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The purpose of this study was to obtain a broad view of the knowledge, attitudes, beliefs, and lived experiences of emergency nurses regarding implicit and explicit bias.An exploratory, descriptive, sequential mixed-methods approach using online surveys and focus groups to generate study data. Two validated instruments were incorporated into the survey to evaluate experiences of microaggression in the workplace and ethnocultural empathy. Focus group data were collected using Zoom meetings.The final sample comprised 1140 participants in the survey arm and 23 focus group participants. Significant differences were found in reported experiences of institutional, structural, and personal microaggressions for non-White vs White participants. Respondents who identified Christianity as their religious group had lower mean scores on items representing empathetic awareness. Respondents who identified as nonheterosexual had significantly higher mean total Scale of Ethnocultural Empathy scores, empathetic awareness subscale scores, and empathetic feeling and expression subscale scores. Thematic categories that arose from the focus group data included witnessed bias, experienced bias, responses to bias, impact of bias on care, and solutions.In both our survey and focus group data, we see evidence that racism and other forms of bias are threats to safe patient care. We challenge all emergency nurses and institutions to reflect on the implicit and explicit biases they hold and to engage in purposeful learning about the effects of individual and structural bias on patients and colleagues. We suggest an approach that favors structural analysis, intervention, and accountability.

Charge nurses (CNs) are shift leaders who manage resources and facilitate patient care, yet CNs in EDs receive minimal training, with implications for patient safety and emergency nursing practice. The purpose of the study was to describe the experiences of emergency nurses related to training, preparation, and function of the CN role.An explanatory sequential mixed methods design using survey data (n = 2579) and focus group data (n = 49) from both CN and staff nurse perspectives.Participants reported minimal training for the CN role, with divergent understandings of role, required education and experience, the need for situational awareness, and the acceptability of the CN taking on other duties.The ED CN is critical to the safety of both nursing environment and patient care. Nurses in this pivotal role do not receive adequate leadership orientation or formal training in the key areas of nurse patient assignment, communication, and situational awareness. Formal training in nurse-patient assignment, communication, and situational awareness are critical to appropriate patient care and maintenance of interprofessional trust necessary for successful execution of the CN role. ED nurse managers should advocate for this training.

PDF file - 401K, Supplementary Figure S1. Parental and 2nd generation anti-androgen resistant cell line proliferation. Supplementary Figure S2. AR levels in parental and 2nd generation anti-androgen resistant cell lines. Supplementary Figure S3. AR levels in transfection assays. Supplementary Figure S4. Transcriptional reporter assay of AR mutants. Supplementary Figure S5. Ligand binding domain of the AR bound to DHT (1T7T;(1)). Supplementary Figure S6. Competitive binding assay of wild-type AR vs. F876L AR. Supplementary Figure S7. AR levels in AR overexpressing cell lines. Supplementary Figure S8. LNCaP/AR(cs), LNCaP/SRF876L and LNCaP/pCDNAF876L cell proliferation. Supplementary Figure S9. Transcriptional activity of ARN-509 and enzalutamide in LNCaP/pCDNAF876L cells. Supplementary Figure S10. AR ChIP analysis of AR target genes. Supplementary Figure S11. PSA response for 3 patients with detectable AR F876L mutation.

PDF file - 183K, Supplementary Table S1. 1st and 2nd generation AR antagonist activity on F876L-AR. Supplementary Table S2. LNCaP/SRF876L Xenograft Pharmacokinetics Supplementary Table S3. AR nucleotide changes monitored by BEAMing assay Supplementary Table S4. Primary F876L BEAMing of ARN-509-001 Patients Supplementary Table S5. Transcriptional Real-time PCR Oligonucleotide Sequence Supplementary Table S6. ChIP Real-time PCR Oligonucleotide Sequence

The general problem of constructing regions that have a guaranteed coverage probability for an arbitrary parameter of interest $$\psi \in \Psi $$ ψ ∈ Ψ is considered. The regions developed are Bayesian in nature and the coverage probabilities can be considered as Bayesian confidences with respect to the model obtained by integrating out the nuisance parameters using the conditional prior given $$\psi .$$ ψ . Both the prior coverage probability and the prior probability of covering a false value (the accuracy) can be controlled by setting the sample size. These coverage probabilities are considered as a priori figures of merit concerning the reliability of a study while the inferences quoted are Bayesian. Several problems are considered where obtaining confidence regions with desirable properties have proven difficult to obtain. For example, it is shown that the approach discussed never leads to improper regions which has proven to be an issue for some confidence regions.

