Academic literature on the topic 'Weak Cousin condition'

Background. Arthrogryposis is severe congenital musculoskeletal disease with contractures of two or more joints of the lower and/or upper limbs and usually in combination with muscular hypo- or atrophy.Clinical Case Description. Child F. was hospitalized in the department of newborns and premature babies’ pathology on 6th day of life in critical condition. Spontaneous motor activity was severely decreased. He responds to the examination with little increase in motor activity and weak painful scream. Muscle tone is dystonic: it is diffusely reduced in the proximal parts of the upper and lower limbs, in the distal parts of the upper limbs it is significantly increased, there are flexion contractures of the fingers on both hands (mostly on the left one). Passive fingers contractures reversal is difficult. There were no feet deformities or craniofacial anomalies. Hereditary history is burdened: child’s father (1984 year of birth), great-grandfather and cousin uncle (on the paternal line) have finger deformities on both hands. Father and relatives have not been diagnosed before. The clinical diagnosis was established after consultation of geneticist and orthopedist: «Distal arthrogryposis, type 2A, autosomal dominant type of inheritance with incomplete penetrance». The molecular genetic testing was not performed due to the refusal of the child's parents. Therapeutic gymnastics, stage plaster correction of finger contractures were performed in the department during the child hospitalization (21 days). Positive dynamics was noted: finger extension amplitude has increased.Conclusion. Early conservative treatment of infants with arthrogryposis allows to correct musculoskeletal deformities. Early initiation of treatment is expected to increase the amplitude of both passive and active movements in the hand joints, whereas, it will improve the function of hand grasping and self-care capacities of patients.

A 19-year-old African American woman presented to the emergency department with a history of left upper quadrant pain for a week, associated with nausea, malaise, loss of appetite, subjective fevers and chills. Her family history is significant for thalassemia in her maternal aunt, and hereditary spherocytosis in her brother, sister and cousin. A contrast-enhanced CT scan of the abdomen and pelvis revealed massive splenomegaly and multiple splenic infarcts. On the second day of admission, she developed a fever of 103°F. Further evaluation revealed acute Epstein-Barr virus (EBV) infection and hereditary spherocytosis. Her condition improved after 4 days on piperacillin/tazobactam, intravenous fluids, analgesics and antipyretics. Our case report describes a thorough clinical evaluation of a patient with fever, anaemia, massive splenomegaly and multiple splenic infarcts. It highlights the need for careful interpretation of multiple positive IgM results on viral serological testing that often accompanies acute EBV infections.

Virginia, Britain's most populous and arguably most important North American colony, once seemed the perfect fit for the “consensus” interpretation of the War of Independence. Indeed, the percentage of white colonists who became loyalists was probably lower in Virginia than in any other rebelling colony. The widespread agreement on secession from Britain should not, however, be mistaken for social consensus. The reality was that revolutionary Virginia was frequently in turmoil. One of the most intriguing of the local insurrections broke out in the northern county of Loudoun just five months before the Declaration of Independence. In February 1776, the county erupted into a heated confrontation pitting gentlemen against their less wealthy neighbours. Lund Washington, who was managing Mount Vernon, warned his cousin, General George Washington, who was outside Boston training his fledgeling patriot army, that the “first Battle we have in this part of the Country will be in Loudon” – not against British soldiers, but against fellow patriots. Within a week, the revolutionary government in Williamsburg, the Committee of Safety, felt compelled to send troops to quell the disturbances. Yet, for months afterwards, gentry Virginians worried that their effort to suppress the rebellion had failed. In mid-May, Andrew Leitch told Leven Powell of Loudoun, “I really lament the torn and distracted condition of your County.” The “troublesome times,” as another gentleman called them, were slow to abate.

The global economy is moving uncertainly towards recession. An economy in the balance that remains uncertain on the threshold of recession, relying on the benevolent contribution of support policies. Without the help of fiscal policy and the complacency of the Central Banks through new liquidity injections, and therefore through easy credit, it can certainly be admitted that the recession would tend to prevail. But the recession is not a bad thing in itself, it’s rather the treatment for the evil afflicting the economy: the growing instability of economic systems under the increasing weight of excessive liquidity and an abnormal increase of public and private debt. The result of this negative equation is the growth of the economy sustained by abundant liquidity and credit availability and then a weak and doped development. A development line that cannot go on without the resources of politics. The problem is therefore whether this dependency condition can last. That is, if the economy can find the virtuous energies to reabsorb the accumulated excesses through a sustainable growth. The compulsive use of fiscal policy to fight the damage caused by the serious 2008-2010 crisis has undoubtedly reduced the economic and above all social damage due to the loss of jobs, and therefore helped the recovery. However, the massive use of public debt could hide a dark side. First of all, it fueled a legacy of recessive prices and weak development. And this, despite the large river of liquidity injected into the system by the Central Banks. However, the availability of new liquidity did not defeat the tendency of the economy to deflation and then couldn’t support development, which appears generally weak. The US case, which sees the relaunch of development by the fiscal reform that reduces taxation particularly in favor of higher incomes, doesn’t seem to be an exception. However, we are facing economies that require the continuous support of political policies in order to confirm their (weak) growth. On the other hand, it’s quite clear the dark side created by the trap "liquidity - weak growth" now affecting the global development, although without this trick the world in the balance could fall into recession.

Abstract Background Autoimmune polyendocrine syndrome type 1 (APS1) is a rare inherited autoimmune disease, characterized by primary adrenocortical insufficiency and hypoparathyroidism. Pathologic mutations in the autoimmune regulator (AIRE) gene, which participates in the regulation of T-cell self-tolerance can lead to APS-1. Defective function of AIRE encourages production of multiple anti-cytokine and organ-specific autoantibodies, leading to severe autoimmune disease across multiple organs. Autoimmune enteropathy is one of the autoimmune conditions associated with APS-1. Symptoms include chronic diarrhoea and weight loss. Extraintestinal manifestations can include haemolytic anaemia and hepatitis. Purpose To report on a patient with APS-1 who exhibited exacerbations of acute-on-chronic diarrhoea and transaminitis. Method We describe the case of a 14-year-old female, the first child of healthy, first-cousin consanguineous parents, with a history of APS type 1 with a homozygous disease-causing variant in the AIRE gene (c.415C>T, p.139*), hypoparathyroidism and Addison’s disease who presented with worsening diarrhoea and unintentional weight loss (15kg) in the past year. Upper and lower endoscopies performed 10 months and 2 months prior to this admission revealed chronic gastritis and patchy active colitis, without features of a specific etiology. Enteroendocrine cells were present. Celiac disease, inflammatory bowel disease, eosinophilic gastroenteritis, and IPEX syndrome were clinically and histologically ruled out. Result(s) On admission, the patient was having five watery stools per day with associated hypocalcemia and hypokalemia which were felt to be more resistant to treatment than should be explained by her Addison’s disease alone. Albumin was preserved (46 g/L). A stool PCR test for Adenovirus was positive, though serum adenovirus PCR was negative. ALT was 231 U/L and AST was 283 U/L. IgG level was elevated (17.7 g/L), anti-nuclear antibody (ANA) was positive (1:320), and anti-smooth muscle antibody (ASMA) was also positive (1:160). It was therefore suspected that he had autoimmune enteropathy and autoimmune hepatitis, and a liver biopsy was performed as well as upper and lower endoscopies. Liver biopsy demonstrated only minimal macrosteatosis (less than 5%) but no evidence of hepatitis. No abnormal endoscopic findings were observed. Histology showed no typical features of autoimmune enteropathy. Enteroendocrine cells were noted in both small and large intestinal biopsies. Her elevated liver enzymes and diarrhea were resolved spontaneously over a 2-week period. Conclusion(s) We present a patient with APS-1 with acute-on-chronic diarrhoea and transaminitis with elevated IgG and positive ANA and ASMA. Endoscopy and liver biopsy did not reveal evidence of autoimmune enteropathy or autoimmune hepatitis. This case raises the importance of maintaining a broad differential diagnosis when diarrhoea is encountered in APS-1 as this may occur for reasons outside of autoimmune enteroendocrine cell loss. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared ENDOSCOPY, TECHNOLOGY & IMAGING

