Point of View. Cambridge UP, 2006. Kant, Immanuel. “Perpetual Peace.” Political Writings. Ed. H. Reiss. Cambridge UP, 1991 [1795]. 116–130. Kress, G., and T. van Leeuwen. Reading images: The Grammar of Visual Design. Routledge, 1996. Literacy Teaching Toolkit: Visual Literacy. Department of Education and Training (DET), State of Victoria. 29 Aug. 2018. 30 Sep. 2020 <https://www.education.vic.gov.au:443/school/teachers/teachingresources/discipline/english/literacy/ readingviewing/Pages/litfocusvisual.aspx>. Lee, Jae Young. “Otto Neurath's Isotype and the Rhetoric of Neutrality.” Visible Language 42.2: 159-180. Little, D., et al. Looking and Learning: Visual Literacy across the Disciplines. Wiley, 2015. Messaris, Paul. “Visual Literacy vs. Visual Manipulation.” Critical Studies in Mass Communication 11.2: 181-203. DOI: 10.1080/15295039409366894 ———. “A Visual Test for Visual ‘Literacy.’” The Annual Meeting of the Speech Communication Association. 31 Oct. to 3 Nov. 1991. Atlanta, GA. <https://files.eric.ed.gov/fulltext/ED347604.pdf>. McLuhan, Marshall. Understanding Media: The Extensions of Man. McGraw-Hill, 1964. McLuhan, Marshall, Quentin Fiore, and Jerome Agel. The Medium Is the Massage, Bantam Books, 1967. McLuhan, Marshall, Kathryn Hutchon, and Eric McLuhan. City as Classroom: Understanding Language and Media. Agincourt, Ontario: Book Society of Canada, 1977. McTigue, Erin, and Amanda Flowers. “Science Visual Literacy: Learners' Perceptions and Knowledge of Diagrams.” Reading Teacher 64.8: 578-89. Miller, Sarah. “The Secret History of the Paella Emoji.” Food & Wine, 20 June 2017. <https://www.foodandwine.com/news/true-story-paella-emoji>. Munari, Bruno. Square, Circle, Triangle. Princeton Architectural Press, 2016. Newfield, Denise. “From Visual Literacy to Critical Visual Literacy: An Analysis of Educational Materials.” English Teaching-Practice and Critique 10 (2011): 81-94. Neurath, Otto. International Picture Language: The First Rules of Isotype. K. Paul, Trench, Trubner, 1936. Schor, Esther. Bridge of Words: Esperanto and the Dream of a Universal Language. Henry Holt and Company, 2016. Sloboda, Stacey. “‘The Grammar of Ornament’: Cosmopolitanism and Reform in British Design.” Journal of Design History 21.3 (2008): 223-36. Study of Communication Problems: Implementation of Resolutions 4/19 and 4/20 Adopted by the General Conference at Its Twenty-First Session; Report by the Director-General. UNESCO, 1983. Tanchis, Aldo, and Bruno Munari. Bruno Munari: Design as Art. MIT P, 1987. Warren, Gwendolyn, Cindi Katz, and Nik Heynen. “Myths, Cults, Memories, and Revisions in Radical Geographic History: Revisiting the Detroit Geographical Expedition and Institute.” Spatial Histories of Radical Geography: North America and Beyond. Wiley, 2019. 59-86.

Aunty Mary Graham, Kombu-merri elder and philosopher, writes, “you are not alone in the world.” We have a responsibility to each other, as well as to the land, and violence is the refusal of this relationship that binds us (Rose). Similarly, Emmanuel Levinas, a French-Lithuanian Jewish teacher and philosopher who lived through the Holocaust, writes that, “my freedom does not have the last word; I am not alone” (Levinas, Totality 101). For both writers, the recognition that one is not alone in the world creates an imperative to act ethically. For non-Indigenous educators working in the Indigenous Studies space—as arguably all school teachers are, given the Australian Curriculum—their relationship with Indigenous Australia creates an imperative to consider ethics and responsibility in their work. In this article, I use Emmanuel Levinas’s thinking and writing on epistemological violence and ethics as a first philosophy to consider how pre-service teachers engage with the ethical responsibilities inherent in teaching and learning Indigenous Studies.To begin, I will introduce Emmanuel Levinas and his writing on violence, followed by outlining the ways that Indigenous perspectives are incorporated into the Australian Curriculum. I will finish by sharing some of the reflective writing undertaken by pre-service teachers in a compulsory Indigenous education subject at an Australian university. These data show pre-service teachers’ responses to being called into responsibility and relationality, as well as some of the complexities in avoiding what I term here epistemological violence, a grasping of the other by trying to make the other infinitely knowable. The data present a problematic paradox—when pre-service teachers write about their future praxis, they necessarily defer responsibility to the future. This deferral