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Course Title: Apply specialist interpersonal and counselling interview skills
Part B: Course Detail
Teaching Period: Term1 2020
Course Code: HWSS6120C
Course Title: Apply specialist interpersonal and counselling interview skills
School: 375T Vocational Design and Social Context
Campus: City Campus
Program: C5360 - Diploma of Financial Counselling
Course Contact: Jo Wallwork
Course Contact Phone: +61 3 9925 3983
Course Contact Email: firstname.lastname@example.com
Name and Contact Details of All Other Relevant Staff
Nominal Hours: 60
Regardless of the mode of delivery, represent a guide to the relative teaching time and student effort required to successfully achieve a particular competency/module. This may include not only scheduled classes or workplace visits but also the amount of effort required to undertake, evaluate and complete all assessment requirements, including any non-classroom activities.
Pre-requisites and Co-requisites
Course Description
This course describes the skills and knowledge required to support clients to identify and work through their concerns using advanced and specialised communication skills.
The counselling skills developed within this course will be considered in a financial counselling context.
This course is clustered with three (3) other courses:
- Establish and confirm the counselling relationship CHCCSL001
- Facilitate the counselling relationship and process CHCCSL003
- Support counselling clients in decision-making processes CHCCSL007
These four courses are delivered and assessed together.
National Codes, Titles, Elements and Performance Criteria
National Element Code & Title:
CHCCSL002 Apply specialist interpersonal and counselling interview skills
E1. Communicate effectively
Performance Criteria:
1.1 Identify communication barriers and use strategies to overcome these barriers in the client-counsellor relationship
1.2 Facilitate the client-counsellor relationship through selection and use of micro skills
1.3 Integrate the principles of effective communication into work practices
1.4 Observe and respond to non-verbal communication cues
1.5 Consider and respond to the impacts of different communication techniques on the client-counsellor relationship in the context of individual clients
1.6 Integrate case note taking with minimum distraction
E2. Use specialised counselling interviewing skills
Performance Criteria:
2.1 Select and use communication skills according to the sequence of a counselling interview
2.2 Identify points at which specialised counselling interviewing skills are appropriate for inclusion
2.3 Use specialised counselling communication techniques based on their impacts and potential to enhance client development and growth
2.4 Identify and respond appropriately to strong client emotional reactions
E3. Evaluate own communication
Performance Criteria:
3.1 Reflect on and evaluate own communication with clients
3.2 Recognise the effect of own values and beliefs on communication with clients
3.3 Identify and respond to the need for development of own skills and knowledge
Learning Outcomes
On successful completion of this course you will have developed and applied the skills and knowledge required to demonstrate competency in the above elements. By applying these skills and this knowledge, you will be able to use specialised communication skills within a counselling process. You will be able to use a structured approach to establish the counselling process; work with clients to clarify goals, options, and courses of action; and manage the counselling process to its conclusion.
Details of Learning Activities
In-class activities:
- teacher directed group activities/projects peer teaching
- group discussion
- class exercises to review discussions/lectures role play activities
- independent project based work online and other research
- independent study
Teaching Schedule
|Workshop 1
|Structured approach & 'Person-centred practice' information required before seeing client Legal and ethical considerations for initial stages of counselling and how to apply these – codes of conduct/duty of care/mandatory reporting/privacy-confidentiality-disclosure/work role boundaries/practitioner-client boundaries/discrimination/human rights Using the initial session to gather client information as a foundation for counselling process Communication techniques to support the initial session's objectives The client's needs and expectations Establishing the nature of the counselling relationship Context: financial counselling – discuss: how does financial counselling sit within a counselling framework? This is an essential point to keep coming back to. To consider: Explaining clearly the (financial) counselling process How this fits with client's expectations, needs and immediate concerns – clarify, confirm or modify client's expectations where needed Addressing anxieties re counselling process Identify when client's issues are beyond scope of own role and report/refer where necessary Working on a plan for counselling in collaboration with client Making documented agreement with the client Communication techniques identifying communication barriers and developing strategies for overcoming these Micro-skills – what these are and how to use them non-verbal communication impacts of different communication techniques on the client-counsellor relationship based on context of individual clients How to take notes unobtrusively The sequence of a counselling interview Identifying when specialised counselling interview skills are appropriate for inclusion, and when they can impact positively to enhance client development and growth How to identify and respond appropriately to strong client emotional reactions How to reflect on and evaluate how you have communicated with the client: why do this? how to do this? Identify when/how/what skills need developing
|Workshop 2
|Micro-skills required for effective counselling (communication techniques) Looking at: Following the client's story and staying with their perspective (so client can feel comfortable and express themselves/their concerns freely) What the client's presenting concerns are – exploring these to see if there are possibly underlying issues How to identify and promptly deal with situations requiring immediate action – this is in a financial counselling context, but will need to focus on crisis situations, family violence, abuse, etc. Recognising indicators of client issues that require referrals or reporting Working with client barriers – these could be uncertainty/ambivalence/anxiety How to support clients to experience and process difficulties Paying attention to the particular story of the client in regard to parallels, links in client's experience and meaningful interventions (related to client situation) Strengths-based approach – what this is, how this can work in financial counselling context Using techniques such as: reflecting back; clarification; review Working with the client to look at underlying issues and collaboratively working on how to deal with them Acknowledging and working with changes in client's life as appropriate Monitoring and reviewing counselling process with client to ensure relevance, including how counsellor and how client both perceive process and progress How to address tension between client's hopes/expectations and the reality of resource limitations Facilitating change at a pace that the client can work with How to bring the counselling process to a conclusion: Identifying this point with the client Looking at what can be changed, what can't be, in client's life/situation Using boundaries of the counselling relationship to assist ending process Support client's autonomy during ending process Work with the client to identify any opportunities for further support How to deal with what seems unresolved
