Journal articles on the topic 'Personalized pattern-Making'

Along with the continuous development and improvement of the garment pattern making theory and echnique, as well as the more wide application of computer technique, the garments intelligent renders making pattern more efficient. Due to the complex body measure variation, the intelligent of garment personalized custom which is regularly limited by various spects also needs to continuously explore. Howe-ver, the conventional garment pattern process that is making brand new pattern or triamming the pieces of the standard size designation pattern in accordance with the individual sizes. This study intends to discuss the breakthrough of traditional pattern mode. For example the shirts, based on a series of the garments’ size designation pattern, extract individual samples from the anthropometric database. The series size designation patterns are split into the collar, sleeves, body and other garment parts that may involve variety. According to the need, g-enerate individual measure of the sample, extract the existing silhouette of corresponding parts from the series size designation patterns and fit them. Ultimately cbtain the experimental method of personalized pattern.

Fashionable FMCG clothing brands have emerged in large numbers, and fast fashionable and personalized clothing is increasingly favored by young people. In this era of rapid renewal, clothing has obviously become a fast moving consumer good. China’s textile industry continues to develop, and the speed of development accelerates, coupled with the introduction and promotion of the use of Western textile technology, making the pattern design of Chinese textiles develop more quickly. The long-term disconnection between product pattern design and product production has led to the fact that the research on product pattern has been only on the plane, so there is an urgent need to improve the design level of product pattern and the market competitiveness of products through systematic research on product pattern. Newton’s iteration is an important research content of nonlinear theory, which is a hot spot in the field of scientific research at present. Newton’s iteration is a common method for finding the roots of nonlinear equations, which has at least second-order convergence speed, but requires the calculation of first-order derivative values. In this paper, a preliminary discussion on the design method of pattern design based on Newton’s iterative algorithm is conducted to explore a new way of personalized pattern design while using nonlinear graphs as pattern design materials. The experimental results show that the average value of EME of Newton’s iteration algorithm is 3.479 and 2.072 higher than that of AVG Filter and CB Filter, respectively, and the difference of pattern generation accuracy between CB Filter and AVG Filter is not much, so the accuracy of Newton’s iteration algorithm for pattern generation is better than that of CB Filter and AVG Filter. Therefore, it is proved that it is feasible to transform the special texture effect based on Newton’s iteration algorithm into fabric.

The paper presents the theoretical and algorithmic aspects for making a personalized recommender system (mobile service) designed for public route transport users. The main focus is on identifying and formalizing the concept of "user preferences", which is the basis of modern personalized recommender systems. Informal (verbal) and formal (mathematical) formulations of the corresponding problems of determining "user preferences" in a specific spatial-temporal context are presented: the preferred stops definition and the preferred "transport correspondence" definition. The first task can be represented as a well-known classification problem. Thus, it can be formulated and solved using well-known pattern recognition and machine learning methods. The second is reduced to the construction of dynamic graphs series. The experiments were conducted on data from the mobile application "Pribyvalka-63". The application is the tosamara.ru service part, currently used to inform Samara residents about the public transport movement.

Purpose – The purpose of this paper is to concentrate on the development of individualized prototype of apparel patterns for young females from 3D body scanning data. Design/methodology/approach – The authors presented a new pattern-making approach that is composed of three major steps: to establish the relationships between body features and corresponding elements in a prototype (e.g. curve or a point); to classify the relationship into grades that provide alternatives to fit a variety of bodies; and to assemble each individual element into a personalized prototype. Findings – The experiment demonstrated that this method could be used for customized prototype development from 3D body scanning in a relatively easy way. Research limitations/implications – Currently, the subjects of this study included only Chinese young females, and the regression models were just suitable for the similar body types though, the research method could be extended to other somatotypes and age groups. Social implications – This approach can be used in the field of made-to-measure, mass customization, and the quick response for apparel pattern making. The technology in this paper facilitates to generate an individualized pattern prototype from 3D body scanning data. Originality/value – Originated from the relationship between the features of a human body and the elements of a pattern prototype, the authors presented a new approach to develop an individualized pattern prototype by classifying the features into grades.

Nowadays, location based services (LBS) has become one of the most popular applications with the rapid development of mobile Internet technology. More and more research is focused on discovering the required services among massive information according to the personalized behavior. In this paper, a collaborative filtering (CF) recommendation algorithm is presented based on the Location-aware Hidden Markov Model (LHMM). This approach includes three main stages. First, it clusters users by making a pattern similarity calculation of their historical check-in data. Then, it establishes the location-aware transfer matrix so as to get the next most similar service. Furthermore, it integrates the generated LHMM, user's score and interest migration into the traditional CF algorithm so as to generate a final recommendation list. The LHMM-based CF algorithm mixes the geographic factors and personalized behavior and experimental results show that it outperforms the state-of-the-art algorithms on both precision and recall.

The rise of personalized medicine and its remarkable advancements have revealed new requirements for the availability of appropriate medical decision-making models. Computer science is an area that plays an essential role in the field of personalized medicine, where one of the goals is to provide algorithms and tools to extrapolate knowledge and improve the decision-support process. The minimum clinically important difference (MCID) is the smallest change in PROM scores that patients perceive as meaningful. Treatment that does not achieve the minimum level of improvement is considered inappropriate as well as a potential waste of resources. Using the MCID threshold to identify patients who fail to achieve the minimum change in PROM that results in a meaningful outcome may aid in pre-surgical shared decision-making. The decision tree algorithm is a method for extracting valuable information and providing further meaningful information to the domain expert that supports the decision-making. In the present study, different tools based on machine learning were developed. On the one hand, we compared three XGBoost models to predict the non-achievement of the MCID at six months post-operation in the SF-12 physical score. The prediction score threshold was set to 0.75 to provide three decision-making areas on the basis of the high confidence (HC) intervals; the minority class was re-balanced by weighting the positive class to penalize the loss function (XGBoost cost-sensitive), oversampling the minority class (XGBoost with SMOTE), and re-sampling the negative class (XGBoost with undersampling). On the other hand, we modeled the data through a decision tree (assessment tree), based on different complexity levels, to identify the hidden pattern and to provide a new way to understand possible relationships between the gathered features and the several outcomes. The results showed that all the proposed models were effective as binary classifiers, as they showed moderate predictive performance both regarding the minority or positive class (i.e., our targeted patients, those who will not benefit from surgery) and the negative class. The decision tree visualization can be exploited during the patient assessment status to better understand if those patients will benefit or not from the medical intervention. Both of these tools can come in handy for increasing knowledge about the patient’s psychophysical state and for creating an increasingly specialized assessment of the individual patient.

Personalization in the apparel industry shows importance and the potential for demand, but the existing personalization has unreasonable time cost, labor cost, and resource waste. To solve the problems of the waste of resources as well as both time and labor cost caused by manual pattern making in clothing personalization, a method of automatic garment pattern generation based on a parametric formula and the Python language was proposed. Based on the classification of common curves in patterns, three curve fitting algorithms based on different parameters were derived and combined with the Python language to achieve personalized generation of different patterns by classifying the parameters in the system into key parameters, secondary parameters, and variable parameters. Three different methods for verifying the accuracy of the garment patterns were proposed based on curve fitting similarity and three-dimensional virtual modeling, and the accuracy of the proposed system was verified. The results show that the accuracy and comfort of the patterns generated via the system were high. Meanwhile, the Python-language-based system fits well with the production system of enterprises, which can improve the rapid response capability of garment personalization, greatly save the time cost and labor cost of enterprises, reduce resource loss, and contribute to the sustainable development of the garment industry.

This paper focuses on a new method to classify and convert the lower-body features of young females into the rules of individualized elements that are necessary for pant pattern design. Approaches used to develop a customized apparel pattern and their advantages and disadvantages are discussed in the literature review. Subsequently, a new method to analyze lower-body features for the development of individualized pant patterns is presented. The main method involved is the classification of certain body features into grades that provided alternatives for different body shapes, and the use of elements that are needed for pattern-making but that are difficult to measure directly in a three-dimensional image to predict the girths, half-girths and the other key measurements of a body. Three sets of rules were derived from this method: (a) individualized rules on height to classify the height at a feature into different grades, which help to find the location of the feature based on the height of a body; (b) individualized rules on girth to sort the thickness/width ratio of different cross-sections into grades at different features, which predict the girth of a characteristic feature from the thickness and the width of a feature; and (c) individualized rules on the crotch to find the relationship between the length of the measuring line at the divided points and the thickness of a certain girth, which reveal the individuality of the crotch and benefit the development of an individualized pant pattern. The method presented has the potential to realize individuality in female pant design by converting lower-body features into grades and establishing relationships with personalized parameters. This method can reduce the complexity of customization in pattern design.

Recent years have seen the rise of user-generated contents (UGCs) in online social media. Diverse UGC sources and information overload are making it increasingly difficult to satisfy personalized information needs. To organize UGCs in a user-centered way, we should not only map them based on textual topics but also link them with users and even user communities. We propose a multi-dimensional framework to organize information by connecting UGCs, users, and user communities. First, we use a topic model to generate a topic hierarchy from UGCs. Second, an author-topic model is applied to learn user interests. Third, user communities are detected through a label propagation algorithm. Finally, a multi-dimensional information organization pattern is formulated based on similarities among the topic hierarchies of UGCs, user interests, and user communities. The results reveal that: 1) our proposed framework can organize information from multiple sources in a user-centered way; 2) hierarchical topic structures can provide comprehensive and in-depth topics for users; and, 3) user communities are efficient in helping people to connect with others who have similar interests.

Blood pressure (BP) follows a circadian variation, increasing during active hours, showing a small postprandial valley and a deeper decrease during sleep. Nighttime reduction of 10–20% relative to daytime BP is defined as a dipper pattern, and a reduction of less than 10%, as a non-dipper pattern. Despite this BP variability, hypertension’s diagnostic criteria and therapeutic objectives are usually based on BP average values. Indeed, studies have shown that chrono-pharmacological optimization significantly reduces long-term cardiovascular risk if a BP dipper pattern is maintained. Changes in the effect of antihypertensive medications can be explained by circadian variations in their pharmacokinetics (PK) and pharmacodynamics (PD). Nevertheless, BP circadian variation has been scarcely included in PK-PD models of antihypertensive medications to date. In this work, we developed PK-PD models that include circadian rhythm to find the optimal dosing time (Ta) of first-line antihypertensive medications for dipper and non-dipper patterns. The parameters of the PK-PD models were estimated using global optimization, and models were selected according to the lowest corrected Akaike information criterion value. Simultaneously, sensitivity and identifiability analysis were performed to determine the relevance of the parameters and establish those that can be estimated. Subsequently, Ta parameters were optimized to maximize the effect on BP average, BP peaks, and sleep-time dip. As a result, all selected models included at least one circadian PK component, and circadian parameters had the highest sensitivity. Furthermore, Ta with which BP>130/80 mmHg and a dip of 10–20% are achieved were proposed when possible. We show that the optimal Ta depends on the therapeutic objective, the medication, and the BP profile. Therefore, our results suggest making chrono-pharmacological recommendations in a personalized way.

Objective: The management of diabetes mellitus requires a precise interpretation of blood glucose (BG) data by patients and providers and is increasingly associated with a need for medical technologies that aid in achieving patient-specific outcomes while making the process convenient. This review aims to summarize the current landscape in diabetes management technology, focusing specifically on devices that assist with pattern management in patients with type 2 diabetes (T2DM) who are on multiple-dose insulin regimens. Data Sources: The authors searched MEDLINE to identify articles from 2007 to 2018 that evaluated technologies for BG pattern management and diabetes monitoring. Additional references were generated through review of identified literature citations. Article selection was based on mutual agreement for inclusion. Data Selection and Data Extraction: Relevant articles were defined as English-language articles, describing technologies that assist with diabetes management in insulin-injecting patients with T2DM. Articles that focused exclusively on type 1 diabetes were excluded. Data Synthesis: The literature search yielded 334 articles, of which 21 were included for synthesis. The current BG monitoring practices emphasize the benefit of the structured self-monitoring of BG approach. Several randomized controlled trials conclude that the available technology aids in comprehensive data collection and facilitates communication between patients and providers. Digitally enabled “smart” devices are valuable tools that may help improve outcomes while providing a flexible, personalized approach. Conclusions: Integration of digital technology with diabetes management allows for accurate collection and analysis of data. Emergence of digital tools promotes a comprehensive, precise, and objective approach to glucose monitoring and encourages patient-provider collaborations.

Patient prognosis is a critical consideration in the treatment decision-making process. Conventionally, patient outcome is related to tumor characteristics, the cancer spread, and the patients’ conditions. However, unexplained differences in survival time are often observed, even among patients with similar clinical and molecular tumor traits. This study investigated how inflammatory radiomic features can correlate with evidence-based biological analyses to provide translated value in assessing clinical outcomes in patients with NSCLC. We analyzed a group of 15 patients with stage I NSCLC who showed extremely different OS outcomes despite apparently harboring the same tumor characteristics. We thus analyzed the inflammatory levels in their tumor microenvironment (TME) either biologically or radiologically, focusing our attention on the NLRP3 cancer-dependent inflammasome pathway. We determined an NLRP3-dependent peritumoral inflammatory status correlated with the outcome of NSCLC patients, with markedly increased OS in those patients with a low rate of NLRP3 activation. We consistently extracted specific radiomic signatures that perfectly discriminated patients’ inflammatory levels and, therefore, their clinical outcomes. We developed and validated a radiomic model unleashing quantitative inflammatory features from CT images with an excellent performance to predict the evolution pattern of NSCLC tumors for a personalized and accelerated patient management in a non-invasive way.