constructs an image of the future which transcends the present, without requiring change in the here and now.Of note, some of this writing speaks to the violence enacted upon Indigenous peoples through the colonisation of Australia. I have tried to write respectfully about these topics. Yet the violence continues, in part via the traumatic nature of such accounts. As a non-Indigenous educator and researcher, I also acknowledge that such histories of violence have predominantly benefited people like myself and that the Countries on which this article was written (Countries of the sovereign Bindal and Wulgurukaba peoples) have never been ceded.Emmanuel Levinas: Ethics as First PhilosophyEmmanuel Levinas was a French-Lithuanian Jewish teacher and philosopher for whom surviving the Holocaust—where most of his family perished—fundamentally changed his philosophy. Following World War II, Levinas critiqued Heidegger’s philosophy, writing that freedom—an unencumbered being in the world—could no longer be considered the first condition of being human (Levinas, Existence). Instead, the presence of others in the world—an intersubjectivity between oneself and another—means that we are always already responsible for the others we encounter. Seeing the other’s face calls us to be accountable for our own actions, to responsibility. If we do not respect that the other is different to one’s self, and instead try to understand them through our own frames of reference, we commit the epistemological violence of reducing the other to the same (Levinas, Totality 46), bringing their infinity into our own totality.The history of Indigenous and non-Indigenous relations both in Australia and globally has been marked by attempts to bring Indigenous peoples into non-Indigenous orders of knowledge (Nakata, “Cultural Interface”). The word “Aboriginal”, derived from the Latin “of the original”, refers to both Indigenous peoples’ position as original inhabitants of lands, but also to the anthropological idea that Indigenous peoples were early and unevolved prototypes of human beings (Peterson). This early idea of what it means to be Indigenous is linked to the now well-known histories of ontological violence. Aboriginal reserves were set up as places for Aboriginal people to perish, a consequence not just of colonisation, but of the perception that Indigenous people were unfit to exist in a modern society. Whilst such racist ideologies linger today, most discourses have morphed in how they grasp Indigenous people into a non-Indigenous totality. In a context where government-funded special measures are used to assist disadvantaged groups, categories such as the Indigenous/non-Indigenous binary can become violent. The Closing the Gap campaign, for example, is based on this categorical binary, where “sickness=Indigenous” and “whiteness=health”. This creates a “moral imperative upon Indigenous Australians to transform themselves” (Pholi et al. 10), to become the dominant category, to be brought into the totality.Levinas’s philosophical writings provide a way to think through the ethical challenges of a predominantly non-Indigenous teaching workforce being tasked to not just approach the teaching of Indigenous students with more care than previous generations, but to also embed Indigenous perspectives and knowledges into their teaching work. Levinas’s warning of a “disinterested acquisition of knowledge” (Reader 78), seemingly unrestrained by memory or relationships, is useful in two ways. First, for pre-service teachers learning about Indigenous education, Levinas’s work provides a reminder of the ethical responsibilities that all members of a community have to each other. However, this responsibility cannot be predicated on unwittingly approaching Indigenous topics through Western knowledge lenses. Instead, Levinas’s work also reminds us about the ethics of knowledge production which shape how others—in this case Indigenous peoples—come to be known; teachers and pre-service teachers must engage with the politics of knowledge that shape how Indigenous peoples come to be known in educational settings.You Are Not Alone in the World: Indigenous Perspectives in the Australian CurriculumIn 2010, the Australian Curriculum was launched by the Australian Curriculum, Assessment and Reporting Authority (ACARA) with the goal of unifying state-driven curricula into a common approach. Developed from the 2008 Melbourne Declaration on Educational Goals for Young Australians (Ministerial Council for Education, Early Childhood Development and Youth Affairs [MCEECDYA]), the Curriculum has occupied