|Workshop 3
|Assisting clients to clarify goals and requirements identifying and exploring client's aims, requirements and ideas Assisting client's with goals – how to identify these, including requirements for these How client-strengths contribute to goal setting/modifications Identifying when client's aims/requirements can't be met and what to do (includes referrals to alternative sources of guidance and support) Review Communication techniques – micro-skills etc Exploring options with clients – look at this in counselling context and financial counselling context Working collaboratively with client in considering potential courses of action for meeting client's goals Looking at factors that can influence a course of action What are consequences of possible courses of action? How to work with client to identify these, and how to ensure client understands these Looking at possible courses of action – how to work with the client to look at possible advantages and disadvantages and how this matches client's requirements – Use financial counselling context Case study activities Working with the client to decide on course of action, and how to consider alternatives where necessary. Documenting decisions and agreeing ongoing support within organisational guidelines
Workshop 4
|In-class final assessment activities
Learning Resources
Prescribed Texts
Other Resources
Overview of Assessment
Your knowledge and understanding of course content is assessed through:
- Practical demonstration of skills
- Case study scenarios
- Written assignments/questions
Assessment Tasks
This course is assessed in accordance with competency-based assessment. To demonstrate competency in this course you will need to complete the following assessment tasks to a satisfactory standard. You will receive feedback from the teacher when you have completed the assessment tasks. You should refer to the assessment plan which is available on Canvas for details of each assessment task and for detailed assessment criteria. Assessment Task 1: Role Play (in class) Assessment Task 2: Case studies and written questions Assessment Task 3: Case studies and written questions Assessment Task 4: Video submission counselling session Assessment Task 5: Case studies with questions Assessment Task 6: Role play/observation (in class October) Grades that apply to courses that are delivered and assessed in accordance with competency-based assessment are: CA: Competency Achieved NYC: Not Yet Competent DNS: Did not Submit for Assessment
Assessment Matrix
The assessment matrix demonstrates alignment of assessment tasks with the relevant unit of competency. These matrices are available with the assessment tasks on Canvas.
Other Information
Please refer to the RMIT student page for extensive information about study support, assessment, extensions, appeals and a range of other matters: rmit.edu.au/students
Course Overview: Access Course Overview


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(Left-click to enlarge image.)
I recently ordered some book proofs from CreateSpace. I expected them to be shippd via Express Mail, for next-day delivery.
On 3/16 I received a message saying that the books were shipped. I expected to receive them on 3/17. By 3/19 they had not arrived and I contacted customer support. I was told that the proofs were actually sent via UPS "second day" and were shipped a day later than I was told.
- What's the point of lying when it's so easy for people to find out that you're lying?
- Why do computers lie? Are they learning from their human masters?

subset: commoncrawl


text: Super Mario is ready to take part in the mini karts racing championship, but the game requires you to unlock this option first by playing as Luigi and winning one of the first 3 places. Yoshi and Peach also waits for you so try not to disappoint them by proving that you really master the art of driving. Don't let the view from top mislead you when taking turns, try to accommodate a little in the first race then show your real potential.


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Homeless (2013)
Installation in Ikuinen Galleria with Emmi Kallio
Homeless is an installation formed of sounds, video and objects, installed in a small room. Inside the room ordinary furniture turn into sculptures, wallpaper rolls of the walls and the mirror shows merely half a reflection. There are no explanations, just a room with cues and questions. Can a home lose its home?


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Unchosen Forge: Validity Exercise in Retro Graphics – DelvroidContinue reading
Indie Game Blog
Sprite In Progress
Fun sprite work this week, crammed between meetings and feedback on first very rough full playthrough. Woohoo have a great weekend all!
Mecromage Elgon Concepts
Some concept work on group of enemies called the Elgon, for Indie game Mecromage.
Study – Castlevania Legends
Art by Joshua Keyes – Characters and scene inspired by Castlevania, owned by Konami.
I decided it might be fun to submit a piece for Jazza's Contest of the Month: New Resolution. The goal was to take a scene from a game that was made for a 1990 or prior machine and redraw it in a higher resolution. *placed 2nd – Runner up in open category*
Team Aegis
Inspired by the original X-Com game and their alloy armor, I decided to spent a bit of time imaging my team of badass alien brawlers. I didn't reference directly the game, but purely went about illustrating the headshots from a sense of inspiration and how I saw a team of mine existing in a world where elite soldiers were trained to go head to head with an unknown and ever-present threat of extraterrestrial terror. Continue reading
Keyes Possibilities
This Spring, 2014 a few family member of mine dedicated themselves to be apart of a triathlon. They decided to make motivational family Keyes Jerseys. I was called into action in effort to make this a reality.
The keys' esthetic was a bit on the 'techy' side, but I'd been deep into my game project when I designed them, so some of the content philosophy bled over. The intent was to ensure that each key was interesting, being that they are blown up about tens times larger than an actual key would be. I enjoyed the the challenge of making print quality interesting compositions out of enlarged every day objects. Though, the hurtle and real life issues made the project more of an obstacle than it should have, I did quite enjoy the result.
Being that the style easily could be something that could fit within the context of my science-fantasy platformer, Mecromage, I decided to try to use them as in game assets you'll be able to interact with. I'm always looking forward to unlocking doors to new possibilities, thanks to my family for being motivating and inspiring, never stop exploring new thresholds.
Codrak Shaman
The Codrak Shaman is a spry caster intelligently weaving the less wise of his clan into a unified force. He's cunning wit ensure enemies are constantly considering their tactical position. His tainted totems have the power persuade the natural elements to obey his command.
The Shaman is not only a charmer of the elements, his fellow Codrak, but also of the his flying half kin. In times of need his loyal drakes can be commanded to drop mana fused stones upon enemies.
Art Update: Litte Bot Buddy
Today I did some concept work for a little robot guy. Was fun, we'll see if he ends up as one of our little critters 😀 I could see him being a friendly guy, and maybe he transforms to a couple different modes? What do you think? I know he's not too original, what would you like to see changed?