Background and Objective: Suicide attempts are 10-20X more common than completed suicide and an important risk factor for death by suicide, yet most people who attempt suicide do not die by suicide. The process of recovering after a suicide attempt has not been well studied. The Reasons to go on Living (RTGOL) Project, a narrative web-based study, focuses on experiences of people who have attempted suicide and made the decision to go on living, a process not well studied. Narrative research is ideally suited to understanding personal experiences critical to recovery following a suicide attempt, including the transition to a state of hopefulness. Voices from people with lived experience can help us plan and conceptualize this work. This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. Material and Methods: A website created for The RTGOL Project (www.thereasons.ca) enabled participants to anonymously submit a story about their suicide attempt and recovery, a process which enabled participation from a large and diverse group of participants. The only direction given was “if you have made a suicide attempt or seriously considered suicide and now want to go on living, we want to hear from you.” The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Over 5 years, data analysis occurred in several phases over the course of the study, resulting in the identification of data that were inputted into an Excel file. This analysis used stories where participants described positive involvement with the mental health system (50 stories). Results: Several participants reflected on experiences many years previous, providing the privilege of learning how their life unfolded, what made a difference. Over a five-year period, 50 of 226 stories identified positive experiences with mental health care with sufficient details to allow analysis, and are the focus of this paper. There were a range of suicidal behaviours in these 50 stories, from suicidal ideation only to medically severe suicide attempts. Most described one or more suicide attempts. Three themes identified included: 1) trust and relationship with a health care professional, 2) the role of friends and family and friends, and 3) a wide range of services. Conclusion: Stories open a window into the experiences of the period after a suicide attempt. This study allowed for an understanding of how mental health professionals might help individuals who have attempted suicide write a different story, a life-affirming story. The stories that participants shared offer some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers, including immediately after a suicide attempt. Results of this study reinforce that just one caring professional can make a tremendous difference to a person who has survived a suicide attempt. Key Words: web-based; suicide; suicide attempt; mental health system; narrative research Word Count: 478 Introduction My Third (or fourth) Suicide AttemptI laid in the back of the ambulance, the snow of too many doses of ativan dissolving on my tongue.They hadn't even cared enough about meto put someone in the back with me,and so, frustrated,I'd swallowed all the pills I had with me— not enough to do what I wanted it to right then,but more than enough to knock me out for a good 14 hours.I remember very little after that;benzodiazepines like ativan commonly cause pre- and post-amnesia, says Google helpfullyI wake up in a locked rooma woman manically drawing on the windows with crayonsthe colors of light through the glassdiffused into rainbows of joy scattered about the roomas if she were coloring on us all,all of the tattered remnants of humanity in a psych wardmade into a brittle mosaic, a quilt of many hues, a Technicolor dreamcoatand I thoughtI am so glad to be able to see this. (Story 187)The nurse opening that door will have a lasting impact on how this story unfolds and on this person’s life. Each year, almost one million people die from suicide, approximately one death every 40 seconds. Suicide attempts are much more frequent, with up to an estimated 20 attempts for every death by suicide.1 Suicide-related behaviours range from suicidal ideation and self-injury to death by suicide. We are unable to directly study those who die by suicide, but effective intervention after a suicide attempt could reduce the risk of subsequent death by suicide. Near-fatal suicide attempts have been used to explore the boundary with completed suicides. Findings indicated that violent suicide attempters and serious attempters (seriousness of the medical consequences to define near-fatal attempts) were more likely to make repeated, and higher lethality suicide attempts.2 In a case-control study, the medically severe suicide attempts group (78 participants), epidemiologically very similar to those who complete suicide, had significantly higher communication difficulties; the risk for death by suicide multiplied if accompanied by feelings of isolation and alienation.3 Most research in suicidology has been quantitative, focusing almost exclusively on identifying factors that may be predictive of suicidal behaviours, and on explanation rather than understanding.4 Qualitative research, focusing on the lived experiences of individuals who have attempted suicide, may provide a better understanding of how to respond in empathic and helpful ways to prevent future attempts and death by suicide.4,5 Fitzpatrick6 advocates for narrative research as a valuable qualitative method in suicide research, enabling people to construct and make sense of the experiences and their world, and imbue it with meaning. A review of qualitative studies examining the experiences of recovering from or living with suicidal ideation identified 5 interconnected themes: suffering, struggle, connection, turning points, and coping.7 Several additional qualitative studies about attempted suicide have been reported in the literature. Participants have included patients hospitalized for attempting suicide8, and/or suicidal ideation,9 out-patients following a suicide attempt and their caregivers,10 veterans with serious mental illness and at least one hospitalization for a suicide attempt or imminent suicide plan.11 Relationships were a consistent theme in these studies. Interpersonal relationships and an empathic environment were perceived as therapeutic and protective, enabling the expression of thoughts and self-understanding.8 Given the connection to relationship issues, the authors suggested it may be helpful to provide support for the relatives of patients who have attempted suicide. A sheltered, friendly environment and support systems, which included caring by family and friends, and treatment by mental health professionals, helped the suicidal healing process.10 Receiving empathic care led to positive changes and an increased level of insight; just one caring professional could make a tremendous difference.11 Kraft and colleagues9 concluded with the importance of hearing directly from those who are suicidal in order to help them, that only when we understand, “why suicide”, can we help with an alternative, “why life?” In a grounded theory study about help-seeking for self-injury, Long and colleagues12 identified that self-injury was not the problem for their participants, but a panacea, even if temporary, to painful life experiences. Participant narratives reflected a complex journey for those who self-injured: their wish when help-seeking was identified by the theme “to be treated like a person”. There has also been a focus on the role and potential impact of psychiatric/mental health nursing. Through interviews with experienced in-patient nurses, Carlen and Bengtsson13 identified the need to see suicidal patients as subjective human beings with unique experiences. This mirrors research with patients, which concluded that the interaction with personnel who are devoted, hope-mediating and committed may be crucial to a patient’s desire to continue living.14 Interviews with individuals who received mental health care for a suicidal crisis following a serious attempt led to the development of a theory for psychiatric nurses with the central variable, reconnecting the person with humanity across 3 phases: reflecting an image of humanity, guiding the individual back to humanity, and learning to live.15 Other research has identified important roles for nurses working with patients who have attempted suicide by enabling the expression of thoughts and developing self-understanding8, helping to see things differently and reconnecting with others,10 assisting the person in finding meaning from their experience to turn their lives around, and maintain/and develop positive connections with others.16 However, one literature review identified that negative attitudes toward self-harm were common among nurses, with more positive attitudes among mental health nurses than general nurses. The authors concluded that education, both reflective and interactive, could have a positive impact.17 This paper is one part of a larger web-based narrative study, the Reasons to go on Living Project (RTGOL), that seeks to understand the transition from making a suicide attempt to choosing life. When invited to tell their stories anonymously online, what information would people share about their suicide attempts? This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. The focus on the positive impact reflects an appreciative inquiry approach which can promote better practice.18 Methods Design and Sample A website created for The RTGOL Project (www.thereasons.ca) enabled participants to anonymously submit a story about their suicide attempt and recovery. Participants were required to read and agree with a consent form before being able to submit their story through a text box or by uploading a file. No demographic information was requested. Text submissions were embedded into an email and sent to an account created for the Project without collecting information about the IP address or other identifying information. The content of the website was reviewed by legal counsel before posting, and the study was approved by the local Research Ethics Board. Stories were collected for 5 years (July 2008-June 2013). The RTGOL Project enabled participation by a large, diverse audience, at their own convenience of time and location, providing they had computer access. The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Of the 226 submissions to the website, 112 described involvement at some level with the mental health system, and 50 provided sufficient detail about positive experiences with mental health care to permit analysis. There were a range of suicidal behaviours in these 50 stories: 8 described suicidal ideation only; 9 met the criteria of medically severe suicide attempts3; 33 described one or more suicide attempts. For most participants, the last attempt had been some years in the past, even decades, prior to writing. Results Stories of positive experiences with mental health care described the idea of a door opening, a turning point, or helping the person to see their situation differently. Themes identified were: (1) relationship and trust with a Health Care Professional (HCP), (2) the role of family and friends (limited to in-hospital experiences), and (3) the opportunity to access a range of services. The many reflective submissions of experiences told many years after the suicide attempt(s) speaks to the lasting impact of the experience for that individual. Trust and Relationship with a Health Care Professional A trusting relationship with a health professional helped participants to see things in a different way, a more hopeful way and over time. “In that time of crisis, she never talked down to me, kept her promises, didn't panic, didn't give up, and she kept believing in me. I guess I essentially borrowed the hope that she had for me until I found hope for myself.” (Story# 35) My doctor has worked extensively with me. I now realize that this is what will keep me alive. To be able to feel in my heart that my doctor does care about me and truly wants to see me get better.” (Story 34). The writer in Story 150 was a nurse, an honours graduate. The 20 years following graduation included depression, hospitalizations and many suicide attempts. “One day after supper I took an entire bottle of prescription pills, then rode away on my bike. They found me late that night unconscious in a downtown park. My heart threatened to stop in the ICU.” Then later, “I finally found a person who was able to connect with me and help me climb out of the pit I was in. I asked her if anyone as sick as me could get better, and she said, “Yes”, she had seen it happen. Those were the words I had been waiting to hear! I quickly became very motivated to get better. I felt heard and like I had just found a big sister, a guide to help me figure out how to live in the world. This person was a nurse who worked as a trauma therapist.” At the time when the story was submitted, the writer was applying to a graduate program. Role of Family and Friends Several participants described being affected by their family’s response to their suicide attempt. Realizing the impact on their family and friends was, for some, a turning point. The writer in Story 20 told of experiences more than 30 years prior to the writing. She described her family of origin as “truly dysfunctional,” and she suffered from episodes of depression and hospitalization during her teen years. Following the birth of her second child, and many family difficulties, “It was at this point that I became suicidal.” She made a decision to kill herself by jumping off the balcony (6 stories). “At the very last second as I hung onto the railing of the balcony. I did not want to die but it was too late. I landed on the parking lot pavement.” She wrote that the pain was indescribable, due to many broken bones. “The physical pain can be unbearable. Then you get to see the pain and horror in the eyes of someone you love and who loves you. Many people suggested to my husband that he should leave me in the hospital, go on with life and forget about me. During the process of recovery in the hospital, my husband was with me every day…With the help of psychiatrists and a later hospitalization, I was actually diagnosed as bipolar…Since 1983, I have been taking lithium and have never had a recurrence of suicidal thoughts or for that matter any kind of depression.” The writer in Story 62 suffered childhood sexual abuse. When she came forward with it, she felt she was not heard. Self-harm on a regular basis was followed by “numerous overdoses trying to end my life.” Overdoses led to psychiatric hospitalizations that were unhelpful because she was unable to trust staff. “My way of thinking was that ending my life was the only answer. There had been numerous attempts, too many to count. My thoughts were that if I wasn’t alive I wouldn’t have to deal with my problems.” In her final attempt, she plunged over the side of a mountain, dropping 80 feet, resulting in several serious injuries. “I was so angry that I was still