a prominent position in the Australian educational policy space. As well as preparing a future workforce, contemporary Australian education is essentially aspirational, “governed by the promise of something better” (Harrison et al. 234), with the Australian Curriculum appearing to promise the same: there is a concerted effort to ensure that all Australians have access to equitable and excellent educational opportunities, and that all students are represented within the Curriculum. Part of this aspiration included the development of three Cross-Curriculum Priorities (CCPs), focus areas that “give students the tools and language to engage with and better understand their world at a range of levels” (ACARA, “Cross-Curriculum Priorities” para. 1). The first of these CCPs is Aboriginal and Torres Strait Islander Histories and Cultures and is organised into three key concepts: connection to Country/Place; diversity of Aboriginal and Torres Strait Islander cultures; and diversity of Aboriginal and Torres Strait Islanders societies. In the curriculum more broadly, content descriptions govern what is taught across subject areas from Prep to Year 10. Content elaborations—possible approaches to teaching the standards—detail ways that Aboriginal and Torres Strait Islander Histories and Cultures can be incorporated. For example, Year 7 Science students learn that “predictable phenomena on Earth, including seasons and eclipses, are caused by the relative positions of the sun, Earth and the moon”. This can be taught by “researching knowledges held by Aboriginal and Torres Strait Islander Peoples regarding the phases of the moon and the connection between the lunar cycle and ocean tides” (ACARA, “Science” ACSSU115). This curriculum priority mandates that teachers and learners across Australia engage in representations of Indigenous peoples through teaching and learning activities. However, questions about what constitutes the most appropriate activities, when and where they are incorporated into schooling, and how to best support educators to do this work must continue to be asked.As Indigenous knowledges and perspectives are brought into the classroom where this curriculum is played out, they are shaped by the discourses of the space (Nakata, “Cultural Interface”): what is normalised in a classroom, the teachers’ and students’ prior understandings, and the curriculum and assessment expectations of teaching and learning. Nakata refers to this space as the cultural interface, the contested space between Indigenous and Western knowledge systems where disciplinary discourses, practices and histories translate what is known about Indigenous peoples. This creates complexities and anxieties for teachers tasked with this role (Nakata, “Pathways”). Yet to ignore the presence of Indigenous histories, lifeworlds, and experiences would be to act as if non-Indigenous Australia was alone in the world. The curriculum, as a socio-political document, is full of representations of people. As such, care must be given to how teachers are prepared to engage in the complex process of negotiating these representations.The Classroom as a Location of PossibilityThe introduction of the Australian Curriculum has been accompanied by the Australian Professional Standards for Teachers (APST) which govern the requirements for graduating teachers. Two particular standards—1.4 and 2.4—refer to the teaching of Indigenous students and histories, cultures and language. Many initial teacher education programs in Australian universities have responded to the curriculum requirements and the APSTs by developing a specific subject dedicated to Indigenous education. It is difficult to ascertain the success of this work. Many in-service teachers suggest that more knowledge about Indigenous cultures is required to meet the APST, risking an essentialised view of the Indigenous learner (Moodie and Patrick). Further, there is little empirical research on what improves Indigenous students’ educational outcomes, with the research instead focusing on engaging Indigenous students (Burgess et al.). Similarly, there is yet to be a broadscale research program exploring how teacher educators can best educate pre-service teachers to improve educational outcomes for Indigenous students. Instead, much of the research focuses on engaging (predominantly non-Indigenous) becoming-teachers through a variety of theoretical and pedagogical approaches (Moreton-Robinson et al.) A handful of researchers (e.g. Moodie; Nakata et al.; Page) are considering how to use curriculum design to structure tertiary level Indigenous Studies