Overseas Hospital Research Articles

Infectious shock after liposuction

BackgroundLiposuction has become one of the most popular cosmetic surgeries in China. However, few studies have discussed infectious shock caused by C. perfringens as one of the causes of death after liposuction.Case presentationA 24-year-old woman was brought to the emergency department (ED) of Guangzhou Chinese Overseas Hospital for treatment. The patient had undergone liposuction in her bilateral lower limbs two days prior. At the ED, the patient was unconscious, and had bilateral equal-sized (diameter, 6 mm) round pupils, no light reflex, a blood pressure (BP) of 71/33 mmHg, a heart rate of 133 bpm, and an SpO2 of 70%. She had bilateral limb swelling, extensive ecchymoses in her lower abdomen and bilateral thighs, local crepitus, blisters, weak pulses on her femoral artery and dorsalis pedis, high skin tension, and hemoglobin of 32 g/L. The patient was diagnosed with Clostridium perfringens infection, and she underwent debridement surgery and supportive treatment. But the patient’s BP could not improve. At 8:28 pm on the day of admission, the patient was declared clinically dead after the electrocardiograph showed a horizontal line and spontaneous respiration ceased.ConclusionsFailure to meet surgical disinfection and environmental standards may be the cause of infection of C. perfringens through wounds. Therefore, it is necessary to strengthen the environmental disinfection of the operating room, and standardize the sterile conditions of the operation staff and patients before and during operation. Liposuction surgery necrotizing fasciitis is a rare but fatal complications, especially if diagnosis delay, therefore it is critical for early diagnosis and treatment of gas gangrene.

Needs Analysis: The Primary Step in Designing English Instructional Materials for Nursing Students

This research intended to analyze and identify the needs of English instructional materials (ESP) for nursing students. English in higher education in non-English major is only as a General Basic Subject and the material provided is only general English. Whereas ideally English material taught should be adjusted to their major. So, needs analysis was required to find out the need for English teaching materials on the nursing department so that students could get the appropriate materials they really need to support their future careers to be professional nurses. This study design was a descriptive qualitative with subjects were 81 nursing students, heads of nursing study programs, 3 ESP lecturers, 2 Indonesian nurses, 2 Indonesian nurses who work in overseas hospital. The research instrument used a questionnaire and interviews. The results showed that in general, students' English skills were still low. From the 4 language skills, speaking become the main priority to provide them fulfilling their profession’s demands in accordance with the job market, namely being able to communicate in English well. They also expected ESP English teaching materials that are relevant to nursing major to support their professional careers. 86% students believed if English materials related to nursing major will improve their interest in learning. Besides that, there are also 12 nursing topics that students need to support their world of work later. This research results will be guidance in making appropriate syllabus and developing English for nursing textbook.

A preliminary study of the rate of hospitals and satellite clinics worldwide for top US cancer centers

IntroductionHealthcare is a globalized endeavor. With an increasing number of overseas collaborations being announced as profit-driven business structures, we sought to investigate the prevalence of the top-ranked United States (US) cancer hospitals investing in overseas hospitals. MethodWe conducted a web search of publicly available information to determine the frequency in which US hospitals with top-ranked cancer centers expand into offshore markets. ResultsOf the 53 offshore entities identified, 17 (32 %) are in China. Other tops locations include Italy (9%), United Arab Emirates (8%), and Saudi Arabia (8%). DiscussionOur findings show many international US-partnered clinics are located in countries designated as either high-income or upper-middle-income economies. Further research is needed to understand the full scope of US hospitals abroad and the impact it may have on the global cancer care landscape. Policy summaryThe business-model for globalized US healthcare should be investigated for implications to local and foreign cancer care.

The Challenging but Imperative Path to Monoclonal Antibody Use Against COVID-19 for a Small Overseas Military Hospital.