alive.” However, “During my hospitalization I began to realize that my family and friends were there by my side continuously, I began to realize that I wasn't only hurting myself. I was hurting all the important people in my life. It was then that I told myself I am going to do whatever it takes.” A turning point is not to say that the difficulties did not continue. The writer of Story 171 tells of a suicide attempt 7 years previous, and the ongoing anguish. She had been depressed for years and had thoughts of suicide on a daily basis. After a serious overdose, she woke up the next day in a hospital bed, her husband and 2 daughters at her bed. “Honestly, I was disappointed to wake up. But, then I saw how scared and hurt they were. Then I was sorry for what I had done to them. Since then I have thought of suicide but know that it is tragic for the family and is a hurt that can never be undone. Today I live with the thought that I am here for a reason and when it is God's time to take me then I will go. I do believe living is harder than dying. I do believe I was born for a purpose and when that is accomplished I will be released. …Until then I try to remind myself of how I am blessed and try to appreciate the wonders of the world and the people in it.” Range of Services The important role of mental health and recovery services was frequently mentioned, including dialectical behavioural therapy (DBT)/cognitive-behavioural therapy (CBT), recovery group, group therapy, Alcoholics Anonymous, accurate diagnosis, and medications. The writer in Story 30 was 83 years old when she submitted her story, reflecting on a life with both good and bad times. She first attempted suicide at age 10 or 12. A serious post-partum depression followed the birth of her second child, and over the years, she experienced periods of suicidal intent: “Consequently, a few years passed and I got to feeling suicidal again. I had pills in one pocket and a clipping for “The Recovery Group” in the other pocket. As I rode on the bus trying to make up my mind, I decided to go to the Recovery Group first. I could always take the pills later. I found the Recovery Group and yoga helpful; going to meetings sometimes twice a day until I got thinking more clearly and learned how to deal with my problems.” Several participants described the value of CBT or DBT in learning to challenge perceptions. “I have tools now to differentiate myself from the illness. I learned I'm not a bad person but bad things did happen to me and I survived.”(Story 3) “The fact is that we have thoughts that are helpful and thoughts that are destructive….. I knew it was up to me if I was to get better once and for all.” (Story 32): “In the hospital I was introduced to DBT. I saw a nurse (Tanya) every day and attended a group session twice a week, learning the techniques. I worked with the people who wanted to work with me this time. Tanya said the same thing my counselor did “there is no study that can prove whether or not suicide solves problems” and I felt as though I understood it then. If I am dead, then all the people that I kept pushing away and refusing their help would be devastated. If I killed myself with my own hand, my family would be so upset. DBT taught me how to ‘ride my emotional wave’. ……….. DBT has changed my life…….. My life is getting back in order now, thanks to DBT, and I have lots of reasons to go on living.”(Story 19) The writer of Story 67 described the importance of group therapy. “Group therapy was the most helpful for me. It gave me something besides myself to focus on. Empathy is such a powerful emotion and a pathway to love. And it was a huge relief to hear others felt the same and had developed tools of their own that I could try for myself! I think I needed to learn to communicate and recognize when I was piling everything up to build my despair. I don’t think I have found the best ways yet, but I am lifetimes away from that teenage girl.” (Story 67) The author of story 212 reflected on suicidal ideation beginning over 20 years earlier, at age 13. Her first attempt was at 28. “I thought everyone would be better off without me, especially my children, I felt like the worst mum ever, I felt like a burden to my family and I felt like I was a failure at life in general.” She had more suicide attempts, experienced the death of her father by suicide, and then finally found her doctor. “Now I’m on meds for a mood disorder and depression, my family watch me closely, and I see my doctor regularly. For the first time in 20 years, I love being a mum, a sister, a daughter, a friend, a cousin etc.” Discussion The 50 stories that describe positive experiences in the health care system constitute a larger group than most other similar studies, and most participants had made one or more suicide attempts. Several writers reflected back many years, telling stories of long ago, as with the 83-year old participant (Story 30) whose story provided the privilege of learning how the author’s life unfolded. In clinical practice, we often do not know – how did the story turn out? The stories that describe receiving health care speak to the impact of the experience, and the importance of the issues identified in the mental health system. We identified 3 themes, but it was often the combination that participants described in their stories that was powerful, as demonstrated in Story 20, the young new mother who had fallen from a balcony 30 years earlier. Voices from people with lived experience can help us plan and conceptualize our clinical work. Results are consistent with, and add to, the previous work on the importance of therapeutic relationships.8,10,11,14–16 It is from the stories in this study that we come to understand the powerful experience of seeing a family members’ reaction following a participant’s suicide attempt, and how that can be a potent turning point as identified by Lakeman and Fitzgerald.7 Ghio and colleagues8 and Lakeman16 identified the important role for staff/nurses in supporting families due to the connection to relationship issues. This research also calls for support for families to recognize the important role they have in helping the person understand how much they mean to them, and to promote the potential impact of a turning point. The importance of the range of services reflect Lakeman and Fitzgerald’s7 theme of coping, associating positive change by increasing the repertoire of coping strategies. These findings have implications for practice, research and education. Working with individuals who are suicidal can help them develop and tell a different story, help them move from a death-oriented to life-oriented position,15 from “why suicide” to “why life.”9 Hospitalization provides a person with the opportunity to reflect, to take time away from “the real world” to consider oneself, the suicide attempt, connections with family and friends and life goals, and to recover physically and emotionally. Hospitalization is also an opening to involve the family in the recovery process. The intensity of the immediate period following a suicide attempt provides a unique opportunity for nurses to support and coach families, to help both patients and family begin to see things differently and begin to create that different story. In this way, family and friends can be both a support to the person who has attempted suicide, and receive help in their own struggles with this experience. It is also important to recognize that this short period of opportunity is not specific to the nurses in psychiatric units, as the nurses caring for a person after a medically severe suicide attempt will frequently be the nurses in the ICU or Emergency departments. Education, both reflective and interactive, could have a positive impact.17 Helping staff develop the attitudes, skills and approach necessary to be helpful to a person post-suicide attempt is beginning to be reported in the literature.21 Further implications relate to nursing curriculum. Given the extent of suicidal ideation, suicide attempts and deaths by suicide, this merits an important focus. This could include specific scenarios, readings by people affected by suicide, both patients themselves and their families or survivors, and discussions with individuals who have made an attempt(s) and made a decision to go on living. All of this is, of course, not specific to nursing. All members of the interprofessional health care team can support the transition to recovery of a person after a suicide attempt using the strategies suggested in this paper, in addition to other evidence-based interventions and treatments. Findings from this study need to be considered in light of some specific limitations. First, the focus was on those who have made a decision to go on living, and we have only the information the participants included in their stories. No follow-up questions were possible. The nature of the research design meant that participants required access to a computer with Internet and the ability to communicate in English. This study does not provide a comprehensive view of in-patient care. However, it offers important inputs to enhance other aspects of care, such as assessing safety as a critical foundation to care. We consider these limitations were more than balanced by the richness of the many stories that a totally anonymous process allowed. Conclusion Stories open a window into the experiences of a person during the period after a suicide attempt. The RTGOL Project allowed for an understanding of how we might help suicidal individuals change the script, write a different story. The stories that participants shared give us some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers immediately after a suicide attempt. While we cannot know the experiences of those who did not survive a suicide attempt, results of this study reinforce that just one caring professional can make a crucial difference to a person who has survived a suicide attempt. We end with where we began. Who will open the door? References 1. World Health Organization. Suicide prevention and special programmes. http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html Geneva: Author; 2013.2. Giner L, Jaussent I, Olie E, et al. Violent and serious suicide attempters: One step closer to suicide? J Clin Psychiatry 2014:73(3):3191–197.3. Levi-Belz Y, Gvion Y, Horesh N, et al. Mental pain, communication difficulties, and medically serious suicide attempts: A case-control study. Arch Suicide Res 2014:18:74–87.4. Hjelmeland H and Knizek BL. Why we need qualitative research in suicidology? Suicide Life Threat Behav 2010:40(1):74–80.5. Gunnell D. A population health perspective on suicide research and prevention: What we know, what we need to know, and policy priorities. Crisis 2015:36(3):155–60.6. Fitzpatrick S. Looking beyond the qualitative and quantitative divide: Narrative, ethics and representation in suicidology. Suicidol Online 2011:2:29–37.7. Lakeman R and FitzGerald M. How people live with or get over being suicidal: A review of qualitative studies. J Adv Nurs 2008:64(2):114–26.8. Ghio L, Zanelli E, Gotelli S, et al. Involving patients who attempt suicide in suicide prevention: A focus group study. J Psychiatr Ment Health Nurs 2011:18:510–18.9. Kraft TL, Jobes DA, Lineberry TW., Conrad, A., & Kung, S. Brief report: Why suicide? Perceptions of suicidal inpatients and reflections of clinical researchers. Arch Suicide Res 2010:14(4):375-382.10. Sun F, Long A, Tsao L, et al. The healing process following a suicide attempt: Context and intervening conditions. Arch Psychiatr Nurs 2014:28:66–61.11. Montross Thomas L, Palinkas L, et al. Yearning to be heard: What veterans teach us about suicide risk and effective interventions. Crisis 2014:35(3):161–67.12. Long M, Manktelow R, and Tracey A. The healing journey: Help seeking for self-injury among a community population. Qual Health Res 2015:25(7):932–44.13. Carlen P and Bengtsson A. Suicidal patients as experienced by psychiatric nurses in inpatient care. Int J Ment Health Nurs 2007:16:257–65.14. Samuelsson M, Wiklander M, Asberg M, et al. Psychiatric care as seen by the attempted suicide patient. J Adv Nurs 2000:32(3):635–43.15. Cutcliffe JR, Stevenson C, Jackson S, et al. A modified grounded theory study of how psychiatric nurses work with suicidal people. Int J Nurs Studies 2006:43(7):791–802.16. Lakeman, R. What can qualitative research tell us about helping a person who is suicidal? Nurs Times 2010:106(33):23–26.17. Karman P, Kool N, Poslawsky I, et al. Nurses’ attitudes toward self-harm: a literature review. J Psychiatr Ment Health Nurs 2015:22:65–75.18. Carter B. ‘One expertise among many’ – working appreciatively to make miracles instead of finding problems: Using appreciative inquiry as a way of reframing research. J Res Nurs 2006:11(1): 48–63.19. Lieblich A, Tuval-Mashiach R, Zilber T. Narrative research: Reading, analysis, and interpretation. Sage Publications; 1998.20. Braun V and Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006:3(2):77–101.21. Kishi Y, Otsuka K, Akiyama K, et al. Effects of a training workshop on suicide prevention among emergency room nurses. 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Abstract Background There is some evidence that autism spectrum disorder (ASD) frequently co-occurs with immune-mediated conditions including asthma. We aimed to explore the familial co-aggregation of ASD and asthma using different genetically informed designs. Methods We first examined familial co-aggregation of asthma and ASD in individuals born in Sweden from 1992 to 2007 (n = 1 569 944), including their full- and half-siblings (n = 1 704 388 and 356 544 pairs) and full cousins (n = 3 921 890 pairs), identified using Swedish register data. We then applied quantitative genetic modeling to siblings (n = 620 994 pairs) and twins who participated in the Child and Adolescent Twin Study in Sweden (n = 15 963 pairs) to estimate the contribution of genetic and environmental factors to the co-aggregation. Finally, we estimated genetic correlations between traits using linkage disequilibrium score regression (LDSC). Results We observed a within-individual association [adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.28–1.37] and familial co-aggregation between asthma and ASD, and the magnitude of the associations decreased as the degree of relatedness decreased (full-siblings: OR 1.44, 95% CI 1.38–1.50, maternal half-siblings: OR 1.28, 95% CI 1.18–1.39, paternal half-siblings: OR 1.05, 95% CI 0.96–1.15, full cousins: OR 1.06, 95% CI 1.03–1.09), suggesting shared familial liability. Quantitative genetic models estimated statistically significant genetic correlations between ASD traits and asthma. Using the LDSC approach, we did not find statistically significant genetic correlations between asthma and ASD (coefficients between −0.09 and 0.12). Conclusions Using different genetically informed designs, we found some evidence of familial co-aggregation between asthma and ASD, suggesting the weak association between these disorders was influenced by shared genetics.