programs—for pre-service teachers and more generally—to best prepare students to work within complex uncertainties.Levinas’s philosophy reminds us that we need to push beyond thinking about the engagement of Indigenous peoples within the curriculum to the relationship between educator-researchers and their students. Further, Levinas prompts us to question how we can research in this space in a way that is more than just about “disinterested acquisition of knowledge” (Reader 78), instead utilising critical analysis to consider a praxis which ultimately benefits Indigenous students, families and communities. The encounter with Levinas’s writing challenges us to consider how teacher educators can engage with pre-service teachers in a way that does not suggest that they are inherently racist. Rather, we must teach pre-service teachers to not impress the same type of epistemological violence onto Indigenous students, knowledges and cultures. Such questions prompt an engagement with teaching/research which is respectful of the responsibilities to all involved. As hooks reminds us, education can be a practice of freedom: classrooms are locations of possibilities where students can think critically and question taken-for-granted assumptions about the world. To engage with praxis is to consider teaching not just as a practice, but as a theoretically and justice-driven approach. It is with this backdrop that I move now to consider some of the writings of non-Indigenous pre-service teachers.The Research ProjectThe data presented here is from a recent research project exploring pre-service teachers’ experiences of a compulsory Indigenous education subject as part of a four-year initial teacher education degree in an Australian metropolitan university (see McDowall). The subject prepares pre-service teachers to both embed the Aboriginal and Torres Strait Islander Histories and Cultures CCP in their praxis and to teach Indigenous students. This second element engages both an understanding of Indigenous students as inhabiting an intercultural space with particular tensions (Nakata, “Pathways”), and the social-political-historical discourses that impact Indigenous students’ experiences. This includes the history of Indigenous education, the social construction of race, and a critical awareness of deficit approaches to working with Indigenous students. The subject was designed to promote a critical engagement with Indigenous education, to give pre-service teachers theoretical tools to make sense of both how Indigenous students and Indigenous content are positioned in classrooms and develop pedagogical frameworks to enable future teaching work. Pre-service teachers wrote weekly reflective learning journals as an assessment task (weighted at 30% of their total grade). In the final weeks of semester, I asked students in the final weeks of semester for permission to use their journals for a research project, to which 93 students consented.Reading the students’ reflective writing presents a particular ethical paradox, one intricately linked with the act of knowing. Throughout the semester, a desire to gain more knowledge about Indigenous peoples and cultures shifted to a desire to be present as teacher(s) in the Indigenous education landscape. Yet for pre-service teachers with no classroom of their own, this being present is always deferred to the future, mitigating the need for action in the present. This change in the pre-service teachers’ writing demonstrates that the relationship between violence and responsibility is exceedingly complex within the intersection of Indigenous and teacher education. These themes are explored in the following sections.Epistemological ViolenceOne of the shifts which occurred throughout the semester was a subtle difference in the types of knowledges students sought. In the first few weeks of the subject, many of the pre-service teachers wrote of a strong desire to know about Indigenous people and culture as a way of becoming a better educator. Their expectations were around wanting to address their “limited understandings”, wanting to “heighten”, “develop”, and “broaden” “understanding” and “knowledge”; to know “more about them, their culture”. At the end, knowing and understanding is presented in a different type of way. For some students, the knowledge they now want is about their own histories and culture: “as a teacher I need the bravery to acknowledge what happened in the past”, wrote one student in her final entry.For other students, the idea of knowing was shaped by not-knowing. Moving away from a desire to know, and thereby