ABSTRACTUpon the U.S. FDA approval in early November for a monoclonal antibody proven to potentially mitigate adverse outcomes from coronavirus disease 2019 (COVID-19) infections, our small overseas community hospital U.S. Naval Hospital Rota, Spain (USNH Rota) requested and received a limited number of doses. Concurrently, our host nation, which previously had reported the highest number of daily deaths from COVID-19, was deep within a second wave of infections, increasing hospital admissions, near intensive care unit capacity, and deaths. As USNH Rota was not normally equipped for the complex infusion center required to effectively deliver the monoclonal antibody, we coordinated a multi-directorate and multidisciplinary effort in order to set up an infusion room that could be dedicated to help with our fight against COVID. Identifying a physician team lead, with subject matter experts from nursing, pharmacy, facilities, and enlisted corpsmen, our team carefully ensured that all requisite steps were set up in advance in order to be able to identify the appropriate patients proactively and treat them safely with the infusion that has been clinically proven to decrease hospital admissions and mortality. Additional benefits included the establishment of an additional negative pressure room near our emergency room for both COVID-19 patients and, when needed, the monoclonal antibody infusion. In mid-January, a COVID-19-positive patient meeting the clinical criteria for monoclonal antibody infusion was safely administered this potentially life-saving medication, a first for small overseas hospitals. Here, we describe the preparation, challenges, obstacles, lessons learned, and successful outcomes toward effectively using the monoclonal antibody overseas.

Incursions of Candida auris into Australia, 2018.

Candida auris is an emerging global healthcare-associated pathogen. During July–December 2018, four patients with C. auris were identified in Victoria, Australia, all with previous overseas hospitalization. Phylogenetic analysis revealed putative transmission between 2 patients and suspected overseas acquisition in the others. Vigilant screening of at-risk patients is required.

Exploring Service and Environment: In-patient trust and satisfaction in public hospital

This study focused on in-patient trust in the Regional Public Hospital of M. Sani in Tanjung Balai Karimun Regency in regards to the services given and its position as a comparative and exemplary hospital representing the international-level ones. This hospital is called so because it is located in the entrance area to the neighboring countries. The problem regarding the services in this government-owned Regional Public Hospital has become a part of discussion requiring a solution. The medical officers in the government-owned hospitals have recently been distinguished from the medical officers in the overseas hospitals. The responsiveness and motivation giving in the foreign hospitals have been found better than the government-owned ones. This study aimed at establishing the influence of responsiveness and motivation giving towards patient satisfaction and its impact towards in-patient trust in Tanjung Balai Karimun Regency. This study used the survey method with 100 patients and their families as the samples by employing an accidental sampling technique. The data collection technique used questionnaires and the data analysis technique used SEM analysis instrument via WarpPLS software. The results of the study indicated that the medical officers responsive towards the patients and motivating them will make them satisfied towards the services given. Patient satisfaction significantly influences their trust towards in-patient services in the Regional Public Hospital of M. Sani of Tanjung Balai Karimun Regency.

A case report of malignant primary pericardial mesothelioma with atypical imaging appearance: multimodality imaging with histopathological correlation.

Background Primary pericardial mesothelioma is a rare primary cardiac malignancy, with three main histopathological types, sarcomatoid histotype being the rarest. The imaging features were atypical due to concomitant extensive calcification, which resulted in aggravated differential diagnosis.Case summary A 45-year-old man presented to our hospital with non-specific clinical symptoms. According to clinical history, a mediastinal tumour had been suspected with a previous unsuccessful attempt of transthoracic computed tomography-guided biopsy at an overseas hospital with limited data of performed imaging procedures. Multimodality imaging at our centre revealed extensively calcified solid masses in the pericardium, invading the left atrium. As the imaging features suggested an atypical primary pericardial malignancy, a diagnostic thoracoscopy was performed. Histopathological analysis of specimen revealed sarcomatoid type of pericardial mesothelioma with areas of necrosis and foci of osteogenic differentiation. Despite planned treatment, 2 weeks after histological diagnosis, the patient passed away due to perforated peptic ulcer-related sepsis.Discussion The presence of extensive calcification in the lesion resulted in a challenging imaging workup and diagnosis. Initial differential diagnosis included primary or metastatic calcification-prone tumour, secondary calcification due to haemorrhage after previous interventional procedure and other pathologies, such as tuberculous pericarditis, calcified amorphous tumour, among others. Calcification may be part of the histological tumour characteristics; however, proper history taking is crucial as concomitant diseases, previous treatment, and interventional procedures may alter the imaging pattern.