On March 11, 2020, the World Health Organization declared that COVID-19 was a pandemic.1 At that time, only 118,000 cases had been reported globally, 90% of which had occurred in 4 countries.1 Since then, the world landscape has changed dramatically. As of March 31, 2020, there are now nearly 800,000 cases, with truly global involvement.2 Countries that were previously unaffected are currently experiencing mounting rates of the novel coronavirus infection with associated increases in COVID-19–related deaths. At present, Canada has more than 8000 cases of COVID-19, with considerable variation in rates of infection among provinces and territories.3 Amid concerns over growing resource constraints, cardiac surgeons from across Canada have been forced to make drastic changes to their clinical practices. From prioritizing and delaying elective cases to altering therapeutic strategies in high-risk patients, cardiac surgeons, along with their heart teams, are having to reconsider how best to manage their patients. It is with this in mind that the Canadian Society of Cardiac Surgeons (CSCS) and its Board of Directors have come together to formulate a series of guiding statements. With strong representation from across the country and the support of the Canadian Cardiovascular Society, the authors have attempted to provide guidance to their colleagues on the subjects of leadership roles that cardiac surgeons may assume during this pandemic: patient assessment and triage, risk reduction, and real-time sharing of expertise and experiences. A visual abstract of the main principles underlying our recommended approach is provided in Figure 1.

Significance: Time-domain functional near-infrared spectroscopy (TD-fNIRS) has been considered as the gold standard of noninvasive optical brain imaging devices. However, due to the high cost, complexity, and large form factor, it has not been as widely adopted as continuous wave NIRS systems. Aim: Kernel Flow is a TD-fNIRS system that has been designed to break through these limitations by maintaining the performance of a research grade TD-fNIRS system while integrating all of the components into a small modular device. Approach: The Kernel Flow modules are built around miniaturized laser drivers, custom integrated circuits, and specialized detectors. The modules can be assembled into a system with dense channel coverage over the entire head. Results: We show performance similar to benchtop systems with our miniaturized device as characterized by standardized tissue and optical phantom protocols for TD-fNIRS and human neuroscience results. Conclusions: The miniaturized design of the Kernel Flow system allows for broader applications of TD-fNIRS.

The spectrum on how to manage aortic valve disease continues to widen. The purpose of this study is to add further clarification to the role of rapid deployment valves (RDVs) by comparing their outcomes with traditional sutured valves (TSVs) in the reoperative aortic valve replacement (AVR) setting.This study was a retrospective review of all patients undergoing a second surgical reoperation for aortic valve disease. Patients were categorized into 2 groups: RDV and TSV. Cox proportional hazards regression models were used to determine the association between exposures of interest and the primary and secondary outcomes, after adjusting for all the baseline characteristics. The primary outcome was major adverse cardiovascular events (MACE) within 3 years, which was the composite of all-cause death, readmission for myocardial infarct, readmission for stroke, and readmission for heart failure.A total of 307 patients made up the study population from 2010 to 2019. Of those, 254 patients received TSV, and 53 patients received RDV. RDV patients were significantly older than TSV patients by 10 years, on average. Shorter cardiopulmonary bypass (CPB) times were found with the RDV group. There was no significant difference in the primary outcome of MACE within 3 years.This single-centre large cohort study of patients with reoperative AVR found that RDVs facilitate smoother operations by saving 1 hour of cross-clamp time and CPB time. Furthermore, RDVs have comparable outcomes with TSVs, despite the significantly older patient population.Les nouvelles méthodes pour la prise en charge de la maladie de la valve aortique continuent de se multiplier. Cette étude vise à apporter d’autres précisions sur le rôle des valves à déploiement rapide (VDR) en comparant leurs résultats avec ceux des valves suturées traditionnelles (VST) dans le cadre d’un remplacement valvulaire aortique (RVA) réopératoire.Cette étude était une analyse rétrospective de tous les patients subissant une deuxième réopération chirurgicale pour la maladie valvulaire aortique. Les patients ont été classés en deux groupes : VDR et VST. Des modèles de régression des hasards proportionnels de Cox ont été utilisés pour déterminer l’association entre les expositions d’intérêt et les critères d’évaluation principal et secondaires, après ajustement pour toutes les caractéristiques initiales. Le paramètre principal était les événements cardiovasculaires indésirables majeurs (ECIM) dans les trois ans, soit un critère composite incluant le décès toutes causes confondues, la réadmission pour un infarctus du myocarde, la réadmission pour un accident vasculaire cérébral et la réadmission pour une insuffisance cardiaque.Au total, 307 patients faisaient partie de la population de l’étude de 2010 à 2019. Parmi ceux-ci, 254 patients ont reçu une VST, et 53 patients ont reçu une VDR. Les patients porteurs d’une VDR étaient significativement plus âgés que ceux porteurs d’une VST, soit de 10 ans en moyenne. Des temps plus courts sous circulation extracorporelle (CEC) ont été constatés dans le groupe VDR. Aucune différence significative n’a été observée en ce qui concerne le critère d’évaluation principal des ECIM dans les trois ans.Cette importante étude de cohortes menée à un seul centre auprès de patients subissant un RVA réopératoire a permis de constater que les VDR facilitaient les interventions en réduisant d’une heure le temps de clampage et le temps de CEC. De plus, les VDR ont procuré des résultats comparables à ceux obtenus avec les VST, malgré une population de patients significativement plus âgée.

