Hi everybody, I'm so delighted to do art here tonight. On behalf of Elizabeth A. Sackler Feminist Art, it's a pleasure to have you all here. I'm one of the council members. I'm Marjorie Martay. I'm also founder of R.W., which promotes women artists through creation, education, and advocacy. So tonight we are delighted to have Intimate Transgressions Act of Doing. And we've had an amazing show at the White Blacks Gallery with the curator Juan Puntes as well as Rello Samundo and Fiona Gunn, who is here from London, who's been the curator. The moderation tonight is by Anita Galesta, who is somebody I've known for a long time, who recently just came back by the way from London, and has done a great show part of the Thames Festival called Watershed. And it was a big success in London, so we're very happy about that. We also have on the panel Eleanor Hartney, who is a writer for Art in America. We have Louisa Valenzuela, who just flew in from Buenos Aires. We have Sharon Nishat, a wonderful photographer. And we have all the other people, well, Vian, who is also an artist as well in this. What we're going to see behind myself is a loop of all the artwork that was at the incredible show, which, by the way, will still be on this weekend, so you can see it. And tomorrow there will be two shows that you can see. What tonight is all about is the discussion of what art's role is in raising awareness of war, genocide, rape, and sexual violence, as well as the ways that art is used as a tool for transformation in the face of conflicts and human rights. I just also want to thank Jessica Wilcox for helping me tonight to make this happen. Rebecca Teffel, without her help, would not be here. And Elizabeth Sackler, who believes in this kind of programming. Unfortunately, she had a conflict, but she called to tell me that these are the kinds of programs that the Sackler Center should be doing. So I'm going to turn this over. Oh, and the other thing I want to say is this particular program is organized by COPPA, which is the Center for Asian-Pacific Affairs and the White Box. So we are here tonight to celebrate that, as well as the wonderful panelists. So I'm going to turn it over to both Leon and Anita Gleister. Thank you. Thank you, Marjorie, for who you are and for the wonderful work that you're doing on behalf of women artists and for extending yourself to make this possible for White Box and for the show and for everyone's opportunity to speak a little bit from our respective disciplines about this issue. And I'm not going to say too much right now, because I'll have quite a few questions to ask after. But I will talk a little bit about how we're going to be structured, which is conversational. And we will not run on, however. It doesn't mean that it's going to be never-ending conversation. So we will put some limits to that. We will probably be about an hour. And then our respondents, who will be Juan Puntes and Rao Samuria, will ask questions of the panel. And then we will open this up to you all. So that's how we are going. And without further ado, if you can introduce everybody. Thank you. And welcome to everybody. Thanks again to Marjorie. Thanks to the Sackler Center. And I would have to say a huge thanks to Kappa, which is the sponsor for this exhibition, which wouldn't have happened without them. And it's been done with the best humanitarian intentions. I would like to introduce Eleanor Hartney, the art critic, who is going to be the first person I will ask a question to. And we've got to share a mic as well. So I just wanted to ask, Eleanor, you've spoken about how art has opened up windows for you, windows into science, technology, philosophy. And I'd like to know what you feel about art opening up windows into moral issues and ethical issues. And if you think that's an effective way, an effective way to move forward. Yes, of course. I think that art, nothing human is foreign to art. And I think that art is actually a very effective way of bringing up moral and political dilemmas. I think that, I mean, it's interesting, as we sort of had a little conversation before all this. And I've been thinking about this question of efficacy of art and what can art do? What can art be? And on the one hand, the question is always asked of political art, will it affect change? And I think it's very difficult to say whether art can affect change. And on the one hand, I'm very political arts and that's very dear to my heart. But on the other hand, I feel like insisting on a kind of instrumental definition of art in that way is a problem and is dangerous. It's almost as bad as the kind of mercantile definition of art, which is the other side of the coin right now, where art is of value because it does well in the market. To insist that art, to narrow it down, I guess, to a instrumental purpose, I think it narrows what art can be because part of what I think has always attracted me to art is the open-endedness of it and the way that it does pose questions. And yes, it absolutely brings up ethical dilemmas, but it doesn't necessarily tell us what we're supposed to think. And I think that's the value of art. Thank you for that, and yeah, I agree. Louisa Valenzuela, a writer who is currently living in Argentina but lived in New York for 12 years. And I wanted to ask you about how you feel that art can contribute to the particular message of this exhibition. Is there a role? And how do you, as a writer, feel about passing on that information? What I was thinking when this situation was presented to me is that finally, one of the big definitions of art is that it makes visible the invisible. And our situation, our Argentine situation, and thinking from my own experience in my country, we invented of sorts that terrible figure of the disappeared. The Argentine military, during the dictatorship, decided that those people that were killed by them or tortured or really disappeared wouldn't exist at all, wouldn't be forgotten forever. So one of the missions of art, and the mothers of Plaza de Marjor, who were the first ones to really protest and that brought that situation into the picture, because it was one way to let these people live forever. There were many, many experiments, and many, many things done around that. For example, the white masks. At some point, already the dictatorship was over. But when they were celebrating the 400 and something marches of the Thursdays, every Thursday the mothers would march with a, this is a very iconic image of mothers with a white kerchiefs on their head, which were actually the nappies. The idea that the only thing they had were the nappies and then they put the name of their sons and daughters who had been disappeared. At some point, right after the, not before even the dictatorship was over, but when already the situation was getting a little more easy flowing and things were sort of changing, they did something that was called the silhouettes. So the artist came over and suggested they should paint, do the silhouettes, empty silhouettes. And so they would lie down on the floor on white papers and white wrapping paper and do the silhouettes. So this whole city, mainly the many I measure for the marches, were covered by the silhouettes of the disappeared. So that was a not manifestation that was very striking for us. And then another one of these marches, they gave away white masks. And people that were marching, there were already there were thousands of people marching on the special dates, would march with white masks. And what I learned lately is that in Milano, by the Scala, by the Piazza that's in front of the Scala, they are putting red cloth and white masks. Remembering the mothers of plus I measure because of immigrants that are disappeared. So this is in many, there are many more contributions of art into the sense of bringing back to life those that were tortured and were dead in the moment. So I think it's an important dialogue. And it's that moment when that that cannot be said, is said for another manner. And it's much more, the impact is stronger than just a simple protest. Yes, and it's interesting that you talk about that, about the strength of the image. Anita and I were speaking earlier today and we were talking about exactly the danger of being reductive and where you've got art reduced to either the commercial or something that becomes just about message. And Anita, you said some, I think, quite interesting things about the danger of art becoming reduced in that way. Well, I think the question that you were asking me, which I have written here, was specifically, can visual art have a political message? And I think that I responded to the question about the word message, first of all, and which I think is tricky. And the other is that it is complex to think about a visual image, a two-dimensional image, for example, a poster as being totally effective. And the reason that I question that and question message as well is that it can as often be used as propaganda and it has been historically. And so one of the things that I just found very compelling about what you said that was so moving about art was how it was manifested physically and viscerally in the street as a performance rather than something that is slapped on a wall or even in a gallery that has images of people shooting. We're not in the 18th century and it's not Goya anymore. We have a very, very different relationship to what the role of art is. And so I think it is much more nuanced than a message and then a visual image. That's my response to that. And again, I mean, I think one of the ambitions with this exhibition was, yes, there is a message, but the artworks themselves are complex and very multi-layered pieces of work which approach the situation and the issues from all different angles and hopefully keep the sense of poetry in what artists produce. So the curation may be on message, but actually the artworks are far more subtle than that. And so we've come to Shiran to ask you. And Anita is going to pose the question about your practice and what you do. So I was going to ask you about the fact that your work explores issues of patriotism and courage and love and devotion, but at the same time it also addresses betrayal and cruelty and suffering. And I'm just wondering how you are able to integrate this and move the global discourse forward through your work as context. What's difficult for me to answer that question before saying that I think my work is obviously very much inspired by reality, the socio-political reality of my country, Iran, and the personal aspect of my life as a person who has been abroad, looking in a country that has gone through all kinds of upheavals from revolutions, et cetera.  