Malignant melanoma is the most serious, life-threatening form of all dermatologic diseases, with a poor prognosis in the presence of metastases and advanced disease. Despite recent advances in targeted therapy and immunotherapy, there is still a critical need for a better understanding of the fundamental mechanisms behind melanoma progression and resistance onset. Recent advances in genome-wide methylation methods have revealed that aberrant changes in the pattern of DNA methylation play an important role in many aspects of cancer progression, including cell proliferation and migration, evasion of cell death, invasion, and metastasization. The purpose of the current review was to gather evidence regarding the usefulness of DNA methylation tracking in liquid biopsy as a potential biomarker in melanoma. We investigated the key genes and signal transduction pathways that have been found to be altered epigenetically in melanoma. We then highlighted the circulating tumor components present in blood, including circulating melanoma cells (CMC), circulating tumor DNA (ctDNA), and tumor-derived extracellular vesicles (EVs), as a valuable source for identifying relevant aberrations in DNA methylation. Finally, we focused on DNA methylation signatures as a marker for tracking response to therapy and resistance, thus facilitating personalized medicine and decision-making in the treatment of melanoma patients.

The incidence of papillary thyroid cancer (PTC) has increased in recent years. To improve the diagnostic management of PTC, we propose the use of microRNAs (miRNAs) as a biomarker. Our aim in this study was to evaluate the miRNA expression pattern in PTC using NanoString technology. We identified ten miRNAs deregulated in PTC compared with reference tissue: miR-146b-5p, miR-221-3p, miR-221-5p, miR-34-5p, miR-551b-3p, miR-152-3p, miR-15a-5p, miR-31-5p, and miR-7-5p (FDR < 0.05; |fold change (FC)| ≥ 1.5). The gene ontology (GO) analysis of differentially expressed miRNA (DEM) target genes identified the predominant involvement of epidermal growth factor receptor (EGFR), tyrosine kinase inhibitor resistance, and pathways in cancer in PTC. The highest area under the receiver operating characteristic (ROC) curve (AUC) for DEMs was found for miR-146-5p (AUC = 0.770) expression, indicating possible clinical applicability in PTC diagnosis. The combination of four miRNAs (miR-152-3p, miR-221-3p, miR-551b-3p, and miR-7-5p) showed an AUC of 0.841. Validation by real-time quantitative polymerase chain reactions (qRT-PCRs) confirmed our findings. The introduction of an miRNA diagnostic panel based on the results of our study may help to improve therapeutic decision making for questionable cases. The use of miRNAs as biomarkers of PTC may become an aspect of personalized medicine.

Chronic rhinosinusitis (CRS) with (CRSwNP) or without nasal polyps (CRSsNP) is a persistent, heterogeneous inflammatory condition affecting the upper respiratory tract. The present study aimed to improve the characterization of CRS endotypes based on the chemokine and cytokine expression pattern in the CRS tissues. Concentrations of chemokines and cytokines were measured in tissues from nasal biopsies obtained from 66 CRS patients and 25 control subjects using multiplexing or single analyte technologies. Cluster analysis based on the concentration of type-1 (MCP-3/CCL7, MIP-1 α/CCL3), type-2 (IL-5, MCP-3/CCL7, MIP-1 α/CCL3, TARC/CCL17, PARC/CCL18, IP-10/CXCL10, ECP), and type-3 (IL-22) chemokines and cytokines identified six CRS endotypes (clusters). Cluster 1 (type-3) and 2 (type-1) were associated with a low prevalence of nasal polyps, Cluster 3 (type-1, -2, -3) and Cluster 4 (type-2, -3, medium IL-22) with medium, and Cluster 5 (type-2, -3, high Il-22) and Cluster 6 (type-2) with high prevalence of nasal polyps. Asthma was highly prevalent in Cluster-6. Our findings add to the existing knowledge of CRS endotypes and may be useful for the clinical decision-making process. The advancement of biologics therapy for upper respiratory tract disorders rationalizes the personalized diagnostic approach to warrant a successful treatment and monitoring of CRS.

Abstract We know from human genetic studies that practically all aspects of biology are strongly influenced by the genetic background, as reflected in the advent of “personalized medicine.” Yet, with few exceptions, this is not taken into account when using laboratory populations as animal model systems for research in these fields. Laboratory strains of zebrafish (Danio rerio) are widely used for research in vertebrate developmental biology, behavior, and physiology, for modeling diseases, and for testing pharmaceutic compounds in vivo. However, all of these strains are derived from artificial bottleneck events and therefore are likely to represent only a fraction of the genetic diversity present within the species. Here, we use restriction site-associated DNA sequencing to genetically characterize wild populations of zebrafish from India, Nepal, and Bangladesh, and to compare them to previously published data on four common laboratory strains. We measured nucleotide diversity, heterozygosity, and allele frequency spectra, and find that wild zebrafish are much more diverse than laboratory strains. Further, in wild zebrafish, there is a clear signal of GC-biased gene conversion that is missing in laboratory strains. We also find that zebrafish populations in Nepal and Bangladesh are most distinct from all other strains studied, making them an attractive subject for future studies of zebrafish population genetics and molecular ecology. Finally, isolates of the same strains kept in different laboratories show a pattern of ongoing differentiation into genetically distinct substrains. Together, our findings broaden the basis for future genetic, physiological, pharmaceutic, and evolutionary studies in Danio rerio.

651 Background: With recent improvements in survival of cancer patients and emphasis on high-value care at end-of-life, the management of cardiovascular disease in patients with cancer is increasingly important. To our knowledge, there is no current US data examining how the presence and extent of cancer influence cardiologists’ decision-making for common cardiovascular conditions. Methods: An anonymous online vignette-based survey of cardiologists was conducted at five US institutions investigating how the extent of gastrointestinal and thoracic malignancies (prior/localized, metastatic) would influence treatment recommendation for atrial fibrillation (AF), aortic stenosis (AS), unstable angina (UA) and obstructive coronary artery disease (CAD). Results: Thirty-three percent (86/259) of cardiologists completed the survey between September and November 2019. Participants were 67% male, 51% below age 40, and 58% had five or more years of clinical experience. Majority of cardiologists practiced at teaching hospitals (72%) and were non-interventional (63%). Cardiologists were more likely to recommend procedural interventions in patients with localized cancer than with metastatic disease: AF (LAAO: 20% vs 8%), AS (AVR: 83% vs 11%), UA (LHC: 70% vs 27%) and obstructive CAD (PCI: 81% vs 38%) (Table). In patients with metastatic cancer, most cardiologists sought an oncology (82%) or a palliative care (69%) consult. Conclusions: Cardiologists were less likely to recommend invasive cardiovascular therapies to patients with metastatic cancer. This preference pattern likely reflects the influence of comorbidities and quality of life expectation on cardiologists’ treatment recommendations but may also be related to the stigma of advanced cancer. Better communication between cardiologists and oncologists is necessary to a personalized care of patients with cancer and cardiovascular disease that would maximize treatment benefit with least morbidity.[Table: see text]

Triple negative breast cancer (TNBC) lacks well-defined molecular targets and is highly heterogenous, making treatment challenging. Using gene expression analysis, TNBC has been classified into four different subtypes: basal-like immune-activated (BLIA), basal-like immune-suppressed (BLIS), mesenchymal (MES), and luminal androgen receptor (LAR). However, there is currently no standardized method for classifying TNBC subtypes. We attempted to define a gene signature for each subtype, and to develop a classification method based on machine learning (ML) for TNBC subtyping. In these experiments, gene expression microarray data for TNBC patients were downloaded from the Gene Expression Omnibus database. Differentially expressed genes unique to 198 known TNBC cases were identified and selected as a training gene set to train in seven different classification models. We produced a training set consisting of 719 DEGs selected from uniquely expressed genes of all four subtypes. The highest average accuracy of classification of the BLIA, BLIS, MES, and LAR subtypes was achieved by the SVM algorithm (accuracy 95–98.8%; AUC 0.99–1.00). For model validation, we used 334 samples of unknown TNBC subtypes, of which 97 (29.04%), 73 (21.86%), 39 (11.68%) and 59 (17.66%) were predicted to be BLIA, BLIS, MES, and LAR, respectively. However, 66 TNBC samples (19.76%) could not be assigned to any subtype. These samples contained only three upregulated genes (EN1, PROM1, and CCL2). Each TNBC subtype had a unique gene expression pattern, which was confirmed by identification of DEGs and pathway analysis. These results indicated that our training gene set was suitable for development of classification models, and that the SVM algorithm could classify TNBC into four unique subtypes. Accurate and consistent classification of the TNBC subtypes is essential for personalized treatment and prognosis of TNBC.

Abstract Motivation Somatic mutations result from processes related to DNA replication or environmental/lifestyle exposures. Knowing the activity of mutational processes in a tumor can inform personalized therapies, early detection, and understanding of tumorigenesis. Computational methods have revealed 30 validated signatures of mutational processes active in human cancers, where each signature is a pattern of single base substitutions. However, half of these signatures have no known etiology, and some similar signatures have distinct etiologies, making patterns of mutation signature activity hard to interpret. Existing mutation signature detection methods do not consider tumor-level clinical/demographic (e.g. smoking history) or molecular features (e.g. inactivations to DNA damage repair genes). Results To begin to address these challenges, we present the Tumor Covariate Signature Model (TCSM), the first method to directly model the effect of observed tumor-level covariates on mutation signatures. To this end, our model uses methods from Bayesian topic modeling to change the prior distribution on signature exposure conditioned on a tumor’s observed covariates. We also introduce methods for imputing covariates in held-out data and for evaluating the statistical significance of signature-covariate associations. On simulated and real data, we find that TCSM outperforms both non-negative matrix factorization and topic modeling-based approaches, particularly in recovering the ground truth exposure to similar signatures. We then use TCSM to discover five mutation signatures in breast cancer and predict homologous recombination repair deficiency in held-out tumors. We also discover four signatures in a combined melanoma and lung cancer cohort—using cancer type as a covariate—and provide statistical evidence to support earlier claims that three lung cancers from The Cancer Genome Atlas are misdiagnosed metastatic melanomas. Availability and implementation TCSM is implemented in Python 3 and available at https://github.com/lrgr/tcsm, along with a data workflow for reproducing the experiments in the paper. Supplementary information Supplementary data are available at Bioinformatics online.

Patients with traumatic amputations of the lower limbs have a number of typical dysfunctions and complications. Optimal results of prosthetics are achieved when the quality of the stump formation corresponds to the capabilities of the prosthesis and an adequate rehabilitation program in terms of goals and objectives. At the same time, the rehabilitation program affects both the quality of the formation of the stump and the functional reserves of the body, which ultimately affects the choice of prosthesis joints. Aim. To clarify the approaches on making up physical rehabilitation programs, taking into account the prevention and correction of complications. Medical rehabilitation expert diagnostics is both the basis in compiling rehabilitation programs, allowing to achieve their personalized nature, and an assessment tool of rehabilitation measures effectiveness. Counseling is an important preparatory part of the rehabilitation program for prosthetics, the theoretical foundations for the prevention of complications for the disabled. Prosthesis manufacturing. When knowing prosthesis manufacturing stages, it is possible to create conditions for the most complete adaptation in the prosthesis-limb-organism system both in the short and long term periods. Preparation of a limb for prosthetics often one of the longest, occupying and significant sections of preparation for the restoration of static-dynamic function, associated with the largest number of complications; where the use of physical rehabilitation technologies allows the prevention and correction of such complications. Preparatory work in accordance with the general algorithm for conducting rehabilitation measures, taking into account the individual characteristics of the patient, the continuity and regularity of rehabilitation measures allows to achieve the greatest possible result. Teaching the use of the prosthesis. Starting from the sequential mastering of all the basic elements with the subsequent transition to performing complex coordinated movements with the help of the prosthesis and only then working out the walking options directly on the prosthesis, allows to master the correct technique from the outset. It means that training to master walking on a prosthesis can also be represented as a sequence, an algorithm of actions. Stepping away from the required sequence may lead to the appearance and consolidation of irrational patterns when walking, which in turn is fraught with a violation of the correct walking pattern, an increase in its energy intensity and pronounced difficulties in its correction in the future. Conclusion. The complication prevention in the implementation of prosthetics with the help of physical rehabilitation is based primarily on the observance of a clear algorithm of sequential actions in conjunction with an individualized selection of rehabilitation means.

The generalized arrival of Digital TV will lead to a significant increase in the amount of channels and programs available to end users, making it difficult to find interesting programs among a myriad of irrelevant contents. Thus, in this field, automatic content recommenders should receive special attention in the following years to improve assistance to users. Current approaches of content recommenders have significant well-known deficiencies that hamper their wide acceptance. In this paper, a new approach for automatic content recommendation is presented that considerably reduces those deficiencies. This approach, based on the so-called Semantic Web technologies, has been implemented in the AVATAR tool, a hybrid content recommender that makes extensive use of well-known standards, such as TV-Anytime and OWL. Our proposal has been evaluated experimentally with real users, showing significant increases in the recommendation accuracy with respect to other existing approaches.

Simulation of human intelligence process is made possible with the help of artificial intelligence. The learning, reasoning and self-correction properties are made possible in computer systems. Along with AI, other technologies are combined effectively in order to create remarkable applications. We apply the changing role of AI and its techniques in new educational paradigms to create a personalised teaching-learning environment. Features like recognition, pattern matching, decision making, reasoning, problem solving and so on are applied along with knowledge based system and supervised machine learning for a complete learning and assessment process.

Semantic trajectory analytics and personalised recommender systems that enhance user experience are modern research topics that are increasingly getting attention. Semantic trajectories can efficiently model human movement for further analysis and pattern recognition, while personalised recommender systems can adapt to constantly changing user needs and provide meaningful and optimised suggestions. This paper focuses on the investigation of open issues and challenges at the intersection of these two topics, emphasising semantic technologies and machine learning techniques. The goal of this paper is twofold: (a) to critically review related work on semantic trajectories and knowledge-based interactive recommender systems, and (b) to propose a high-level framework, by describing its requirements. The paper presents a system architecture design for the recognition of semantic trajectory patterns and for the inferencing of possible synthesis of visitor trajectories in cultural spaces, such as museums, making suggestions for new trajectories that optimise cultural experiences.