It seems clear that people who are deaf ... struggle continually against the meanings that others impose on their experience, and the way that this separates them from others. They struggle for acknowledgement of the way they see their lives and wish to live them, and aspire to connection?with other people, to share and belong. (David Moorhead. Knowing Who I Am. 1995. 85.) Nga Tapuwae and Before I am deaf but, before that part of my life started, I was hearing and worked for many years as a librarian in New Zealand. My first job was in a public library located within a secondary school Nga Tapuwae Secondary College in South Auckland. Its placement was a 1970’s social experiment to see if a public library could work within the grounds of a community college (and the answer was no, it could not). The experience was a great introduction for me to the Maori and Polynesian cultures that I had not previously encountered. Until then, I was wary of both groups, and so it was a revelation to realise that although there were many social problems in the area including low literacy, many of the children and teenagers were bright, talented individuals. They simply did not connect to the Anglo-Saxon reading materials we offered. Years later, my interest in the social dynamics of literacy led to my enrolment in a post-graduate literacy degree in Melbourne. This action may have saved my life because at the end of this course, a minor ailment resulted in a visit to the university doctor who diagnosed me with the life-threatening medical condition, Neurofibromatosis Type 2 (NF 2). NF2 is a late onset genetic condition in which one’s body grows tumours, always on both hearing nerves, sometimes elsewhere as well. The tumours usually cause deafness and can cause death. I was told I needed to have my tumours removed and would probably become fully deaf as a result. This is how my life as I knew it changed direction and I started the long journey towards becoming deaf. Diagnosis and Change Predictably, once diagnosed, friends and colleagues rallied to comfort me. I was told things probably weren’t as bad as they sounded. Helen Keller was mentioned several times as an example of someone who had succeeded despite being deaf and blind. ‘Really,’ my friends asked, ‘how bad can it be? ‘Inside myself however, it couldn’t have been worse. A day later the enormity of it all hit me and I became inconsolable. A friend drove me back to the doctor and she did two things that were to change my life. She referred me to the University’s counselling services where, happily, I was counselled by Elizabeth Hastings who later went on to become Australia’s first Disability Services Commissioner. Secondly, the doctor organised for me to visit the HEAR Service at the Victorian Deaf Society (VDS). Again by happy accident, my friend and I stumbled into the ‘wrong building’ where I ended up meeting John Lovett, who was Deaf and the CEO there, via an interpreter. When I met John Lovett I was distraught but, unlike other people, he made no attempt to stop me crying. He simply listened carefully until I realised he understood what I was saying and stopped crying myself. He said my fears that I could end up alone and lonely were valid and he suggested the best thing I could do for myself was to join the ‘Deaf community’; a community. I had never heard of. He explained it was made up of people like him who used Australian sign language (Auslan) to communicate. He was so engaging and supportive that this plan sounded fine to me. By the time we finished talking and he walked me over to the HEAR Service, I was so in his thrall that I had enrolled for a Deaf awareness workshop, an Auslan class, and had plans to join the Deaf community. Had I stayed on and learned Auslan, my life may well have followed a different path, but this was not to be at that time. Becoming Hearing Impaired (HI) Across at the HEAR service, an alternate view of my potential future was put to me. Instead of moving away from everything familiar and joining the Deaf community, I could learn to lip-read and hopefully use it to stay in the workforce and amongst my hearing friends. I had a cousin and aunt who were late deafened; my cousin in particular was doing well communicating with lip-reading. I discussed this with friends and the idea of staying with the people I already knew sounded far less confronting than joining the Deaf community and so I chose this path. My surgeon was also optimistic. He was confident he could save some of my hearing. Suddenly learning Auslan seemed superfluous. I phoned John Lovett to explain, and his response was that I should do what suited me, but he asked me to remember one thing: that it was me who decided to leave the Deaf Community, not that the Deaf community had not wanted me. He told me that, if I changed my mind, I could always go back because the door to the Deaf community would always be open and he would be still be there. It would be a decade before I decided that I wanted to go back through that door, and around that time this great man passed away, but I never forgot my promise to remember our conversation. It, and a few other exchanges I had with him in the following years, stayed at the back of my mind, especially as my residual hearing sank over the years, and the prospect of total deafness hung over me. When I had the surgery, my surgeon’s optimism proved unfounded. He could not save any hearing on my left side and my facial and balance nerves were damaged as well. The hospital then decided not to operate again, and would only attempt to remove the second tumour if it grew and threatened my health again. Consequently, for close to a decade, my life was on hold in many ways. I feared deafness—for me it signalled that my life as I knew it would end and I would be isolated. Every hearing test was a tense time for me as I watched my remaining hearing decline in a slow, relentless downward path on the graph. It was like watching the tide go out knowing it was never going to come in as fully again. My thinking started to change too. Within a week of my diagnosis I experienced discrimination for the first time. A library school that had offered me a place in its post graduate librarianship course the following year made it clear that they no longer wanted me. In the end it did not matter as I was accepted at another institution but it was my first experience of being treated less favourably in the community and it was a shock. After the surgery my life settled down again. I found work in public libraries again, rekindled an old relationship and in 1994 had a baby boy. However, living with a hearing loss is hard work. Everything seemed tiring, especially lip-reading. My ears rejected my hearing aid and became itchy and inflamed. I became aware that my continual hearing problems were sometimes seen as a nuisance in work situations. Socialising lost a lot of its appeal so my social world also contracted. Around this time something else started happening. Outside work, people started expressing admiration for me—words like ‘role model’ and ‘inspiring’ started entering the conversation. Any other time I might have enjoyed it but for me, struggling to adapt to my new situation, it felt odd. The whole thing reminded me of being encouraged to be like Helen Keller; as if there is a right way to behave when one is deaf in which you are an inspiration, and a wrong way in which one is seen as being in need of a role model. I discussed this with Elizabeth Hastings who had helped me prepare mentally for the surgery and afterwards. I explained I felt vulnerable and needy in my new situation and she gave me some useful advice. She thought feeling needy was a good thing as realising one needs people keeps one humble. She observed that, after years of intellectualising, educated people sometimes started believing they could use intellectualisation as a way to avoid painful emotions such as sadness. This behaviour then cut them off from support and from understanding that none of us can do it alone. She believed that, in always having to ask for help, people with disabilities are kept aware of the simple truth that all people depend on others to survive. She said I could regard becoming deaf as a disability, or I could choose to regard it as a privilege. Over the years the truth of her words became increasingly more evident to me as I waded through all the jargon and intellectualisation that surrounds discussion of both deafness and the disability arena, compared to the often raw emotion expressed by those on the receiving end of it. At a personal level I have found that talking about emotions helps especially in the face of the ubiquitous ‘positive thinking’ brigade who would have us all believe that successful people do not feel negative emotions regardless of what is happening. The Lie Elizabeth had initially sympathised with my sadness about my impending deafness. One day however she asked why, having expressed positive sentiments both about deaf people and people with disabilities, I was saying I would probably be better off dead than deaf? Up until that conversation I was unaware of the contradictions between what I felt and what I was saying. I came to realise I was living a lie because I did not believe what I was telling myself; namely, that deaf people and people with disabilities are as good as other people. Far from believing this, what I really thought was that being deaf, or having a disability, did lessen one’s worth. It was an uncomfortable admission, particularly sharing it with someone sitting in a wheelchair, and especially as up until then I had always seen myself as a liberal thinker. Now, faced with the reality of becoming deaf, I had been hoist by my own petard, as I could not come to terms with the idea of myself as a deaf person. The Christian idea of looking after the ‘less fortunate’ was one I had been exposed to, but I had not realised the flip side of it, which is that the ‘less fortunate’ are also perceived as a ‘burden’ for those looking after them. It reminded me of my initial experiences years earlier at Nga Tapuwae when I came face to face with cultures I thought I had understood but did not. In both cases it was only when I got to know people that I began to question my own attitudes and assumptions and broadened my thinking. Unfortunately for deaf people, and people with disabilities, I have not been the only person lying to myself. These days it is not common for people to express their fears about deaf people or people with disabilities. People just press on without fully communicating or understanding the other person’s attitude or perspectives. When things then do not work out, these failures reinforce the misconceptions and these attitudes persist. I believe it is one of the main reasons why true community inclusion for deaf and people with disabilities is moving so slowly. Paying for access is another manifestation of this. Everyone is supportive of access in principle but there is continuous complaint about paying for things such as interpreting. The never-ending discussions between deaf people and the wealthy movie industry about providing more than token access to captioned cinema demonstrate that the inclusion lie is alive and well. Until it can be effectively addressed through genuine dialogue, deaf people, hard of hearing people and people with disabilities will always be largely relegated to life outside the mainstream. Collectively we will also continue to have to endure this double message that we are of equal value to the community while simultaneously being considered a financial burden if we try to access it in ways that are meaningful to us. Becoming Deaf In 2002 however all this thinking still lay ahead of me. I still had some hearing and was back living in New Zealand to be close to my family. My relationship had ended and I was a solo mother. My workplace had approved leave of absence, and so I still had my job to go back to in Melbourne if I wanted it. However, I suspected that I would soon need the second tumour removed because I was getting shooting pains down my face. When my fears were confirmed I could not decide whether to move back to Melbourne or let the job go, and risk having trouble finding one if I went back later. I initially chose to stay longer as my father was sick but eventually I decided Melbourne was where I wanted to be especially if I was deaf. I returned, found temporary employment, and right up to the second surgery I was able to work as I could make good use of the small amount of hearing I still had. I thought that I would still be able to cope when I was made fully deaf as a result of the surgery. It was, after all, only one notch down on the audiogram and I was already ‘profoundly deaf’ and still working. When I woke up after the surgery completely deaf, it felt anti-climactic. The world seemed exactly the same, just silent. At home where I was surrounded by my close family and friends everything initially seemed possible. However, when my family left, it was just my seven-year-old son and myself again, and on venturing back into the community, it quickly became clear to me that at some level my status had changed. Without any cues, I struggled to follow speech and few people wanted to write things down. Although my son was only seven, people communicated with him in preference to me. I felt as if we had changed roles: I was now the child and he was the adult. Worse was soon to follow when I tried to re-enter the workforce. When I had the surgery, the hospital had installed a gadget called an auditory brainstem implant, (ABI) which they said would help me hear. An ABI is similar to a cochlear implant but it is attached to the brainstem instead of the cochlear nerve. My cochlear nerve was removed. I hoped my ABI would enable me to hear enough to find work but, aside from clinical conditions in which there was no background noise and the staff knew how to assist, it did not work. My most humiliating moment with it came when it broke down mid job interview and I spent half the time left trying to get it going again in full view of the embarrassed interview panel, and the other half trying to maintain my composure whilst trying to lip-read the questions. The most crushing blow came from the library where I had happily worked for seven years at middle management level. This library was collaborating with another institution to set up a new library and they needed new staff. I hopefully applied for a job at the same level I had worked at prior to becoming deaf but was unsuccessful. When I asked for feedback, I was told that I was not seen as having the skills to work at that level. My lowest point came when I was refused a job unpacking boxes of books. I was told I did not have experience in this area even though, as any librarian will attest, unpacking boxes is part of any librarian’s work. When I could not find unskilled work, it occurred to me that possibly I would never work again. While this was unfolding, my young son and I went from being comfortable financially to impoverished. My ex-partner also decided he would now make childcare arrangements directly with my son as he was annoyed at being expected to write things down for me. My relationship with him, some family members, and my friends were all under strain at that time. I was lost. It also became clear that my son was not coping. Although he knew the rudiments of Auslan, it was not enough for us to communicate sufficiently. His behaviour at school deteriorated and one night he became so frustrated trying to talk to me that he started to pull out his own hair. I calmed him and asked him to write down for me what he was feeling and he wrote down ‘It is like you died. It is like I don’t have a Mum now’. It was now clear to me that although I still had my friends, nobody including myself knew what to do. I realised I had to find someone who could understand my situation and I knew now it had to be a Deaf person. Fortunately, by this stage I was back learning Auslan again at La Trobe University. The week after the conversation with my son, I told my Auslan teacher what had happened. To my relief she understood my situation immediately. She told me to bring my son to class, at no cost, and she would teach him herself. I did and my life started to turn around. My son took to Auslan with such speed and application that he was able to not only converse with her in one month but immediately started using Auslan with me at home to get the things he wanted. We were able to re-establish the mother/son relationship that we both needed. I was also able to help my son talk through and deal with all the changes that me becoming deaf had foisted upon him. He still uses Auslan to talk to me and supplements it using speech, copious finger spelling, notes and diagrams. More than anything else, this relationship has kept me anchored to my long-term goal of becoming a clear signer. Encouraged by my son’s success, I put all my energy into learning Auslan and enrolled in a full time TAFE Auslan course. I also joined a chat group called ‘Here to Hear’ (H2H). The perspectives in the group ranged from strongly oral to strongly Deaf but for me, trying to find a place to fit in any of it, it was invaluable. Almost daily I chatted with the group, asking questions and invariably someone responded. The group acted as a safety net and sounding board for me as I worked out the practicalities of living life deaf. The day of my fateful interview and the ABI humiliation, I came home so shaken that I used the Irish remedy of a couple of swigs of whisky, and then went online and posted an account of it all. I can still remember the collective indignation of the group and, as I read the responses, beginning to see the funny side of it . . . something I could not have done alone. I also made use of easy access to Deaf teachers at TAFE and used that to listen to them and ask advice on situations. I found out for example, that if I instructed my son to stand behind me when people in shops insisted on addressing him, they had no alternative but to talk to me; it was a good clear message to all concerned that my son was the child in this relationship. About this time, I discovered the Disability Discrimination Act (DDA) that Elizabeth Hastings had worked so hard on, filed my first DDA complaint, and received my first apology at the mediation session that followed. My personal life also improved, relationship by relationship as everyone adjusted. Slowly the ice melted in most of my relationships; some relationships faded and were replaced with new ones with signing people, and eventually hearing people again. My life moved forward. Through a member of ‘Here to Hear’, I was invited to apply for my first post deaf job—covering holiday leave at a Deaf sports organisation. I practically finger-spelt my way through the interview but not only did they offer me the job, they were delighted to have me. I was able to buy a few things with the money I earned, and suddenly it felt as if everything was possible again. This acceptance of me by Deaf people had a profound impact on me. I mixed with people more, and it was not too long before I was able to use my basic signing skills to use Auslan interpreters and re-enter the workplace. I have discovered over time that living in silence also has advantages—no more noisy parties or rubbish trucks clanging at dawn and in its place a vastly heightened visual awareness that I enjoy. Before I was deaf I thought it would be lonely in the silence but in fact many of life’s best moments—watching rain hit and then run down a window, swimming in the sea, cooking and being with good friends—do not rely upon sound at all; they feel the same way they always did. Sometimes I have felt somewhat of an outsider in the Deaf community. I have sometimes been taken aback by people’s abruptness but I have learned over time that being succinct is valued in Auslan, and some people like to come straight to the point. At crisis points, such as when I asked for help at the Victorian Deaf Society and my Auslan class, it has been a huge relief to talk to Deaf people and know immediately that they understand just from reading their eyes. Having access to an additional world of deaf people has made my life more enjoyable. I feel privileged to be associated with the Deaf community. I can recall a couple of Christmases ago making dinner for some signing friends and suddenly realising that, without noticing, everything had become alright in my world again. Everyone was signing really fast – something I still struggle with; but every now and then someone would stop and summarise so I felt included. It was really relaxed and simply felt like old times, just old times without the sound thrown in. Le Page and Tabouret-Keller, two ethnographers, have this to say about why people communicate the ways they do: The individual ... creates for himself the patterns of his linguistic behaviour so as to resemble those of the group or groups with which from time to time he wishes to be identified, or so as to be unlike those from whom he wishes to be distinguished ... . We see speech acts as acts of projection; the speaker is projecting his inner universe, implicitly with the invitation to others to share it ... he is seeking to reinforce his models of the world, and hopes for solidarity from those with whom he wishes to identify. (181) This quote neatly sums up why I choose to communicate the ways I do. I use Auslan and speech in different situations because I am connected to people in both groups and I want them in my life. I do not feel hugely different from anyone these days. If it is accepted that I have as much to contribute to the community as anyone else, becoming deaf has also meant for me that I expect to see other people treated well and accepted. For me that means contributing my time and thoughts, and advocating. It also means expecting a good level of access to interpreters, to some thought provoking captioned movies in English, and affordable assistive technologies so I can participate. I see this right to participate and engage in genuine dialogue with the rest of the community as central to the aspirations and identity of us all, regardless of who we are or where others think we belong. References Le Page, R.B., and Andree Tabouret-Keller. Acts of Identity: Creole-Based Approaches to Language and Ethnicity. London: Cambridge University Press, 1985. Moorhead, D. “Knowing Who I Am.” In S. Gregory, ed., Deaf Futures Revisited. Block 3, Unit 10, D251 Issues in Deafness. Open University, 1995.