Multidisciplinary Intestinal Rehabilitation in Children: Trial in Overseas Hospitals

Multidisciplinary Intestinal Rehabilitation in Children: Trial in Overseas Hospitals

High and intermediate anorectal malformation in males with perineal fistula: Beware of urethral involvement

Anorectal malformation (ARM) with recto-perineal fistula is considered low-type anomaly and standard management of perineal anoplasty without colostomy is recommended. Unusual variants are scarcely reported and present unique challenges in management. We present two cases of ARM with unusual fistula managed in our hospital. Case 1 A term baby boy status-post colostomy creation at birth in an overseas hospital for ARM presented to us at 4 months of age for definitive surgery. Distal loopogram demonstrated a very fine recto-penile fistulous opening at the peno-scrotal area hence perineal anorectoplasty was planned. Intra-operatively, the bulbar urethra was laid open for complete fistula tract excision due to a 3cm shared common wall between fistula tract and urethra. A double-layered urethral repair was performed and a neoanus created after mobilisation of a high rectal pouch. The baby recovered well post-operatively after 3 weeks of urethral stenting and is currently awaiting stoma closure. Case 2 A term male newborn was noted to have ARM with a recto-scrotal fistula. After initial stabilisation and workup, he was scheduled for perineal anoplasty on day 2 of life. Intra-operatively, we noted a fine, long cutaneous track running in the scrotal raphe close to the bulbar urethra. The bulbar urethra was inadvertently entered during fistula tract excision and needed repair. The rectal pouch located above the levator muscle was mobilised and anorectoplasty was performed. The baby was managed post-operatively with gut rest and total parenteral nutrition, and recovered well. Rare-variant ARM with recto-penile/recto-scrotal fistulae can be associated with high or intermediate type anomalies in contrary to classical recto-perineal fistula. Management of these cases should be planned carefully, with possible need for urethral repair during anorectoplasty.

Epidemiological and clinical profile of Korean travelers receiving international medical repatriation.

The aim of this study was to investigate the experiences of medical transportation of Korean travelers who suffered accidents abroad and then transferred home by our aeromedical team.We collected demographic and clinical data on patients injured while traveling abroad from January 2013 to July 2017. Descriptive analyses based on 4 different transportation methods and transport time since hospitalization were performed.A total of 33 patients were repatriated during the study period. Of these, 28 (84.8%) were trauma cases with pedestrian injuries being the most common (11 cases; 39.3%). Twenty patients were repatriated by flight-stretchers, 6 by flight-prestige, 2 by ship, and 5 by air ambulance. The air ambulance was the most expensive (average 61,124 US Dollars) mode of transportation (P = .001) and the ship took the longest time (14 hours) to transport patients back to Korea from regions with similar distance (P = .0023).We experienced medical repatriation of 33 seriously injured Korean travelers back to South Korea. Transfer time should be an important considering factor and directly contacting and communicating with the specialized staff of foreign hospitals could also be very important to reduce unnecessary overseas hospital stay and cost incidence.

Arte e Medicina como Instrumentos do Poder: considerações em torno de um painel cerâmico de Manuel Lima para o Hospital do Ultramar em Lisboa (1973)

Este texto pretende abordar o painel cerâmico realizado por Manuel Lima (1911-1991), em 1973, para decoração do então ampliado Hospital do Ultramar, em Lisboa (actual Hospital Egas Moniz). A análise da composição considera a conjuntura sociopolítica de então, cruzando-a com as opções iconográficas tomadas pelo artista e com a integração no espaço arquitectónico para o qual o painel foi concebido. É objetivo deste artigo contribuir para uma reflexão acerca da apropriação das artes plásticas pelo poder político para veiculação de mensagens ideológicas, concretamente no período do Estado Novo.