But yet my expression is very much metaphoric, it's poetic. So it's very difficult for me to really take that role of someone who's an expert or an activist or who can speak with that kind of authority because I think my reaction to political reality has been no different than a poet. And it's very emotional. And not to say that it's not informed and intelligent, but I want to say that. So for example, what you're speaking about in this notion of patriotism has been a subject of my work because with the woman of Allah, it was the subject of women who were voluntarily martyrs and militants in their devotion to religion. And then yet in the green movement, there was a new form of activism, particularly among women as much as men who now had the strong conviction for democracy. And yet in both instances, there was a direct interface with violence and atrocity and death. So for me, that became a major, more sleeve philosophical and emotional question that I created for myself, that how could this act of love of God or love of nation sacrifice devotion be so often intersecting with atrocity and cruelty and hate, which whether it comes from the Islamic revolution or from the green movement. So I have created a whole series, The Book of Kings that really sort of showed simple body gestures, the touch of heart, the pledge of honor that is universal with yet the feeling of terror and et cetera. So I guess what I'm saying is that my work keeps returning the questions that relate very specifically to the Iranian culture and that how historically Iranian people have gone through this circle of revolutions, revolt and yet repression and atrocity and oppression and then many years later this occurs. So I know if I answered your question. Actually, I think that the way that you answered that is to point to this strange and crazy paradox of being human that might be Iranian, but is also particularly this incredibly strange dialectic of the thin line between good and evil and that's what you distill poetically in your work. It also comes back to the issue of what happens at time of social revolution generally and that also is something that there's a lot of crossover between what happens in times of conflict and the upsurge of war and genocide rape, for example. That the extremities are reached. And I know that, I think you were going to ask me something. Were you Anita? No? No, no, no. Yes, I think you were going to ask me about links between objectification and commodification. Okay, I'm gonna ask you that, will you answer that now? I'm really sorry about this, where we're obviously, as you can see, we're terribly inefficient as a double act, but we were talking about this the other day, the difficulties where if you think about what happens to victims of sexual violence generally, there is that making of them a thing. They become things to the people who are abusing them and who are violating them. They are as nothing, they are not human. And we were drawing strange parallels with actually how art can objectify as well. And historically the idealization of things that are beautiful, idealization of women, idealization of beautiful children, young boys, it doesn't have to be just women. It's not actually that gender specific. And the thrust of that is the flip side to that idealization which goes back to what you were talking about, the flip side of patriotism and love and all those things, is the destruction.  It seems to be the flip side of that idealization that happens in art. And so I'd like to bring it back to Eleanor again and I have to check what I'm supposed to ask. But actually this comes back to what you wrote about the incredible shrinking art critic. And there is a link really because you were outlining your concerns about delivery systems. And I think that many artists who are working in the non-commercial area for, you know, we're making art about meaning and sometimes art that has an element of protest that's raising issues of social justice. But if the art world is very commercial, then obviously that work will never be sold. And how do you survive as an artist? Do you go and stack shelves in a supermarket in order to make art that is meaningful? That isn't something that necessarily you want to hang up in a dining room in sort of a middle class suburb. So I think there are kind of parallels with our experiences there. And I'd like you to sort of tell us a little bit about your concerns about art criticism in this area. Well, you know, I mean, I think in many ways there are, I always like to think that there are a lot of parallel art universes. There's not just one art universe. But the problem is that there is one art universe that seems to get more attention than the other art universes. And a lot of that, and that's particularly the case now. I mean, and this is part of what I was talking about in the article, that at a time when there is so much, you know, kind of money at the top, when there's so much concern about art as investment, et cetera, et cetera, you know, when the art magazines are all being purchased by collectors and auction houses, and you know, all of these things begin to make you think that there's only this one art world, which is the art world of like the hundred top artists, or you know, all these lists that they're always like putting out there. And you know, I think it's difficult for artists. It's difficult for critics also, because you know, it's really not very interesting as a critic to be, you know, just kind of making lists. So there are these parallel art universes and these are the ones that are more interesting to me. There's for example, one of the issues actually that came up for me in just the discussion we've just had is the difference between kind of public art and non, I guess we don't know what to call it, non-public art, but public art is a place where there's a certain kind of, certain kinds of things are possible, certain kinds of things are not possible. What Louisa was talking about, there's a certain kind of directness that's possible there. On the other hand, in the kind of work that Sharon's talking about, which is not necessarily out there on the public street, but is very thoughtful and is very poetic and metaphoric and that you know, brings us to an understanding of things through metaphor, which is something that art and literature have always done. I mean, that's another universe in a way. So there's these different universes that the real problem is it's not that people aren't doing this kind of work and people are doing this kind of non-commercial work, but the problem really is that right now, the delivery systems, as I was talking about in this article, seem to be so honed and focused towards this very high end commercial part. And I mean, I think, I just kind of sit here thinking, well, wouldn't it be nice if the art market would crash? But we can sort of get back to kind of what it really ought to be about. But instead, we sort of have to exist within these different art universes. Do, and could I just quickly go back to Louisa here, because it was very, I mean, talking about this in the sort of honed commercial nature of the art world, and yet to hear you describe the interventions, the public interventions by the mothers of the Plata de Mayo. Actually, what we go back to is the huge importance of the physicality of the object, actually, that you can read your thousand words, you can look at slick digital images, but to have the physical, material art in front of you has an impact that maybe other forms don't. Well, literature doesn't, in a sense, but then theater does. So we can move from one side of the situation to the other. I kept thinking because of this proposition here about women being tortured, or women being mistreated, or women being disappeared, so on and so forth. Not only of this public art, or supposedly art, it might not be perfect art, but this is this way of putting the situation in the front through metaphors. So this is finally what art does. So I go back again to this time of censorship and difficulty in Argentina, and we had what was called Teatro Averto. The theater did a lot of good work, and the theater people decided they couldn't do things against the dictatorship in a very elaborate way. So they had this read and they wrote very short pieces to be read in a small theater that was called Picadero, and the theater was burned the next week. They only could do it for a week and it was burned. So the whole theater business of Buenos Aires offered the venues for this to go on. So it went on in a very, very popular, an obroadway, which is a Calle Corrientes. This was helpful, and this is a way to make people conscious of what is going on. I am against the idea of a message as such, because if you're really doing art, you cannot think of a message, but the immediacy of the need to respond to those terrible situations, then this concept of message or non-message evaporates of sorts. So you really have to act in that way. And one important thing that happened also with theater in Argentina is that one of the mothers of Plaza de Marche already during the year 2000, wrote a piece about the disappeared son and those people that didn't know his identity. There were 500 children born in captivity that were taken away and given to foster parents, mainly many of the torturers. So they didn't know who they were and the people who lost their grandmothers couldn't know about their grandchildren. So they started looking for, with that play, the one appeared, recognizing stuff. So they started a movement that every Monday in the month of August, every theater in Buenos Aires, and there are many, many, because there are really small theater playing all the time, had to give a play with this subject. So generally the actors would stand up at the beginning and say, well, I'm so and so, I'm so and so. So we know who we are, but there are 500 people here who don't know who they really are. So this is what we are going to give this play for. And now there are 175 appeared along the last 30 years and they keep on appearing. So this is something that not necessarily only the theater did, but the theater helped a lot. And the writing of the literature is strange, a situation of literature is strange, because we thought there would be so many manuscripts hidden during the dictatorship, and there were not that many. And my own experience, and I'll be short with this, is that I did write a very strong short story that was meant to be a novel and with a starting point, a different, would start before the situation of the short story was told that it would go on after that situation, which I never could go on with. It was too hard. And I couldn't even, when I finished it during the hard of the dictatorship, I couldn't even show it to my best friends because I had the feeling that that would put them into danger, that knowledge of something which I thought it was even exaggerated from my point of view. And then I can tell you more about that. And then we learned through the trials that what I was thinking was happening was actually happening and even worse. And, but then it is more, the literature situation is more secluded than the visuals part and then the street art or whatever can be done in a very immediate way, without recognition. So I was never thinking about commercial art when this subject matter popped up because it's really not necessarily, then it can be very moving, then it can become commercial, but the intention is elsewhere. The intention is really to, again, to speak about what it cannot be said or to put in a scene or to paint or to do whatever you can do without as to be conscious and not to forget the memory situation, that you have memory. And then I can tell you more of what happens with women and all that in South America and Latin America. So I'm going to segue thank you about women now and ask Shirin a question about going back to women, which is that the revolution is always affects women. And I'm wondering how in particular what do you feel about how women in the Middle East are being treated and whether you can speak about that as an artist? Well, I keep wanting to speak more abstractly about things as I told you, I'm a woman of... It's fine, it's fine. It's fine what you do, by the way. I mean, I was just thinking in response to what was being said that for me, because there was a question of where does the art comes from and I think art grows out of an obsession of the artist and very often it's this obsession grows in relation to their personal history and personal ends and existential as well as political, cultural, sexual issues. And then the artist has to formulate it so it becomes a form of communication that is no longer about just the artist but the world they inhabit and the issues of humanity that others share. So in some ways for me it's impossible to talk about Iranian revolution without thinking about myself, like where do I fit in because I'm not a sociologist, I'm not an expert of any kind of political activists. So I only look at revolution in that point of where do I fit in? How do I see other women participating in revolution? But to be very practical about your question, I mean, I think that one of the things that I think unconsciously I've captured in my work is the changes by the study of the woman in Iran, I could speak about Iran, not entire Middle East, you can go about a study of the country and how indeed every revolution, every change of the country, it's read through the lives of the woman. If the Islamic revolution came, it