possess, the students wrote about the need to know no longer being present: “I owe my current sense of confidence to that Nakata article. The education system can’t expect all teachers to know exactly how to embed Indigenous pedagogy into their classrooms, can they?” writes one student in her final entry, following on to say, “the main strategy I got from the readings … still stands true: ‘We don’t know everything’ and I will not act like I do”. Another writes, “I am not an expert and I am now aware of the multitude of resources available, particularly the community”.For the students to claim knowledge of Indigenous peoples would be to enact epistemological violence, denying the alterity—difference—of the other and drawing them into our totalities. In the final weeks of the semester, some students wrote that they would use hands-on, outdoor activities in order to enact a culturally responsive pedagogy. Such a claim shows the tenacity of Western knowledge about Indigenous students. In this case, the students’ sentiment can be traced back to Aboriginal Learning Styles (Harris), the idea that Aboriginal students inherently learn via informal hands-on (as opposed to abstract) group approaches. The type of difference promoted in Aboriginal learning styles is biological, suggesting that on account of their Indigeneity, Aboriginal students inherently learn differently. Through its biological function, this difference essentialises Indigenous learners across the nation, claiming a sameness. But perhaps even more violently, it denies the presence of an Indigenous knowledge system in the place where the research took place. Such an Indigenous knowledge system begins from the land, from Country, and entails a rich set of understandings around how knowledge is produced, shared, learnt and, enacted through place and people-based knowledge practices (Verran). Aboriginal learning styles reduces richness to a more graspable concept: informal learning. To summarise, students’ early claims to knowledge shifted to an understanding that it is okay to ‘not know’—to recognise that as beginning teachers, they are entering a complex field and must continue learning. This change is complicated by the tenacity of knowledge claims which define Indigenous students into a Western order of knowledge. Such claims continue to present themselves in the students writing. Nonetheless, as students progressed through the semester and engaged with some of the difficult knowledges and understandings presented, a new form of knowing emerged. Ethical ResponsibilitiesAs pre-service teachers learned about the complex cultural interface of classrooms, they began to reconsider their own claims to be able to ‘know’ Indigenous students and cultures. This is not to say that pre-service teachers do not feel responsibility for Indigenous students: in many journals, pre-service teachers’ wanted-ness in the classroom—their understanding of their importance of presence as teachers—is evident. To write for themselves a need to be present demonstrates responsibility. This took place as students imagined future praxis. With words woven together from several journals, the students’ final entries indicate a wanting-to-be-present-as-becoming-ethical-teachers: I willremember forever, reactionsshocked, sad, guilty. A difference isI don’t feel guilt.I feelI’m not alone.I feelmore aware ofhow I teachhow my opinionscan affect people. I guesswe are the oneswho must makethe change. I feelsomewhat relieved bywhat today’s lecturer said.“If you’re willingto step outfrom behind fencesto engage meaningfullywith Indigenous communitiesit will not be difficult.” I believethe 8-ways frameworkthe unit of workprovide authentic experiencesare perfect avenuesshape pedagogical practicesI believemy job isto embrace remembrancemake this happenmake sure it stays. I willtake away frameworkssupport Indigenous studentsalongside Indigenous teacherslearn from themconsult with communityimprove my teaching. In these students’ words is an assumed responsibility to incorporate Indigenous knowledges and perspectives into their work as teachers. To wish representations of Indigenous peoples and knowledges present in the classroom is one way in which the becoming-teachers are making themselves present. Even a student who had written that she still didn’t feel completely equipped with pedagogical tools still felt “motivated” to introduce “political issues into Australia’s current system”.Not all students wrote of such presence. One student wrote of feeling left “disappointed”, “out of pocket”, “judged” – that the subject had “just ‘ticked the