Management of Adverse Reactions to Iodinated Contrast Media for Computed Tomography in Korean Referral Hospitals: A Survey Investigation.

ObjectiveTo evaluate the current status of managing adverse reactions to iodinated contrast media (ICM) for computed tomography in referral hospitals in South Korea compared with hospitals in other countries.Materials and MethodsThis survey investigation involved 59 Korean and 15 overseas hospitals using guideline-based questionnaires consisting of 24 items in 7 main categories related to managing adverse reactions to ICM.ResultsInformed written consent with risk factor evaluation was appropriately performed in most of the Korean hospitals. There was considerable variability in assessing renal function across the hospitals; serum creatinine level was used as a reference in 76.4% of Korean hospitals. The Korean hospitals preferred a more stringent approach to determining normal renal function (p = 0.01), withholding metformin (p = 0.01), and fasting before ICM exposure (p < 0.001) compared with overseas hospitals. All the Korean hospitals had an emergency protocol and in-hospital system for adverse reactions to ICM. The Korean (87.7%) and overseas hospitals (100%) were similarly equipped with epinephrine (p = 0.332), but only 38.6% of Korean hospitals were equipped with a bronchodilator (p = 0.004). For patients with a previous hypersensitivity reaction to ICM, 62.3% of Korean hospitals pre-medicated with anti-histamine and corticosteroid according to the severity of the previous reaction, and changed the culprit ICM in 52.8%, while skin test was performed in 17%.ConclusionIn general, Korean referral hospitals were well-prepared regarding informed consent, protocol, and an in-hospital system for managing adverse reactions to ICM. Nevertheless, there was considerable variability in details and management, thus requiring standardization by reflecting current guidelines.

NDM-1 Hazard in the Balkan States: Evidence of the First Outbreak of NDM-1-Producing Klebsiella pneumoniae in Bulgaria.

New Delhi MBL (NDM) carbapenemase-producing Klebsiella pneumoniae has become one of the most concerning multidrug-resistant pathogens. The Balkan counties are considered a reservoir for the spread of such strains based on several reports documenting NDM infections after hospitalization in this region. Nevertheless, NDM-producing K. pneumoniae have been only occasionally documented from Balkans. The current study documents the first polyclonal outbreak caused by NDM-1-producing K. pneumoniae in Bulgaria. From July 2015 to April 2016, all 25 single-patient carbapenem-nonsusceptible K. pneumoniae isolates were collected. Phenotypic and molecular screening revealed that 17 produced NDM-1 carbapenemase. All NDM-1 producers harbored blaCTX-M-15, blaCMY-4, blaTEM-1, and blaOXA-2; five also harbored blaOXA-1. In all cases, blaNDM-1 was flanked upstream by ISAba125 element and downstream by bleMBL. Pulsed-field gel electrophoresis (PFGE) clustered NDM-1-positive isolates into four distinct clonal types, A to D. MLST assigned isolates of the dominant clonal type A (n = 14) to sequence type (ST) 11, while isolates of clonal types B, C, and D to ST16, ST15, and ST391, respectively. Of interest, ST11 isolates belonged to the same PFGE type as those of the recently described NDM-1 ST11 clonal outbreak in Greece. Traveling abroad or overseas hospitalization was not reported in any case, suggesting most likely intra- and interhospital dissemination. The study presents the first polyclonal outbreak of NDM-producing K. pneumoniae in the Balkans and underlines the need for larger epidemiological studies in the region to illustrate commonalities in the transmission of NDM clones and possible sources in the community.

Developing a checklist for collecting information from overseas hospitals.