forced the woman to wear the veil and it completely transformed their private and public lives. We're during the Shah's time, women actually were forced to take down the veil and they lived a very modern life. And now, since the early years of the revolution, you see a new generational woman that are highly educated and are not abiding to the rules. And that was very evident in the green movement where you see that the women today are not my generation or my mother's generation because they're highly educated and they are very aware of the world and therefore they're very mobilized, very vocal. A majority of them are working. They're not just mothers at home. So this is a new form of feminism, in my opinion, where they're still Islamic in some ways and they are still believed in separation of sexes, but they're very, very active members of the society where in my generation, maybe 30% of the women were educated and active and in my mother's generation, very few women did. So just to answer your question on practical level, I think it is very interesting how the political changes the regime brings in really a definite change in the woman's lives. And I think that sort of following on from what you've said, do you feel that you've got a particular role to play as an artist and as an Iranian woman artist? Do you have a particular role in your wider society to play? No, I hope not. That's too much of a responsibility. I think there is, at times, I think in the Iranian culture, where there's the artist and then there's the work. And sometimes the artist is pulled in the public arena and has to be vocal, like in my part. I was very outspoken and during tough periods in Iranian history, in the green movement, I was very vocal against the government and pro-democracy movement. But I never tried to directly inflict that on my work. So because I think that's really wrong and I don't want to be a vehicle of a propaganda. And so I think I have a different relationship to my country where they're seeing me as a public person and they see my work as something that I think it's far more mysterious, I hope, and it's not overtly being biased about, I'm not in a position to dictate what is wrong and what is right and who is good and who is bad. But I can speak about tyranny and I could question people of power, but I'm not going to create work that makes the decision for the people. But when I'm vocal publicly, I could take that liberty and really speak the truth. Yes, and actually what you're doing is you're making the division between art and politics very clearly as well. I hope so. Yeah, because actually, if you want to do politics, be a politician. Yeah, however, the artist message, which is, I think you can see, we're all more or less on the same page in terms of the complexity and what you're doing as a human being and you brought up very interestingly the fact that what you do as an artist is reflecting your own personal engagement with your own life, your own stuff that's happened to you, and that becomes emblematic of the sort of culture that you come from wherever you may be in the world. It also brings up the issue of artistic and aesthetic quality and I think you've partly answered that, actually, very clearly, but I wanted to pass that over to Anita as well, that if you are making work that is engaging with meaning and protest and exploration of very difficult issues, how do you go about doing that as an artist and not sacrifice the artistic quality of what you are making? Well, I'm gonna answer that directly and then I actually wanna go back to the two universes because I think there's something happening here with actually an urgency in these two particular cultures from which you both are, where separate universes are not as clearly about commercial and political because it lacks the urgency of that and I really think that's an important distinction and then in terms of my own work, I can answer to specifically actually the work in this show where I was asked to do a work by Juan about how women were used in sexual slaves during World War II in the camps and I thought hard about how to encapsulate that into as a way as a visual artist because a lot has been written about it, films have been done about it but what really could have resonance for me to encapsulate that and so I did a lot of reading of archival material about what happened during that time and felt that the best way in which I could address this was to create an installation where I focused on a particular story apocryphal story that had many different versions but they were all similar which was about a woman who was online for the camps for Auschwitz and she was very beautiful and she was a dancer and of course the Nazis didn't believe in having sex with Jewish women or the Roma women because they were considered animals but this particular woman was so beautiful that the Gestapo officer couldn't resist her and pulled her out of the line and she decided to do a striptease and in so doing was able to take the pistols from both this Schillinger, the name of the officer and another guy who he was with another Gestapo officer and she shot them dead and then she was shot and I was very interested in this story because it was both about her empowerment for a moment as a woman and then of course her disempowerment and the only way I could think that I could really begin to talk about what happened there not as a filmmaker or a writer was to somehow use that story as a metaphor for this work and I'm speaking to this because I don't think that it's as much an aesthetic decision as part of a larger whole which is how you conceptually understand a situation and then how it's distilled as a work of visual or performative or interactive art and I do the same thing when I work in the public and hopefully I believe that people can rise to the occasion if it is nuanced and I think that that's happening more and more but I think that what is an unfortunate is in our world, in this country, in this Western universe there really are two worlds there is the very commercial terrible one that's kind of eating the rest of the world and then there are those who really are concerned with history and memory and with current social situation so that's how I'm answering that is it my turn to ask another question? Well, the next bit is about art and transformation and all the rest of it so actually, and I'm throwing this open to all of the panelists, if art is going to be an agent for transformation and I mean this in the widest possible sense I don't mean it in a narrow political sense I mean transformation on every level. How can it be a transformative agent if it's always going to be in galleries and what do you do about that? Well, yeah, I guess this kind of goes back to that the public art versus non-public art kind of division that I was talking about and I think, well obviously there's public art and so public art is out there in the world and talks to non-art people but that doesn't necessarily mean that it's more politically effective I think than art in galleries I mean we talk about as if the galleries are some kind of sort of separate world cut off and have nothing to do with the other world but if what you're talking about is sort of is transformation and changing people's minds and making people think differently you don't really know, you put a work out there you don't really know how it's going to touch someone how it's going to open them up to something I mean and those kind of epiphanies can happen they can happen in public art but they can happen also and they do happen in these kind of more private spaces as well so in certain ways I think the whole notion while it's just preaching to the converted well you don't know who you're preaching to actually and I think it's good to show in a kind of wide variety of spaces I mean we have big museums like this we have alternative spaces like white box I mean there are different kinds of places also and where things can happen I think it's not likely to have transformative stuff happening in an art fair but that's a whole other question but no I mean I think you know it maybe it's too easy to just say well it's in a gallery it doesn't you know it's sort of boxed off from the world what effect can it have you don't know and that's a reasonable point and actually it brings me to you the audience could you no no not questions yet sorry I just would like to have a show of hands how many people here tonight have a connection with the art world are you an artist a gallerist are you connected with the art world would you mind putting your hands up anybody who's connected with the art world well I have a horrible feeling we may be preaching to the converted and this is my concern and this is my concern about art in galleries because it's true that my transformative experiences with art happened largely within you know very small provincial galleries in the middle of nowhere in Ireland a long time ago but I would say that growing up most of the people around me never went into those art galleries and never saw the stuff this is the danger that of course the power of the artwork is there in the gallery of course it is but if the gallery itself is inaccessible for whatever reason then we need to look at how to make these things more accessible I was really hoping tonight that 50% of you would kind of say well actually no I have nothing to do with art and I've just come here by chance and great but anyway I think in a horrible way that's sort of yeah but people aren't just one thing I mean you know people yes people are connected to the art world but everybody here is connected to a lot of other worlds too so it yeah I mean I understand the dilemma that you're talking about but you know I think yeah I think it's too easy to just sort of dismiss you know the art audience as being you know kind of one that doesn't need to be addressed really I'm not dismissing it's not that it's not that it's just I do quite a lot of work with socially excluded women and I know that taking them to sort of galleries and spaces there's an area of anxiety when they go there and for many of them their first experience of an art gallery would be maybe at 40-50 years of age and and I'm it's good that they get there but there are so many people who don't you know and so I think on to you Anita definitely so I'm going to ask you Luisa if in Latin America there has been a change in how sexual violence is being addressed I was thinking about the situation that you are setting up here and things propagate I mean the people go a few people go to galleries or to museums but the thing is like contagious you know generally artists and writers respond to what's going on in the world so there is this constant dialogue even if we don't know about it I do have that feeling going back to the women being mistreated and badly treated and all that there are many in Latin America many women are considered as a femicide going on very intensively we don't know exactly if now the count has been well done and people are counting really or this is happening more intensely because women are being empowered we have a woman president I mean women have powers so men feel more threatened and they kill their spouses or their fiances or whatever but then the reaction has been very interesting in many towns in Mexico for example you have the Ciudad Juarez disappearances of these women and there were many writers many artists doing things and even if you don't know exactly what has been done this whole reaction is intense and in Argentina on June the 3rd this year we had this very very big march on Nuna Menos not one less to protesters they're killing one woman every day and a half a woman has been murdered by the next of kin generally so this was very intense and the movement was intense and the artists were of course there and that's what drew more the attention the manifestation of the artists what they would be doing in the street art but also what they were doing in galleries or what they were doing in private and at some point there was this movement I wanted to speak about today the