AbstractRecent image aesthetic assessment methods have achieved remarkable progress due to the emergence of deep convolutional neural networks (CNNs). However, these methods focus primarily on predicting generally perceived preference of an image, making them usually have limited practicability, since each user may have completely different preferences for the same image. To address this problem, this paper presents a novel approach for predicting personalized image aesthetics that fit an individual user’s personal taste. We achieve this in a coarse to fine manner, by joint regression and learning from pairwise rankings. Specifically, we first collect a small subset of personal images from a user and invite him/her to rank the preference of some randomly sampled image pairs. We then search for the K-nearest neighbors of the personal images within a large-scale dataset labeled with average human aesthetic scores, and use these images as well as the associated scores to train a generic aesthetic assessment model by CNN-based regression. Next, we fine-tune the generic model to accommodate the personal preference by training over the rankings with a pairwise hinge loss. Experiments demonstrate that our method can effectively learn personalized image aesthetic preferences, clearly outperforming state-of-the-art methods. Moreover, we show that the learned personalized image aesthetic benefits a wide variety of applications.

At the present time, consumers often disclose their privacy when using online platforms to receive personalized recommendation information and services, but they are also highly concerned whether their privacy is being violated. “Privacy paradox” is becoming a hot topic of research. What are the potential impacts of individual cognitive differences and situational cues on privacy decision-making? How to balance the internal causes of the “privacy paradox” so that consumers are more willing to accept personalized recommendation services based on users’ privacy data? Can the transparency of privacy rights ease user conflict perceptions and promote disclosure intentions? These questions are inconclusive. Therefore, the purpose of this our research was to explore consumer privacy paradoxical behaviors from a novel perspective of the characteristics of authorization cues, and to clarify the internal relationship between individual cognitive processing and privacy authorization cues. This study suggests that the big data platform, when collecting or using user information, should try to reduce the behaviors that induce users’ resistance. It also provides a reference for how to better achieve benign interaction in personalized recommendation between Internet companies and users. The event-related potential technique is adopted to explore the matching relationship between individual cognitive processing and privacy authorization cues and to analyze the internal neural mechanism of the personalized recommendation user in the authorization decision. The experiment simulated the privacy authorization situation, and adopted a 2 × 2 × 2 hybrid experimental design: authority sensitivity (high/low) * authorization transparency (with/without permission) * cognitive style (field dependent/field independent). The experimental results show that: (1) Authorization transparency, authority sensitivity and their interactions will affect the user’s privacy authorization behaviors, and the interaction of the two cues has a greater impact on the behavior than the role of a single cue; (2) The cognitive style will affect the individual’s attention resource allocation in the authorization scenario, which, limited by cognitive resources, will result in selective attention to contextual cues: Compared with the field-independent group with self-characterization as a reference, the field-dependent group induced a greater P2 amplitude; (3) When the two-cue valences in the authoritative scenario are inconsistent, the amplitude of the N2 component is greater than that when the valences are consistent, and the amplitude of the N2 induced by the field-dependent group is more affected by the scenario cue valence; (4) Regardless of whether it is a field-dependent group or a field-independent group, there is no salient difference in the amplitude of LPP components induced in each scenario. According to the results of this study, even if privacy authorization involves high risks, individuals tend to selectively seek supportive cues or avoid obtaining information that is inconsistent with their cognition. This research reveals the differences of neural mechanisms in users’ actual decision-making, provides the possibility for further exploration of the black box behind users’ attitudes and behaviors, and opens up new ideas for the study of the “privacy paradox.”

One of the most significant accomplishments of translational oncogenomics is a realistic promise of efficient diagnostic tests that would facilitate implementation of the concept of individualized cancer therapies. Recent discovery of the BMI1 pathway rule indicates that gene expression signatures (GESs) associated with the “stemness” state of a cell might be informative as molecular predictors of cancer therapy outcome. We illustrate a potential clinical utility of this concept using GESs derived from genomic analysis of embryonic stem cells (ESCs) during transition from self-renewing, pluripotent state to differentiated phenotypes. Signatures of multiple stemness pathways (signatures of BMI1, Nanog/Sox2/Oct4, EED, and Suz12 pathways; transposon exclusion zones and ESC pattern 3 signatures; signatures of Polycomb-bound and bivalent chromatin domain transcription factors) seem informative in stratification of cancer patients into low- and high-intensity treatment groups on the basis of prediction of the long-term therapy outcome. A stemness cancer therapy outcome predictor (CTOP) algorithm combining scores of nine stemness signatures outperforms individual signatures and demonstrates a superior prognostic accuracy in retrospective supervised analysis of large cohorts of breast, prostate, lung, and ovarian cancer patients. Our analysis suggests that stemness genomics law governs clinical behavior of human malignancies and defines epigenetic boundaries of therapy-resistant and -sensitive tumors within distinct stemness/differentiation programs. One of the main conclusions of our analysis is that near-term progress in practical implementation of the concept of personalized cancer therapies would depend on timely delivery to practicing physicians of relevant scientific information regarding the outcome of prospective trials validating prognostic performance of CTOP tests in a clinical setting.

Background: Several specific therapies for MDS are now available. Molecular genetics plays a key role, as some therapies target distinct mutations and others are particularly effective for molecularly defined subgroups (e.g. SF3B1). In parallel, broad mutation studies suggest a continuous progression from clonal cytopenia of undetermined significance (CCUS) to MDS. Since panel sequencing is available for routine laboratory workflows, we evaluated its potential for diagnosis of CCUS and extended the question to possible (future) therapeutic decisions. Aim: (1) Identify the frequency of clonality (mutations) in a real life MDS vs. cytopenia cohort; (2) subdivide CCUS with a low and high risk of developing MDS; (3) identify the subset of patients qualifying for personalized treatments Patients and Methods: We performed morphology and cytogenetic analysis according to current WHO gold standard algorithms in 576 patients (F:221, M:355; median age: 72 [17-94]) with cytopenia and clinical conditions requiring bone marrow biopsy to exclude or diagnose MDS. Individuals with other possible explanations (e.g. lymphoma, PNH) had been excluded upfront by combining morphology and flow cytometry. DNA was isolated from bone marrow; sequencing was performed on NovaSeq after NextFlex library preparation (Illumina, ILMN, San Diego, CA) and hybrid capture of a 41 gene panel (IDT Inc. Coralville, IA). Data was analyzed with Pisces and Pindel (for FLT3-ITD) (BaseSpace, ILMN) using a minimum sensitivity of 3%. Genetic variants were classified by combining databases and in silico predictions. Results: We found 499 mutations in 181/213 (85%) patients with diagnosis of MDS, and 259 mutations in 132/363 (36%) other cytopenic patients (p &lt;0.01). Cases with mutations are by definition CCUS and without mutation ICUS (idiopathic cytopenia of undetermined significance). CCUS and MDS patients were significantly older than ICUS (CCUS: 74, MDS: 75 vs. ICUS: 66 years, p &lt;0.02, each). MDS patients had significantly more mutations per case than CCUS (average: 2.8 vs. 2.0, p&lt;0.01). By contrast, the typical aging pattern (DNMT3A, TET2 and ASXL1 mutations [DTA] with VAF &lt;10%) as the only molecular genetic aberration was significantly more frequent in CCUS than in MDS with mutations: 25% vs. 4% (33/132 vs. 7/181; p&lt;0.01). The International Working Group for the Prognosis of MDS - IWG-PM - (Malcovati, et al. Blood 2020) suggested SF3B1 mutations to define the first subgroup of patients by molecular genetics. Using their criteria, 12% of our MDS (26/213) patients fall into this novel category of SF3B1-mutated MDS. Due to the high risk of developing MDS, the IWG-PM suggests to use the mutation as presumptive evidence of MDS even without definitive morphological features. In our CCUS cohort the same genetic SF3B1 constellation was significantly less frequent, however 5% of individuals (7/132, p=0.03) qualified for MDS diagnoses by molecular genetics. In addition, CCUS patients show other MDS typical mutations: e.g. 4% (5/132) had RUNX1 mutations and 30% (39/132) had splicing factor mutations other than SF3B1. Malcovati et. al. (Blood 2017) defined a "highly specific pattern" of mutations for patients with a 20% risk of developing a myeloid malignancy per year. This pattern was frequent in MDS (71%, 151/213), but was detected in 55% of CCUS (72/132), which corresponds to 20% of cytopenia patients without a definitive MDS diagnosis (72/363). Next, we subdivided the cohorts according to their potential treatment options (Figure 1). (A) SF3B1 mutations would suggest use of Luspatercept. (B) According to Bejar et al. (ASH 2015), 95/213 (45%) of our MDS and 37/132 (28%) of our CCUS have a high-risk genetic profile. Individuals with high-risk mutations could be considered for alloSCT depending on progression of disease or clinical settings. (C) A potential for targeted therapies (mutations in CSNK1A1, FLT3 [ITD, TKD], IDH1, IDH2, KRAS, NRAS) was found in 6% (12/213) of the remaining MDS and 3% (4/132) of the CCUS cohort. Conclusions: We suggest that molecular genetic markers should be recognized as presumptive evidence of MDS and allow the diagnoses to be based on three cornerstones: morphology, cytogenetics and molecular genetics. In two thirds of MDS and one third of CCUS patients mutations can be identified that allow personalized treatment based on respective molecular genetics even independent of other currently used diagnostic labels. Disclosures No relevant conflicts of interest to declare.

Genomic classifiers such as the Genomic Prostate Score (GPS) could help to personalize treatment for men with intermediate-risk prostate cancer (I-PCa). In this study, we aimed to evaluate the ability of the GPS to change therapeutic decision making in I-PCa. Only patients in the intermediate NCCN risk group with Gleason score 3 + 4 were considered. The primary objective was to assess the impact of the GPS on risk stratification: NCCN clinical and genomic risk versus NCCN clinical risk stratification alone. We also analyzed the predictive role of the GPS for locally advanced disease (≥pT3+) and the potential change in treatment strategy. Thirty patients were tested for their GPS between November 2018 and March 2020, with the median age being 70 (45–79). Twenty-three patients had a clinical T1 stage. Eighteen patients were classified as favorable intermediate risk (FIR) based on the NCCN criteria. The median GPS score was 39 (17–70). Among the 23 patients who underwent a radical prostatectomy, Gleason score 3 + 4 was found in 18 patients. There was a significant correlation between the GPS and the percentage of a Gleason grade 4 or higher pattern in the surgical sample: correlation coefficient r = 0.56; 95% CI = 0.2–0.8; p = 0.005. In this study, the GPS combined with NCCN clinical risk factors resulted in significant changes in risk group.

Purpose Several review articles have been published within the Artificial Intelligence (AI) literature that have explored a range of applications within the tourism and hospitality sectors. However, how efficiently the applied AI methods and algorithms have performed with respect to the type of applications and the multimodal sets of data domains have not yet been reviewed. Therefore, this paper aims to review and analyse the established AI methods in hospitality/tourism, ranging from data modelling for demand forecasting, tourism destination and behaviour pattern to enhanced customer service and experience. Design/methodology/approach The approach was to systematically review the relationship between AI methods and hospitality/tourism through a comprehensive literature review of papers published between 2010 and 2021. In total, 146 articles were identified and then critically analysed through content analysis into themes, including “AI methods” and “AI applications”. Findings The review discovered new knowledge in identifying AI methods concerning the settings and available multimodal data sets in hospitality and tourism. Moreover, AI applications fostering the tourism/hospitality industries were identified. It also proposes novel personalised AI modelling development for smart tourism platforms to precisely predict tourism choice behaviour patterns. Practical implications This review paper offers researchers and practitioners a broad understanding of the proper selection of AI methods that can potentially improve decision-making and decision-support in the tourism/hospitality industries. Originality/value This paper contributes to the tourism/hospitality literature with an interdisciplinary approach that reflects on theoretical/practical developments for data collection, data analysis and data modelling using AI-driven technology.

Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma and the most common indolent B-cell malignancy. The disease often presents in advanced stage and can often be observed before initiation of therapy. Although the incidence is only approximately 15,000 new cases per year, the prevalence is substantially higher owing to the favorable overall survival (OS) of most patients. The most impactful advance responsible for the improvement of OS in FL was the introduction of the anti-CD20 monoclonal antibody (mAb) rituximab over 20 years ago. Phase III trials demonstrate that rituximab improves the OS in FL when combined with chemotherapy. However, unlike aggressive B-cell lymphomas, advanced stage FL is generally incurable and often displays a pattern of progressively shorter remissions with subsequent lines of therapy. Hence, maintenance strategies have been developed to prolong remissions achieved with frontline therapy. The value of maintenance after frontline therapy has been most extensively studied with extended treatment of anti-CD20 mAb, but recent approaches include chemotherapy-free combinations and targeted therapies given for extended durations. Here, we review relevant data that provide rationale in support of maintenance therapy in FL as well as the risks and limitations of a “one-size-fits-all” approach. Importantly, we note the biologic and clinical heterogeneity across patients with FL that must be considered when making clinical decisions. Finally, we highlight ongoing research that explores response-adapted approaches based on the depth of response as defined by PET scans and assays for minimal residual disease (MRD) that aim to better personalize individual management strategies.