Memory depends on void, as void depends on memory, to think. -- Anne Carson Sunday, 26th December, 1999 It was a peculiar ritual to perform to bring a personal end to the twentieth century. A journey through the snow to visit Egypt, at the Metropolitan Museum in Manhattan. I took two books, the latest New Yorker and the New York Times to keep me company. Ancient Egyptian funeral art fascinates me. How unreadable it is. Perhaps it isn't meant to be read. If it is addressed to anyone, or anything, it isn't human. It addresses otherness itself, eternity. Serenity masks, and faces, nothingness. A reminder of how little a decade, or a century matters, even a millennium, compared to these fragments of monuments that could stare down handfuls of years in their thousands -- and still not blink. As Paul Valery wrote: "we later civilisations ... we too now know we are mortal. We had long heard tell of whole worlds that had vanished, of empires sunk without a trace, gone down with all their men and all their machines into the unexplorable depths of the centuries..." (23). Our ancestors may have conquered space, spread ourselves thin across the bread of the earth, but Egypt conquered time. Their empires of the dead will probably still be living when the last of ours are rat food. As Paul Valery wrote: "we later civilisations ... we too now know we are mortal. We had long heard tell of whole worlds that had vanished, of empires sunk without a trace, gone down with all their men and all their machines into the unexplorable depths of the centuries..." (23). Our ancestors may have conquered space, spread ourselves thin across the bread of the earth, but Egypt conquered time. Their empires of the dead will probably still be living when the last of ours are rat food. Thanks to universal standard time, everyone could know where they stood in relation to the planet's movement. Thanks to geopositioning, everyone could know the coordinates upon the map that corresponded to the patch of earth under foot. As the world turned, an arc of humans from one latitude to another could experience the arbitrary yet somehow convincing sensation of leaving the twentieth century. As the New Yorker reported: "in a daring act of multiculturalism, the good people of Tonga rose at midnight to sing the 'Hallelujah Chorus' from Handel's Messiah" (Lane 24). Meanwhile, in New York, the Caligula of capital George Soros offered his 250-odd guests bronze medallions featuring etched profiles of himself, and the inscription: "Enlightened by the Past. Embraced by the present. Empowered by the future" (Cassidy 26). Y2K kept bothering me. It was all a little too much data hitting the sensoria. I tried to ignore it, to think about Egypt. I thought that if I closed my eyes to the world's turning, it would go away. It won't go away. Not any more. There is nowhere left to hide. At twilight, in the desert, your satellite phone rings. It's a telemarketer. Egypt is exhausting, even at the Met. There's so many objects, so much information. I'd brought a book or two, so I could pause for coffee and make some notes. The books were by Harold Innis, that quirky old communication theorist. He's a detour, like Egypt, but he'll get us to where I want to go, to thinking media. Egypt is exhausting, even at the Met. There's so many objects, so much information. I'd brought a book or two, so I could pause for coffee and make some notes. The books were by Harold Innis, that quirky old communication theorist. He's a detour, like Egypt, but he'll get us to where I want to go, to thinking media. A simple observation. Consider what it makes it possible to think: "empires must be considered from the standpoint of two dimensions, those of space and time, and persist by overcoming the bias of media, which over-emphasise either dimension. They have tended to flourish under conditions in which civilisation reflects the influence of more than one medium and in which the bias of one medium toward decentralisation is offset by the bias of another toward centralisation" (Empire 7). Consider, for instance, Egypt, where: "a concern with problems of space and time appears to have marked the beginnings of civilisation... A change from a pre-dynastic to dynastic society, or a precise recognition of time... appears to have coincided with writing, monumental architecture and sculpture" (Bias 92). Kings and priests colonised time. "The permanence of death became a basis of continuity through the development of the idea of immortality, preservation of the body, and development of writing in the tombs by which the magical power of the spoken word was perpetuated in pictorial representation of the funeral ritual" (Bias 93). On the one hand, "the pyramids were an index to power over time" (Bias 135). On the other, "by escaping from the heavy medium of stone, thought gained lightness" (Empire 16). The papyrus document became the means for scribes and soldiers to colonise space. These different media, with their different properties, were the basis of a flexible continuity and integrity for the empire, but also a source of conflict within it. "The profound disturbances in Egyptian civilisation involved in the shift from absolute monarchy to a more democratic organisation coincides with a shift in emphasis on stone as a medium of communicating or as a basis of prestige, as shown in the pyramids, to an emphasis on papyrus" (Empire 15). But it was not to last. Egypt "failed to establish a stable compromise between a bias dependent on stone in the pyramids and a bias dependent on papyrus and hieroglyphics" (Bias 96). Failed, and yet succeeded, in replicating itself by virtue of the fascination those of us who, like Valery, see something strikingly different in the shape of this ancient space and time. There's some irony in monuments to eternity being themselves preserved at the Met. "The emphasis of a civilisation on means of extending its duration as in Egypt accompanied by reliance on permanence gives that civilisation a prominent position in periods such as the present when time is of little significance" (Bias 66). What can you say about a civilisation that gives itself an early mark and toddles into its second millennium a year early? One in which global empires grow and merge and collapse each week on the lone and level sands of the market. Or where Danny Hillis, Silicon Valley magus, is making a monument to last out the centuries -- and it's a clock. What is to become of it all? Consider this observation, by Innis, of what became of Egypt: "we can perhaps assume that the use of a medium of communication over a long period will to some extent determine the character of knowledge to be communicated and suggest that its pervasive influence will eventually create a civilisation in which life and flexibility will become exceedingly difficult to maintain and that the advantages of a new medium will become such as to lead to the emergence of a new civilisation" (Bias 34). The scribes and the priests, between them, ran things, and for centuries kept control of the skills to do so. This very facility became a limit, making the empire vulnerable to stagnation and conquest from without. Consider how this might work out in more recent times, when monopolies guard their source code and battle against open source technologies. Innis writes that "a simple flexible system of writing admits of adaptation to the vernacular but slowness of adaptation facilitates monopoly of knowledge and hierarchies" (Bias 4). Microsoft write twentieth century hieroglyphics. It is an empire with an Egyptian approach to source code intended to perpetuate itself through time, even at the risk of arresting flexible and adaptive approaches to creating communication tools anywhere else. Or take the lead story that greeted me over coffee in the Met's cafe: AMERICA ONLINE AGREES TO BUY TIME WARNER FOR $165 BILLION; MEDIA DEAL IS RICHEST MERGER (New York Times 11 Jan 2000). This is the way of things now. Vigorous new empires annex old Egypts in a burst of press release fireworks. Empires that straddle continents but are not built to last much longer than London's Millennium Dome, structures held aloft by tensed steel cables, built to be seen on television by distant cousins by not by any descendants. We may have left the twentieth century, but has it left us? Its ruins lie about us, persisting, insisting. Its miniature monuments lie in the landfill of memory. So many new ways that were discovered, during the century, for impressing the century on memory. Perhaps that's why so little of its architecture is built to last. The great pyramid of Las Vegas is an image preserved in a million snapshots. The monument has become something miniature, even molecular. Exotic pesticide residues now shop up in Antarctic penguins. As Gilles Deleuze and Felix Guattari write: "a monument does not commemorate or celebrate something that happened but confides to the ear of the future the persistent sensations that embody the event" (176). Perhaps Innis is wrong about this civilisation. It looks like its bias is towards the colonising of space, but in its own way it has colonised time, too. It communicates its chaos, its blind will to creative destruction, through the pulverising of every last particle of the earth. The twentieth century's answer to the pyramids, it's ongoing contributions to civilisation, are the death factories of the Holocaust and the negative architecture of the bombing of Hiroshima. And yet, those memories aside, it was also the century in which for the first time one glimpses a possible life outside the monopoly of knowledge by priests and scribes, where no matter how hard they try, empires can no longer control for millennia the flows of information that allow them to colonise space and time. I'm tempted to say that if Egypt lives on in the Book of the Dead, our time will live on as a Book of the Undead. It left its mark by mummifying nothing except change itself. But the book is one of the things the twentieth century changed too. As Friedrich Kittler writes, "as long as the book was responsible for all serial data flows, words quivered with sensuality and memory" (10). But the book has lost its sovereignty. The scribes and priests and scholars who monopolised knowledge and prestige through mastery of textual codes are going the way of their Egyptian precursors, into the museums. References Cassidy, John. "The Well-Heeled and the Wonky Toast the Millennium." New Yorker 17 Jan. 2000: Deleuze, Gilles, and Félix Guattari. What Is Philosophy? London: Verso, 1994. Innis, Harold A. The Bias of Communication. Toronto: U of Toronto P, 1964. ---. Empire and Communications. Toronto: U of Toronto P, 1972. Friedrich A. Kittler. Gramophone, Film, Typewriter. Stanford: Stanford UP, 1999. Anthony Lane. "The New Year Stumbles In." New Yorker 17 Jan. 2000: 24. Paul Valery. The Outlook for Intelligence. Princeton: Princeton UP, 1989. Citation reference for this article MLA style: McKenzie Wark. "Book of the Undead." M/C: A Journal of Media and Culture 3.3 (2000). [your date of access] <http://www.api-network.com/mc/0006/undead.php>. Chicago style: McKenzie Wark, "Book of the Undead," M/C: A Journal of Media and Culture 3, no. 3 (200x), <http://www.api-network.com/mc/0006/undead.php> ([your date of access]). APA style: McKenzie Wark. (2000) Book of the Undead. M/C: A Journal of Media and Culture 3(3). <http://www.api-network.com/mc/0006/undead.php> ([your date of access]).