Mecron Bot
– Raihn
Revamping Work Flows
I've be pretty crippled by the abundance of work that I must do in my game and daily life, so I'm looking for ways to revamp my current situations. I plan to attack the situation by giving myself proper tools and workflows to circumvent the speed bumps and focus on the hurtles. A new desktop arrangement, savvy task management tools, taking time to properly annotate and build personal references, and proper outlets for expression and logging are my initial thoughts on mitigating the madness.


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NBA Fantasy Basketball Market Watch: Ramon Sessions Gives Some Hope In ClevelandJanuary 26, 2011
The truth is that no one in a long time will come close to replacing the huge void that LeBron left in Cleveland, but any little shimmer of light is worth mentioning. So here's to you Ramon Sessions! Plus a look at Mario Chalmers, Richard Jefferson & the Detroit Pistons.
Ramon Sessions, PG – Cleveland Cavaliers
In an otherwise lost season for the Cavs, Ramon Sessions is seemingly one of the only bright spots (besides a slightly above average Antawn Jamison). In the midst of a 17 game losing streak, Sessions has stepped in as the starter and is embracing the role.
The former second round pick of the Heat (26th overall in '07) has only 11 starts to his credit on the season, but has performed admirably considering the circumstances. As a starter, Sessions has a 12.7 PPG average and 4.4 assists, but wait, it gets better.
In the past six games, Coach Scott has rewarded Sessions with almost 34 minutes per game (besides the 11 minute aberration against Chicago on 1/22). Sessions is rewarding the Cavs by averaging 19 PPG, 6.6 assists and almost four rebounds in those games.
For the month of January, Sessions averages currently sit at 14 PPG, 5.6 assists and 3.5 rebounds. He has scored in double digits in all but two of his team's last 14 games. It's hard to ask for more from an eight-win team at this stage of the game.
Sessions' ownership rate has taken a remarkable leap to 55 percent and is projected to jump to 74 percent by next week. As impressive as this may be, owners are still hesitant to plug him into their starting lineup, with only 31 percent doing so. While there isn't much hope for the Cavs this season, Sessions is turning heads and proving to be a vital part of the post-LeBron rebuilding era in Cleveland.
Mario Chalmers, PG – Miami Heat
Let's move on from the point guard who would have been dishing assists to LeBron to the one who actually will, at least going forward. Mario Chalmers has also been anointed as the starting point guard of his NBA squad.


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ARTICLE BY Adam Jane
Parley Joins adidas' Speedfactory Family
What the devil is this? The adidas Speedfactory has turned out an all-new shoe produced in partnership with Parley for the Oceans. This round sees the knitted portions fashioned from recycled ocean plastic materials.
The AM4LA design strays from the tried and tested Futurecraft formula, ditching the zigzag lacing supports and triangular heel cage in favour of a few pill-shaped panels. Of course, the BOOST sole remains in place to keep your nature loving feet in complete comfort.
The Parley x adidas Speedfactory AM4LA will be on May 25 at select Californian stockists.


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Life Insurance Coverage: Start Using These Guidelines To Help You Opt For The Correct Type
For those who have a household or some other dependents, buying insurance coverage is a vital step. The end result is, in the event you pass away, you have to carry on and provide income for the dependents. The following article will help you choose and acquire an existence insurance coverage that suits your unique circumstanceskawaii
Before investing in an existence insurance policies, you ought to make time to carry out some price comparisons. Premiums may vary around 50% from the different providers, so try using online comparisons to discover the cheaper quotes. Look at quotes that reflect your personal and family medical history. You may have to provide some general health background to obtain accurate quotes.
Eat consideration ongoing and fixed expenses when choosing a policy. However, funds paid out through insurance coverage are also a good choice for single occurrences, for example expensive funeral costs and estate taxes.
Always be informed and make sure you are obtaining the coverage that yourself and your family need out of your life insurance policy. It might seem tough, but knowing ahead exactly how much coverage you need will help you avoid many issues down the line. You house payment continues even though you die, as will taxes and insurance policy. Your children will still have to go to university plus your spouse has making it until retirement.
Any hobbies or jobs that you have that happen to be regarded as dangerous will boost your insurance coverage premiums. You might like to stop trying diving, bungee jumping and skydiving if you notice your rates for being excessive. If you regularly go to dangerous or troubled destinations, you might nullify your coverage or forgo discounts.
If there are actually individuals who depend upon you financially, you should think of getting life insurance. In the event you should die, your daily life insurance may help your family members pay off your mortgage or send your youngsters to university.
Increasing your health helps you get life insurance to get a cheaper price. Generally speaking, insurers give healthier people better deals since they have a greater life expectancy.
Avoid paying high commissions while you are purchasing insurance coverage. These commissions are paid into a broker and agent, and the price of them is included in the premiums. If you achieve an insurance plan that may be "no load" it can save you a ton of money, but you must locate an insurance agency that offers this.
Purchase more insurance coverage to economize overall. Many nationwide insurance carriers offer discounts that increase with the level of coverage that you purchase. This really is a win-win situation as you spend less and might provide more support for the beneficiaries.
It really is with enough concentration to grieve for lost family and friends, and financial issues really should not be an issue during this time period. In the event you pass away, it really is imperative that those who depend upon you have a method to continue paying the bills. Use everything you discovered from this article to be of assistance to make an effective decision about insurance coverage..


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Last week, the Italian internet was briefly galvanized by an anonymous troll with a rather Catholic-looking Facebook page (see right), apparently created to advocate for the abortion of gay fetuses. Yes — gay fetuses, which, claimed the troll, doctors now have the ability to identify with some specificity. The page launched on June 19th, with this exhortation:
Too many people have been misled by the false morality of the sodomites. But now, thanks to the miracle of science, we can prevent this. Yes, it is terrible to abort even the poor children burdened with sodomite genes, but it is the lesser evil.
(The translation's approximate, but that's the gist.)