EKS : This is a dream I had a couple of years ago. I was shopping for clothes for myself at a store that was nominally Bloomingdale's. I was dubious about whether they would have any clothes that would be big enough for me, but a saleswoman said they did, adding that rather than being marked by size numbers, each size-group of clothes was gathered under a graphic symbol: over here, she said, were the clothes that would fit me. "Over here" referred to a cluster of luscious-looking clothes, hung on a rack between two curtained dressing-rooms. The graphic symbol that surmounted them was a pink triangle. I woke up extremely cheerful. MM : My love of opera as a proto-gay child growing up in rural Oklahoma in the fifties had at least as much to do with the

The coronavirus disease 2019 (COVID-19) has had a profound global effect. Its rapid transmissibility has forced whole countries to adopt strict measures to contain its spread. As part of necessary pandemic planning, most Canadian cardiac surgical programs have prioritized and delayed elective procedures in an effort to reduce the burden on the health care system and to mobilize resources in the event of a pandemic surge. While the number of COVID-19 cases continue to increase worldwide, new cases have begun to decline in many jurisdictions. This "flattening of the curve" has inevitably prompted discussions around reopening of the economy, relaxing some public health restrictions, and resuming nonurgent health care delivery. This document provides a template for cardiac surgical programs to begin to ramp-up the delivery of cardiac surgery in a deliberate and graded fashion as the COVID-19 pandemic burden begins to ease that is guided by 3 principles. First, all recommendations from public health authorities regarding COVID-19 containment must continue to be followed to minimize disease spread, ensure patient safety, and protect health care personnel. Second, patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating. Finally, case volumes should be steadily increased in a mutually agreed upon fashion and must balance the clinical needs of patients awaiting surgery against the overall requirements of the health care system.

In 2014, the Canadian Cardiovascular Society (CCS) published a position statement on the management of thoracic aortic disease addressing size thresholds for surgery, imaging modalities, medical therapy, and genetics. It did not address issues related to surgical intervention. This joint Position Statement on behalf of the CCS, Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. The position statement is constructed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and has been approved by the primary panel, an international secondary panel, and the CCS Guidelines Committee. Advent of endovascular technology has improved aortic surgery safety and extended the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery.

ER-targeted therapeutics provide valuable treatment options for patients with ER+ breast cancer, however, current relapse and mortality rates emphasize the need for improved therapeutic strategies. The recent discovery of prevalent ESR1 mutations in relapsed tumors underscores a sustained reliance of advanced tumors on ERα signaling, and provides a strong rationale for continued targeting of ERα. Here we describe GDC-0810, a novel, non-steroidal, orally bioavailable selective ER downregulator (SERD), which was identified by prospectively optimizing ERα degradation, antagonism and pharmacokinetic properties. GDC-0810 induces a distinct ERα conformation, relative to that induced by currently approved therapeutics, suggesting a unique mechanism of action. GDC-0810 has robust in vitro and in vivo activity against a variety of human breast cancer cell lines and patient derived xenografts, including a tamoxifen-resistant model and those that harbor ERα mutations. GDC-0810 is currently being evaluated in Phase II clinical studies in women with ER+ breast cancer.