I called your producer on the way here in the car because I was very excited. I found out … I did one of those genetic testing things and I found out that I'm 63 percent Irish … I had no idea. I had no idea! I thought I was Scottish and Welsh. It turns out my parents are just full of shit, I guess. But now I’m Irish and it just makes so much sense! I'm a really good drinker. I love St. Patrick's Day. Potatoes are delicious. I'm looking forward to meeting all my cousins … [to Conan O’Brien] You and I are probably related! … Now I get to say things like, “It’s in me genes! I love that Conan O’Brien; he’s such a nice fella.” You’re kinda like a giant leprechaun. (Reese Witherspoon, Tuesday 21 March 2017)IntroductionAs an Irishman and a football fan, I watched the unfolding 2016 UEFA European Championship in France (hereafter ‘Euro 2016’) with a mixture of trepidation and delight. Although the Republic of Ireland team was eventually knocked out of the competition in defeat to the host nation, the players performed extremely well – most notably in defeating Italy 1:0. It is not the on-field performance of the Irish team that interests me in this short article, however, but rather how Irish fans travelling to the competition were depicted in the surrounding international news coverage. In particular, I focus on the centrality of fan footage – shot on smart phones and uploaded to YouTube (in most cases by fans themselves) – in this news coverage. In doing so, I reflect on how sports fans contribute to wider understandings of nationness in the global imagination and how their behaviour is often interpreted (as in the case here) through long-established tropes about people and places. The Media ManifoldTo “depict” something is to represent it in words and pictures. As the contemporary world is largely shaped by and dependent on mass media – and different forms of media have merged (or “converged”) through digital media platforms – mediated forms of depiction have become increasingly important in our lives. On one hand, the constant connectivity made possible in the digital age has made the representation of people and places less controllable, insofar as the information and knowledge about our world circulating through media devices are partly created by ordinary people. On the other hand, traditional broadcast media arguably remain the dominant narrators of people and places worldwide, and their stories, Gerbner reminds us, are largely formula-driven and dramatically charged, and work to “retribalize” modern society. However, a more important point, I suggest, is that so-called new and old media can no longer be thought of as separate and discrete; rather, our attention should focus on the complex interrelations made possible by deep mediatisation (Couldry and Hepp).As an example, consider that the Youtube video of Reese Witherspoon’s recent appearance on the Conan O’Brien chat show – from which the passage at the start of this article is taken – had already been viewed 54,669 times when I first viewed it, a mere 16 hours after it was originally posted. At that point, the televised interview had already been reported on in a variety of international digital news outlets, including rte.ie, independent.ie., nydailynews.com, msn.com, huffingtonpost.com, cote-ivoire.com – and myriad entertainment news sites. In other words, this short interview was consumed synchronously and asynchronously, over a number of different media platforms; it was viewed and reviewed, and critiqued and commented upon, and in turn found itself the subject of news commentary, which fed the ongoing cycle. And yet, it is important to also note that a multiplicity of media interactions does not automatically give rise to oppositional discourse and ideological contestation, as is sometimes assumed. In fact, how ostensibly ‘different’ kinds of media can work to produce a broadly shared construction of a people and place is particularly relevant here. Just as Reese Witherspoon’s interview on the Conan O’Brien show perpetuates a highly stereotypical version of Irishness across a number of platforms, news coverage of Irish fans at Euro 2016 largely conformed to established tropes about Irish people, but this was also fed – to some extent – by Irish fans themselves.Irish Identity, Sport, and the Global ImaginationThere is insufficient space here to describe in any detail the evolving representation of Irish identity, about which a vast literature has developed (nationally and internationally) over the past several decades. As with other varieties of nationness, Irishness has been constructed across a variety of cultural forms, including advertising, art, film, novels, travel brochures, plays and documentaries. Importantly, Irishness has also to a great extent been constructed outside of Ireland (Arrowsmith; Negra).As is well known, the Irish were historically constructed by their colonial masters as a small uncivilised race – as primitive wayward children, prone to “sentimentality, ineffectuality, nervous excitability and unworldliness” (Fanning 33). When pondering the “Celtic nature,” the renowned English poet and cultural critic Mathew Arnold concluded that “sentimental” was the best single term to use (100). This perception pervaded internationally, with early depictions of Irish-Americans in US cinema centring on varieties of negative excess, such as lawlessness, drunkenness and violence (Rains). Against this prevailing image of negative excess, the intellectuals and artists associated with what became known as the Celtic Revival began a conscious effort to “rebrand” Ireland from the nineteenth century onwards, reversing the negatives of the colonial project and celebrating Irish tradition, language and culture (Fanning).At first, only distinctly Irish sports associated with the amateur Gaelic Athletic Association (GAA) were co-opted in this very particular nation-building project. Since then, however, sport more generally has acted as a site for the negotiation of a variety of overlapping Irish identities. Cronin, for example, describes how the GAA successfully repackaged itself in the 1990s to reflect the confidence of Celtic Tiger Irishness while also remaining rooted in the counties and parishes across Ireland. Studies of Irish football and rugby have similarly examined how these sports have functioned as representatives of changed or evolving Irish identities (Arrowsmith; Free). And yet, throughout Ireland’s changing economic fortunes – from boom to bust, to the gradual renewal of late – a touristic image of Irishness has remained hegemonic in the global imagination. In popular culture, and especially American popular culture, Ireland is often depicted as a kind of pre-industrial theme park – a place where the effects of modernity are felt less, or are erased altogether (Negra). The Irish are known for their charm and sociability; in Clancy’s words, they are seen internationally as “simple, clever and friendly folk” (98). We can identify a number of representational tropes within this dominant image, but two in particular are apposite here: ‘smallness’ and ‘happy-go-luckiness’.Sporting NewsBefore we consider Euro 2016, it is worth briefly considering how the news industry approaches such events. “News”, Dahlgren reminds us, is not so much “information” as it is a specific kind of cultural discourse. News, in other words, is a particular kind of discursive composition that constructs and narrates stories in particular ways. Approaching sports coverage from this vantage point, Poulton and Roderick (xviii) suggest that “sport offers everything a good story should have: heroes and villains, triumph and disaster, achievement and despair, tension and drama.” Similarly, Jason Tuck observes that the media have long had a tendency to employ the “vocabulary of war” to “hype up sporting events,” a discursive tactic which, he argues, links “the two areas of life where the nation is a primary signifier” (190-191).In short, sport is abundant in news values, and media professionals strive to produce coverage that is attractive, interesting and exciting for audiences. Stead (340) suggests that there are three key characteristics governing the production of “media sports packages”: spectacularisation, dramatisation, and personalisation. These production characteristics ensure that sports coverage is exciting and interesting for viewers, but that it also in some respects conforms to their expectations. “This ‘emergent’ quality of sport in the media helps meet the perpetual audience need for something new and different alongside what is familiar and known” (Rowe 32). The disproportionate attention to Irish fans at Euro 2016 was perhaps new, but the overall depiction of the Irish was rather old, I would argue. The news discourse surrounding Euro 2016 worked to suggest, in the Irish case at least, that the nation was embodied not only in its on-field athletic representatives but more so, perhaps, in its travelling fans.Euro 2016In June 2016 the Euros kicked off in France, with the home team beating Romania 2-1. Despite widespread fears of potential terrorist attacks and disruption, the event passed successfully, with Portugal eventually lifting the Henri Delaunay Trophy. As the competition progressed, the behaviour of Irish fans quickly became a central news story, fuelled in large part by smart phone footage uploaded to the internet by Irish fans themselves. Amongst the many videos uploaded to the internet, several became the focus of news reports, especially those in which the goodwill and childlike playfulness of the Irish were on show. In one such video, Irish fans are seen singing lullabies to a baby on a Bordeaux train. In another video, Irish fans appear to help a French couple change a flat tire. In yet another video, Irish fans sing cheerfully as they clean up beer cans and bottles. (It is noteworthy that as of July 2017, some of these videos have been viewed several million times.)News providers quickly turned their attention to Irish fans, sometimes using these to draw stark contrasts with the behaviour of other fans, notably English and Russian fans. Buzzfeed, followed by ESPN, followed by Sky News, Le Monde, Fox News, the Washington Post and numerous other providers celebrated the exploits of Irish fans, with some such as Sky News and Aljazeera going so far as to produce video montages of the most “memorable moments” involving “the boys in green.” In an article titled ‘Irish fans win admirers at Euro 2016,’ Fox News reported that “social media is full of examples of Irish kindness” and that “that Irish wit has been a fixture at the tournament.” Aljazeera’s AJ+ news channel produced a video montage titled ‘Are Irish fans the champions of Euro 2016?’ which included spliced footage from some of the aforementioned videos. The Daily Mirror (UK edition) praised their “fun loving approach to watching football.” Similarly, a headline for NPR declared, “And as if they could not be adorable enough, in a quiet moment, Irish fans sang on a French train to help lull a baby to sleep.” It is important to note that viewer comments under many of these articles and videos were also generally effusive in their praise. For example, under the video ‘Irish Fans help French couple change flat tire,’ one viewer (Amsterdam 410) commented, ‘Irish people nicest people in world by far. they always happy just amazing people.’ Another (Juan Ardilla) commented, ‘Irish fans restored my faith in humanity.’As the final stages of the tournament approached, the Mayor of Paris announced that she was awarding the Medal of the City of Paris to Irish fans for their sporting goodwill. Back home in Ireland, the behaviour of Irish fans in France was also celebrated, with President Michael D. Higgins commenting that “Ireland could not wish for better ambassadors abroad.” In all of this news coverage, the humble kindness, helpfulness and friendliness of the Irish are depicted as native qualities and crystallise as a kind of ideal national character. Though laudatory, the tropes of smallness and happy-go-luckiness are again evident here, as is the recurrent depiction of Irishness as an ‘innocent identity’ (Negra). The “boys” in green are spirited in a non-threatening way, as children generally are. Notably, Stephan Reich, journalist with German sports magazine 11Freunde wrote: “the qualification of the Irish is a godsend. The Boys in Green can celebrate like no other nation, always peaceful, always sympathetic and emphatic, with an infectious, childlike joy.” Irishness as Antidote? The centrality of the Irish fan footage in the international news coverage of Euro 2016 is significant, I suggest, but interpreting its meaning is not a simple or straightforward task. Fans (like everyone) make choices about how to present themselves, and these choices are partly conscious and partly unconscious, partly spontaneous and partly conditioned. Pope (2008), for example, draws on Emile Durkheim to explain the behaviour of sports fans sociologically. “Sporting events,” Pope tells us, “exemplify the conditions of religious ritual: high rates of group interaction, focus on sacred symbols, and collective ritual behaviour symbolising group membership and strengthening shared beliefs, values, aspirations and emotions” (Pope 85). Pope reminds us, in other words, that what fans do and say, and wear and sing – in short, how they perform – is partly spontaneous and situated, and partly governed by a long-established fandom pedagogy that implies familiarity with a whole range of international football fan styles and embodied performances (Rowe). To this, we must add that fans of a national sports team generally uphold shared understandings of what constitutes desirable and appropriate patriotic behaviour. Finally, in the case reported here, we must also consider that the behaviour of Irish fans was also partly shaped by their awareness of participating in the developing media sport spectacle and, indeed, of their own position as ‘suppliers’ of news content. In effect, Irish fans at Euro 2016 occupied an interesting hybrid position between passive consumption and active production – ‘produser’ fans, as it were.On one hand, therefore, we can consider fan footage as evidence of spontaneous displays of affective unity, captured by fellow participants. The realism or ‘authenticity’ of these supposedly natural and unscripted performances is conveyed by the grainy images, and amateur, shaky camerawork, which ironically work to create an impression of unmediated reality (see Goldman and Papson). On the other hand, Mike Cronin considers them contrived, staged, and knowingly performative, and suggestive of “hyper-aware” Irish fans playing up to the camera.However, regardless of how we might explain or interpret these fan performances, it is the fact that they play a role in making Irishness public that most interests me here. For my purposes, the most important consideration is how the patriotic performances of Irish fans both fed and harmonized with the developing news coverage; the resulting depiction of the Irish was partly an outcome of journalistic conventions and partly a consequence of the self-essentialising performances of Irish fans. In a sense, these fan-centred videos were ready-made or ‘packaged’ for an international news audience: they are short, dramatic and entertaining, and their ideological content is in keeping with established tropes about Irishness. As a consequence, the media-sport discourse surrounding Euro 2016 – itself a mixture of international news values and home-grown essentialism – valorised a largely touristic understanding of Irishness, albeit one that many Irish people wilfully celebrate.Why such a construction of Irishness is internationally appealing is unclear, but it is certainly not new. John Fanning (26) cites a number of writers in highlighting that Ireland has long nurtured a romantic self-image that presents the country as a kind of balm for the complexities of the modern world. For example, he cites New York Times columnist Thomas Friedman, who observed in 2001 that “people all over the world are looking to Ireland for its reservoir of spirituality hoping to siphon off what they can feed to their souls which have become hungry for something other than consumption and computers.” Similarly, Diane Negra writes that “virtually every form of popular culture has in one way or another, presented Irishness as a moral antidote to contemporary ills ranging from globalisation to post-modern alienation, from crises over the meaning and practice of family values to environmental destruction” (3). Earlier, I described the Arnoldian image of the Irish as a race governed by ‘negative excess’. Arguably, in a time of profound ideological division and resurgent cultural nationalism – a time of polarisation and populism, of Trumpism and Euroscepticism – this ‘excess’ has once again been positively recoded, and now it is the ‘sentimental excess’ of the Irish that is imagined as a salve for the cultural schisms of our time.ConclusionMuch has been made of new media powers to contest official discourses. Sports fans, too, are now considered much less ‘controllable’ on account of their ability to disrupt official messages online (as well as offline). The case of Irish fans at Euro 2016, however, offers a reminder that we must avoid routine assumptions that the “uses” made of “new” and “old” media are necessarily divergent (Rowe, Ruddock and Hutchins). My interest here was less in what any single news item or fan-produced video tells us, but rather in the aggregate construction of Irishness that emerges in the media-sport discourse surrounding this event. Relatedly, in writing about the London Olympics, Wardle observed that most of what appeared on social media concerning the Games did not depart significantly from the celebratory tone of mainstream news media organisations. “In fact the absence of any story that threatened the hegemonic vision of the Games as nation-builder, shows that while social media provided an additional and new form of newsgathering, it had to fit within the traditional news structures, routines and agenda” (Wardle 12).Obviously, it is important to acknowledge the contestability of all media texts, including the news items and fan footage mentioned here, and to recognise that such texts are open to multiple interpretations based on diverse reading positions. And yet, here I have suggested that there is something of a ‘preferred’ reading in the depiction of Irish fans at Euro 2016. The news coverage, and the footage on which it draws, are important because of what they collectively suggest about Irish national identity: here we witness a shift from identity performance to identity writ large, and one means of analysing their international (and intertextual significance), I have suggested, is to view them through the prism of established tropes about Irishness.Travelling sports fans – for better or worse – are ‘carriers’ of places and cultures, and they remind us that “there is also a cultural economy of sport, where information, images, ideas and rhetorics are exchanged, where symbolic value is added, where metaphorical (and sometimes literal, in the case of publicly listed sports clubs) stocks rise and fall” (Rowe 24). There is no question, to borrow Rowe’s term, that Ireland’s ‘stocks’ rose considerably on account of Euro 2016. In news terms, Irish fans provided entertainment value; they were the ‘human interest’ story of the tournament; they were the ‘feel-good’ factor of the event – and importantly, they were the suppliers of much of this content (albeit unofficially). Ultimately, I suggest that we think of the overall depiction of the Irish at Euro 2016 as a co-construction of international news media practices and the self-presentational practices of Irish fans themselves. The result was not simply a depiction of idealised fandom, but more importantly, an idealisation of a people and a place, in which the plucky little people on tour became the global standard bearers of Irish identity.ReferencesArnold, Mathew. Celtic Literature. Carolina: Lulu Press, 2013.Arrowsmith, Aidan. “Plastic Paddies vs. Master Racers: ‘Soccer’ and Irish Identity.” International Journal of Cultural Studies 7.4 (2004). 25 Mar. 2017 <http://journals.sagepub.com/doi/pdf/10.1177/1367877904047864>.Boards and Networked Digital Media Sport Communities.” Convergence 16.3 (2010). 25 Mar. 2017 <http://journals.sagepub.com/doi/abs/10.1177/1354856510367622>.Clancy, Michael. Brand New Ireland: Tourism, Development and National Identity in the Irish Republic. Surrey and Vermont: Ashgate, 2009.Couldry, Nick, and Andreas Hepp. The Mediated Construction of Reality. Cambridge: Polity Press, 2016.Cronin, Michael. “Is It for the Glamour? Masculinity, Nationhood and Amateurism in Contemporary Projections of the Gaelic Athletic Association.” Irish Postmodernisms and Popular Culture. Eds. Wanda Balzano, Anne Mulhall, and Moynagh Sullivan. New York: Palgrave Macmillan, 2007. 39–51.Cronin, Mike. “Serenading Nuns: Irish Soccer Fandom as Performance.” Post-Celtic Tiger Irishness Symposium, Trinity College Dublin, 25 Nov. 2016.Dahlgren, Peter. “Beyond Information: TV News as a Cultural Discourse.” The European Journal of Communication Research 12.2 (1986): 125–36.Fanning, John. “Branding and Begorrah: The Importance of Ireland’s Nation Brand Image.” Irish Marketing Review 21.1-2 (2011). 25 Mar. 2017 <https://www.dit.ie/media/newsdocuments/2011/3%20Fanning.pdf>.Free, Marcus. “Diaspora and Rootedness, Amateurism and Professionalism in Media Discourses of Irish Soccer and Rugby in the 1990s and 2000s.” Éire-Ireland 48.1–2 (2013). 25 Mar. 2017 <https://muse.jhu.edu/article/510693/pdf>.Friedman, Thomas. “Foreign Affairs: The Lexus and the Shamrock.” The Opinion Pages. New York Times 3 Aug. 2001 <http://www.nytimes.com/2001/08/03/opinion/foreign-affairs-the-lexus-and-the-shamrock.html>.Gerbner, George. “The Stories We Tell and the Stories We Sell.” Journal of International Communication 18.2 (2012). 25 Mar. 2017 <http://dx.doi.org/10.1080/13216597.2012.709928>.Goldman, Robert, and Stephen Papson. Sign Wars: The Cluttered Landscape of Advertising. New York: Guilford Press, 1996.Negra, Diane. The Irish in Us. Durham, NC: Duke University Press, 2006.Pope, Whitney. “Emile Durkheim.” Key Sociological Thinkers. 2nd ed. Ed. Rob Stones. Hampshire: Palgrave Macmillan, 2008. 76-89.Poulton, Emma, and Martin Roderick. Sport in Films. London: Routledge, 2008.Rains, Stephanie. The Irish-American in Popular Culture 1945-2000. Dublin: Irish Academic Press, 2007.Rowe, David, Andy Ruddock, and Brett Hutchins. “Cultures of Complaint: Online Fan Message Boards and Networked Digital Media Sport Communities.” Convergence: The International Journal of Research into New Media Technology 16.3 (2010). 25 Mar. 2017 <http://journals.sagepub.com/doi/abs/10.1177/1354856510367622>.Rowe, David. Sport, Culture and the Media: The Unruly Trinity. 2nd ed. Berkshire: Open University Press, 2004.Stead, David. “Sport and the Media.” Sport and Society: A Student Introduction. 2nd ed. Ed. Barrie Houlihan. London: Sage, 2008. 328-347.Wardle, Claire. “Social Media, Newsgathering and the Olympics.” Journalism, Media and Cultural Studies 2 (2012). 25 Mar. 2017 <https://publications.cardiffuniversitypress.org/index.php/JOMEC/article/view/304>.