The page stuck around, and its author stayed busy. Eventually, if I've got the translation right, it seems the author began to provide fake reports from clinics about the murder of infants — in one case, a report of gay babies who'd been strangled with their umbilical cords. Fake testimonials from fake mothers appeared, including this one:
After my [unborn] son was diagnosed with homosexuality, I wandered aimlessly and craved death above all things … After aborting the homosexual fetus I became pregnant again. My son is now healthy. I have seen God. I am happy.
It was all insane. It looked like the mindless jabbering of an under-supervised and over-caffeinated 14-year-old with psych issues. None of it was very worth thinking about. Except — for some reason, this particular detonation of nuttery managed to capture the attention of thousands. By the end of last week, when public furor over the troll caused Facebook to can his account, the profile had racked up more than 2,000 comments, and illicited comment from Italian politicians. Paola Tanning, some kind of official with the Democratic Party, threatened legal action against Facebook if the troll's page didn't disappear. Paola Concia, a member of the Italian parliament, publicly expressed solidarity with any gay kids who might have seen the page. And Stoppello Daniel, a famed lawyer who deals with cases of threats and discrimination against gays, told La Repubblica that the Facebook page was actionable:
In my opinion, [the page demonstrates] abuse of popular credulity — Article 661 of the penal code — in which you try to deceive people by promoting scientifically false and completely unfounded hypotheses, exploiting ignorance … We shouldn't underestimate the fact that [the profile constitutes] a public incitement to abortion.


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Whether you've seen a lion during a safari or in photo's did you ever wonder their age. Now with a few tips you can tell the age of a lion. Learn how to age a lion.
During your photo safari you'll be guided by top-rated Naturalists. These guides have 15+ years of experience and are former park rangers, biologists, and conservationists in Tanzania's National Parks. Our expert guides know to take serious photographers game-driving during peak hours for optimal lighting, for example, so you may capture incredible sunrises over the savanna or animals grazing in the morning mist. Our guides are experienced enough to position their vehicles for the best camera angles, allowing you to capture the primitive beauty of Tanzania and the unrivaled concentration of African wildlife in the Serengeti National Park. Additionally, we provide professional quality beanbags to help balance your camera, and, more importantly, our vehicles roll-back open-top roofs allow you to stand-up for a 360 degree view for uninterrupted game-viewing and ultimately the perfect photo safari experience.
What to Expect on Your Photo Safari to Tanzania
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Word nerds are everywhere.
Spotted by one of MRP's overseas correspondents.
This little tidbit was spotted on BuzzFeed.
Okay, here's the deal. When you mean "a comprehensive and fundamental law, doctrine, or assumption," "a primary source," or "an underlying faculty or endowment" (M-W), then the word you want is principle. When you mean "a person who has controlling authority or is in a leading position" (M-W), such as the person who has the power to put you in detention until the day you graduate from high school, then the word you want is principal. In this case, although Allen Gregory may very well love his principles, what they meant to show was that Allen Gregory loves his principal.
In principle, the proofreader of this article might want to make checking for spelling of principal importance.
Bonus MRP moment: In addition to this delicious typo, BuzzFeed also brings us "14 Punctuation Marks That You Never Knew Existed." Impress your friends and scare your enemies with your new knowledge of guillemets, sheffer strokes, and asterisms.
So I have been disposed to find the title of the new Steve Carell/Julianne Moore vehicle (the one with the words crazy stupid and love in it), I don't know, lame at best. A little been there, Eat, Pray, Loved that.
And also, I'd like you to note, without commas in the ad. So I definitely did a doubletake when I saw the title referred to in text as Crazy, Stupid, Love. I mean, what's with all the commas? (And oh yeah, that's a period at the end of the title, too.)
That there were any commas at all came as kind of a surprise to me after seeing the ads, but that there were two commas seems, I don't know, odd. It's not like Eat, Pray, Love, in which a series of like things is divided by commas. With two adjectives and a noun (or a verb), it doesn't stand up as a series. Are we not meant to think that crazy and stupid are adjectives that modify the noun love (in which case Crazy, Stupid Love would suffice)? Or are crazy, stupid, and love three nouns, as in, she is bringing the crazy, she is bringing the love, and she is bringing the stupid?
And I'm not alone. A quick search brings up many questions, but few answers. These guys don't have any problems with it, but Nathan Heller at Slate refers to it as "the hair raising savagery of the second comma" (yowzers). Oh, what does it mean?
From xkcd:
Reminds me of the E. E. Cummings poem:
since feeling is first
who pays any attention
to the syntax of things
will never wholly kiss you;
wholly to be a fool
while Spring is in the world
my blood approves,
and kisses are a better fate
than wisdom
lady i swear by all flowers. Don't cry
– the best gesture of my brain is less than
your eyelids' flutter which says
we are for each other; then
laugh, leaning back in my arms
for life's not a paragraph
And death i think is no parenthesis
H/t @copycurmudgeon
Bonus MRP moment: Are you getting ready for National Grammar Day on March 4? It's a word nerd's first sign of spring.
Did you have fun celebrating National Punctuation Day? Good, me, too! Here's a little something-something to remember the day by until next year:
How awesome is the Godzilla Mark? I can picture many ways it could be useful. For instance, when I was in elementary school, I had this teacher who I loved but who was also a little scary. And nothing was scarier than when you got some worksheet back with nothing written on it but SEE ME in big red letters. You knew instantly you had screwed up. But wouldn't it be even more awesomely scary with a Godzilla Mark? SEE ME <GODZILLA MARK>? I'm scared just thinking about it.
Also, I could see it coming in handy in my work as an editor. I'm thinking, for example, that no one would be tempted to ask you questions such as "Are these real edits or just your personal preference?" (true story) if they got their articles back with INSERT COMMA <GODZILLA MARK> and PLEASE LEARN THE DIFFERENCE BETWEEN ITS AND IT'S <GODZILLA MARK>. Oh, the places we could go with this.
Hat tip Savage Chickens and also @rantyeditor.