Background Hybrid aortic arch surgery has evolved to include several technical variations, with most including an off-label use of a conventional thoracic endograft. We describe the early clinical outcomes of the Thoraflex Hybrid graft (Vascutek, Glasgow, Scotland) specifically designed for the treatment of complex arch and proximal descending aortic disease. Methods Between January 2014 and April 2017, 40 consecutive patients (66 ± 14 years of age, 45% women) underwent hybrid aortic arch and frozen elephant trunk repair with the multibranched Thoraflex Hybrid graft at 9 Canadian centers. Surgical indications included transverse arch or proximal descending aortic aneurysm in 100%, acute dissection in 10%, chronic dissection in 43%, and acute aortic rupture in 1 patient. Antegrade cerebral perfusion and moderate hypothermia (24.3 ± 1.8°C) were employed in all cases. Results All 40 device implants were successful. The 30-day or in-hospital mortality was 5%. Stroke and transient neurological deficits occurred in 5% and 3% of patients, respectively. Two (5%) patients experienced transient spinal cord ischemia—there were no instances of permanent paraplegia. Mean follow-up was 550 ± 328 days and late complications included type A aortic dissection in 1 patient, type B dissection in 2 patients, and further distal endografting in 2 patients. Survival at 30 days, 1 year, and 2 years was 95%, 95%, and 90%, respectively. Conclusions Hybrid aortic arch and frozen elephant trunk repair with the Thoraflex Hybrid graft appears to be associated with good clinical outcomes, despite being early in the learning curve with this graft. Further investigation with this device is warranted to establish its role within the variations of hybrid arch repair.

OBJECTIVES: A North American prospective, 15-centre Food and Drug Administration (FDA) valve trial was designed to assess the safety and effectiveness of the Freedom SOLO stentless pericardial aortic valve in the treatment of surgical aortic valve disease. METHODS: Beginning in 2010, 251 patients (mean: 74.7 ± 7.5 years), were recruited in the Freedom SOLO aortic valve trial. One hundred eighty-nine patients have been followed for at least 1 year and are the basis for this review. Preoperatively, 54% of patients had NYHA functional class III or IV symptoms, and the majority of patients had a normal ejection fraction (EF) (median EF = 61%). Concomitant procedures were performed in 61.9% of patients, with coronary artery bypass grafting (CABG) (48.7%) being the most common followed by a MAZE procedure (13.7%). Reoperations were performed in 8.5% of patients in the study. RESULTS: The entire cohort of 251 patients enrolled had 7 deaths prior to 30 days, 2 of which were valve-related (aspiration pneumonia and sudden death) and 5 were not valve-related. There were 11 deaths after 30 days, 1 valve-related (unknown cardiac death) and 10 not valve-related. Five valves were explanted, 3 early (endocarditis, acute insufficiency and possible root dissection) and 2 late (endocarditis). Thirty-day adverse events include arrhythmias requiring permanent pacemaker (4.2%), thromboembolic events (3.7%) and thrombocytopenia (7.4%). One-year follow-up of all 189 patients demonstrated mean gradients for valve sizes 19, 21, 23, 25 and 27 mm of 11.7, 7.8, 6.3, 4.6 and 5.0 mmHg, respectively. Effective orifice areas for the same valve sizes were 1.2, 1.3, 1.6, 1.8 and 1.9 cm 2 , respectively. Ninety-six percent of patients (181/189) were in NYHA class I or II at the 1-year follow-up. CONCLUSIONS: The Freedom SOLO stentless pericardial aortic valve demonstrated excellent haemodynamics and a good safety profile out to the 1 year of follow-up.