Approximation theory is a fundamental tool in order to study the representation theory of a ring R. Roughly speaking, it consists in determining suitable additive or abelian subcategories of the whole module category Mod-R with nice enough functorial properties. For example, torsion theory is a well suited incarnation of approximation theory. Of course, such an idea has been generalised to the additive setting itself, so that both Mod-R and other interesting categories related with R may be linked functorially. By the seminal work of Beilinson, Bernstein and Deligne (1982), the derived category of the ring turns out to admit useful torsion theories, called t-structures: they are pairs of full subcategories of D(R) whose intersection, called the heart, is always an abelian category. The so-called standard t-structure of D(R) has as its heart the module category Mod-R itself. Since then a lot of results devoted to the module theoretic characterisation of the hearts have been achieved, providing evidence of the usefulness of the t-structures in the representation theory of R. In 2020, following a research line promoted by many other authors, Saorin and Stovicek proved that the heart of any compactly generated t-structure is always a locally finitely presented Grothendieck categories (actually, this is true for any t-structure in a triangulated category with coproducts). Essentially, this means that the hearts of D(R) come equipped with a finiteness condition miming that one valid in Mod-R. In the present thesis we tackle the problem of characterising when the hearts of certain compactly generated t-structures of a commutative ring are even locally coherent. In this commutative context, after the works of Neeman and Alonso, Jeremias and Saorin, compactly generated t-structures turned out to be very interesting over a noetherian ring, for they are in bijection with the Thomason filtrations of the prime spectrum. In other words, they are classified by geometric objects, moreover their constituent subcategories have a precise cohomological description. However, if the ascending chain condition lacks, such classification is somehow partial, though provided by Hrbek. The crucial point is that the constituents of the t-structures have a different description w.r.t. that available in the noetherian setting, yet if one copies the latter for an arbitrary ring still obtains a t-structure, but it is not clear whether it must be compactly generated. Consequently, pursuing the study of the local coherence of the hearts given by a Thomason filtration, we ended by considering two t-structures. Our technique in order to face the lack of the ascending chain condition relies on a further approximation of the hearts by means of suitable torsion theories. The main results of the thesis are the following: we prove that for the so-called weakly bounded below Thomason filtrations the two t-structures have the same heart (therefore it is always locally finitely presented), and we show that they coincide if and only they are both compactly generated. Moreover, we achieve a complete characterisation of the local coherence for the hearts of the Thomason filtrations of finite length.