It's National Punctuation Day (9/24)! Go to the official website for more information. Also, the topic is trending on Twitter, so check that out to see how others are celebrating!
Because you need a new earworm, here's a catchy little ditty: "The Apostrophe Song," brought to you by coolrules.com.
H/t to word_czar.
There's a handy new guide from the Oatmeal, "How to use a semicolon: The most feared punctuation on Earth." Here's a taste:
In true Oatmeal fashion, the explanations are sensible and straightforward, if just a wee bit quirky. But what did you expect?
However, there is a joke about unicorn meat that once read, cannot be unread. Just sayin'.
So you remember the Scholastic Books you could order through your school? Well, S. (age 6 1/2) got a Scholastic order form the other week, and while he selected a volume from the Magic Tree House series, I could not pass up the opportunity to order a little somethin' somethin' for myself. There's nothing wrong with that now, is there?
I was actually kind of excited when his order, which included my copy of Alfie the Apostrophe by Moira Rose Donohue, arrived the other day:
It's talent show day at Alfie the apostrophe's school, and he's nervous as he gets ready to perform his magic show in front of everyone. As the other punctuation marks show off their talents (the question marks tell jokes, the exclamation points show off their cheerleading chops, and the periods and hyphens tap out SOS in Morse Code), Alfie sweats the idea of showing the audience what he can do.
In the end, his amazing ability to make letters disappear and to form new words earns him the top prize of the show!
If you like Alfie the Apostrophe, you can also check out Donohue's other homage to punctuation, Penny and the Punctuation Bee.
I've been meaning to write about the SarcMark since I read about it in Erin McKean's column the other week. What's the SarcMark you ask? It's a bit of punctuation meant to signal that what you've just read is meant to be sarcastic. It looks like this:
Now how do you get your own keyboard to make the SarcMark, you ask? Well, you download it for $1.99 from Sarcasm, Inc., the creators and marketers of the SarcMark. According to their website:
The official, easy-to-use punctuation mark to emphasize a sarcastic phrase, sentence or message. Once downloaded to your computer or cell phone, it's a quick key-stroke or two to insert the ® where you want, when you want, in your communications with the world. Never again be misunderstood! Never again waste a good sarcastic line on someone who doesn't get it!
The idea of having to pay to use the SarcMark seems a little weird to me and also antithetical to promoting its widespread use. But I'm just an editor, what do I know about marketing? There's also a part of me that bristles at the idea of introducing new punctuation, but I want to be open-minded, as McKean urges:
This kind of novel punctuation tends to be sniffed at by purists, but history isn't on the purists' side. All punctuation marks were once new inventions to make writing clearer. Periods (or full stops) were used first to separate words, which previouslyallrantogetherlikethis, with other marks following as needed: the comma to indicate where to take a breath, the exclamation point to indicate emphasis, and so on. Ancient manuscripts sometimes included marks to convey the copyists' opinions about the text itself, such as the obelus ( -or ÷) used to indicate a "doubtful or spurious" passage.
Mainly, I'm just not sure we have a real use for it. I mean, for example, I'm comfortable with the idea of the interrobang, but I think that's partly because it just formalizes an idea (the joined question mark/exclamation point) that is already effectively and organically in use. Having said that, I don't actually use the interrobang. The SarcMark seems superfluous, sort of antithetical to the idea of sarcasm. If a person doesn't already get that what you are saying is sarcastic, do you really want to point it out to them? As McKean comments, "One of the reasons to employ sarcasm is enjoying the possibility—often, the probability—that your sarcastic remark will sail right over the target's head."
The folks at Open Sarcasm, on the other hand, have a real problem with the SarcMark. They have a whole website, with a manifesto and so on, decrying the concept of a licensed punctuation mark for identifying sarcasm:
Of late, certain capitalist forces have brought forth onto the internet the idea that sarcasmists everywhere must license and download their proprietary new "punctuation"—called the "SarcMark"®—in order to clarify sarcasm in their writing.
A growing chorus of voices has joined together to decry this idea. It is high time that Open Sarcasmists should openly, in the face of the whole world, publish their views, their aims, their tendencies, and meet this nursery tale of the Spectre of Open Sarcasm with a manifesto of the punctuation itself.
For additional comments, check out the Sarcasmist's World Peace Can't Be Far Behind Now That the Sarcasm Mark Has Been Created.
So what do you think? Is the SarcMark some kind of elaborate joke on punctuation peevologists? Is there room is this town for another punctuation mark?


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The following is an excerpt from the Los Angeles Times on October 16, 2010. Copyright by the Los Angeles Times.
"He was way ahead of his time," said Craig Krull. "When he photographed the Hollywood Freeway, nobody at that time was thinking about photographing a project like that for artistic purposes."
There were also images of an evolving Los Angeles, "'snapshots' of a city coming into its own," The Times said earlier this year, as well as Miller's signature prints made with the Carbro process, a complex and now-arcane color-printing technique that produces vibrant archival-quality prints from pigments rather than dye.
Never one for self-promotion, Miller rarely exhibited his work. Three books featuring his photographs were first printed in 2009, the year he turned 97.
To read the complete Times article go to http://www.latimes.com/news/obituaries/la-me-richard-miller-20101016,0,1022176.story
You can also read more about Miller at http://www.photoicon.com/online_features/38/
By Jim McKinniss


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ICJR REWIND: Techniques for Optimizing Acetabular Component Positioning in THA
In an article originally published on June 7, 2018, the authors review techniques and tools available to improve surgical competency and reduce the risk for component malpositioning, as well as provide expert recommendations for surgeons who perform total hip arthroplasty.