Background The International Consortium for Health Outcomes Measurement has published a set of patient-centered outcome measures for pregnancy and childbirth (PCB set), including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). To establish value-based pregnancy and childbirth care, the PCB set was implemented in the Netherlands, using the outcomes on the patient level for shared decision-making and on an aggregated level for quality improvement. Objective This study aims to report first outcomes, experiences, and practice insights of implementing the PCB set in clinical practice. Methods In total, 7 obstetric care networks across the Netherlands, each consisting of 1 or 2 hospitals and multiple community midwifery practices (ranging in number from 2 to 18), implemented the PROM and PREM domains of the PCB set as part of clinical routine. This observational study included all women participating in the clinical project. PROMs and PREMs were assessed with questionnaires at 5 time points: 2 during pregnancy and 3 post partum. Clinical threshold values (alerts) supported care professionals interpreting the answers, indicating possibly alarming outcomes per domain. Data collection took place from February 2020 to September 2021. Data analysis included missing (pattern) analysis, sum scores, alert rates, and sensitivity analysis. Results In total, 1923 questionnaires were collected across the 5 time points: 816 (42.43%) at T1 (first trimester), 793 (41.23%) at T2 (early third trimester), 125 (6.5%) at T3 (maternity week), 170 (8.84%) at T4 (6 weeks post partum), and 19 (1%) at T5 (6 months post partum). Of these, 84% (1615/1923) were filled out completely. Missing items per domain ranged from 0% to 13%, with the highest missing rates for depression, pain with intercourse, and experience with pain relief at birth. No notable missing patterns were found. For the PROM domains, relatively high alert rates were found both in pregnancy and post partum for incontinence (469/1798, 26.08%), pain with intercourse (229/1005, 22.79%), breastfeeding self-efficacy (175/765, 22.88%), and mother-child bonding (122/288, 42.36%). Regarding the PREM domains, the highest alert rates were found for birth experience (37/170, 21.76%), shared decision-making (101/982, 10.29%), and discussing pain relief ante partum (310/793, 39.09%). Some domains showed very little clinical variation; for example, role of the mother and satisfaction with care. Conclusions The PCB set is a useful tool to assess patient-reported outcomes and experiences that need to be addressed over the whole course of pregnancy and childbirth. Our results provide opportunities to improve and personalize perinatal care. Furthermore, we could propose several recommendations regarding methods and timeline of measurements based on our findings. This study supports the implementation of the PCB set in clinical practice, thereby advancing the transformation toward patient-centered, value-based health care for pregnancy and childbirth.

PurposeAn exact pattern prototype is a prerequisite for female girdle pattern-making. The purpose of this paper is to develop new ways to make girdle pattern prototypes based on 3D technology.Design/methodology/approachThis paper presented two novel methods for creating girdle pattern prototypes. The first one was the girdle's parametric foundation pattern developing method based on 3D geometric modeling. In this method, considering the different characteristics of a female's lower body shape, several models were created to define the relationship between the female's lower body shape and the pattern, such as a side-waist curvature model, an interior-posterior waist-warping model, a buttocks' parametric model and an abdomen parametric model. Then, parameters of drawing the prototype were abstracted to facilitate transforming the 3D geometric model into the 2D pattern. Another method was implemented by 3D virtual modeling and unwrapping. The whole process included surface division, surface reconstruction and surface unwrapping.FindingsThe prototypes created by these two methods were tested using the 3D virtual trying-on examination. Trial tests showed that the patterns can be dressed in the right positions on the virtual model with little pressure. This means that the proportions and shapes of the pattern are correct. The prototypes obtained through the methods proposed in this paper have good effects and high precision. Both methods can be used for making the girdle's foundation pattern.Originality/valueTwo pragmatic approaches of girdle's prototype building have been put forward. The parametric prototype designing method has changed the unconstrained state of free modeling. The pattern structure can be controlled by parameter constraints. In the other method, with 3D scanning and surface modeling technology, personalized girdle's pattern is generated, and the segmentation lines of the girdle can be designed flexibly according to the requirements. These findings also can be used in other tight garments' prototype making.

Abstract Background Predictive modeling with longitudinal electronic health record (EHR) data offers great promise for accelerating personalized medicine and better informs clinical decision-making. Recently, deep learning models have achieved state-of-the-art performance for many healthcare prediction tasks. However, deep models lack interpretability, which is integral to successful decision-making and can lead to better patient care. In this paper, we build upon the contextual decomposition (CD) method, an algorithm for producing importance scores from long short-term memory networks (LSTMs). We extend the method to bidirectional LSTMs (BiLSTMs) and use it in the context of predicting future clinical outcomes using patients’ EHR historical visits. Methods We use a real EHR dataset comprising 11071 patients, to evaluate and compare CD interpretations from LSTM and BiLSTM models. First, we train LSTM and BiLSTM models for the task of predicting which pre-school children with respiratory system-related complications will have asthma at school-age. After that, we conduct quantitative and qualitative analysis to evaluate the CD interpretations produced by the contextual decomposition of the trained models. In addition, we develop an interactive visualization to demonstrate the utility of CD scores in explaining predicted outcomes. Results Our experimental evaluation demonstrate that whenever a clear visit-level pattern exists, the models learn that pattern and the contextual decomposition can appropriately attribute the prediction to the correct pattern. In addition, the results confirm that the CD scores agree to a large extent with the importance scores generated using logistic regression coefficients. Our main insight was that rather than interpreting the attribution of individual visits to the predicted outcome, we could instead attribute a model’s prediction to a group of visits. Conclusion We presented a quantitative and qualitative evidence that CD interpretations can explain patient-specific predictions using CD attributions of individual visits or a group of visits.

Abstract The current World Health Organization classification integrates histological and molecular features of brain tumors. The aim of this study was to identify generalizable topological patterns with the potential to add an anatomical dimension to the classification of brain tumors. We applied non-negative matrix factorization as an unsupervised pattern discovery strategy to the fine-grained topographic tumor profiles of 936 patients with neuroepithelial tumors and brain metastases. From the anatomical features alone, this machine learning algorithm enabled the extraction of latent topological tumor patterns, termed meta-topologies. The optimal parts-based representation was automatically determined in 10,000 split-half iterations. We further characterized each meta-topology’s unique histopathologic profile and survival probability, thus linking important biological and clinical information to the underlying anatomical patterns. In neuroepithelial tumors, six meta-topologies were extracted, each detailing a transpallial pattern with distinct parenchymal and ventricular compositions. We identified one infratentorial, one allopallial, three neopallial (parieto-occipital, frontal, temporal) and one unisegmental meta-topology. Each meta-topology mapped to distinct histopathologic and molecular profiles. The unisegmental meta-topology showed the strongest anatomical-clinical link demonstrating a survival advantage in histologically identical tumors. Brain metastases separated to an infra- and supratentorial meta-topology with anatomical patterns highlighting their affinity to the cortico-subcortical boundary of arterial watershed areas. Using a novel data-driven approach, we identified generalizable topological patterns in both neuroepithelial tumors and brain metastases. Differences in the histopathologic profiles and prognosis of these anatomical tumor classes provide insights into the heterogeneity of tumor biology and might add to personalized clinical decision making.

Introduction: Chest pain is the chief complaint in ~10,000 visits/day in the primary care provider (PCP) office and results in approximately $5 billion/yr in testing costs. Better methods are needed to more accurately assess the CAD risk of patients (pts) in an office-based, non-invasive fashion and to optimize referrals to advanced non-invasive testing for further evaluation and care planning. Hypothesis: We hypothesized that gene expression score (GES) results would lead to a change in the PCP’s diagnostic evaluation of stable pts presenting in the ambulatory setting with symptoms suggestive of obstructive CAD. Methods: The IMPACT-PCP Trial was a multi-center, prospective study which enrolled 251 consecutive pts with no history of CAD seen by nine clinicians for evaluation of chest pain and related symptoms. All patients underwent GES testing: the clinician’s diagnostic strategy was evaluated before and after the GES result was known. The GES is a blood-based molecular diagnostic test with a 96% NPV for excluding the diagnosis of obstructive CAD (defined as at least one vessel with ≥50% coronary artery stenosis by quantitative coronary angiography or core-lab CT-angiography) in symptomatic patients. The primary outcome of interest was the decision change in the diagnostic testing pattern pre/post GES testing as measured by McNemar’s test and logistic regression modeling. Results: Characteristics of the 251 pts eligible for primary endpoint analysis included 140 (56%) women, mean age of 56.2 years (SD± 13.0), average BMI of 29.7 (SD± 6.7), and mean GES of 16 (SD± 10). Following GES, a decision change in treatment plan (e.g. MPI, CTA, and cardiac catheterization) was noted in 145 pts (58% observed vs 10% expected change, p<0.001). More patients had a decreased (n=93, 37%) versus increased (n=52, 21%) intensity of testing (p<0.001). In particular, among the 127 low GES pts (51% of study pts), 60% (76/127) had decreased testing and only 2% (3/127) had increased testing. Follow-up is ongoing, with 233 (93%) pts having completed 30-day follow-up. There has been one MACE event (stroke) reported. Conclusion: The GES was associated with a statistically significant and clinically relevant change in clinical decision making among pts evaluated for suspected symptomatic CAD. In conclusion, the addition of the GES showed clinical utility above and beyond conventional decision-making by optimizing the pt’s diagnostic evaluation, particularly around the reduction in the intensity of diagnostic testing among low GES patients.

Background and Objectives: Aneuploidy is one of the major concerns to cause genetic anomalies. This condition is mostly related to addition and/or deletion with respect to set(s) of chromosomes. Here, we report an analysis of 5740 referral cases during three consecutive years (2015 – 2018) from our Diagnostic Research Center, Ahmedabad for aneuploidy pattern. Methodologies: The patients were asked to fill the necessary forms and their blood (5ml) was drawn for chromosomal studies using the Karyotyping following International System for Human Cytogenetic Nomenclature (ISCN) manual. Results: The data revealed the numerical aberrations for only aneuploidy detected was (3.7%; 211/5740). In this report, constitutional (c) autosomal aneuploidy was 75% (158/211). The total mosaic cases were nine (9/211) comprising constitutive (2) and acquired (7) aneuploidy cases. In autosomal aneuploidy, cT21 was higher (96%; 152/158) than others (4%; 6/158) comparatively. Among cT21 (152), males (76%; 115/152) were more affected than females (24%; 37/152). These statistical data also revealed that acquired chromosomal aneuploidy (leukemia) possessed (25%; 53/211); with more mosaic cases (7/211). Conclusion: Couples with such conditions are eligible for genetic tests and counseling as well as new strategies are urgently to be undertaken by governmental organizations (GOs) and non-governmental organizations (NGOs) for affected families with better personalized and informed decision making. The significance of these data is thus discussed in relation to genetic disorders caused by constitutional and acquired aneuploidy of leukemic blood in this report.

AbstractA decision-making system is one of the most important tools in data mining. The data mining field has become a forum where it is necessary to utilize users' interactions, decision-making processes and overall experience. Nowadays, e-learning is indeed a progressive method to provide online education in long-lasting terms, contrasting to the customary head-to-head process of educating with culture. Through e-learning, an ever-increasing number of learners have profited from different programs. Notwithstanding, the highly assorted variety of the students on the internet presents new difficulties to the conservative one-estimate fit-all learning systems, in which a solitary arrangement of learning assets is specified to the learners. The problems and limitations in well-known recommender systems are much variations in the expected absolute error, consuming more query processing time, and providing less accuracy in the final recommendation. The main objectives of this research are the design and analysis of a new transductive support vector machine-based hybrid personalized hybrid recommender for the machine learning public data sets. The learning experience has been achieved through the habits of the learners. This research designs some of the new strategies that are experimented with to improve the performance of a hybrid recommender. The modified one-source denoising approach is designed to preprocess the learner dataset. The modified anarchic society optimization strategy is designed to improve the performance measurements. The enhanced and generalized sequential pattern strategy is proposed to mine the sequential pattern of learners. The enhanced transductive support vector machine is developed to evaluate the extracted habits and interests. These new strategies analyze the confidential rate of learners and provide the best recommendation to the learners. The proposed generalized model is simulated on public datasets for machine learning such as movies, music, books, food, merchandise, healthcare, dating, scholarly paper, and open university learning recommendation. The experimental analysis concludes that the enhanced clustering strategy discovers clusters that are based on random size. The proposed recommendation strategies achieve better significant performance over the methods in terms of expected absolute error, accuracy, ranking score, recall, and precision measurements. The accuracy of the proposed datasets lies between 82 and 98%. The MAE metric lies between 5 and 19.2% for the simulated public datasets. The simulation results prove the proposed generalized recommender has a great strength to improve the quality and performance.

Ayurveda is science of life. Prevention and cure of disease is the aim of Ayurveda. Prakriti is one of the major Ayurvedic principles derived from the Veda, Purana, Upanishad, and Darshana. Prakriti in Ayurveda refers to an individual’s inherent nature; an inborn inclination that governs consciousness and activity. Prakriti is supposed to be fixed in every person. It is influenced by the status of Tridosha, at the time of union of ovum and sperm. Also, an individual's Prakriti is determined based on the predominance of any single or a combination of two or three Dosha. Every individual, like genetic coding, has a different combination and is thus a distinct entity. In Ayurvedic texts different Acharyas have described different features of Doshaj, Manasa, Bhautika & Jatyadi Prakriti. For fulfilling the aim of Ayurveda and alleviating disorders in diseased states, knowledge of an individual's constitution and status of Dosha is required, and with this knowledge, we can prevent and cure disease stages by managing the diet, physical activities, and psychological conditions of the individual. Prakriti also determine an individual's reaction to environmental circumstances, lifestyle choices, medications, and illness susceptibility, making it one of the earliest known concepts in preventive and personalized or genomic medicine. To understand the pattern of susceptibility of an individual to different diseases, selection of drugs, their dose, drug reaction to the body, disease prognosis, course, and preventive measures, Prakriti analysis is performed first, followed by Vikriti analysis. Hence, Prakriti emphasizes uniqueness and plays a significant role in disease prevention and cure, as well as maintaining a healthy body throughout one's life.