box’” (a phrase used by a second student as well). Another student wrote a short reflection that scratched the surface of the Apology¹, noting that “sorry is something so easy to say”. It is the mixture of these responses which reminds us as researchers and educators that it is easy to write a sense of presence as a projection into the future into an assessment task for a university subject. Time is another other, and the future can never be grasped, can never truly be known (Levinas, Reader). It is always what is coming, for we can only ever experience the present. These final entries by the students claim a future that they cannot know. This is not to suggest that the words written—the I wills and I believes which roll so quickly off the pen—are not meaningful or meant. Rather, responsibility is deferred to the future. This is not just a responsibility for their future teaching. Deferral to the future can also be a way to ease one’s self of the burden of feeling bad about the social injustices which students observe. As Rose (17) writes,The vision of a future which will transcend the past, a future in which current contradictions and current suffering will be left behind enables us to understand ourselves in an imaginary state of future achievement … enables us to turn our backs on current social facts of pain, damage, destruction and despair which exist in the present, but which we will only acknowledge as our past.The pre-service teachers’ reflective writing presents us with a paradox. As they shift away from the epistemological violence of claiming to know Indigenous others from outside positions, another type of violence manifests: claiming a future which can transcend the past just as they defer responsibility within the present. The deferral is in itself an act of violence. What types, then, of presence—a sense of responsibility—can students-as-becoming-professionals demonstrate?ConclusionRose’s words ask us as researchers and educators to consider what it might mean to “do” ethical practice in the “here and now”. When teachers claim that more knowledge about Indigenous peoples will lead to better practice, they negate the epistemological violence of bringing Indigeneity into a Western order of knowledge. Yet even as pre-service teachers’ frameworks shift toward a sense of responsibility for working with Indigenous students, families, and communities—a sense of presence—they are caught in a necessary but problematic moment of deferral to future praxis. A future orientation enables the deflection of responsibility, focusing on what the pre-service teachers might do in the future when they have their own classrooms, but turning their backs on a lack of action in the present. Such a complexity reveals the paradox of assessing learnings for both researchers and university educators. Pre-service teachers—visitors in placement classrooms and students in universities—are always writing and projecting skill towards the future. As educators, we continually ask for students to demonstrate how they will change their future work in a time yet to come. Yet when pre-service teachers undertake placements, their agency to enact difference as becoming-teachers is limited by the totality of the current school programs in which they find themselves. A reflective learning journal, as assessment directed at projecting their future work as teachers, does not enable or ask for a change in the here and now. We must continue to engage in such complexities in considering the potential of epistemological violence as both researchers and educators. Engaging with philosophy is one way to think about what we do (Kameniar et al.) in Indigenous education, a complex field underpinned by violent historical legacies and decades of discursive policy and one where the majority of the workforce is non-Indigenous and working with ideas outside of their own experiences of being. To remember that we are not alone in the world is to stay present with this complexity.ReferencesAustralian Curriculum and Assessment Reporting Authority. “Cross-Curriculum Priorities.” Australian Curriculum. Australian Curriculum and Assessment Reporting Authority, n.d. 23 Apr. 2020 <https://www.australiancurriculum.edu.au/f-10-curriculum/cross-curriculum-priorities/­>.