James E. Feng, MD; Afshin A. Anoushiravani, MD; Nima Eftekhary, MD; Jonathan Vigdorchik, MD; and Ran Schwarzkopf, MD, MSc
Ideal and accurate acetabular component positioning in total hip arthroplasty (THA) remains a challenge. It is estimated that newly fellowship-trained arthroplasty surgeon must perform 50 consecutive THAs to achieve a satisfactory level of surgical competency. [1] Even for the experienced surgeon, between 39% and 50% of acetabular cup placements fall outside the Lewinnek abduction and/or anteversion safe zones.[ 2–6]
Moreover, poor component positioning is the most significant risk factor for hip instability and excessive early liner wear. [7] Other complications of poor component positioning include: [5,8–13]
- Impingement
- Shell-liner dissociation
- Leg-length discrepancy
- Limited range of motion (ROM)
- Osteolysis
- Hardware squeaking in ceramic bearing hips
In this article, we review a variety of techniques and tools available to improve surgical competency and reduce the risk for component malpositioning. Key points include the following:
- For a near anatomic positioning, acetabular cup placement should have 40°±10° of abduction and 15°±10° of anteversion.
- Medialization of the acetabular component optimizes joint reaction forces, but it also increases the risk for reduced global offset, decreased ROM until impingement, and reduces acetabular bone stock for future revision surgery. Medialization should be tailored to each individual patient.
- Preoperative surgical templating should be performed for all patients using standardized digital radiographs with known magnification or a known reference marker.
- The transverse acetabular ligament is a reliable anatomic structure that can improve the surgical accuracy and consistency of acetabular cup depth, height and version.
- Computer-assisted navigation and robotic surgery have demonstrated improved component positioning, reduced surgical variability and may be a useful asset in complex THA.
Acetabular Component Positioning and Templating
Preoperative templating is regarded by many surgeons as an essential step in the preparation for THA (Figure 1). [9] Although no study to date has investigated the direct effects of templating on improved acetabular positioning versus not templating the hip, 80% to 97% of the implanted cups can be correctly estimated within a ±1 stem size when templating is used. [14,15] Thus, templating allows surgeons to preoperatively select an appropriately sized component inventory, which reduces surgical idle time. In addition, templating encourages the surgeon to think 3-dimensionally and anticipate complex anatomy and potential intraoperative complications.
Figure 1. Anteroposterior pelvis radiographs demonstrate presurgical templating of the hip and results at the 2-week post-surgery follow-up.
The major variables to be accounted for in the preoperative phase of THA acetabular cup placement include:
- Acetabular cup inclination and version
- Center of rotation (CoR)
- Offset
- Leg length
- Shell size
Cup Angle/Orientation
In a landmark study by Lewinnek et al, [4] reduced hip dislocation rates were observed after placing acetabular cups between 30 ° and 50° of abduction and 5° and 25° of anteversion. Shortly after its publication, the study gained widespread acceptance among the orthopaedic community as a guideline for the acetabular cup "safe zone," despite the fact that the study analyzed only 113 hip radiographs and 9 hip dislocations. [4]
More recent studies have called these findings into question. [16,17] Abdel et al [17] demonstrated that cup placement was within the Lewinnek abduction safe zone in 92% of patients who dislocated after undergoing a posterior THA and 65% of patients who dislocated after an anterolateral THA. Other studies have also shown that an inclination angle in excess of 45° accelerates the rate of polyethylene linear wear by 40% and may also be correlated with an increased risk of hip squeaking in patients with ceramic-on-ceramic THAs. [7,13] Similarly, metal-on-metal bearings with excessive inclination angles suffer from increased edge wear, leading to elevated serum metal ion levels and the risk for adverse reaction to metal debris such as local tissue necrosis, lymphocytic infiltration, and, in rare cases, pseudotumors. [10–12]
Acetabular anteversion has also been shown to affect polyethylene wear, but it is more commonly identified as playing a greater role in THA stability. [4,7,18] As with inclination, the existence of an anteversion safe zone is now being questioned. Abdel et al [17] reported that 69% of posterior and 33% of anterolateral THAs were complicated by subsequent hip dislocation despite cups being placed in the anteversion safe zone.
Although cup placement in most of the hips that dislocated fell within the Lewinnek safe zone, [17] cup placement outside the safe zone has been found to increase the relative risk of dislocation. In a study by Biedermann et al, [18] a U-shaped distribution was observed for anterior and posterior dislocations as acetabular anteversion angles deviated from 15° bi-directionally. Patients with less than 4° or more than 24° of anteversion were at 6-times greater risk for posterior and anterior dislocations, respectively.
Current studies are limited in assessing other complications related to anteversion, potentially due to the difficulties of evaluating anteversion using standard postoperative imaging. Even when evaluating 342 controls in the study by Biedermann et al, [18] only one third of the hips could be evaluated for cup anteversion using digital radiographs.
In summary, most dislocations following THA occur in patients whose acetabular cups were placed within the Lewinnek safe zone, although the relative risk for dislocation is greater in patients in whom acetabular cup placement falls outside the safe zone. [17] It is also evident that known and unknown patient factors, such as spinopelvic alignment and developmental dysplasia of the hip (DDH), are unaccounted for at this time and may affect the outcome of THA in a subset of patients. Current evidence on how to identify and surgically manage these patient factors is lacking, but with the advent of new technologies, such as full-body, 3-dimensional radiographs, new guidelines are likely to be developed in the near future.