Bahta, little Bahta books this little Bahta books was born in Chile and they called for a hundred women writers to write micro fiction on the subject of the woman being killed or the assassination of women and then Argentina did this Bahta a hundred writers wrote micro fiction on the subject then Peru did, then Mexico did this is very contagious so I invite the United States to do this also the Bahta, enough women killed so what we managed and I think the art had a lot to do there is to really have this legal figure of femicide before there were crimes of passion all these women being killed or it was a crime of passion he got jealous, he got desperate and it was a crime of passion couldn't, it's not accountable for not that much accountable that's the end, that's been ended also and I think the art world as such it's permeable, no? it's, how do you say it in English? it's leaking, I mean it's it's permeable it's not, they're not so close to situations and then big museums are open to the public and people are more or less being aware and more and more being aware of things which the artist called or the attention upon those subjects before anybody did and then journalists will respond and this is a non-goer, this is a snowballing well, whatever, I'm sorry so it grows, so this is what we want to do I suppose let this situation grow out of the galleries out of everywhere because there have to be responses by the journalists, by the common public you go out now and speak to your friends and tell them about them, you go to jail and speak to the women in jail and God knows, I mean this is an ongoing movement all over the world, we need it it's a fact to me so this was about the issue of art helping people to understand at all different levels what is going on and so you should be able to speak about it yes openly, you should be able to speak about what is so hard to be said and to recognize and to acknowledge and to accept what is so hard to accept and I mean in particular relationship to relation to the theme of the exhibition that of sexual violence carries with it a stigma that for example murder does not, I mean oddly enough it carries with it a stigma that murder does not and there's a situation in Guatemala one of the artists, Reginald Jose Galindo is showing very very interesting work at the exhibition but there's a situation there where one of the townships set up a system whereby people could wear a paper flower to show that they had suffered during the conflict and I can't remember exactly how it was there was a red flower if you lost somebody there was a purple flower if you were injured and you had your name so all the victims were named but the white flowers which were for the victims of sexual violence were without name and for me that's such a terrible thing because it's saying that those people who were victims are now doubly victims because they have to remain anonymous even though they did nothing wrong they are not broken, the people who attacked them are the broken ones and I think there's that what we would really like to do in the exhibition is to sort of subvert that notion and say you do not have to be anonymous you have done nothing and have the others who are in the same situation to speak up and be able to face us yes, but now this is happening this is happening more and more it is happening more and more at least in my country it's happening even though they go to TV and they speak about the horrors in that situation yes, and then it is hard but it is also empowering I mean it is encouraging for others and the people are grateful and in the context also of, I mean when what we've been talking about has been focused I suppose generally on the notion of women being victims of sexual violence but actually a lot of men and boys are and an awful lot of children are and this is what we forget absolutely, absolutely would you like to add to that, Al-Sharin? so I'm going to then ask Fiona a little bit about why you chose who you did in the show that you've curated well firstly, when I was asked to curate it the reason I came to it was because I've been working for some years on the issue in my own work and was put in touch with the organisers by an artist I'd worked with in another show about what happens to women at times of revolution so the reason I was approached was because the sponsors in particular wanted to highlight the issue of the comfort women which I don't know if many of you know about this situation but the comfort women were basically sexual slaves during World War II and they were victims of the Japanese military regime which it's got its parallels with Nazism and the Japanese military were doing exactly what the Nazis did in Europe and they were doing it in Asia and at the end of the war just 25% of them had survived and their health was broken to this day as people are getting older of course there are very few of them left and one of the things they want is they want sort of moral justice from the Japanese government and I really want to make the division here between Japanese government and people because it's not the same but basically they've been fighting for years to not be called prostitutes to not be disrespected for the fact that they were victimized in the most brutal and terrible ways but in talking about this with the sponsors we realized I said we can't just do this because it becomes a Chinese, Japanese, Korean only problem it remains niche with the Asian community and actually this is a problem that is contemporaneously very very important if we look at what Islamic State is doing in the Middle East if you look at situations that have arisen in the Congo, Democratic Republic of Congo where the issue of war and genocide rape and post-war and genocide rape is huge and impacts on everybody in the society that so the fundamental thing was we had to involve artists from as many cultures as possible and to hear their voices their specific responses because it is an international dilemma so that was the first criterion actually you were speaking about this and I was thinking in our situation in 19th century though many women from Northern province of Corrientes of high society women would take and would get them and taken to Parawai to be prostituted by the hierarchy of that dictatorship in Parawai so then when they came back they would close themselves in the house and they wouldn't want to see anybody this was a terrible shame so now we're starting to learn about that situation that happened a century ago and this is the idea I mean I think it's so important that not to be ashamed as you say about this happened to you by Charles again also the feeling of cowardice because there must be this sense of why didn't you defend yourself why didn't you do something about it and I suppose it's impossible they're broken I brought, we don't have it here do we? There is a book that just came out that recently came out of Gabriela Gabison Kamara and it's a story of a woman who's been because we have this problem again all over the world probably of human trafficking so there are women not this very moment of being kidnapped to be taken to brothels so this is a story of a very very interesting we've written in as a free verse story of a young woman who's been taken into a brothel and the way they mistreat them they break them to no extent so then you cannot protest and she does defend herself and comes out of it but they did it as a comic book so it is interesting I see Heidi Hatry here also she quote also for all these stories about women being brutalized or really mistreated and she made sculptures in pig skin of these faces of these women and the different short stories when wrote a book and published a book called Heads and Tails and this one is very interesting because you are able to read this terrible mistreatment of women and very realistic because it has all these drawings and this presentation as a comic book in free verse also so all this has happened these things are going on yes that's right as you say the might not be so well noticed but they are happening and they start moving around and being exactly and you have to think as well that if you have that notion of of victimhood if people feel oh I have been broken then obviously that's going to be a very effective strategy if you're trying to destroy people whereas if you have people saying well I'm not broken you're the broken one maybe it'll be less effective as a strategy I don't know I mean it's one way of looking at it I mean this yeah just a quick aside I just on the way here actually I was reading in the New Yorker there's a very interesting article about in Iraq you know where human trafficking is a huge problem right now and it was an article that was sort of following this woman who had been she had been pressed into prostitution and her response she escaped from it and her response now is that she and her husband go and they in this kind of very clandestine undercover way are trying to you know because she has all these contacts in that world and to try to get women out of there and get them into safe houses and it's an inspiring and heartbreaking article because it also talks about how the official structures are completely useless you know and you know so you have to have these you know kind of just individuals but again a woman who was refused to be broken by the situation Anita would you like to add anything before we pass over to the respondents well I would like to just maybe attempt to sum what was trying to be addressed here which is I suppose putting forward the question of the effectiveness of using or the role of the art with not only as activism but perhaps catalyzing people's awareness of what's happening in the world and I think that in different ways we've been attempting to answer this and really great to listen to everybody on the panel I want to thank you all and I would love to open this up to respondents and then to everybody else in the audience because I'm sure there's a lot of questions about this and it's a discussion that's really in a way just begun but we're limited with time and it's a huge it's a huge issue so we'll let you start Raul I guess I'll stay here then anyway I think it was clarified that Fiona was the curator and as well as Juan that might have been some confusion in the beginning but anyway this is an exhibition that was both envious and very proud envious because it's a very strong and powerful show and also very proud because I'm on the advisory board of White Box and these are kind of exhibitions that with the defunding of important alternative quote unquote spaces like White Box the problem is that there's a propensity to sort of homogenize art out there and so it's very crucial for institutions like the White Box to to be around and to continue their work however my first question Marjorie can we go back to the Teresa Margoia's photograph can we seize that image is that possible? all right well anyway I found that image to be probably one of the most arresting and uncomfortable works in the exhibition and I was thinking about Susan Tontag's text regarding the pain of others on how that image which I'll give you some context is an anonymous photograph from the 70s that Teresa Margoia's received and it's a photograph of a sort of strip show in Sioux Alcoates in the 1970s and so you see the woman sprayed out on her stomach and basically she offers sex acts to anybody who wants to sort of come on stage and so my question is how do you resolve questions about the pornography of violence or imagery of that sort considering son text text and as well of like let's say a perception of that image like let's say Andrea Dworkin or Catherine McKinnon that see that as like untouchable. Well I think one of the first things that had to be considered in curating the exhibition and you have pointed out this very disturbing image but I would say that it is one of the very few images in the exhibition that engenders that kind of response and the way it has been yes and the way it has been curated I was very aware of the fact that we wanted people to be able to come and see the exhibition and not