———. “Science.” Australian Curriculum. Australian Curriculum and Assessment Reporting Authority, n.d. 23 Apr. 2020 <https://www.australiancurriculum.edu.au/f-10-curriculum/science/>.Burgess, Cathie, Christine Tennent, Greg Vass, John Guenther, Kevin Lowe, and Nikki Moodie. “A Systematic Review of Pedagogies That Support, Engage and Improve the Educational Outcomes of Aboriginal Students.” Australian Education Researcher 46.2 (2019): 297-318.Burns, Marcelle. “The Unfinished Business of the Apology: Senate Rejects Stolen Generations Bill 2008 (Cth).” Indigenous Law Bulletin 7.7 (2008): 10-14.Graham, Mary. “Some Thoughts about the Philosophical Underpinnings of Aboriginal Worldviews.” Australian Humanities Review 45 (2008). 6 Nov. 2016 <http://australianhumanitiesreview.org/2008/11/01/some-thoughts-about-the-philosophical-underpinnings-of-aboriginal-worldviews/>.Harris, Stephen. “Aboriginal Learning Styles and Formal Schooling.” The Aboriginal Child at School 12.4 (1984): 3-23.Harrison, Neil, Christine Tennent, Greg Vass, John Guenther, Kevin Lowe, and Nikki Moodie. “Curriculum and Learning in Aboriginal and Torres Strait Islander Education: A Systematic Review.” Australian Educational Researcher 46.2 (2019): 233-251.hooks, bell. Teaching to Transgress: Education as the Practice of Freedom. New York: Routledge, 1994.Kameniar, Barbara, Sally Windsor, and Sue Sifa. “Teaching Beginning Teachers to ‘Think What We Are Doing’ in Indigenous Education.” The Australian Journal of Indigenous Education 43.2 (2014): 113-120.Levinas, Emmanuel. Existence and Existents. Trans. Alphonso Lingis. Pittsburgh, PA: Duquesne UP, 1947/1978.———. Totality and Infinity. Trans. Alphonso Lingis. Pittsburgh, PA: Duquesne UP, 1969.———. The Levinas Reader. Ed. Sean Hand. Oxford: Basil Blackwell, 1989.McDowall, Ailie. “Following Writing Around: Encountering Ethical Responsibilities in Pre-Service Teachers’ Reflective Journals in Indigenous Education.” PhD dissertation. Brisbane: University of Queensland, 2018.Ministerial Council for Education, Early Childhood Development and Youth Affairs. Melbourne Declaration on Educational Goals for Young Australians. Ministerial Council for Education, Early Childhood Development and Youth Affairs, 2008. <http://www.curriculum.edu.au/verve/_resources/National_Declaration_on_the_Educational_Goals_for_Young_Australians.pdf>.Moodie, Nikki. “Learning about Knowledge: Threshold Concepts for Indigenous Studies in Education.” Australian Educational Researcher 46.5 (2019): 735-749.Moodie, Nikki, and Rachel Patrick. “Settler Grammars and the Australian Professional Standards for Teachers.” Asia-Pacific Journal of Teacher Education 45.5 (2017): 439-454.Moreton-Robinson, Aileen, David Singh, Jessica Kolopenuk, and Adam Robinson. Learning the Lessons? Pre-service Teacher Preparation for Teaching Aboriginal and Torres Strait Islander Students. Queensland University of Technology Indigenous Studies Research Network, 2012. <https://www.aitsl.edu.au/docs/default-source/default-document-library/learning-the-lessons-pre-service-teacher-preparation-for-teaching-aboriginal-and-torres-strait-islander-studentsfb0e8891b1e86477b58fff00006709da.pdf?sfvrsn=bbe6ec3c_0>.Nakata, Martin. “The Cultural Interface.” The Australian Journal of Indigenous Education 36.S1 (2007): 7-14.———. “Pathways for Indigenous Education in the Australian Curriculum Framework.” The Australian Journal of Indigenous Education 40 (2011): 1-8.Nakata, Martin, Victoria Nakata, Sarah Keech, and Reuben Bolt. “Decolonial Goals and Pedagogies for Indigenous Studies.” Decolonization: Indigeneity, Education & Society 1.1 (2012): 120-140.Page, Susan. “Exploring New Conceptualisations of Old Problems: Researching and Reorienting Teaching in Indigenous Studies to Transform Student Learning.” The Australian Journal of Indigenous Education 32.1 (2014): 21–30.Peterson, Nicolas. “‘Studying Man and Man’s Nature’: The History of the Institutionalisation of Aboriginal Anthropology.” Australian Aboriginal Studies 2 (1990): 3-19.Pholi, Kerryn, Dan Black, and Craig Richards. “Is ‘Close the Gap’ a Useful Approach to Improving the Health and Wellbeing of Indigenous Australians?” Australian Review of Public Affairs 9.2 (2009): 1-13.Rose, Deborah B. Reports from a Wild Country: Ethics of Decolonisation. Sydney: U of New South Wales P, 2004.Verran, Helen. “Knowledge Systems of Aboriginal Australians: Questions and Answers Arising in a Databasing Project.” Encyclopaedia of the History of Science, Technology, and Medicine in Non-Western Cultures. Ed. Helaine Selin. New York: Springer, 2008. 1171-1177.Note1. The Apology refers to a motion moved in the Federal Parliament by the 2008 Prime Minister. The motion, seconded by the Leader of the Opposition, was an official apology to members of the Stolen Generations, Indigenous peoples who had been removed from their families by the state. A bill to establish a compensation fund as reparations was not passed (Burns).