Expert Recommendation
- At this time, optimal cup placement is 40° of inclination, with a tolerance of 30° to 50°, and 15° of anteversion, with a range of 5° to 25°, in a normal primary THA. [19,20]
Center of Rotation and Sizing
Optimal acetabular cup placement also depends on anterior-posterior (AP), medial-lateral (depth) and superior-inferior (height) positioning. Changes in these axes alter the hip's CoR, which in turn alters the joint reaction force (JRF), maximal hip abductor muscle forces (Fmax), and minimum required abductor muscle forces to maintain a stable pelvis during normal gait (Freq). [21,22]
In a biomechanical computer modeling study by Heller et al, [22] lateralization of the hip CoR resulted in the most drastic alteration in the JRF, with each 10-mm shift resulting in an 8% increase in the JRF, compared with a 1% increase in JRF with superior shifts. Moreover, superior and lateral shifts in the CoR may also lead to a postoperative abductor lurch or Trendelenburg sign due to prominent decreases in abductor muscle forces or required abductor muscle forces to maintain a stable pelvis. [21]
Although superior translation of the hip's CoR is unfavorable, the increase in JRF and Freq is relatively small. The trade-off of anatomic superior-inferior acetabular positioning for satisfactory bony purchase is warranted in patients with significant acetabular dysplasia. In a study of hip dysplasia by Nawabi et al, [23] patient with Crowe type II and III hips had a 97% 12-year survivorship for all-cause revisions when the hip CoR was medialized and placed superiorly to improve bony purchase. This was no different from patients with Crowe type I dysplasia with anatomically placed CoR. Moreover, patient-reported outcomes, acetabular loosening, and wear rates were the same. [23]
Medialization of the acetabular cup has been demonstrated to reduce the rate of liner wear, and in turn, improve the survivability of the implant. [22] These benefits must be balanced against the increased risk for bony impingement, reduced ROM, and loss of bone stock for future potential revision surgeries. Medialization of the hip also requires restoration of the hip's global offset using extended offset femoral heads or acetabular liners. Failure to do so may result in increased head-liner microseparation due to poor abductor tensioning, which could cause accelerated liner wear. [24] Furthermore, extended offset acetabular liners nullify the benefits afforded by acetabular medialization and increase the rate of aseptic loosening due to altered torsional forces at the bone-cup interface. [25,26]
Expert Recommendations
- Using a standard supine AP radiograph of the pelvis, the acetabular component should be appropriately templated at 40° of inclination with respect to the horizontal tear drop line.
- The medial border of the cup is medialized towards the radiographic teardrop. The biochemical advantage of medializing the hip's CoR and obtaining improved bony purchase must be balanced against the risk of acetabular protrusion and the need to preserve bone stock.
- The inferior border of the acetabular cup should be approximately in line to the inferior border of the radiographic teardrop line.
- The superior aspect of the acetabular cup should maximize bony coverage, but up to 33% of acetabular cup may be uncovered.
- Femoral neck osteotomy should also be accounted for to ensure proper restoration of the patient's leg length discrepancy and global offset of the hip.
Perioperative and Intraoperative Optimizations
Patient setup on the operating table is integral to optimal acetabular positioning. Ideally, the sagittal plane of the pelvis should be parallel with the floor for patients in the lateral decubitus position, while the coronal and transverse planes should be parallel with the walls of the room. Deviations in any of these parameters can significantly alter the positioning of the acetabulum and can distort the surgeon's sense of geometric orientation. With each 1° increase of anterior pelvic tilt, acetabular anteversion decreases on average by 0.74°, with a 0.2° to 0.5° increase in inclination. [27,28] Similarly, alterations in pelvic axial rotation can lead to changes in anteversion and inclination. [29] Rotation of the pelvis in the coronal plane alters acetabular inclination. [30]
Milone et al [30] assessed rigid pelvic positioners for their reliability in patients in the lateral decubitus position for computer-navigated THA. With the computer navigation system's arm placed into the wound, true anteversion angles deviated by more than 5° in 41% of patients and more than 10° in 22% of patients compared with the surgeon's predicted anteversion angle. Similarly, actual inclination angles also deviated from the surgeon's expected inclination angles by more than 5° in 18% of patients and more than 10° in 2% of patients. These alterations in positioning are likely due to patient positioning and patient positioner type used.
Lower extremity manipulation and dislocation has also been shown to introduce additional pelvic pitch and roll. [31,32] In a study by Nishihara et al, [32] mean pelvic movement following hip dislocation resulted in 12°±4° of posterior pelvic tilt, 2°±4.4° of pelvic inclination, and 7°±5° of pelvic internal rotation. These studies demonstrate the need for a reliable technique to assess 3-dimensional pelvic orientation intraoperatively.
The transverse acetabular ligament (TAL), identified by Archbold et al, [33] is an anatomic structure that has been proposed to reliably re-approximate the anteversion, height, and depth of the natural hip (Figure 2). [8,33] Successful intraoperative identification of the TAL occurred in 99.7% of 1000 consecutive THAs, of which only 0.6% dislocated over an 8 to 41-month follow-up period. [33] In a randomized control study by Meermans et al, [34] acetabular component positioning using the TAL resulted in a significantly more accurate and less variable placement of the acetabular cup. More importantly, no acetabular components fell outside the Lewinnek safe zone when assessed by postoperative radiographs, compared with 20% of free-handed acetabular cups that did. Beverland et al [8] have further described identification of the TAL.
Figure 2. The TAL should be well exposed for optimal acetabular positioning. Subsequent cup placement should be placed parallel to the TAL for optimal anteversion and to assist in assessing the most appropriate depth and height of the cup.
Interobserver reliability in identifying the TAL is variable. [33–36] As originally described by Archbold et al, [33] soft-tissue and osteophytes must be removed in approximately 50% of surgical cases prior to properly exposing the TAL. Surgical experience, therefore, may be associated with consistent identification of the TAL. It should also be noted that a follow-up cadaveric study by Hiddema et al [37] demonstrated the TAL could also be utilized in gauging acetabular cup inclination. However, no other studies have been performed to evaluate this finding, and the original studies by Beverland and Archbold reported the TAL did not assist with inclination. [8,33]
With the growing popularity of direct anterior approach THA, some surgeons have proposed the use of intraoperative fluoroscopy to improve acetabular positioning, and several studies have demonstrated the benefits of fluoroscopic guidance when used with this approach. [37,38] When comparing the direct anterior approach with fluoroscopy with a standard posterior approach, the results become less clear.