to be completely horrified by it if you have people coming in the door so shocked by what they see they're going to go away they're not going to engage with the issue it was very carefully displayed it was in the lower floor where actually if you were somebody who was going to be very disturbed by this particular image you wouldn't be exposed to it straight off you were led down to it and you could always turn your back if it became too difficult yeah and I think this is actually very important that that was in place the rest of the images in the exhibition tend to be ones that are the meaning the meaning of it and the way it addressed the issue was actually much more subtle you know so by the time you got to that particular image it did have that absolute shocking effect but it wasn't fetishized you know there's no glamourization of violence in the exhibition because I think that would be a double victimhood to go through for anybody who has been a victim of sexual violence so those were all considerations but sometimes you cannot draw back from using a particular image because it is in the right place and it is also one of the things that Theresa spoke about with that image the thing that's most disturbing is not the woman on the ground who's naked it's the fact that you're looking at all the American guys sitting down watching her as if she is an animal and you cannot help but look at them and their faces and be disturbed by that aspect of it so I hope I've answered your question thank you I have a question here for everybody not only for you is pornography in the eye of the beholder? yes it's a question well I've been doing the wrong one yeah they say eroticism is what I like pornography is what you like so my question is about the human aesthetics across cultures and of course also across history when you see a Muslim going to Mecca and sees the house of God the first time there are tears and when the crusaders got the holy places back from Muslims in Jerusalem they were also crying like babies throughout human history identity has been a crucial factor and there is a tendency to look at the product of art rather than the processes of perception and the reader and the developmental stages of the reader across the board curriculum is highly political and children learn certain things very early on which becomes part of their aesthetic response so where are the households where are the textbooks where are the discourses which have to be there if human education is to be informed by human rights and planetary consciousness and world art are you aware of any curriculum which is informed by human rights very early on especially in the world of art well I'm not actually I don't know anywhere you can go and learn these things and you have to learn by experience and I would say that an interesting point about the curation of this particular exhibition is that when I came to the project Juan came on board as the local co-curator and one of the things that we were very clear about is we had to have an approach that embraced the international aspect of art but the local aspect of art as well and so when this exhibition leaves it's next going to Beijing it opens in Beijing on the 25th of October it's actually going to be a different exhibition because some of the artists will remain but there will be many Chinese artists and artists who are non-Chinese but resident in Beijing who will join the exhibition and actually it will have a different feel to it because it's evolving and it's going to involve the local aesthetic as well and I think that's terribly important I think you can't just kind of globalize things and send things all over the world and expect the response to be the same and we will be recurating this exhibition with different local co-curators everywhere the exhibition goes so I don't know if that kind of... Keep it in hold like, thank you Does anybody else want to say something? I have my own microphone, thank you All right I will have a comment to that The capitalist Anglo-Saxon communities have made erotics be pornography quite big up in other places Catholics and other places around the world The erotics were very, very important If you go to Paris, for example I remember entering La Garde de Lyon and there was a huge, enormous billboard with a naked woman and a little gold watch Did you look at the watch or the woman? It was just beautiful and simple Men too, we have them with underwear now And so I think this particular Protestant community shines away from what we call lovely, organic, erotic and even in advertising everything has this subliminal taste of the forbidden, the dirty, the nasty night time, SNM Oh, it's most of the advertising we see Berniel, that was just a little comment Sorry I think Anita, one can make art about any subject in places like white box will show it regardless of the consequences, yeah other than with a little bit of funding And my question will be to all the panelists now Very simple Running a very small place in an extremely touch Marjorie, Anita All of you really flying from all over the world To come to the Suggler Center for Feminist Art The Temple, yeah Brooklyn Museum One of my most fabulous favorite museums in America We're here, these little guys, white box A small budget with our friends from Taiwan With a show that really is exquisite, powerful Has been very well attended And has not been very well covered So the small places like that we face I would say three viruses And then comes the question Art, very simple Lack of proper press coverage Means effects are funding The real estate markets have changed since we moved here Eight years ago And they're doubling up right now as we speak We're going into litigation Three, academic stops Every ten tours That artists who are teachers at SVA At all the schools That walk by will skip white box In favor of a very bright show next door In a very bright show before next door Or across the street Now in a two out of ten I counted a clock So we have three viruses to contend with I'm not complaining, I'm only stating So my question to you on the panel And I know you come from alternative spaces Early on, et cetera Right, as the place to go Is, and in 1993 I read Ed Koch predicted the day when non-profits Would exist any longer in Manhattan 1983 because of the real estate going up so high And nobody taking care of the bottom line Supporting like in Europe or Latin America And other places around the world The bottom line of the small independent Artist running spaces that we are At white box, right So to all of you It's only one question Are these kind of small little elephant White elephant like white box Alternative not for profit artist spaces Necessary today to exist, to remain In Manhattan Or have we seen the best of our days And we should back up and go to industry city Al dombo and lower our pants to the real estate Bosses Hello Well, I think you just have to do what you have to do And you're right, I mean that the, you know That, I mean a lot of the market, the real estate All these things, and as I was saying before Even with the change in the ownership Of various art magazines All of these things sort of conspire, I think In a way, what they say to me really Is that we need to come up with some Maybe some new systems for this whole thing I mean it's, yeah What we have right now doesn't seem to be working And I think it's very important obviously To have places like white box Places where you can do shows like this You know, where you're not worried about Sort of commercial things or even I'm sure you probably couldn't do this At a university either Or it'd be difficult because of the nature Of the subject matter I mean, I don't know if you looked into that But you know, sometimes there are Constraints there as well Yeah, I mean we, you know The system is kind of broken right now I mean, I think that's true I mean, that's kind of a whole other discussion But, yeah, I think things are We need this kind of thing And we need to figure out a way For there to be this kind of thing I'm sure, how do you see this With the panorama since you grew up In some of the alternatives in 1983 I saw a beautiful piece of you A course of street from white box with Ai Weiwei as painters You know, A's gallery How is it today to you? Well, I can only speak for myself And I believe in the power of community I work with a small community I function in that realm Which is why I'm here tonight Because I believe in white box For what it is And so I think there is an importance But I think it is up to the constituency To recognize this importance And it's not really just a media Or it's a chain of Sources that have to support you But I think most of all it comes from individual And whether you are in fact I know in the art world I'm always at a loss How little dialogue there is between the artist You only see them in the openings And the reason a lot of artists teach Is because they really envy that discourse And I know many artists that I've encountered Throughout visiting critics that I've done Where they obviously make much more money In the art world than teaching But the only reason they do it is because They lack that sense of community That sense of discourse Where you are able to speak with a young person About ideas, about importance of art About arguments that you wouldn't have In the art world today But I go back to that The origin of all that comes from the individual interest In my part I'm deeply interested in underground And community-based So I move to cinema Because it's all about the community Of people coming together and working So again, I only offered you my own Personal observation Doesn't help very much Well, I think thank you to all the panelists And to the respondents And I would like to now open up The subject to the floor And ask you if you have got any questions Please do ask And we've now got a mic So you don't have to come and stand up here If you don't want Has anybody got a question? It's unbelievable Gosh, did we cover the subject that well? Yes, at the back I have a response And to me that's the point My question is why do we still walk in And feel shocked? It's because we're uninformed That we are shocked At these images And I'm grateful for the documentation Earlier someone said that Even universities won't accept Pieces like this When Mo Taro wanted to show out of the grave No one would take it So he had to show it in his own studio Until the Katzen Center In Washington, D.C. took his work And it was the only place that was shown And so... Yes, I would have to argue with you About the interpretation of pornographic Because actually it is about It's like looking at a film That's dealing with the subject of racism And calling it racist I think there is a difference And I think Theresa Margoyes presents her image Which is about pornography It is not pornographic Yeah? And I think this is a crucial difference What I meant means was pornographic Yes, absolutely It was violent And you're left with what happened to human beings Absolutely So we should be shocked Yeah, you're right You are right I know, but at the same time At the same time, you want a lot of people... You don't want people coming and saying I just can't look at this You know, I've spent three years Doing an awful lot of reading and research About the subject And I have lain awake at night And it has been a huge burden For me personally to carry To have to deal with this So it's not easy And I don't really want people coming in To the exhibition and, for example Censoring their children Not allowing their children to see it And just going away Not able to... You have to... It is a fine line Because you're not compromising on the meaning front But you do have to respect the fact that You know, if you want people to engage with the subject You've got to draw them in You've got to draw them in And be kind, perhaps In showing them I wouldn't wish anybody The reading material that I've been reading You know I just wouldn't wish it on anybody And yet we should know about it And yet we have to know about it Well, our job is to bear witness Actually I want to thank Vionn Gunn and Juan Putez For actually putting this whole thing together It's... And I want to thank the panel The panel was terrific today And on behalf of the Sackler Center Thank you all for coming And I think it's A wonderful thing to be doing These kind of talks And with this kind of subject matter I think it's a very important issue To let everybody know what's going on In the world And for here, for tonight So thank you all And I so appreciate this great turnout