Large amounts of tiny microparticles are ingested into gas turbines over their operating life, resulting in unexpected wear and tear. Knowledge of such microparticle behavior at gas turbine operating temperatures is limited in published literature. In this study, Arizona Road Dust (ARD) is injected into a hot flow field to measure the effects of high temperature and velocity on particle rebound from a polished 304 Stainless Steel (SS) coupon. The results are compared with baseline (27m/s) measurements at ambient (300°K) temperature made in the Virginia Tech Aerothermal Rig, as well as previously published literature. Mean Coefficient of Restitution (COR) was shown to decrease with the increased temperature/velocity conditions in the VT Aerothermal Rig. The effects of increasing temperature and velocity led to a 12% average reduction in COR at 533°K (47m/s), 15% average reduction in COR at 866°K (77m/s), and 16% average reduction in COR at 1073°K (102m/s) compared with ambient results. The decrease in COR appeared to be almost entirely a result of increased velocity that resulted from heating the flow. Trends show that temperature plays a minor role in energy transfer between particle and impact surface below a critical temperature.

Abstract Many components in helicopter dynamics systems depend on hard, wear resistant coatings for reliable performance. Component replacement times are currently limited by performance of these coatings in many cases. Thermal spray coatings have been evaluated for these applications to replace nickel and chromium electroplate. The effect of coatings on fatigue strength is quantified by a strain limit concept to reduce test requirements during development phase. Full scale bench testing and coupon wear testing were conducted to reveal large improvement in sliding and fretting wear resistance. A fine porosity network in thermal spray coatings, high hardness and high fatigue strength are shown to be the main contributors to improved wear performance. Thermal spray coatings also exhibited enhanced corrosion resistance in salt fog and crevice corrosion conditions. These data permitted implementation on several critical helicopter components.

The United States Department of Energy is building a Waste Treatment Plant (WTP) at the DOE Hanford Site in the state of Washington to process stored radioactive wastes for long-term storage and disposal. The Savannah River National Laboratory (SRNL) is helping resolve technical concerns with the WTP, which are related to piping erosion/corrosion (wear). SRNL is assisting in the design of a flow loop to obtain long term wear that will use prototypic simulant chemistry, operating conditions, and materials for total wear rate. The challenge is to accurately measure slurry wear to a pipe wall thickness tolerance of ∼47 microns/year anywhere in the test flow loop in a timely manner. To help in the design of the flow loop a test was performed with a smaller loop, which contained many of the pipe fittings expected in WTP to determine where high wear locations exist. One aspect of this test was to understand the rate of wear to straight pipe and to protrusions from the surface of the pipe. Initially, wear to straight pipe was studied because wear in other flow loop situations, e.g., around bends, through tees, etc. will be higher. To measure such low wear rates requires sensitive measurement techniques. To that end, twelve wear coupons were placed in one section of the pipe system and at different protrusion heights into the flow stream. They were made of 316L stainless steel, which is the expected material of pipe to be utilized. From the wear coupons, an estimate of wear rate was obtained, as well as illustrating when a protrusion above a pipe surface no longer disturbs the flow streams with respect to slurry wear. It appears when a surface is just above the laminar sublayer it produces a wear rate equivalent to a surface with no protrusions. The slurry was a mixture of water and 30 wt% of sand, d50 ∼ 200 microns. The test flow conditions were a velocity of 4 m/s in a 0.07793-m inside diameter (3-inch, Schedule 40) pipe system, resulting in Reynolds number just above 3 × 105, i.e., turbulent flow at a temperature of 25°C. The wear was to a vertically oriented straight section of pipe that was 1.86 meter long. The twelve wear coupons were located on the inside surface starting from 10 diameters from the pipe entrance to 21 diameters, with a separation of 1-pipe diameter between each successive coupon. Furthermore, each set of two adjacent coupons were rotated 180 degrees apart which were then rotated 30 degrees from the next set to minimize disturbance to the flow for the downstream coupon. This paper describes the wear rates obtained, the effect of increasing a wear coupon’s protrusion into the flow stream, and the overall operation of the test apparatus.

Growing usage of lightweight materials such as Al and Mg alloys in automotive body manufacture has come to a point that bonding of dissimilar materials is a realistic problem to address. A significant issue related to the bonding of dissimilar materials is that the differences in substrate surface conditions and substrate strengths often lead the bond to fail at strength far less than the bond strength established by adhesive manufacturer for a balanced joint. This research experimentally studied several factors potentially influencing initial strengths and debonding modes of adhesively-bonded Al-steel joints using single lap-shear coupons with comparison to like-substrate joints. Three commonly-used SLS coupon fabricating processes were investigated to determine which provided consistent bond strength and was efficient in making large quantities of coupons for the subsequent study. Next, the effect of prelube on the initial bond strength and debonding mode was investigated since the amount of prelube varies from sheet to sheet in automotive production. It was observed that even a very small change in the amount of prelube being applied on Al affected the initial bond strength. The more the prelube the weaker the bond became and the more adhesive failure occurred on the bonded Al surface. On the other hand, varying amount of the mill oil on the steel surface did not make much change to the bonding strength. Finally, various combinations of Al and steel substrates were studied to observe the effect of substrate materials on the initial bond strength and failure behavior. It revealed that the strength of joints between a relatively strong substrate and a relatively weak substrate fell below the strength of identical material joint made of the relatively strong substrate, and was closer to the strength of identical material joint made of the relatively weak substrate. For bonds having a high joint efficiency, adhesive failures were observed mostly on the surfaces of relatively weak substrates in the dissimilar material bonds due to large deformation in the weak substrate resulting in higher loading on that interface.

Abstract The fatigue behavior of a unidireclionally reinforced titanium matrix composite (TMC), SiC/Ti-15-3, was thoroughly characterized to support life prediction modeling of advanced TMC disks designed for gas turbine engine rotor applications. The results of this coupon-level experimental investigation are reviewed in this paper. On a stress basis, the isothermal fatigue behavior of the [0°] TMC revealed significant improvements over the unreinforced matrix. In contrast, the [90°] TMC exhibited degraded properties and lives for similar comparisons. This was attributed to the weak fiber/matrix interfacial bond. Encasing the [0°] TMC with a Ti-15-3 case did not affect isothermal fatigue lives at higher strain levels. However, at lower strain levels, relatively rapid initiation and propagation of large fatigue cracks in the case degraded the fatigue lives. Thermomechanical fatigue (TMF) lives were significantly reduced for the [0°] TMC when compared to isothermal lives. At high strains, in-phase TMF produced extremely short lives. This degradation was attributed to fiber overload failures bought about by stress relaxation in the matrix. At low strains, out-of-phase TMF conditions became life-limiting. Environment-assisted surface cracking was found to accelerate fatigue failure. This produced extensive matrix damage with minimal fiber damage. For the [90°] TMC, TMF conditions did not promote an additional degradation in cyclic life beyond that observed under isothermal conditions.

Research studies confirm that embracing sustainability in product design and manufacturing not only yields environmental improvements, but offers key business benefits. There is an increasing pressure to adopt a more sustainable approach to product design and manufacture. Organizations that are actively engaged in sustainable product design and development cite impressive levels of improvement over their poorer performing peers in product innovation, quality, safety and revenue growth alongside anticipated environmental and energy gains. Sustainability in design and manufacturing has a lot to do with “doing better with less,” and embracing a broader view of product development, and examining full lifecycle of the product and the impact that its design, manufacture, performance and disposal can have across not only on business, but on the environment and society, as well. The process of rethinking a product’s design so that it is more durable contains fewer parts and easily packaged and recycled also drives innovation and quality. The goal of sustainable product design (SPD) is to produce products and/or to provide services, which are sustainable and achieve their required functionality, meet customer requirements and are cost effective. In other words, SPD is about producing superior products and/or services that fulfil traditional criteria as well as sustainability requirements. The requirement to develop sustainable product is one of the key challenges of 21st century. This paper describes a system that identifies sustainability related performance measures for products in terms of: a) Sustainable product design by robust design. b) Sustainable design by quality of service. The first case study is on a laser based measuring instrument which supports the theory of sustainable product by robust design techniques The objective of the robust design study is to find the optimum recommended factor setting for the surface roughness analyser to minimize the variability in the readings. This instrument relies on the spread of the laser light on the work piece to determine surface roughness; therefore, the analyser’s reliability depends primarily on everything involved with the laser and its path. There are a minimum number of parts to achieve this function since the laser can scan over the work piece, substituting functionality in place of additional parts. The use of surface roughness analyser for online measurement of surface finish and continuous online monitoring and control with a feedback provides the robustness in quality and sustainability. The second case study, which is on elevator quality of service, is considered to support the theory of sustainable design by quality of service. This example shows how the design considerations are influenced and closely linked to the quality of service and maintenance. To support the theory of sustainability by quality of service, this case study examines elevator design and maintenance and recommends a new procedure based on Root Couse Analysis resulting in Elevator Condition Index (ECI). ECI is a new procedure and is applied based on original equipment reliability, projected average life cycle of key wear components, number of run cycles since maintenance was last performed on each component, cost of emergency repair vs. cost of maintenance vs. likelihood of failure. It supports service based on prognostics rather than routine service cycles. Sustainable design and manufacturing is possible if we deploy the virtual engineering tools to monitor and service manufacturing machinery so that the sustainable benefits are maintained throughout the product design cycle. The choice of a workplace structure depends on the design of the parts and lot sizes to be manufactured as well as market factors, such as the responsiveness to changes. Designers should be aware of the manufacturing consequences of their decisions because minor design changes during the early stages often prevent major problems later. As a part of product performance evaluation, the use of capability index to maintain process quality can lead to beneficial results.