AbstractIn personalised decision making, evidence is required to determine whether an action (treatment) is suitable for an individual. Such evidence can be obtained by modelling treatment effect heterogeneity in subgroups. The existing interpretable modelling methods take a top-down approach to search for subgroups with heterogeneous treatment effects and they may miss the most specific and relevant context for an individual. In this paper, we design a Treatment effect pattern (TEP) to represent treatment effect heterogeneity in data. To achieve an interpretable presentation of TEPs, we use a local causal structure around the outcome to explicitly show how those important variables are used in modelling. We also derive a formula for unbiasedly estimating the Conditional Average Causal Effect (CATE) using the local structure in our problem setting. In the discovery process, we aim at minimising heterogeneity within each subgroup represented by a pattern. We propose a bottom-up search algorithm to discover the most specific patterns fitting individual circumstances the best for personalised decision making. Experiments show that the proposed method models treatment effect heterogeneity better than three other existing tree based methods in synthetic and real world data sets.

Abstract Background We assessed predictive factors of patients with fractures of the lower extremities caused by trauma. We examined which factors are associated with an increased risk of failure. Furthermore, the predictive factors were set into context with other long-term outcomes, concrete pain and physical functioning. Methods We performed a prospective cohort study at a single level I trauma center. We enrolled patients with traumatic fractures of the lower extremities treated with internal fixation from April 2017 to July 2018. We evaluated the following predictive factors: age, gender, diabetes, smoking status, obesity, open fractures and peripheral arterial diseases. The primary outcome was time to failure (nonunion, implant failure or reposition). Secondary outcomes were pain and physical functioning measured 6 months after initial surgery. For the analysis of the primary outcome, we used a stratified (according fracture location) Cox proportional hazard regression model. Results We included 204 patients. Overall, we observed failure in 33 patients (16.2 %). Most of the failures occurred within the first 3 months. Obesity and open fractures were associated with an increased risk of failure and decreased physical functioning. None of the predictors showed an association with pain. Age, female gender and smoking of more than ≥ 10 package years increased failure risk numerically but statistical uncertainty was high. Conclusions We found that obesity and open fractures were strongly associated with an increased risk of failure. These predictors seem promising candidates to be included in a risk prediction model and can be considered as a good start for clinical decision making across different types of fractures at the lower limbs. However, large heterogeneity regarding the other analyzed predictors suggests that “simple” models might not be adequate for a precise personalized risk estimation and that computer-based models incorporating a variety of detailed information (e.g. pattern of injury, x-ray and clinical data) and their interrelation may be required to significantly increase prediction precision. Trial registration NCT03091114.

Abstract Background Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Methods Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Results Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Conclusions Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success. Graphical abstract

Abstract Objectives To develop a cost-effective program for safe weight loss and sustainable maintenance for overweight adults with associated comorbidities through dietary modifications. Methods The approach of Individualized Diet Improvement Program (iDip) was to build knowledge of participants to enable personalized selection of food items for weight loss and maintenance with an emphasis on increasing protein and fiber intake and reducing calories. Fourteen adults with BMI ≥ 27 kg/m2 and associated comorbidities were recruited. The study comprised of 22 diet improvement education sessions over 12 months with follow-up for 6 months. Daily self-weighing was required via Wi-Fi scale. Food Frequency Questionnaire (FFQ) data was collected at baseline and at 12 months. Feedback was provided for 24-hour records in the form of a protein-fiber (PF) plot, in which a target weight loss (protein: 7–11 g/100 kcal, fiber: 1.8–3.2 g/100 kcal) and maintenance (protein: 4–8 g/100 kcal, fiber: 1.4–2.8 g/100 kcal) box were plotted for easy target visualization. Results Out of 14 participants, 12 (86%) completed all 22 diet improvement sessions and most of them weighed daily. All completers found the program beneficial. Mean weight loss at 6 months and 12 months was −6.1 kg ± 1.2 and −4.8 kg ± 1.4, respectively. Four participants did not lose weight but no significant weight gain from baseline was observed. Of these 4, 1 participant showed rebound weight gain (−14.5 kg at 6 months and + 0.7 kg at 12 months). Eight participants achieved weight loss with maintenance: mean weight loss at 6 months and at 12 months was −6.6 kg ± 1.1 and −7.8 kg ± 0.8, respectively. Although mean fiber intake showed no change from baseline (maintained at 1.3 g/100 kcal), overall PF plot dietary pattern moved toward the target weight loss box as the program continued. Mean protein intake at 6 months increased to 5.4 g/100 kcal ± 0.3 from 4.1 g/100 kcal ± 0.3 at baseline. Conclusions The majority (67%) of participants successfully lost weight and maintained losses for 12 months without strict diet instructions, showing the feasibility of the informed decision-making approach. Further studies will be required to improve weight loss rates and develop an approach to no-responders. Funding Sources USDA NIFA; NIBIB NIH (CA).

Background: Weight loss, consumption of a Dietary Approaches to Stop Hypertension (DASH) dietary pattern, reduced sodium intake, and increased physical activity have been shown to lower systolic blood pressure (SBP). Use of website or smartphone-based tools could be potentially scalable solutions to improve lifestyle behaviors and lower SBP, but little data exists to support their use in clinical practice. Methods: In an ongoing single-center, 2-arm, randomized controlled trial, we compare the efficacy of a dietitian-guided approach vs. a self-guided approach in lowering 24-hour SBP in overweight/obese patients with 24-hour SBP 120-160 mmHg on 0-1 BP medication. As part of standard of care, participants with outpatient SBP ≥ 130 mmHg are identified using Geisinger electronic health record data and through Geisinger Health Plan’s health and wellness program and invited to complete 24-hour ambulatory BP monitoring (ABPM). Qualifying participants are then invited to a research visit to sign informed consent and for data collection, including a web-based food frequency questionnaire (Viocare®), which provides personalized recommendations to improve dietary quality. After a 2-week run-in period in which participants must regularly log data into www.bmiq.com, a comprehensive weight management program, and a smartphone app (Lose It!), participants are randomized 1:1 to a self-guided arm or a dietitian-led arm. All participants are instructed to use the website and app, and the dietitian-led arm additionally receives weekly telephone calls from registered dietitian nutritionists, trained in motivational interviewing. The primary outcome is 3-month change in 24-hour SBP. Other outcomes include changes in other ABPM measures, total healthy eating index-2015 (HEI) score, weight, waist circumference, metabolic equivalent of task-minutes per week (International Physical Activity Questionnaire short form), and study satisfaction. Results: Out of 210 patients who have thus far completed ABPM, 128 were eligible for the trial, 85 consented for the trial, and 78 were randomized after completing the run-in period. In a preplanned interim analysis of the first 34 randomized patients, 28 (82%) completed the 3-month study visit. Mean (SD) changes from baseline to 3 months were: -8.0 mmHg (9.9) for 24-hour SBP, -5.4 kg (4.5) for weight, -6.1 cm (7.4) for waist circumference, and 11.2 units (12.0) for HEI score. Conclusions: Confirmation of elevated BP using ABPM may provide an opportunity to engage patients in making lifestyle modifications, as more than 60% of eligible patients after 24-hour ABPM screening were successfully randomized into the trial. Completion of the study is expected by the end of 2020 and will determine the efficacy of a self-directed vs. dietitian-led approach to lower 24-hour SBP using web-based tools.

Background: Decision-making in epilepsy surgery is strongly connected to the interpretation of the intracranial EEG (iEEG). Although deep learning approaches have demonstrated efficiency in processing extracranial EEG, few studies have addressed iEEG seizure detection, in part due to the small number of seizures per patient typically available from intracranial investigations. This study aims to evaluate the efficiency of deep learning methodology in detecting iEEG seizures using a large dataset of ictal patterns collected from epilepsy patients implanted with a responsive neurostimulation system (RNS).Methods: Five thousand two hundred and twenty-six ictal events were collected from 22 patients implanted with RNS. A convolutional neural network (CNN) architecture was created to provide personalized seizure annotations for each patient. Accuracy of seizure identification was tested in two scenarios: patients with seizures occurring following a period of chronic recording (scenario 1) and patients with seizures occurring immediately following implantation (scenario 2). The accuracy of the CNN in identifying RNS-recorded iEEG ictal patterns was evaluated against human neurophysiology expertise. Statistical performance was assessed via the area-under-precision-recall curve (AUPRC).Results: In scenario 1, the CNN achieved a maximum mean binary classification AUPRC of 0.84 ± 0.19 (95%CI, 0.72–0.93) and mean regression accuracy of 6.3 ± 1.0 s (95%CI, 4.3–8.5 s) at 30 seed samples. In scenario 2, maximum mean AUPRC was 0.80 ± 0.19 (95%CI, 0.68–0.91) and mean regression accuracy was 6.3 ± 0.9 s (95%CI, 4.8–8.3 s) at 20 seed samples. We obtained near-maximum accuracies at seed size of 10 in both scenarios. CNN classification failures can be explained by ictal electro-decrements, brief seizures, single-channel ictal patterns, highly concentrated interictal activity, changes in the sleep-wake cycle, and progressive modulation of electrographic ictal features.Conclusions: We developed a deep learning neural network that performs personalized detection of RNS-derived ictal patterns with expert-level accuracy. These results suggest the potential for automated techniques to significantly improve the management of closed-loop brain stimulation, including during the initial period of recording when the device is otherwise naïve to a given patient's seizures.

Abstract Study question Do exosomes from seminal plasma have a role in male fertility? Summary answer Exosomes isolated from seminal plasma have a pivotal role during spermatogenesis and sperm maturation and may represent eligible biomarkers for male fertility/infertility. What is known already During their journey along the male reproductive tract, exosomes contained in seminal fluid are involved in the transfer of several molecules to the maturing sperm. Exosomes are extracellular vesicles (EVs) released by all the cells; they carry a cargo of nucleic acids, proteins and lipids. In the male genital tract, they are released at various levels and their composition differs between men of proven fertility and infertile male patients. Recent studies reported the proteomic profile of exosomes, revealing the presence of several proteins with a well know role in sperm maturation and fertilizing ability acquiring. Study design, size, duration This prospective study consisted of 36 Caucasian men; according to seminal parameters (WHO 2010) they were divided in normozoospermic (N; n = 12), oligoasthenoteratozoospermic (OAT: n = 12) and azoospermic (A; n = 12). Semen samples were collected between October 2020 and January 2021 at the Assisted Reproductive Unit, Siena University Hospital (Italy) after institutional ethical approval and signed written consent from all the participants. Participants/materials, setting, methods Ejaculated sperm were analyzed according to WHO–2010 criteria and divided into the three groups: N, OAT and A. Exosomes were isolated by an in-house modified ExoGAG®-polymer precipitation-based protocol and characterized for size and ultrastructure by Nanoparticle tracking analysis (NTA) and transmission electron microscopy (TEM). The exosomal proteins were extracted and analyzed by 2D-electrophoresis and the identified profiles were examined by applying bioinformatic tools. The expression of selected genes was evaluated by digital droplets PCR (ddPCR). Main results and the role of chance The present work is readily providing an improvement of the standard ExoGAG® protocol and underlines its advantages over more conventional EVs isolation protocols used to date for recovery from seminal fluid: the number of recovered EVs and their size were finely included in the range of exosomes. This isolation protocol provides samples suitable for proteomic analyses, representing the first 2D-electrophoresis reference map of exosome-pay loaded proteins in N respect to OAT/A groups and providing an innovative and comprehensive functional overview of its proteins. Moreover, the STRING protein-protein interaction analysis revealed the deregulation of specific pathways (e.g. signaling proteins, chromatin packaging and/or remodeling, protein folding and apoptosis) in A and OAT in comparison with N group. Gene expression by ddPCR analysis highlighted that most of the analyzed genes are modulated in according to seminal parameters, in particular: GAPDHS (Glyceraldehyde–3-Phosphate Dehydrogenase, Spermatogenic); SPAM1 (Sperm Adhesion Molecule–1) encoding a members of hyaluronidase family; ADAM2 (ADAM Metallopeptidase Domain–2) that plays an important role in sperm-egg interactions; CRISP1,2,3 (Cysteine Rich Secretory Protein 1,2,3) expressed in the epididymis and secreted into the epididymal lumen; CLGN (Calmegin) encoding a testis-specific chaperone protein and PGK2 (Phosphoglycerate Kinase–2) expressed in the later stages of spermatogenesis. Limitations, reasons for caution This study represents a preliminary experiment. We suggest further comparative studies in larger study cohorts. Wider implications of the findings: This pilot study, demonstrating the unique proteomic and transcriptomic pattern of exosomes in N/OAT/A groups, supports the importance of exosomes in sperm production and maturation. This methodological set-up is expected to open new ways for advancement in the use of exosomes as fertility biomarkers, making possible personalized approaches in ART. Trial registration number Not applicable

AbstractAortic dissection (AD) is one of the fatal and complex conditions. Since there is a lack of a specific treatment guideline for type-B AD, a better understanding of patient-specific hemodynamics and therapy outcomes can potentially control the progression of the disease and aid in the clinical decision-making process. In this work, a patient-specific geometry of type-B AD is reconstructed from computed tomography images, and a numerical simulation using personalised computational fluid dynamics (CFD) with three-element Windkessel model boundary condition at each outlet is implemented. According to the physiological response of beta-blockers to the reduction of left ventricular contractions, three case studies with different heart rates are created. Several hemodynamic features, including time-averaged wall shear stress (TAWSS), highly oscillatory, low magnitude shear (HOLMES), and flow pattern are investigated and compared between each case. Results show that decreasing TAWSS, which is caused by the reduction of the velocity gradient, prevents vessel wall at entry tear from rupture. Additionally, with the increase in HOLMES value at distal false lumen, calcification and plaque formation in the moderate and regular-heart rate cases are successfully controlled. This work demonstrates how CFD methods with non-invasive hemodynamic metrics can be developed to predict the hemodynamic changes before medication or other invasive operations. These consequences can be a powerful framework for clinicians and surgical communities to improve their diagnostic and pre-procedural planning.