I was going every one Caleb here with late in sports cards next night We're gonna be working on the flawless football serial left side serial numbers break number 39 Can you grab the box right now? Sorry It's right here to be fair and it's not necessarily every day because I do have multiple hats of different teams So it's not every day. It's most days not every day one in a box Results one more time that'll be the number that you do have left side serial number does determine for the hits go Good luck. Let's do it guys There's no rush to it, but after the last break remind me to play to reply to you. Okay. There's no rush through right now But before I leave tonight, do you want to remember? That's funny Here we go guys. Thanks again so much here one box break. Oh, there's some cool ones in there Some cool ones in there. I tell you see what the inner has Empty and it's jealous Alright starting it out for the one spot Joe Thomas on the legendary patch. What is the blue and red? It's gotta be right. Oh man, that's sick. Nice one there one spot Braden K Next up here for the ninth spot Justin Jefferson patch. Nice You go ninth spot beautiful Leapy we have etched in time auto seven of ten Tyron Matthew Seven spot is Danny C You go we have patch autograph for the bills from eight Edmonds eight of fifteen nice one Eight spot in the break is Jonathan L nice train admins For the Patriots rookie patch auto Horizontal 20 of 20 Ramon Drey Stevenson Congrats there 20 spot Braden K Nice Ramon Drey have here a Cowboys Tony Romo three of ten You go three spot now. That's Colin M Solid there Colin and closing it out with a hit for the two spots TJ Watt flawless honored ink That is sick.  Let's get to the inner that guy's thanks start here We'll start here. This is going to be going to the 10 spot on the diamond gem Fran Tarkinson 10 spot is Peter L. You go Peter That's about there It's gonna be here for the two spot on the Pro Bowl very Sanders gem diamond gem again. Very nice That's really cool. They're like that one a lot to spot. There you go DW again Very cool hit very cool hit Ah Good call on the Fran Fran was triple jersey number, right? Yeah, thanks Chris. Good call on that nice catch Chris And how will we close out with a big one? 15 of 15 Traylands rookie patch auto signature gloves Congrats 15 That is Steven you There you go Steven you Sick hit man Big tray lands for you Steven Congratulations, man Congratulations, we'll mag that There you go Steven and appreciate you guys as always for joining these left side serial number breaks That one there was number 39 will be on a number 40 shortly this evening Thanks again


Hi, I'm Stephanie Coulter, and I'm the Assistant Medical Director here at the Texas Heart Institute. I also serve as the Director of the Center for Women's Heart and Vascular Research. And I also run the Cardiovascular Disease Fellowship here at Texas Heart Institute at Baylor St. Luke's Medical Center. I have here is my esteemed colleague and guest, Dr. Zvonimir Krazier, who's going to help me in this discussion about COVID-19 and the cardiovascular complications therein. Welcome, Dr. Krazier. Thanks for coming. Thank you, Stephanie. Dr. Krazier is an interventionalist cardiologist at the Texas Heart Institute at Baylor St. Luke's Medical Center. He serves as the Program Director for Peripheral Vascular Intervention at THI, is a clinical professor of medicine at the Baylor College of Medicine, and is the immediate past president of the International Society of Endovascular Specialists. Today, we are going to discuss our understanding of COVID-19, and we're going to talk about its diagnosis, its prevention, and treatment, which is rapidly evolving. Without a risk model for cardiac complications, healthcare providers on the front line, such as us, have had to work to understand the clinical variables and cardiovascular complications in order to identify best and predict various response to treatment and the modalities that we should use. In response to the evolving COVID-19 pandemic, the Texas Heart Institute dedicated its technology and techniques education series to provide perspective to the healthcare community, taking care of cardiovascular patients and facilities in which COVID-19 patients are receiving treatments. The discussion that follows today is really a compendium of all the discussions that Dr. Krazier and others have had over the last really 12 weeks where we've had, Dr. Krazier, how many have we had so far? I think we have done 11. 11 series where we look at state-of-the-art discussions as the literature and not the literature as podcasts have evolved. The first series that we conducted was in reference to a paper that one of our former fellows put out, which looked at the effects of the coronavirus on the cardiovascular system in late March of 2020, and we had a discussion with Dr. Majid on that day. And really, at this point, we really had very limited information that was really coming from China, which looked at how did the virus work, that it was a single-strand RNA virus, that it attached itself to the angiotensin converting enzyme 2 receptor, which is really the way the bug invades the body. So it has been known to invade the epithelial cells of the respiratory system, and more important, and in more recent findings, we discovered that the virus directly invades the endothelial cells of the vascular system, which has led to a whole extra lot of complications that have really been elucidated through the observational studies that have gone on in America from both Seattle and to New York. And very interesting. We also know now that from series from both China, from Seattle, and from New York, that there are predictors of in-hospital death due to COVID-19, most importantly, age over 65, male sex, history of coronary artery disease, a history of heart failure, a history of diabetes, which is not included on this, a history of hypertension or even carotid artery disease, have all been determined to be risk factors for in-hospital death. But in addition to this, some important cardiovascular therapies have been shown to be protective, and that includes patients who have hypertension or heart failure or heart disease that are taking ACE inhibitors, and those that are taking statins have been shown, as you can see in this slide, to have a protective advantage from dying in hospital from COVID-19. Again, you can see in another multivariate model where they looked at race, and then they looked at additional modifiers and looked to see if it changed the model. And still race being a black individual was a greater risk than being white, age in five-year increments, male sex, comorbidity index, as well as living in more close contacts. So in denser areas such as New York and in inner city locations have also been shown to be at put people at greater risk of developing the virus or contracting the virus and also from dying from the virus. Patients that had medical insurance that were more expensive fared better and certainly obesity played a role as well. Dr. Crazier, can you tell us more broadly what are these potential effects that the coronavirus has on the cardiovascular system? Thank you, Stephanie. We have learned so much in the last three to four months about the effects of COVID on the human body, not only on the cardiovascular system, but in general. As you have mentioned, the virus typically enters through the respiratory system, through the nasal pharyngeal sites and then through the respiratory tract. And from that point on, it disseminates in certain scenarios, particularly in patients that are at high risk, patients with comorbid conditions, throughout the vascular system. And it not only affects the heart, but also affects the whole vascular system, because as you have mentioned, it affects and it has affinity to the arterial system and it causes arterial dysfunction, destruction and inflammation. So heart is full of ACE2 receptors and they are present not only in their vasculature, but also in the myocardium. So as we can see here in this Dr. Majid's publication, very elaborate scheme of all the cardiac effects of COVID-19, we can see that it can cause obstruction, thrombosis, acute myocardium infarction. It can affect the epicardial or major vessels, but also it can affect the microvascular and elevates troponin, which is significantly elevated in great majority of patients with COVID-19 infection. But it also affects the myocardium and can cause myocarditis and then secondary due to obstructive disease in the coronaries or due to inflammatory process in the myocardium, it can cause malignant ventricular arrhythmias. So those are all the modalities where we can see how this virus affects the cardiovascular system. So it's starting to look like COVID-19 is a vascular disease because most of the injury and death rates are related really to patients that have risk factors for heart disease and evidence of heart inflammation or thrombosis in some blood vessel. Because the ratio of dying in patients that have elevated troponins is really significant. So the hazard ratio for an elevated troponin is at least four. And in patients that died of heart related deaths due to COVID, 51% of the deaths were in patients that had elevated troponin, as opposed to patients that had normal troponin. The rate of death in a big study out of China was only 4%. So it appears that troponin is a significant discriminator of risk. Absolutely. Now, one important thing is there are so far at least 12 or 13 coronaviruses that have been identified. And most of them are relatively benign. However, there are three of them that have shown serious effects as far as the cardiovascular system is concerned. One of them that was previously published was SARS Covirus. And after that, the MERS Covirus and then more recently SARS Covirus 2 that we're dealing with at the present time. As we can see from this particular publication from Majid and Jama, we can see that the other two viruses were significantly more malignant as far as mortality and morbidity is concerned. However, SARS Covirus 2 truly was presented in a large epidemic. And that is probably one of the major concerns that we are dealing with at the present time because of the extent of the infection that occurred worldwide. As we can see, as far as mortality is concerned, it is significantly lower with the SARS Covirus 2 than it has been in SARS Covirus or MERS virus. But of course, the numbers are significantly higher. We were successful in reducing the rapid distribution of infection with the other viruses while we were not as effective with SARS Covirus 2. Well, Dr. Crazier, certainly the asymptomatic and pre-symptomatic spread of this virus with its long incubation period certainly contributed to the speed with which this virus was able to spread silently through our population and contributes to the excess mortality that we're seeing across the world at this time. Can you tell us more about the thrombotic and embolic complications that we're seeing now in the patients in the US that are suffering, that are hospitalized with COVID-19, Dr. Crazier? Certainly, as we have already previously mentioned, since the COVID-19 virus has affinity towards the endothelium or the vasculature, we can certainly expect serious complications and problems such as thrombosis, infarcts, and embolization. Now, as far as risk factors are concerned, in general, related to the thrombosis, we have acquired factors and we have hereditary factors. Acquired factors include advanced age, as we already mentioned, patients that are inactive, patients that have some other inflammatory process, patients that are