Despite the impressive clinical activity of the second-generation antiandrogens enzalutamide and ARN-509 in patients with prostate cancer, acquired resistance invariably emerges. To identify the molecular mechanisms underlying acquired resistance, we developed and characterized cell lines resistant to ARN-509 and enzalutamide. In a subset of cell lines, ARN-509 and enzalutamide exhibit agonist activity due to a missense mutation (F876L) in the ligand-binding domain of the androgen receptor (AR). AR F876L is sufficient to confer resistance to ARN-509 and enzalutamide in in vitro and in vivo models of castration-resistant prostate cancer (CRPC). Importantly, the AR F876L mutant is detected in plasma DNA from ARN-509–treated patients with progressive CRPC. Thus, selective outgrowth of AR F876L is a clinically relevant mechanism of second-generation antiandrogen resistance that can potentially be targeted with next-generation antiandrogens. Significance: A missense mutation in the ligand-binding domain of the androgen receptor F876L confers resistance to the second-generation antiandrogens enzalutamide and ARN-509 in preclinical models of AR function and prostate cancer and is detected in plasma DNA from ARN-509–treated patients with progressive disease. These results chart a new path for the discovery and development of next-generation antiandrogens that could be coupled with a blood-based companion diagnostic to guide treatment decisions. Cancer Discov; 3(9); 1020–9. ©2013 AACR. See related commentary by Nelson and Yegnasubramanian, p. 971 This article is highlighted in the In This Issue feature, p. 953

The main thing is to tell a story. / It is almost / very important.-Frank O'Hara, "Fantasy" (1964)'A leading designer of video games might seem an unlikely exponent of the purity of genres and media (attitudes more commonly associated, as Marcie Frank notes in her introduction to this issue, with high modernism), but Jeffrey Kaplan, former design-team chief of the extremely successful video game World of Warcraft, sounded very much like an advocate of just such separatisms as he reproved his fellow game makers for what he called their "medium envy" at the 2009 Game Developers Conference in San Francisco. Rather than concentrating on what he sees as the specific and singular capacities of the video game, Kaplan argued, his colleagues were allowing their work to be driven by their alleged envy of writers and writing, consequently "drowning the player[s]" of their games in "reams of dialogue and narrative." Kaplan stated bluntly, "[W]e need to stop writing a fucking book . . . [when we design a] game because nobody wants to read it," and concluded, "We need to deliver our story in a way that is uniquely video game."2It is striking that despite Kaplan's disdain for print narrative as a model for video-game design, story is still his way of specifying what it is that he and his fellow designers have to offer those who play their games. This is consonant with Walter Benjamin's pronouncement in "The Storyteller" that "what distinguishes the novel from the story ... is its [i.e., the novel's] essential dependence on the book," on the medium of bound print. "The dissemination of the novel becomes possible only with the invention of printing," Benjamin goes on. For Benjamin, no such relation of medium dependence binds "story" to (printed) book. In the mediascape that emerged in the twentieth century, novels-remediated as films, television series, graphic narratives, etc.-frequently became something other than their native genre. "Story" generally names a number of the kinds of things that novels became. As Kaplan presents it, "story" is entirely compatible with what he calls "uniquely video game" modes of production-what he argues his fellow designers will have succeeded in doing when they have "stop[ped] writing a fucking book."Story is also a term that has circulated widely in the twentieth century for screenplay, soap opera, and other extended nonnovel narrative forms. It is the long-arc serial narrative-as it has informed a number of genres across several media, ranging from the seventeenthand eighteenth-century comedy of intrigue to nineteenth-century melodrama to twentieth-century sitcom and soap opera-that I intend to focus on in these pages. In looking at a somewhat different (although at some points overlapping) set of media archives from those that Frank considers in her introductory essay, I want to consider some of the ways in which certain genres and media forms have drawn extensively on the traditions of melodrama production, performance, and reception: both those that we ordinarily think of as obviously and essentially melodramatic (radio and TV soap operas, for chief examples) and those that we tend to think of as distinctly other to and different from melodrama (radio and TV sitcoms and newspaper comic strips).One route that I want to follow takes up the distinction that Frank discusses in her introduction-the distinction made by Gilbert Seldes in 1924 between early cinema, which he saw as emerging from melodrama and newspaper comic strips, and the cinema that succeeded it. As Seldes sees it, film took a catastrophically wrong turn in shifting away from the most popular entertainment forms of the time toward putatively prestigious forms of drama and "serious" theater for its models. In saying this, Seldes sounds somewhat like Kaplan at the Game Developers Conference in 2009, warning his fellow designers away from a tendency to imitate print too closely, urging his colleagues to "accept that we are not Shakespeare [or] Tolstoy. …

Purulent pericarditis is a rare acutely life-threatening condition. Initial symptoms, signs, and investigations can be nonspecific. Echocardiography is invaluable for establishing the diagnosis and initial management. We present a case of a previously healthy patient with purulent pericarditis caused by Streptococcus pneumoniae in the absence of a primary focus of infection. The patient deteriorated rapidly with cardiac tamponade and septic shock and was managed successfully by a combined medical and surgical approach.