Abstract Purpose Supporting the surgeon during surgery is one of the main goals of intelligent ORs. The OR-Pad project aims to optimize the information flow within the perioperative area. A shared information space should enable appropriate preparation and provision of relevant information at any time before, during, and after surgery. Methods Based on previous work on an interaction concept and system architecture for the sterile OR-Pad system, we designed a user interface for mobile and intraoperative (stationary) use, focusing on the most important functionalities like clear information provision to reduce information overload. The concepts were transferred into a high-fidelity prototype for demonstration purposes. The prototype was evaluated from different perspectives, including a usability study. Results The prototype’s central element is a timeline displaying all available case information chronologically, like radiological images, labor findings, or notes. This information space can be adapted for individual purposes (e.g., highlighting a tumor, filtering for own material). With the mobile and intraoperative mode of the system, relevant information can be added, preselected, viewed, and extended during the perioperative process. Overall, the evaluation showed good results and confirmed the vision of the information system. Conclusion The high-fidelity prototype of the information system OR-Pad focuses on supporting the surgeon via a timeline making all available case information accessible before, during, and after surgery. The information space can be personalized to enable targeted support. Further development is reasonable to optimize the approach and address missing or insufficient aspects, like the holding arm and sterility concept or new desired features.

“Language is inseparable from the world that provokes it”-- Don DeLillo, “In the Ruins of the Future”The attacks of 9/11 generated a public discourse of suspicion, with Osama bin Laden occupying the role of the quintessential “most wanted” for nearly a decade, before being captured and killed in May 2011. In the novel, Falling Man (DeLillo), set shortly after the attacks of September 11, Justin, the protagonist’s son, and his friends, the two Siblings, spend much of their time at the window of the Siblings’ New York apartment, “searching the skies for Bill Lawton” (74). Mishearing bin Laden’s name on the news, Robert, the younger of the Siblings, has “never adjusted his original sense of what he was hearing” (73), and so the “myth of Bill Lawton” (74) is created. In this paper, I draw on postclassical, cognitive narratology to “defamiliarise” processes undertaken by both narrator and reader (Palmer 28) in order to explore how narrative elements impact on readers’ and characters’ perceptions of the terrorist. My focus on select episodes within the novel “pursue[s] the author’s means of controlling his reader” (Booth i), and I refer to a generic reader to identify a certain intuitive reaction to the text. Assuming that “the written text imposes certain limits on its unwritten implications” (Iser 281), I trace a path from the uttered or printed word, through the reading act, to the process of meaning-making. I demonstrate how renaming the terrorist, and other language games, challenge the notion that terror can be synonymous with a locatable, destructible source by activating a suspicion towards the text in particular, and towards language in general.Falling Man tells the story of Keith who, after surviving the attacks on the World Trade Centre, shows up injured and disoriented at the apartment of his estranged wife, Lianne, and their son, Justin. The narrative, set at different periods between the day of the attacks and three years later, focuses on Keith’s and Lianne’s lives as they attempt to deal, in their own ways, with the trauma of the attacks and with the unexpected reunion of their small family. Keith disappears into games of poker and has a brief relationship with another survivor, while Lianne searches for answers in the writings of Alzheimer sufferers, in places of worship, and in conversations with her mother, Nina, and her mother’s partner, Martin, a German art-dealer with a questionable past. Each of the novel’s three parts also contains a short narrative from the perspective of Hammad, a fictional terrorist, starting with his early days in a European cell under the leadership of the real terrorist, Mohamed Atta, through the group’s activities in Florida, to his final moments aboard the plane that crashes into the World Trade Centre. DeLillo’s work is noted for treating language as central to society and culture (Weinstein). In this personalised narrative of post-9/11, DeLillo’s choices reflect his “refusal to reproduce the mass media’s representations of 9/11 the reader is used to” (Grossinger 85). This refusal is manifest not so much in an absence of well-known, mediated images or concepts, but in the reshaping and re-presenting of these images so that they appear unexpected, new, and personal (Apitzch). A notable example of such re-presentation is the Falling Man of the title, who is introduced, surprisingly, not as the man depicted in the famous photograph by Richard Drew (Leps), but a performance artist who uses the name Falling Man when staging his falls from various New York buildings. Not until the final two sentences of the novel does DeLillo fully admit the image into the narrative, and even then only as Keith’s private vision from the Tower: “Then he saw a shirt come down out of the sky. He walked and saw it fall, arms waving like nothing in this life” (246). The bin Laden/Bill Lawton substitution shows a similar rejection of recycled concepts and enables a renewed perspective towards the idea of bin Laden. Bill Lawton is first introduced as an anonymous “man” (17), later to be named Bill Lawton (73), and later still to be revealed as bin Laden mispronounced (73). The reader first learns of Bill Lawton in a conversation between Lianne and the Siblings’ mother, Isabel, who is worried about the children’s preoccupation at the window:“It has something to do with this man.”“What man?”“This name. You’ve heard it.”“This name,” Lianne said.“Isn’t this the name they sort of mumble back and forth? My kids totally don’t want to discuss the matter. Katie enforces the thing. She basically inspires fear in her brother. I thought maybe you would know something.”“I don’t think so.”“Like Justin says nothing about any of this?”“No. What man?”“What man? Exactly,” Isabel said. (17)If “the piling up of data [...] fulfils a function in the construction of an image” (Bal 85), a delayed unravelling of the bin Laden identity distorts this data-piling so that by the time the reader learns of the Bill Lawton/bin Laden link, an image of a man is already established as separate from, and potentially exclusive of, his historical identity. The segment beginning immediately after Isabel’s comment, “What man? Exactly” (17), refers to another, unidentified man with the pronoun “he” (18), as if to further sway the reader’s attention from the subject of that man’s identity. Fludernik notes that “language games” are a key feature of the postmodern text (Towards 221), adding that “techniques of linguistic emasculation serve implicitly to question a simple and naive view of the representational potential of language” (225). I propose that, in Falling Man, bin Laden is emasculated by the Bill Lawton misnomer, and is thereby conceptualised as two entities, one historical and one fictional. The name-switch activates what psychologists refer to as a “dual-process,” conscious and unconscious, that forms the reader’s experience of the narrative (Gerrig 37), creating a cognitive dissonance between the two. Much like Wittgenstein’s duck-rabbit drawing, bin Laden and Bill Lawton exist as two separate entities, occupying the same space of the idea of bin Laden, but demanding to be viewed singularly for the process of recognition to take place. Such distortion of a well-known figure conveys the sense that, in this novel, “all identities are either confused [...] or double [...] or merging [...] or failing” (Kauffman 371), or, occasionally, doing all these things simultaneously.A similar cognitive process is triggered by the introduction of aliases for all three characters that head each of the novel’s three parts. Ernst Hechinger is revealed as Martin Ridnour’s former, ‘terrorist’ identity (DeLillo, Falling 86), and performance artist David Janiak (180) as the Falling Man’s everyday name. But the bin Laden/Bill Lawton switch offers an overt juxtaposition of the historical with the fictional or, as Žižek would have it, “the Raw real” with the “virtual” (387), and allows the mutated bin Laden/Bill Lawton figure to shift, in the mind of the reader, between the two worlds, as well as form a new, blended entity.At this point, it is important to notice that two, interconnected, forms of suspicion exist in the novel. The first is invoked in the story-level towards various terrorist-characters such as Bill Lawton, Hammad, and Martin. The second form is activated when various elements within the narrative prompt the reader to treat the text itself as suspicious, triggering in the reader a cognitive reaction that mirrors that of the narrated character. One example is the “halting process” (Leps) that is forced on the reader when attempting to manoeuvre through the narrative’s anachronical arrangement that mirrors Keith’s mental perception of time and memory. Another such narrative device is the use of “unheralded pronouns” (Gerrig 50), when ‘he’ or ‘she’ is used ambiguously, often at the beginning of a chapter or segment. The use of pronouns in narrative must adhere to strict grammatical rules (Fludernik, Introduction) and when these rules are ignored, the reading pattern is affected. First, the reader of Falling Man is immersed within an element in the story, then becomes puzzled about the identity of a character, and finally re-reads the passage to gain clarity. The reader, after a while, distances somewhat from the text, scanning for alternative possibilities and approaching interpretation with a tentative sense of doubt.The conversation between the two mothers, the Bill Lawton/bin Laden split, and the use of unheralded pronouns also destabilises the relationship between person and name, and appears to create a world in which “personality has disintegrated into a mere semiotic mark” (Versluys 21). Keith’s obsession with correcting the spelling of his surname, Neudecker, “because it wasn’t him, with the name misspelled” (DeLillo, Falling 31), Lianne’s fondness of the philosopher Kierkegaard, “right down to the spelling of his name. The hard Scandian k’s and lovely doubled a” (118), her consideration of “Marko [...] with a k, whatever that might signify” (119), and Rumsey, who is told that “everything in his life would be different [...] if one letter in his name was different” (149), are a few examples of the text’s semiotic emphasis. But, while Versluys sees this tendency as emblematic of the novel’s portrayal of a decline in humanity, I suggest that the text’s preoccupation with the shape and constitution of words may work to “de-automatise” (Margolin 66) the relationship between sign and perception, rather than to denigrate the signified human. With the renamed terrorist, the reader comes to doubt not only the printed text, but also his or her automatic response to “bin Laden” as a “brand, a sort of logo which identifies and personalises the evil” (Chomsky, September 36). Bill Lawton, according to Justin, speaks in monosyllables (102), a language Justin chooses, for a time, for his own speech (66), and this also contributes to the de-automatisation of the text. The language game, in which a speaker must only use words with one syllable, began as a classroom activity “designed to teach the children something about the structure of words and the discipline required to frame clear thoughts” (66). The game also gives players, and readers, an embodied understanding of what Genette calls the gap between “being and saying” (93) that is inevitable in the production of language and narrative. Justin, who continues to play the game outside the classroom, because “it helps [him] go slow when [he] thinks” (66), finds comfort in the silent pauses that are afforded by widening the gap between thought and utterance. History in Falling Man is a collection of the private narratives of survivors, families, terrorists, artists, and the host of people that are affected by the attacks of 9/11. Justin’s character, with the linguistic and psychic code of a child, represents the way in which all participants, to some extent, choose their own antagonist, language, plot, and sequence to personalise this mega-public event. He insists that the towers did not collapse (72), but that they will, “this time coming” (102); Bill Lawton, for Justin, “has a long beard [...] speaks thirteen languages but not English except to his wives [and] has the power to poison what we eat” (74). Despite being confronted with the factual inaccuracies of his narrative, Justin resists editing his version precisely because these inaccuracies form his own, non-mediated, authentic account. They are, in a sense, a work of fiction and, paradoxically, more ‘real’ because of that. “We want to pass beyond the limits of safe understandings”, thinks Lianne, “and what better way to do it than through make-believe” (63). I have so far shown how narrative elements create a suspicion in the way characters operate within their surrounding universe, in the reader’s attitude towards the text, and, more implicitly, in the power of language to accurately represent a personal reality. Within the context of the novel’s historical setting—the period following the 9/11 attacks—the narration of the terrorist figure, as represented in Bill Lawton, Hammad, Martin, and others, may function as a response to the “binarism” of Bush’s proposal (Butler 2), epitomised in his “either you are with us, or you are with the terrorists” (Silberstein 14) approach. Within the novel’s universe, its narration of terrorist-characters works to free discourse from superficial categorisations and to provide “a counterdiscourse to the prevailing nationalistic interpretations” (Versluys 23) of the events of 9/11 by de-automatising a response to “us” and “them.” In his essay published shortly after the attacks, DeLillo notes that “the sense of disarticulation we hear in the term ‘Us and Them’ has never been so striking, at either end” (“Ruins”), and while he draws distinctions, in the same essay, with technology on ‘our’ side and religious fanaticism on ‘their’ side, I believe that the novel is less settled on the subject. The Anglicisation of bin Laden’s name, for example, suggests that Bush’s either-or-ism is, at least partially, an arbitrary linguistic construct. At a time when some social commentators have highlighted the similarity in the definitions of “terror” and “counter terror” (Chomsky, “Commentary” 610), the Bill Lawton ‘error’ works to illustrate how easily language can destabilise our perception of what is familiar/strange, us/them, terror/counter-terror, victim/perpetrator. In the renaming of the notorious terrorist, “the familiar name is transposed on the mass murderer, but in return the attributes of the mass murderer are transposed on one very like us” (Conte 570), and this reciprocal relationship forms an imagined evil that is no longer so easily locatable within the prevailing political discourse. As the novel contextualises 9/11 within a greater historical narrative (Leps), in which characters like Martin represent “our” form of militant activism (Duvall), we are invited to perceive a possibility that the terrorist could be, like Martin, “one of ours […] godless, Western, white” (DeLillo, Falling 195).Further, the idea that the suspect exists, almost literally, within ‘us’, the victims, is reflected in the structure of the narrative itself. This suggests a more fluid relationship between terrorist and victim than is offered by common categorisations that, for some, “mislead and confuse the mind, which is trying to make sense of a disorderly reality” (Said 12). Hammad is visited in three short separate sections; “on Marienstrasse” (77-83), “in Nokomis” (171-178), and “the Hudson corridor” (237-239), at the end of each of the novel’s three parts. Hammad’s narrative is segmented within Keith’s and Lianne’s tale like an invisible yet pervasive reminder that the terrorist is inseparable from the lives of the victims, habituating the same terrains, and crafted by the same omniscient powers that compose the victims’ narrative. The penetration of the terrorist into ‘our’ narrative is also perceptible in the physical osmosis between terrorist and victim, as the body of the injured victim hosts fragments of the dead terrorist’s flesh. The portrayal of the body, in some post 9/11 novels, as “a vulnerable site of trauma” (Bird, 561), is evident in the following passage, where a physician explains to Keith the post-bombing condition termed “organic shrapnel”:The bomber is blown to bits, literally bits and pieces, and fragments of flesh and bone come flying outwards with such force and velocity that they get wedged, they get trapped in the body of anyone who’s in striking range...A student is sitting in a cafe. She survives the attack. Then, months later, they find these little, like, pellets of flesh, human flesh that got driven into the skin. (16)For Keith, the dead terrorist’s flesh, lodged under living human skin, confirms the malignancy of his emotional and physical injury, and suggests a “consciousness occupied by terror” (Apitzch 95), not unlike Justin’s consciousness, occupied from within by the “secret” (DeLillo, Falling 101) of Bill Lawton.The macabre bond between terrorist and victim is fully realised in the novel’s final pages, when Hammad’s death intersects, temporally, with the beginning of Keith’s story, and the two bodies almost literally collide as Hammad’s jet crashes into Keith’s office building. Unlike Hammad’s earlier and clearly framed narratives, his final interruption dissolves into Keith’s story with such cinematic seamlessness as to make the two narratives almost indistinguishable from one another. Hammad’s perspective concludes on board the jet, as “something fell off the counter in the galley. He fastened his seatbelt” (239), followed immediately by “a bottle fell off the counter in the galley, on the other side of the aisle, and he watched it roll this way and that” (239). The ambiguous use of the pronoun “he,” once again, and the twin bottles in the galleys create a moment of confusion and force a re-reading to establish that, in fact, there are two different bottles, in two galleys; one on board the plane and the other inside the World Trade Centre. Victim and terrorist, then, share a common fate as acting agents in a single governing narrative that implicates both lives.Finally, Žižek warns that “whenever we encounter such a purely evil on the Outside, [...] we should recognise the distilled version of our own self” (387). DeLillo assimilates this proposition into the fabric of Falling Man by crafting a language that renegotiates the division between ‘out’ and ‘in,’ creating a fictional antagonist in Bill Lawton that continues to lurk outside the symbolic window long after the demise of his historical double. Some have read this novel as offering a more relative perspective on terrorism (Duvall). However, like Leps, I find that DeLillo here tries to “provoke thoughtful stillness rather than secure truths” (185), and this stillness is conveyed in a language that meditates, with the reader, on its own role in constructing precarious concepts such as ‘us’ and ‘them.’ When proposing that terror, in Falling Man, can be found within ‘us,’ linguistically, historically, and even physically, I must also add that DeLillo’s ‘us’ is an imagined sphere that stands in opposition to a ‘them’ world in which “things [are] clearly defined” (DeLillo, Falling 83). Within this sphere, where “total silence” is seen as a form of spiritual progress (101), one is reminded to approach narrative and, by implication, life, with a sense of mindful attention; “to hear”, like Keith, “what is always there” (225), and to look, as Nina does, for “something deeper than things or shapes of things” (111).ReferencesApitzch, Julia. "The Art of Terror – the Terror of Art: Delillo's Still Life of 9/11, Giorgio Morandi, Gerhard Richter, and Performance Art." Terrorism, Media, and the Ethics of Fiction: Transatlantic Perspectives on Don DeLillo. Eds. Peter Schneck and Philipp Schweighauser. London: Continuum [EBL access record], 2010. 93–110.Bal, Mieke. Narratology: Introduction to the Theory of Narratology. Toronto: U of Toronto P, 1985.Bird, Benjamin. "History, Emotion, and the Body: Mourning in Post-9/11 Fiction." Literature Compass 4.3 (2007): 561–75.Booth, Wayne C. The Rhetoric of Fiction. Chicago: U of Chicago P, 1961.Butler, Judith. Precarious Life: The Powers of Mourning and Violence. New York: Verso, 2004.Chomsky, Noam. "Commentary Moral Truisms, Empirical Evidence, and Foreign Policy." Review of International Studies 29.4 (2003): 605–20.---. September 11. Crows Nest, NSW: Allen & Unwin, 2002.Conte, Joseph Mark. "Don Delillo’s Falling Man and the Age of Terror." MFS Modern Fiction Studies 57.3 (2011): 557–83.DeLillo, Don. Falling Man. London: Picador, 2007.---. "In the Ruins of the Future." The Guardian (22 December, 2001). ‹http://www.guardian.co.uk/books/2001/dec/22/fiction.dondelillo›.Duvall, John N. & Marzec, Robert P. "Narrating 9/11." MFS Modern Fiction Studies 57.3 (2011): 381–400.Fludernik, Monika. An Introduction to Narratology. Taylor & Francis [EBL access record], 2009.---. Towards a 'Natural' Narratology. Routledge, [EBL access record], 1996.Genette, Gerard. Figures of Literary Discourse. New York: Columbia U P, 1982.Gerrig, Richard J. "Conscious and Unconscious Processes in Reader's Narrative Experiences." Current Trends in Narratology. Ed. Greta Olson. Berlin: De Gruyter [EBL access record], 2011. 37–60.Grossinger, Leif. "Public Image and Self-Representation: Don Delillo's Artists and Terrorists in Postmodern Mass Society." Terrorism, Media, and the Ethics of Fiction: Transatlantic Perspectives on Don DeLillo. Eds. Peter Schneck and Philipp Schweighauser. London: Continuum [EBL access record], 2010. 81–92.Iser, Wolfgang. "The Reading Process: A Phenomenological Approach." New Literary History 3.2 (1972): 279–99.Kauffman, Linda S. "The Wake of Terror: Don Delillo's in the Ruins of the Future, Baadermeinhof, and Falling Man." Modern Fiction Studies 54.2 (2008): 353–77.Leps, Marie-Christine. "Falling Man: Performing Fiction." Terrorism, Media, and the Ethics of Fiction: Transatlantic Perspectives on Don DeLillo. Eds. Peter Schneck and Philipp Schweighauser. London: Continuum [EBL access record], 2010. 184–203.Margolin, Uri. "(Mis)Perceiving to Good Aesthetic and Cognitive Effect." Current Trends in Narratology. Ed. Greta Olson. Berlin: De Gruyter [EBL access record], 2011. 61–78.Palmer, Alan. "The Construction of Fictional Minds." Narrative 10.1 (2002): 28–46.Said, Edward W. "The Clash of Ignorance." The Nation 273.12 (2001): 11–13.Silberstein, Sandra. War of Words : Language Politics and 9/11. Taylor & Francis e-Library, 2004.Versluys, Kristiaan. Out of the Blue: September 11 and the Novel. New York: Columbia U P, 2009.Weinstein, Arnold. Nobody's Home: Speech, Self and Place in American Fiction from Hawthorne to DeLillo. Oxford U P [EBL Access Record], 1993.Žižek, Slavoj. "Welcome to the Desert of the Real!" The South Atlantic Quarterly 101.2 (2002): 385–89.