pregnant, obesity, cancer, hormonal replacement therapy, diabetes, sickle cell anemia, antifosphorylipid syndrome, and prolonged travel certainly within activities plays a role. Patients that have a significant heart failure, hit or myeloproliferative disorders, history of AIDS and the history of DVT are certainly at risk. Those are acquired factors. Now, there are numerous hereditary factors that lead to propensity to develop thrombosis in the vasculose system, such as bacterial or venous system, such as Factor V Leiden deficiency, thrombin-21-2-1-0-A, protein C and protein S deficiency, elevated factors 8, 9, and 11, elevated homocysteine, and also this fibrinogenemia, and 9-10 thrombin deficiency. Those are all the factors that lead to a propensity to develop thrombosis, typically in the venous system, less in arterial system. Now, another important thing is when we talk about SARS-CoV-2 and the vascular injury, that the effect of SARS-CoV-2 by affecting the endothelium and entering into AC2 sites, they stimulate inflammatory substances such as interleukin-6 and other ones to be very active, and that causes further endothelial dysfunction, and then also it affects a Pi-1 that increases tremendously, and by that effect, thromboplastin drops significantly, and all of those lead to thrombosis. Now, the excessive amount of inflammatory markers such as interleukin-6 and also Pi-1 can lead to cytokine storm that causes frequently irreparable damage as far as not only vascular system, but also multi-organ failure. So when we look at the early reports on thrombosis in COVID-19 patients, we can see that incidence is relatively high. It occurs between 30 to 35% of patients, and it can manifest itself in many different ways. What has been discovered that a lot of those patients have a micro thrombi or micro emboli in the pulmonary vascular chair, but they also have a hypercoagulable state by clotting IV lines, CVV HD lines, and we have learned that routine prophylaxis was not always used, unfortunately, and that led to more complications and more problems. Further changes were then initiated once we learned about those mistakes, but even with the proper anticoagulant treatment, the problems continued, particularly in patients that were in so-called cytokine storm. So then we adjusted the anticoagulant dose, and that was certainly helpful in certain subset of patients. One interesting thing is that it's important related to the use of anticoagulants, that the incidence of bleeding in patients with COVID-19 was relatively low and has been on an average reported to be roughly at 1%. Well, that's certainly some good news, Dr. Crazier, but we've also seen patients developing large vessel strokes in young people without any evidence of previous vascular injury. So patients that had no plaque development, no vascular risk factors, and suddenly presented actually in Wuhan, we had patients here in our medical center, young patients that presented with acute large vessel stroke that required treatment with mechanical thrombectomy and the interventional radiology suite. So we think that these patients that have acute COVID-19, that these are just more manifestation of the direct effect on the vasculature by the virus which has also been shown in an autopsy series recently from Mount Sinai where they did as quick, as fresh autopsy as you can get after a patient's death. Viral particles were seen in the endothelial cells in the vasculature upon death in patients that were overwhelmed with severe viral infection. You know, Stephanie, if I may add, so the virus can enter in the CNS system in the brain in several ways. One is through the vascular dissemination. Another one is through the respiratory or actually through the oral route and olfactory channels enters the brain and actually can affect the brain tissue, not only the vasculature but the brain tissue per se and that could also cause irreparable damage that is very frequently manifested with a lot of different scenarios and a lot of patients that actually recovered from the COVID-19 CNS side effects might have still some residual side effects such as seizure disorder, memory deficiency and a lot of other problems related to COVID-19 infection. It's amazing how much we learn as we go. The guidelines for venous thromboembolism, prophylaxis and monitoring have been updated and coagulation testing on presentation is recommended in all patients with COVID-19 that require hospitalization, PT, PTT, D dimer, fibrinogen, platelet count, CRP, ferritin, CBC and basic metabolic panel are all recommended and these individual labs are useful because they are going to help us delineate who are in the highest risk categories and are helpful also for stratification for clinical trials because some clinical trials are only available to patients with very elevated CRP, D dimer, ferritin levels. Clearly patients with elevated fibrinogen and D dimer levels over a thousand indicate a worse outcome and need for admission and careful monitoring. Thrombosis, prophylaxis and treatment recommendations are as follows. All hospitalized patients should receive pharmacologic prophylaxis according to risk stratification. If the creatinine clearance is normal or greater or is better than moderate, we recommend low molecular weight heparin with weight-adjusted regimens, but if the creatinine clearance is less than 30, we recommend unfractionated heparin with weight-adjusted. The monitoring of the PT, the D dimer, the fibrinogen, the platelet count, the creatin and LDH, which is important. The liver function tests are also recommended. But in patients with elevation of D dimer and in those with multiple organ failure, we recommend therapeutic dosage of unfractionated heparin over low molecular weight heparin, because it's easier to control. So, Stephanie, what we have learned in the last few months, really as far as COVID-19 is concerned, that we are building the ship as it sails, there was so much of unknown and there is so much that we have learned in the last few months. It's absolutely amazing how much has been achieved in such a short period of time. We're going to talk a little bit about preparedness, because obviously we're in a large medical center here and we've had to literally shake and roll as we prepared ourselves for the coming increase in caseload. Because COVID-19 is a new pandemic with enormous impact on hospitals, intensive care units, staff and equipment. We had to work to improve the safety of both our patients and our staff. We've learned that we had to think about the way that we optimize patient flow and isolation. We had to prepare special protocols for procedures knowing where and when do we bring the patients to the cath lab or to the echo lab or should we keep them quarantined in a COVID unit. We had to work on staff surging protocols because we didn't know and we didn't want to become overwhelmed by the virus. And we really literally had only 30 intensive care unit doctors who were available on our faculty and literally Dr. Krazier and I worked to help prepare a backup plan, which included cardiovascular ICU type physicians to man COVID units if it became necessary. We also had to work with testing as it became more available and more accurate and we had to streamline surveillance protocols for hospital personnel to make sure that the asymptomatic spread of the virus wasn't occurring in our hospital. So we went to special staffing models where we had half the doctors come in at one time and then while off we had surveillance protocols for testing to make sure that patients weren't given the doctors the virus and that the doctors weren't spreading it and to this day we have had a surveillance program here where we've looked at 700 personnel, both doctors and medical personnel and I can report that at this point we really did a great job Dr. Krazier and we only had three positive patients in that 700 member protocol. So we think that we did a really good job with prevention measures that we implemented because we were lucky because we were in the middle of the country so we had an opportunity to listen to our colleagues both from Louisiana, from California, from Washington state and mostly from New York and as well from Europe and from the Milan area or Bergano area in Italy so that we could plan and to use our resources in the best way we can. So we were very concerned that the safety of our team was threatened and at the beginning of the epidemic those that were helping to plan were worried that we were going to run out of PPE and we were careful to use our PPE but it was the safety of our medical personnel that we were the most concerned with because if your medical personnel go out sick and many others become quarantine the rate limiting factor on medical care is really your medical team. So keeping our team safe and healthy was really one of our strongest desires. So we made sure that we used our PPE properly, we canceled all elective cases and we really were on basically non-elective care for the cardiac community here in Houston for really close to, I'm thinking close to eight to ten weeks. We renovated our telemetry admission criteria and we renovated how we used the Echo Lab and how we utilized our equipment and we also looked at changing how we use the interventional catheterization labs and how we manage STEMI cases. So Dr. Coulter, can you tell me what has been done in Echo Lab as far as COVID-19 precautions are concerned and what is the optimal way to use the Echo Lab during this pandemic? Well, Dr. Crazier, the Echo Lab turned out to be more important than we knew because we didn't understand that COVID-19 was going to have such cardiovascular manifestations. So in patients that have shortness of breath, you know, the echocardiogram is one way to identify other comorbidities. So we tried a lot of things but what we really did was we tried to keep the COVID patients that were either presumed or positive out of the Echo Lab because we wanted to keep the Echo Lab relatively clean. So we decided that we would use designated areas that COVID-19 patients would stay in their designated areas and we'd use designated equipment for those areas. We had a specialized team that went through the hospital. It was an advantage we'd really been looking for and had the hospital buy about 40 of these point of care ultrasounds that could be used on location and completely enclosed in plastic to obtain portable studies with pretty good accuracy. So we implemented this into the ICUs of the COVID units and they became very helpful. Full echocardiograms could be performed but TEEs in high-risk patients because they are an aerosolizing procedure were quite a risk to all the healthcare workers. So TEEs in COVID or COVID suspected patients were highly censored and we only performed a few. All healthcare workers that were involved in TEEs of any patient were required to wear proper PPE which includes an N95 and a facial shield, gown and gloves. We also limited the number of healthcare workers in the rooms during TEEs because of the risk of aerosolization and the risk of spreading virus in asymptomatic patients. How accurate are tests that we have available at the present time in diagnosing COVID-19 infection? Well testing has improved dramatically during the beginning of the epidemic for patients that we knew for sure must have COVID-19. We were taking six days to get a positive test but as our hospital system became available we started doing more quick turnaround times and I think we can get a turnaround COVID PCR type test in four to six hours. We are not submitting cultures for viral culture because of the risk of infecting our virology lab but we're also recommending that patients that are suspected to have COVID-19 have a flu test and other tests that may be reasonable. We've only also just started doing serology testing. It's important because the PCR tests have about 85% sensitivity. So in patients that you are really, really concerned have COVID-19 and if the first test comes back negative we certainly recommend that a second test be performed as well as other kind of confirmatory blood work like a low lymphocyte