Leucht et al [40] compared postoperative radiographs from direct anterior THAs with fluoroscopy with those from standard posterior approach THAs without fluoroscopy. The direct anterior approach demonstrated more anatomically appropriate levels of anteversion, but also significantly more variability: 25.9°±8.2° for the direct anterior approach versus 35.3°±7.1° for the posterior approach. [40] Nam et al [41] found similar outcomes for direct anterior approach THA with fluoroscopy and posterior approach THA without fluoroscopy, with 68.2% and 70% of acetabular cups falling within Lewinnek's safe zone, respectively. However, computer-assisted navigation in posterior THA was superior to both, with 90.9% of acetabular components falling within the expected safe zone. [41]
It should be noted that previous studies have identified 5 major risk factors that increase the incidence for component malpositioning: [3,5]
- Minimally invasive surgery (MIS) (odds ratio [OR] 6.10)
- Surgeon experience (OR 2.30)
- Surgical volume (OR 2.07)
- Anterolateral versus direct lateral approach (OR 2.02)
- Obesity (OR 1.35)
Although many of these variables are modifiable, it may be impractical to modify some of them – for example, surgical approach and volume – in an established orthopaedic practice. Instead, these risk factors should serve as a reminder of situations in which more attention should be paid during acetabular cup positioning.
Expert Recommendations
- Complete exposure of the acetabulum should be performed, with adequate removal of the overlying soft tissue and osteophytes covering the acetabular rim.
- Removal of soft tissue in the proximity of the inferior acetabulum should be performed to adequately expose and identify the TAL.
- Relative to the TAL, the acetabular cup should be placed parallel or slightly anteverted to the TAL. However, in patients with an abnormal TAL – as in the case in DDH, acetabular retroversion, ankylosing spondylitis, lumbosacral fusion, and other spinal deformities – the anteversion presented by the TAL may be inadequate for proper acetabular placement. Considerations should be made for advanced imaging, computer navigation and a discussion with a spinal surgeon.
Computer- and Robotic-Assisted THA
Computer navigation and robotic systems have been developed to assist surgeons when positioning THA components and to reduce the complications related to component malpositioning. [18] Acetabular component malpositioning is the single most important factor in determining the risk of dislocation, responsible for 22.5% of all THA revisions and 33% of acetabular revisions. [42,43] A cadaveric study by Jolles et al [44] compared cup placement with computer navigation versus a freehand method. Computer navigation resulted in a mean error in alignment of 1.5° in inclination and 2.5° in anteversion, compared with 10° and 3.5°, respectively, when using the freehand technique. [44] Similarly, a retrospective observational study evaluating computer navigation and a freehand technique found that 91% of acetabular components were within 40° ±10° and 15° ±10° for both acetabular inclination and anteversion, respectively, versus around 70% when using mechanically guided techniques. [41]
Although computer navigation and robotic-assisted surgery reduce the variability seen with component positioning and potentially increase ROM, no study to date has demonstrated clinically significant superiority. [31,41,45–47] The literature available on these systems only evaluates short-term outcomes. It is hypothesized that their perceived benefits may only be apparent with longer-term follow-up.
Despite offering less variability in component positioning, navigated systems have several limitations that may increase patient morbidity and the cost burden associated with THA:
- Learning curve. Navigated systems are associated with an initial learning curve, which may lead to increased surgical time, preventable systems errors, and in rare cases, component malpositioning. Preliminary studies of the knee demonstrate this learning curve may only be 16 to 20 cases, even in the hands of the general orthopaedic surgeon. [48,49]
- Additional imaging. Most computer navigation and robotic systems require advanced imaging prior to surgery, exposing patients to high radiation doses.
- Increased costs. Many systems require specific hardware, software, instrumentation, and training, which add substantially to the cost of THA without short-term clinical justification.
It should be recognized that computer navigation and robotic-assisted THA provide surgeons with reliable alternatives for the positioning of THA components, particularly in complex cases in which freehand alignment techniques and anatomic landmarks may be less reliable than in a native hip.
Expert Recommendations
- Preoperative advanced imaging and 3-dimensional templating continue to be critical elements for appropriate placement of the acetabular cup in computer-navigated and robotic-assisted surgery (Figure 3).
- Poor patient positioning may cause suboptimal surgical exposure, reference plane acquisition, stability assessment, and anatomic landmark verification, and therefore should not be overlooked.
- Although computer-navigated and robotic-assisted technologies are useful in complex cases, surgeons should be familiar with their use in standard primary THAs prior to their use in more complex surgical cases.
- Intraoperative placement of the acetabular component by computer-assisted guidance should be confirmed through conventional THA principles.
Figure 3. Preoperative templating using 3-dimensional reconstructed CT images allows surgeons to better assess and plan surgical implantation of the acetabular component. All variables, including cup inclination, anteversion, and placement, may be optimized to the patient's inherent factors.
Complex THA
Complex THAs are frequently less forgiving than routine primary procedures. This is particularly true in patients with spinal pathology (eg, scoliosis and lumbar fusions) or hip dysplasia and those requiring revision surgery. The presence of a significantly disrupted anatomy limits the surgeon's ability to align and position the acetabular component due to the distorted or obliterated anatomic landmarks, such as the sourcil line, TAL, and ilioischial and iliopubic lines.
In a propensity score analysis, Perfetti et al [50] reported dislocation rates 7 times higher in patients with 4-level fusions than in patients with no fusion, demonstrating the need for careful preoperative planning and improved intraoperative techniques. As computer navigation and robotic systems become more reliable and affordable, their indications will likely broaden to incorporate more complex THAs, improving the accuracy and outcomes of these challenging surgeries.
Acetabular component positioning continues to be a challenge even for the experienced orthopaedic surgeon. Simple techniques, such as preoperative templating, identification of anatomic landmarks, and surgical experience, have been shown to improve acetabular cup positioning and reduce complication rates. New technologies, including navigated instrumentation, may enhance surgical outcomes.
Author Information
James E. Feng, MD; Afshin A. Anoushiravani, MD; Nima Eftekhary, MD; Jonathan Vigdorchik, MD; and Ran Schwarzkopf, MD, MSc, are from NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York.
The authors have no disclosures relevant to this article.
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