Expatriate workers and their families may encounter difficulties and uncertainties when visiting local hospitals. These problems include differences in the medical system, higher healthcare costs, and language problems. Occupational health staff in companies need to know about the healthcare system, including emergency transportation arrangements, to reduce anxiety in workers and families attending hospitals. This study was designed to create a checklist to allow occupational health staff to collect information from overseas hospitals efficiently and effectively. We used documentary searches and the knowledge and experience of researchers to identify the support requirements of expatriate workers and drafted a checklist for information collection from overseas hospitals. The validity of the checklist was assessed in two stages. First, we interviewed health specialists caring for expatriate workers and their families and then tested the draft in international hospitals. We revised the draft based on our findings and again tested the new version in different overseas hospitals, enabling us to create a final version of the checklist. Our checklist contains 12 major categories: reception, administration, inpatient wards, available tests, outpatient clinics, emergency services, pediatrics, gynecology, dentistry, general health check-ups, vaccination services, and precautions against infection. These categories cover a total of 51 subcategories, each of which is further divided into a total of 131 smaller categories. Occupational health staff can use this checklist to gather information in order to provide comprehensive and effective support for expatriate workers attending hospitals. We recommend that the staff gather all possible information from hospital websites before visiting and use the visiting time to gather information available only on site. In order to gather as much information as accurately as possible, the staff are recommended to visit the facilities related to the checklist categories, that is, Japanese language reception, outpatient services, inpatient wards, emergency services, pediatrics, gynecology, general health check-up centers, and cardiac catheterization labs, and obtain information directly from doctors, nurses, and specialists working at the hospitals.

High rate of multidrug-resistant organism colonization among patients hospitalized overseas highlights the need for preemptive infection control.

We performed 4 years of active screening for multidrug resistant organism (MDRO) colonization among patients with a history of overseas hospitalization. Thirteen (56.5%) of 23 cases were positive for MDROs, which highlights the importance of preemptive infection control to prevent the spread of MDROs in this population.

Training responsibly to improve global surgical and anaesthesia capacity through institutional health partnerships: a case study

Urgent investment in human resources for surgical and anaesthesia care is needed globally. Responsible training and education is required to ensure healthcare providers are confident and skilled in the delivery of this care in both the rural and the urban setting. The Tropical Health and Education Trust (THET), a UK-based specialist global health organisation, is working with health training institutions, health professionals, Ministries of Health and Health Partnerships or 'links' between healthcare institutions in the UK and low- or middle-income country (LMIC) counterparts. These institutions may be hospitals, professional associations or universities whose primary focus is delivery of health services or the training and education of health workers. Since 2011, THET has been delivering the Health Partnership Scheme (HPS), a UK government-funded programme that provides grants and guidance to health partnerships and promotes the voluntary engagement of UK health professionals overseas. To date, the £30 million Scheme has supported peer-to-peer collaborations involving more than 200 UK and overseas hospitals, universities and professional associations across 25 countries in Africa, Asia and the Middle East. In this paper, we focus on four partnerships that are undertaking training initiatives focused on building capacity for surgery and anaesthesia. In order to do so, we discuss their role as a responsible and effective approach to harnessing the expertise available in the UK in order to increase surgical and anaesthesia capacity in LMICs. Specifically, how well they: (1) respond to locally identified needs; (2) are appropriate to the local context and are of high quality; and (3) have an overarching goal of making a sustainable contribution to the development of the health workforce through education and training. The HPS has now supported 24 training initiatives focused on building capacity for surgery and anaesthesia in 16 countries across sub-Saharan Africa, Asia and the Middle East. THET argues that these initiatives are both responsible and effective. The four partnerships featured in this paper have demonstrated not only their effectiveness in increasing health worker skills and knowledge, but have done so across a variety of surgical and anaesthesia disciplines and within different contexts. This wide reach and applicability of partnership initiatives adds even greater value to their use as responsible training interventions. One challenge that has faced these partnerships has been the capture of improvements to patient outcomes as a result of improved practice. To counteract the problems of data collection, partnerships are collecting anecdotal evidence of improvements at the patient outcome level. The interventions supported by THET have been able to demonstrate success in improving health worker skills and knowledge, and albeit to a lesser extent, in improving patient outcomes. The implementing partners are achieving these successes by training responsibly: responding to locally identified need, implementing projects that are appropriate to the local context and are of high quality, and establishing mechanisms that ensure self-sufficiency of the health worker training and education that is delivered. Greater investment in responsible training initiatives such as these are required to address the significant lack of access to appropriate and safe surgical and anaesthesia interventions when needed and the growing burden of disease.

Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting

Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging threat for healthcare providers worldwide. To determine CPE carriage rates and risk factors in an unselected hospital cohort at the time of admission. We approached 4567 patients within 72 h of admission to provide a rectal swab and answer a questionnaire on risk factors for carriage. Rectal swabs were cultured for carbapenem-resistant organisms on chromogenic and non-chromogenic agar, and tested for carbapenemase production by PCR (Check-Direct CPE). The study was approved by the NHS Research Ethics Committee. Only 6 CPE were cultured from 5 (0.1%) of 4006 patients who provided a rectal swab; only 1 was cultured using non-chromogenic media. An additional 76 culture-negative rectal swabs were initially PCR positive, but none grew a carbapenem-resistant organism despite enrichment culture and only two were positive when retested several months later by Check-Direct and a second PCR assay (Cepheid GeneXpert® Carba-R). A modified Ct cut-off of <35 would have resolved these apparent false-positives. 40% of patients had a risk factor that should prompt screening and pre-emptive isolation as defined by UK CPE guidelines but only 8.1% and 20.2% of these patients had been screened and pre-emptively isolated by clinical teams, respectively. Overseas hospitalization was the only significant risk factor for CPE carriage (P < 0.001, OR 64.3, 95% CI 7.3-488.5). This study highlights a very low carriage rate of CPE. Hospitalization abroad is the most important risk factor to guide admission screening in this low-prevalence setting.

Experience of a specialist emergency bariatric surgical service

BackgroundBariatric surgery is associated with late and procedure-specific acute surgical complications. There is very little evidence available regarding the volume, nature, and outcomes of acute surgical admissions directly stemming from bariatric surgery. Centralization of bariatric elective services in the United Kingdom may have an adverse impact on the ability of local services to manage such unpredictable complications. To address this potential problem, we set up a comprehensive and specialist emergency bariatric service. ObjectivesThe aim of this study was to quantify and characterize the workload of a specialist emergency surgical bariatric service. SettingUniversity National Health Service hospital. MethodsOver 2 years, we prospectively collected data on demographic characteristics, management, and outcomes of all acute surgical admissions related directly to previous bariatric surgery. ResultsBetween December 2011 and November 2013, 69 patients had 71 emergency admissions due to a surgical emergency directly related to previous bariatric surgery. Thirty-seven (54%) had undergone primary bariatric surgery at our institution, 13 (19%) at a different National Health Service hospital, 16 (23%) at private U.K. hospitals, and 3 (4%) at private overseas hospitals. Forty-four endoscopic or surgical interventions were required, of which 17 (39%) were performed on nights or weekends and within 12 hours of admission. Of 27 operations, 25 (93%) were completed laparoscopically. Median length of stay was 2 days, there were no mortalities, and there was 1 readmission within 30 days. ConclusionsThere is a significant volume of late bariatric surgical emergencies, many requiring urgent intervention. These may be effectively managed by a specialist bariatric service.

ODA 지원 베트남 중부 꽝남성 종합병원의 거주후 평가

Purpose: This is ex-post evaluation on the Central General Hospital in Quang Nam Province in Vietnam funded by Korean ODA. Through this evaluation, this study tries to explore useful ways to improve effectiveness of Korean ODA projects related to hospital establishment. Methods: Field survey and analysis of questionaire to staffs and patients of Quang Nam Province General Hospital were conducted twice in 2012 and 2014 after completion of Hospital. Two sets of surveys and questionaire outcomes have been comparatively analysed by statistics in order to seek trend of satisfaction level of hospital users and find out improvement way in hospital design and construction. Results: The satisfaction level on hospital was relatively high and that of 2014 is higher than that of 2012. The satisfaction level of users was recorded in Likert 5 scales. Continuous facility complement and maintenance is considered as main contributor in increasing satisfaction level of users. As far as satisfaction level of outpatient is concerned, that of 2012 was recorded as 3.65 and that of 2014 was 4.05. In case of inpatient, satisfaction level on hospital in 2012 was 3.76, and 4.06 in 2014. Implications: In overseas hospital projects, proper hospital project management system including medical service plan, strategic plan, brief, design & construction and maintenance have to be put together effectively and efficiently for success of hospital project. At same time local climate, culture, building material and local code have to be considered in order to build sustainable hospital.