count but as more immunologic tests or serologic tests become available we hope that a PCR test with an IgM test will be available in the near future to help improve the sensitivity of the PCR tests. Certainly IgG tests are now more routinely available to help describe whether or not a patient has had exposure at least seven days before to COVID-19. We're still not clear if the IgG test affords any immunity in the future. We are interested also in review of the treatments because when the pandemic first began we were really without any medical treatment except for supportive care and over the last really short amount of time, six weeks, we've had a lot of trials that have come forward. Dr. Kreiser, would you like to comment about this? Yes. As a matter of fact as you can see here in this information that was published in JAMA in March of 2020 actually. We can see that even at that time which is several months from past we can see that there were more than 30 studies that were ongoing with a variety of different antiviral and other medications and since then additional studies have been initiated. So we already have some answers but yet we're still waiting for additional information that I believe will be appearing relatively soon. Now as far as information that is available at the present time one of the very promising trials using Remdesivir showed kind of mixed results. Remdesivir is inhibitor or viral RNA replication with a specific activity against SARS and MERS and that has been a very effective drug for those coronaviruses that are no longer of a serious concern. The first clinical trial was marginally effective what it actually showed that the hospitalization time and the time of respiration and artificial respiration was shortened but there were no dramatic differences as far as mortality is concerned. The second trial that was a significantly larger trial AC-TT trial with over a thousand patients there were patients that were hospitalized with COVID and also pneumonia also used Remdesivir and this particular study lasted longer and showed significantly better results than the previous study with trends towards lower mortality with 7% mortality in patients that were treated with Remdesivir versus 12% of patients that were treated with placebo so there is at least a trend of benefit over Remdesivir in this subset of patients. What other treatments are we looking at Dr. Prezier for the treatment for COVID-19? Some of them that have been already shown to show preliminary promising results were Lupinavir and Retinavir which has been approved for treatment of HIV and of course interleukin and of course highly publicized use of chloroquine and hydroxychloroquine certainly is one of them that has been extensively studied maybe I should mention a few things about chloroquine and hydroxychloroquine hydroxychloroquine and chloroquine have been used for a very long period of time for treatment and prevention of malaria parasitic infection and also they are used for inflammatory processes such as rheumatoid arthritis and lupus and have been shown to be very effective. Now those drugs have been shown to be useful in inflammatory arthritis or inflammatory processes such as lupus but the drug has been used in relatively low doses. Now here when this drug was used in clinical trials for treatment of COVID-19 infection significantly higher doses were used. Another important factor when we talk about chloroquine and hydroxychloroquine is concerned a lot of patients with this type of infection also have significant cardiac effects. I'm talking about myocardial infarction, elevation of the troponin, affecting microvascular chain in the heart, myocarditis, pericarditis and also a lot of those patients might have actually ventricular tachyuritimias already due to infection with COVID-19 virus. Now when you enter using a drug that belongs to the QT interval and causes prolongation of the repolarization and dispersion of repolarization you add another component of ritmogenicity and propensity towards developing malignant ventricular erythmias and it has been actually discovered that in patients that were treated with hydroxychloroquine a significant number of them developed ventricular acardias or so-called torso de poins type of erythmias that are the most malignant type of ventricular tachyuritimias and as we can see on this study that actually there is no benefit from extensive clinical trial that were carried on in several countries with the use of hydroxychloroquine in decreasing mortality and morbidity using hydroxychloroquine. As a matter of fact there is a certain increased risk as far as cardiac morbidity and mortality is concerned so we have to keep this in mind. This drug is not safe to be used in patients with COVID-19 infections. So Dr. Krazier, the other treatment trials that are ongoing include the interleukin-6 inhibitors which are injectable monoclonal antibodies that target cytokine storm. There are two chemical preparations that are already approved for use in rheumatologic inflammatory conditions. So Tosalizumab and Saralumab have strict criteria for inclusion in clinical trials so we're encouraging all the patients that are very ill to be part of these clinical trials so that we can collect the data because these drugs are really expensive. They're monoclonal antibodies so they're not easily and readily produced for mass huge production and they do increase the risk for bacterial and supra infection with fungal etiology so they have to be more carefully targeted. So the only other treatment trials that are ongoing use convalescent serum which is the plasma where we used and infused the plasma with antibodies from recovered COVID patients and thousands of patients have been treated at this point with convalescent serum because in places where they're overwhelmed with COVID-19 infection there was really no treatment available outside of a study and convalescent serum could be collected at the institution and we've been using it as well. Dr. Crazier can you tell us about vaccine development? Well we're in very early stages as far as vaccine development concerns and we have to realize that to do a proper job there has to be a proper study done and from our previous experiences I'm talking about major vaccines that have been developed it took sometimes up to a decade to develop a safe and reliable vaccine and at the present time there is a tremendous enthusiasm in doing research as far as potential vaccines and to the best of my knowledge there are close to 100 potential vaccines that are currently being developed and analyzed. Of course very few of them will be eventually shown to be very effective and the reason for it is that to do a proper job you have to go to the exploratory phase you have to go through the preclinical phase you have to go through a phase one trial with maybe 100 or less patients phase two trial with a larger number of patients and then eventually phase three trial and all of those steps require time and effort to make sure that we don't have a significant side effect morbidity and mortality related to the vaccines and also that they are effective and doing a proper job so that's the most important factor the second important factor is are we going to be dealing with a significant genetic mutation we know that SARS-CoV-2 already is mutating and at least there are 13 strains that have been identified and whether all those vaccines that are currently being evaluated whether they are going to be effective for all those mutations it's certainly unknown at the present time and the other thing we don't know is whether or not the vaccine itself can cause hyperimmune enhancement which can lead to ARDS or a Guillain-Barre syndrome so we want to be careful before we unleash a vaccine that could cause healthy people to become disabled or sickened by a vaccine that's meant to prevent a disease now one thing that's positive as far as vaccines are concerned that we are in a certain degree ahead of previous vaccine developments for other illnesses for other viral illnesses that SARS-CoV-2 and MERS are very similar in design there are coronaviruses and have a similar genetic structure in a certain degree so a certain evaluation as far as testing for vaccines for SARS and MERS have been already initiated a decade ago or so on so we can certainly expedite this process and objectively the experts believe that probably we can get a vaccine that's relatively safe within the next few years or so well the whole world is watching and waiting as we're held hostage to this virus at this time outside of vaccine development Dr. Crazier there's still a lot of unanswered questions about COVID-19 how to test, how to treat but there are certainly some known things that we know about COVID-19 can you walk us through this slide it is not a typical viral pneumonia when we talk about COVID-19 infections and it's not a typical ARDS that we see with viral pneumonia so we have learned that using PEEP or high pressure on artificial respiration could be detrimental in this type of scenarios we have also learned that COVID-19 has a specific affinity to ACE2 receptors in the respiratory system and also in the vasculature ACE2 receptors are less developed in children we have learned that and less prominent in women and they are more prominent in men and they are more prominent in patients with hypertension and with other comorbid conditions we also have learned that COVID-19 is predominantly a systemic vascular disease or vascular injury that affects the endothelial system and causes endothelial dysfunction and that is manifesting the lungs, heart and other vascular systems causing organ failure, plaque disruption that leads to thrombosis and embolization it can also cause myocarditis and eventually causes cell destruction that can lead eventually to multi-organ failure COVID-19 causes also profound hypoxia and a lot of time it's not diagnosed early enough and this can then lead to serious consequences where the patient eventually ends up on a respirator in a scenario where this could have been prevented we also have learned how much we don't know about the COVID-19 disease and we still don't know what the most effective diagnostic test for COVID-19 or what a combination of tests might yield us we haven't really figured out who should be screened should the population be screened only sick in the beginning of the pandemic we only had very limited testing and we were only testing very sick and very symptomatic people certainly that was allowing people to spread the bug asymptomatic and pre-symptomatically we don't know anything about the risk of COVID-19 reinfection we don't know what the presence of IgG antibodies mean long term whether or not you can be reinfected if immunity is available we don't know how long it lasts we're not sure if COVID-19 will mutate and change the direction of vaccine development we don't really know what combination treatments are going to be available and which treatments are going to have the best outcomes and certainly we know relatively little what the long term sequelae for these patients will be so we have a lot to learn so we're left at the end of the day at the very beginning of a pandemic with a lot of interesting new knowledge and a lot of unanswered questions so we're going to continue to learn and we're going to learn as a medical community and these webinars that we've been making are hopefully helpful to our community to help us spread the word what we know what we don't know and what knowledge we can impart to our community I'd like to thank the participants of the Perfusion Conference as you know the Perfusion School is one of the oldest in America Perfusion was developed here literally on the grounds of this hospital so we're very proud to be part of your conference for those of you in the audience who are interested in more detailed information the Texas Heart website including TexasHeart.org has a series of more detailed lectures for your availability thank you so much for participating and Dr. Crazier thank you for helping me get through this again today it was a lot of fun thank you my pleasure