ER-targeted therapeutics provide valuable treatment options for patients with ER+ breast cancer, however, current relapse and mortality rates emphasize the need for improved therapeutic strategies. The recent discovery of prevalent ESR1 mutations in relapsed tumors underscores a sustained reliance of advanced tumors on ERα signaling, and provides a strong rationale for continued targeting of ERα. Here we describe GDC-0810, a novel, non-steroidal, orally bioavailable selective ER downregulator (SERD), which was identified by prospectively optimizing ERα degradation, antagonism and pharmacokinetic properties. GDC-0810 induces a distinct ERα conformation, relative to that induced by currently approved therapeutics, suggesting a unique mechanism of action. GDC-0810 has robust in vitro and in vivo activity against a variety of human breast cancer cell lines and patient derived xenografts, including a tamoxifen-resistant model and those that harbor ERα mutations. GDC-0810 is currently being evaluated in Phase II clinical studies in women with ER+ breast cancer. DOI: http://dx.doi.org/10.7554/eLife.15828.001

Lesbian and gay studies was still in its academic infancy when Eve Kosofsky Sedgwick wrote her long-unpublished essay on James Merrill's long poem “The Book of Ephraim” (1976). Sedgwick's essay focuses on what she sees as the poem's fascinated concern with the administration of punishment and pain by one man on another. Written at least partly as a bid for recognition from a major American poet of the time, the essay can also be understood as an early act of engagement on Sedgwick's part with some of the most enduring of her critical and theoretical interests, such as abjected sexualities, nonoedipal psychologies, and the analysis of virtuosic performances (including, eventually, her own) of cultural authority.

Background Compared with non-ST-elevation myocardial infarction (MI), ST-elevation MI has been associated with increased mortality after medical treatment and percutaneous coronary intervention. Our study investigated the prognostic value of MI classification in the setting of surgical revascularization within 21 days of MI. Methods We studied 2412 consecutive patients between 1995 and 2007 who underwent an isolated coronary artery bypass grafting procedure within 21 days after MI. The outcomes of interest were in-hospital mortality and major adverse events, which included death, MI, stroke, and renal failure requiring hemodialysis. Results Rates of crude in-hospital mortality and major adverse events were higher in ST-elevation MI patients. Stepwise regression analysis suggested that MI subtype (ST-elevation MI vs non-ST-elevation MI) did not predict in-hospital mortality or major adverse events. A secondary analysis using propensity score matching showed similar surgical outcomes between the two cohorts. Conclusions Surgical risks of patients with recent MI are independent of MI subtype. Distinguishing ST-elevation MI and non-ST-elevation MI is of limited value in the decision-making process of early surgical intervention.

IN OUR INCREASINGLY digital world, Michael Moon uses metaphors to explore how Web sites can be powerful venues for branding. As “deep gravity wells,” they are bright, compelling cyberspace destinations around which stakeholders can take orbit. As “theater,” sites function as a stage and offer performances that keep audiences coming back. In both instances, Moon presents guidelines for the structure and content of sites, with comments on such topics as the personalizing of information, online vending, and the creation of digital communities.

I knew Ian Watt, the author of The Rise of the Novel (1957), a little in his later years, and he once told me a story about his having been one of the Cambridge undergraduates in the 1930s who had invited Gertrude Stein to the university to speak. The responsibility of meeting Stein's train and entertaining her until time for her lecture fell to Watt, and he said he was a little concerned beforehand about whether as an undergraduate he was quite up to interacting with Stein, who was by that time a famously formi dable person. So he was relieved on meeting her to discover that she seemed entirely agreeable and good natured; he probably did not know at the time that Stein had made a career not only of very much making her own way as an artist but of helping the ambitious young men around her—Ernest Hemingway, Aaron Copland, Paul Bowles, Sam Steward, Thornton Wilder, and many others—make theirs. Stein was a dab hand of long experience at drawing out bright young men by the time she met Watt.