LGBTQ Historical Scholarship: What Was It Like Twenty Years Ago?

LGBTQ Historical Scholarship:What Was It Like Twenty Years Ago? Robert A. Schanke and Kim Marra Introduction We developed our project on gays and lesbians in American theatre history from two very different institutions and career stages in our home state of Iowa long before we ever dreamed that we would be able to marry our partners legally in our own backyards. The original catalyst came from what Bob Schanke, then professor and chair of the theatre department at Central College in Pella, Iowa, learned while on a coast-to-coast book signing tour for his 1991 biography Shattered Applause: The Lives of Eva Le Gallienne. People were really interested in how the same-sex sexual desires of this actress impacted her life, her art, and her career. He envisioned a collection of essays on other such figures that he would coedit as a gay male scholar with a lesbian scholar, hence his recruitment of Kim Marra, then a new assistant professor at the University of Iowa, whom he had met at the Mid-America Theatre Conference. Although the University of Iowa in the early 1990s led the Big Ten in establishing health coverage for same-sex domestic partners, administrators were under fire by politically appointed regents for condoning the use of sexually explicit gay-themed materials in classes, which contributed to an anxious climate for untenured out faculty. Bob was long tenured, but he endured homophobic vandalism of his office multiple times on his small, religious campus as his scholarship made his personal proclivities more public. Thus, we both had to consider certain risks in pursuing this project, but those risks fueled our sense of need for such work ultimately to combat homophobia. When our original proposal for a single book was expanded into three books, as LeAnn Fields details below, we needed to bring on a third coeditor as point person for the final volume. The late Billy J. Harbin (1930–2004), professor and former chair of the theatre department at Louisiana State University, who also contributed essays to the first two volumes, took on that role. Whereas the two of us had both been out for nearly a decade, Billy had been deeply closeted for his entire career. This project, which he joined in his mid-sixties, marked his coming out. The contracts for the three books were rendered in the winter of 1994–95. At the ATHE conference in San Francisco the following summer, during sessions of the newly constituted LGT Focus Group led by Tad Currie and Willa Taylor, several of us appeared on a roundtable, “(Re)writing the Invisible: Gay and Lesbian Theatre History,” and we solicited many more of the fifty-eight authors who would ultimately contribute to this multivolume venture. It took considerable maneuvering over the next three years with LeAnn’s and Jill’s sagacious guidance to bring the first volume into print. Among many other revisions, we had to rewrite the introduction four times to justify the project. Passing Performances: Queer Readings of Leading Players in American Theater History finally appeared in October 1998. The second volume, Staging Desire: Queer Readings of American Theater History, followed in 2002, and the third, The Gay and Lesbian Theatrical Legacy: A Biographical Dictionary of Major Figures in American Stage History in the Pre-Stonewall Era, in 2005. [End Page 27] Billy did not live to see the publication of that last volume, whose compilation he directed. He suffered an embolism while leading a London theatre tour the previous summer. Just before the ultimately futile last-ditch procedure to save him, he handwrote us a fax from his overseas hospital bed with instructions about where to find the files in his house in Baton Rouge in case he did not return. He worked to the end on the project that had transformed his life. In the dedication to him at the front of the volume, which LeAnn personally helped us assemble, we quoted from Billy’s remarks at the first symposium on queer American theatre history, held at the Center for Lesbian and Gay Studies (CLAGS) in New York City in 1998 to mark the publication of Passing Performances. These were words that at...