For some time, I have been concerned with uses and abuses of the future, how the exchange of temporally loaded language through conversation and text affects the pace, moods and behaviour of individuals, communities, cultures and civilisations. I am equally curious about Christianity which as a narrative structure begins with creation but awaits a conclusion. Whether it is religions announcing ten-point plans to attain paradise quickly, or cults encouraging group passes to heaven through suicide, it is the future end that counts. Whether it be ego-theologists -- as I prefer to call those pastors who proclaim the 'you are/they are god' creed -- scalping spiritual quick-fixes at the local entertainment centre, with a McDonald's-like serving of 'Would you like a blessing with that?', or the visiting soulwinner from New South Wales distributing 'Mark of the Beast' warning pamphlets, the future conclusion of the Christian narrative plays the lead. I cannot disguise my discomfort with the salvation franchises or merchants who market pre-fabricated responses to the Christian apocalyptic narrative, curiously shaped by contemporary circumstances, and who profit excessively from such business. Many times I wonder what dubious purposes their perception of the future is put to. Surviving Armageddon, it appears, can provide a diverse source of mobilisation for many. With such prominence in the everyday topics of public and mainstream dialogue, our age is the first historical period where the marginal phenomenon of apocalyptism has moved from the edge of society to its present-day popular near-centre. Money, I dare say, is made from such a shift. Ego-theologists are keen to boast the vices of contemporary society that are bringing apocalypse while conveniently offering the hefty-priced product that upon purchase will begin the process of surviving the end. It is no accident that the narrower the definition of salvation, the more specialised the rituals for attaining it, the qualifications for distributing it and the exclusivity for keeping it. Such restrictions place the power of salvation into the hands of a small number of people who make available -- upon specialised or ritualised request -- the means to lease it. I use the word lease because salvation is never completely settled. Instead, a symbolic contract is achieved between the franchise and the seeker in which salvation is conveyed to the seeker for a specified period but usually in exchange for membership and often mental and financial obligation. If the seeker breaks the contract, salvation is lost. Jehovah's Witnesses call this act of severance 'disfellowshipping' and the seeker is designated by continuing followers of Watchtower as an 'apostate', as one against the almighty creator. Many ex-witnesses are emotionally scared by this devastating, violent act of seemingly removing salvation. In this sense, a small elite using exclusive language and narrow definitions and who therefore monopolise the forms and the senses of achieving salvation habitually frame salvation and the rituals of being saved from a monstrous future. Who benefits and who is disempowered by the agenda being set in this manner? Why are only selected people able to lease directions to the road of salvation with maps that periodically imply the master planner has changed compass, be it the secular salvation from ecological doom or theological salvation from the damnable mark of the beast? Saving a person from the antichrist has today become a robust industry. Religious entrepreneurs proliferate their scriptural shandies and spiritual quick-fixes to the middle-class disheartened with the expertise of experienced confidence tricksters and the finesse of door-to-door selling. Subscribe to a local salvation franchise of the 'gospel of wealth' variety found marketing in the early morning hours of Australian televangelism and a continual stream of ministrations will arrive in the mail replete with US postage markings and external messages warning you and your postie: 'This envelope contains important information the devil hopes you will never find out!', 'Eight things you need to know before the new millennium', 'Has Y2K plunged us into a countdown to chaos? Don't panic -- prepare and trust God!' or 'Unleash the power of your faith!'. Content will vary across a range of marketable approaches. Two recent postings I received from the same franchise respectively presented a 4-5 page personalised letter requesting I purchase 'dynamic ministry materials' like Your Y2K New Millennium Survival Personal Library Kit for an appropriate 'seed harvest' of $165.99. This reflected fair market value, naturally, on 'powerful' items including The Antichrist: 666 video, a three audio tape set called End Time Signs and the Book of Revelation Comic Book. An explanation sheet was also included for explaining the rituals required to activate an enclosed 'miracle touch' 2-inch square cloth, apparently anointed -- touched in a supernatural way -- by a special class of persons self-identified as 'prayer warriors'. Some packages have reflected telegram-style formatting to 'emphasize the great URGENCY' felt by a pastor 'that many of you may be on the verge of falling apart or feeling absolutely overwhelmed by fear, anger, depression, rejection, worry' and who desperately require a newly-released 'powerful book of wisdom' to overcome personal tribulation and to successfully 'rebuke the devil'. Often, correspondence signed from the pastor displays these excesses of individual concern, claims of divine new revelation blended with unbiblical doses of numerological deduction. The accompanying letter to my Y2K Personal Request Sheet begins: 'Dear Jason, you are now reading a letter that had to be sent to you ... Yes, the Lord told me to prepare this ... He gave me a vivid, supernatural glimpse of the miracle difference this one letter could make in your life ... especially in this year of 1999 ... See it as your year of double fruitfulness'. What role does this type of 'future-thinking' and others play in Australian forms of hope and expectation? Can we establish a discourse of ethics regarding the use or abuse of future mythology? And how might we engage studies of the future in the historical and sociological disciplines which would see the future as itself: a theory with very particular ideological and metaphysical investments; an address to the present, transforming it into the fulfillment of the future we aim to aspire to; and, often, as a tool or weapon which has been waved about for some form of gain? To answer these questions requires us to place ourselves in a position to see something of the design and construction of contemporary futures as an invented thing with specific limitations. George Orwell's famous and relevant exploration of the future in 1984 is the story of Winston Smith's rebellion against the Party, of his hatred towards Big Brother and the thoughtcrime. On page thirty-four, Winston reflects on the perpetual state of war that has existed between Oceania and Eurasia: 'The Party said that Oceania had never been in alliance with Eurasia ... But where did that knowledge exist? Only in his own consciousness ... if all the others accepted the lie which the party imposed if all records told the same tale, then the lie passed into history and became truth. "Who controls the past," ran the Party slogan, "controls the future: who controls the present controls the past." It was quite simple. All that was needed was an unending series of victories over your own memory. "Reality control," they called it; in Newspeak, "doublethink."' Transposing the direction of Orwell's commentary, from a control of knowledge about the past to a monopoly control of future mythology, provides more than just an occasional point. To paraphrase, I would like to suggest that: 'Who controls the future controls the present. And that all is needed is an unending series of victories over your imagination'. In futurespeak, that is, the language and discursive strategies used to talk and think about the future, I call this 'thinkphobia'. Alvin Toffler, in his successful sociological trilogy, describes the cultural fallout from overchoice and the dangerous discrepancies between society's technological accelerative thrust and the pace of our individual adaptive abilities. This peculiar state results in what Toffler defines as future shock; that is, an overload of our individual decision-making processes from the demands of choice that we simply cannot tolerate. Thinkphobia, as an analogy to thoughtcrime, is one step removed: it is the fear we develop of choice, of options in the future and it is not, I suspect, limited to doomsayers. For members of Watchtower (Jehovah's Witnesses), the present is probed only in the interests of the future and they project only one intended and necessary future, squashing coherent, intellectual responses to it, closing alternatives to active public and popular debate. The future as promoted by Watchtower is totalist, monocultural, and biblically sealed, closed to individual modification, to the extent that a handbook 'Reasoning from the Scriptures' can provide the dialogue that accompanies their knock at your door. But, I wonder, are the future-systems of our societies any different in their application? What I'm suggest here is that the secular billions of people today who are either implicitly or explicitly coerced to reckon the future and time in ways they did not choose is highly questionable. While we may scoff at the witness who has their dialogue mapped out and a sense of the future pre-structured for them, should we ourselves spend much time exchanging talk about things called the 'millennium' and the year 2000, encouraging other cultures to share our enthusiasm, much like a cultist would promote their pattern of future for emulating? In other words, when our societies are diversifying culturally, socially and intellectually, why is our concept of the future homogenising, almost, dare I suggest, in cultic mimicry? The approach of the year 2000/2001AD seems to evoke excess response from Christian groups throughout Australia. But can a culture of apocalypse or a cult of the future -- that is, a philosophically sealed community deriving identity from its expectation of doom in the future -- be limited to popular, extra-societal ideas of cult? A 'cult of the future' could be described as a community of people, which embraces a particular system of linear time reckoning as part of its cultural and/or social code, which encourages (either explicitly or implicitly) and sustains specialised activity as supplication to some qualitative or quantitative 'future'. A 'cult of the future', to draw from sociological literature, does not adhere to the possibility of unforeseen occurrence but rather devotes itself to a presumed unalterable and necessary future to which all current activity and thought seems conditional upon it. I wonder whether the term 'cult of the future' can be applied to a whole society and not just to the small evangelical cult based in the outer suburbs, which studiously awaits the end of the world. Can a cult of the future, traditionally applied to an unconventional extra-societal gathering, include society itself? How our societies conceive of the future may be different in content and style to evangelical and theological communities, but could the aim be similar? Whether it is a social reformer or a cult leader, is the process the same in the way future mythology is constructed? Could future-oriented systems conceivably sit alongside the systems of more controversial groups like Heaven's Gate or Jehovah's Witnesses as related efforts of installing pre-organised future-mythology into the mindset of a group of receptive people? To interrogate the monopolisation of future mythology by the leading mythmakers and the salvation merchants, whose greatest tool is the rumour of what we fear and whose largest assets are the hopes of seekers, is to begin reclaiming responsibility about the future. It is to reclaim meaning for an individual long-term present that would otherwise be lonely in the crowd of social, commercial and regulated short-term futures. Futures thinking should encourage us to ponder what part of ourselves goes on to the future and it should initiate a strong sense of responsibility to prospective generations: it should not invite us to consider what books or tapes to purchase in order to survive the various doomsday scenarios marketed at us. To interrogate the monopolisation of future mythology by the leading mythmakers and the salvation merchants, whose greatest tool is the rumour of what we fear and whose largest assets are the hopes of seekers, is to begin reclaiming responsibility about the future. It is to reclaim meaning for an individual long-term present that would otherwise be lonely in the crowd of social, commercial and regulated short-term futures. Futures thinking should encourage us to ponder what part of ourselves goes on to the future and it should initiate a strong sense of responsibility to prospective generations: it should not invite us to consider what books or tapes to purchase in order to survive the various doomsday scenarios marketed at us. Citation reference for this article MLA style: Jason Ensor. "666 Ways to Ambush the Future." M/C: A Journal of Media and Culture 2.9 (2000). [your date of access] <http://www.uq.edu.au/mc/0001/666.php>. Chicago style: Jason Ensor, "666 Ways to Ambush the Future," M/C: A Journal of Media and Culture 2, no. 9 (2000), <http://www.uq.edu.au/mc/0001/666.php> ([your date of access]). APA style: Jason Ensor. (2000) 666 ways to ambush the future. M/C: A Journal of Media and Culture 2(9). <http://www.uq.edu.au/mc/0001/666.php> ([your date of access]).

In a listicle on becomingminimalist.com, Joshua Becker argues that advances in personal computing have contributed to the growing popularity of the minimalist lifestyle. Becker explains that computational media can efficiently absorb physical artefacts like books, photo albums, newspapers, clocks, calendars, and more. In Nawapol Thamrongrattanarit’s Happy Old Year (2019, ฮาวทูทิ้ง ทิ้งอย่างไร..ไม่ให้เหลือเธอ) the protagonist Jean also argues that material possessions are wasteful and unnecessary in the era of cloud storage. In the film, she redesigns her old-fashioned and messy childhood home to create a minimalist home office. In decluttering their material possessions through a partial reliance on computational storage, Jean and Becker conveniently dispense with the materiality of informational infrastructures and digital archives. Informational technology’s ever-growing capacity for storage and circulation also intensify anxieties about clutter. During our online interactions, we inadvertently leave an amassing trail of metadata behind that allows algorithms to “personalise” our interfaces. Consequently, our interfaces are “cluttered” with recommendations that range from toothpaste to news, movies, clothes, and more, based on a narrow and homophilic comparison of datasets. Notably, this hypertrophic trail of digital clutter threatens to overrepresent and blur personal identities. By mindfully reducing excessive consumption and discarding wasteful possessions, our personal spaces can become tidy and coherent. On the other hand, there is little that individuals can do to control nonhuman forms of digital accumulation and the datafied archives that meticulously record and store our activities on a micro-temporal scale. In this essay, I explore archive fever as the prosthetic externalisation of memory across physical and digital spaces. Paying close attention to Sianne Ngai’s work on vernacular aesthetic categories and Susanna Paasonen’s exploration of equivocal affective sensations, I study how advocates of minimalist design seek to recuperate our fraught capacities for affective experience in the digital era. In particular, I examine how Thamrongrattanarit problematises minimalist design, prosthetic memory, and the precarious materiality of digital media in Happy Old Year and Mary Is Happy, Mary Is Happy (2013, แมรี่ อีส แฮปปี้, แมรี่ อีส แฮปปี้). Transmedial Minimalist Networks and Empty Spaces Marie Kondo famously teaches us how to segregate objects that spark joy from material possessions that can be discarded (Kondo). The KonMari method has a strong transmedial presence with Kondo’s bestselling books, her blog and online store, a Netflix series, and sticky memes that feature her talking about objects that do not spark joy. It is interesting to note the rising popularity of prescriptive minimalist lifestyle blogs that utilise podcasts, video essays, tutorials, apps, and more to guide the mindful selection of essential material possessions from waste. Personal minimalism is presented as an antidote to late capitalist clutter as self-help gurus appear across our computational devices teach us how we can curb our carbon footprints and reduce consumerist excess. Yet, as noted by Katherine Hayles, maximal networked media demands a form of hyper-attention that implicates us in multiple information streams at once. There is a tension between the overwhelming simultaneity in the viewing experience of transmedial minimalist lifestyle networks and the rhetoric of therapeutic selection espoused in their content. In their ethnographic work with minimalists, Eun Jeong Cheon and Norman Makoto Su explore how mindfully constructed empty spaces can serve as a resource for technological design (Cheon and Su). Cheon and Su note how empty spaces possess a symbolic and functional value for their respondents. Decluttered empty spaces offer a sensuous experience for minimalists in coherently representing their identity and serve as a respite from congested and busy cities. Furthermore, empty spaces transform the home into a meaningful site of reflection about people’s objects and values as minimalists actively work to reduce their ownership of physical artefacts and the space that material possessions occupy in their homes and minds: the notion of gazing upon empty spaces is not simply about reading or processing information for minimalists. Rather, gazing gives minimalists, a visual indicator of their identity, progress, and values. (Cheon and Su 10) Instead of seeking to fill and augment empty space, Cheon and Su ask what it might mean to design technology that appreciates the absence of information and the limitation of space. The Interestingness of “Total Design and Internet Plenitude” Sianne Ngai argues that in a world where we are constantly hailed as aesthetic subjects, our aesthetic experiences grow increasingly fragile and ineffectual (Ngai 2015). Ngai further contends that late capitalism makes the elite exaggeration of the autonomy of art (at auction houses, mega-exhibitions, biennales, and more) concurrently possible with the hyper-aestheticisation of everyday life. The increase in inconsequential aesthetic experiences mirrors a larger habituation to aesthetic novelty along with the loss of the traditional friction between art and the commodity form: in tandem with these seismic changes to longstanding ideas of art’s vocation, weaker aesthetic categories crop up everywhere, testifying in their very proliferation to how, in a world of “total design and Internet plenitude”, aesthetic experience while less rarefied also becomes less intense. (Ngai 21) Ngai offers us the cute, interesting, and zany as the key vernacular categories that describe aesthetic experience in “the hyper-commodified, information-saturated, and performance-driven conditions of late-capitalist culture” (1). Aesthetic experience no longer subscribes to an exceptionally single feeling but is located at the ambiguous mixture of mundane affect. Susanna Paasonen notes how Ngai’s analysis of an everyday aesthetic experience that is complex and equivocal helps explain how seemingly contradictory and irreconcilable affective tensions might in fact be mutually co-dependent with each other (Paasonen). By critiquing the broad and binary generalisations about addiction and networked technologies, Paasonen emphasises the ambivalent and fleeting nature of affective formation in the era of networked media. Significantly, Paasonen explores how ubiquitous networked infrastructures bind us in dynamic sensations of attention and distraction, control and helplessness, and boredom and interest. For Ngai, the interesting is a “low, often hard-to-register flicker of affect accompanying our recognition of minor differences from a norm” (18). There is a discord between knowledge and feeling (and cognition and perception) at the heart of the interesting. We are drawn to the interesting object after noticing something peculiar about it and yet, we are simultaneously at a loss of knowledge about the exact contents of that peculiarity. The "interesting" is embodied in the seriality of constant circulation and a temporal experience of in-betweenness and anticipation in a paradoxical era of routinised novelty. Ngai notes how in the 1960s, many minimalist conceptual artists were preoccupied with tracking the movement of objects and information by transport and communication technologies. In offering a representation of networks of circulation, “merely interesting” conceptual art disseminates information about itself and makes technologies of distribution central to its process of production. The interesting is a pervasive aesthetic judgment that also explains our affectively complex rapport with information in the context of networked technologies. Acclimatised to the repetitive tempos of internet browsing and circular refreshing, Paasonen notes we often oscillate between boredom and interest during our usage of networked media. As Ngai explains, the interesting is “a discursive aesthetic about difference in the form of information and the pathways of its movement and exchange” (1). It is then “interesting” to explore how Thamrongrattanarit tracks the circulation of information and the pathways of transmedial exchange across Twitter and cinema in Mary Is Happy, Mary Is Happy. Digital Memory in MIHMIH Mary Is Happy, Mary Is Happy is adapted from a set of 410 consecutive tweets by Twitter user @marymaloney. The film instantiates the phatic, ephemeral flow of a Twitter feed through its deadpan and episodic narrative. The titular protagonist Mary is a fickle-headed high-school senior trying to design a minimalist yearbook for her school to preserve their important memories. Yet, the sudden entry of an autocratic principal forces her to follow the school administration’s arbitrary demands and curtail her artistic instincts. Ultimately, Mary produces a thick yearbook that is filled with hagiographic information about the anonymous principal. Thamrongrattanarit offers cheeky commentary about Thailand’s authoritarian royalist democracy where the combination of sudden coups and unquestioning obedience has fostered a peculiar environment of political amnesia. Hagiographic and bureaucratic informational overload is presented as an important means to sustain this combination of veneration and paranoia. @marymaloney’s haphazard tweets are superimposed in the film as intertitles and every scene also draws inspiration from the tweet displayed in an offhand manner. We see Mary swiftly do several random and unexplained things like purchase jellyfishes, sleep through a sudden trip to Paris, rob a restaurant, and more in rapid succession. The viewer is overwhelmed because of a synchronised engagement with two different informational currents. We simultaneously read the tweet and watch the scene. The durational tension between knowing and feeling draws our attention to the friction between conceptual interpretation and sensory perception. Like the conceptual artists of the 1960s, Thamrongrattanarit also shows “information in the act of being circulated” (Ngai 157). Throughout the film, we see Mary and her best friend Suri walk along emptied railway tracks that figuratively represent the routes of informational circulation across networked technologies. With its quirky vignettes and episodic narrative progression, MIHMIH closely mirrors Paasonen’s description of microevents and microflow-like movement on social media. The film also features several abrupt and spectacular “microshocks” that interrupt the narrative’s linear flow. For example, there is a running gag about Mary’s cheap and malfunctioning phone frequently exploding in the film while she is on a call. The repetitive explosions provide sudden jolts of deadpan humour. Notably, Mary also mentions how she uses bills of past purchases to document her daily thoughts rather than a notebook to save paper. The tweets are visually represented through the overwhelming accumulation of tiny bills that Mary often struggles to arrange in a coherent pattern. Thamrongrattanarit draws our attention to the fraught materiality of digital memory and microblogging that does not align with neat and orderly narrativisation. By encouraging a constant expression of thoughts within its distinctive character limit, Twitter promotes minimal writing and maximal fragmentation. Paasonen argues that our networked technologies take on a prosthetic function by externalising memory in their databases. This prosthetic reserve of datafied memory is utilised by the algorithmic unconscious of networked media for data mining. Our capacities for simultaneous multichannel attention and distraction are increasingly subsumed by capital’s novel forms of value extraction. Mary’s use of bills to document her diary takes on another “interesting” valence here as Thamrongrattanarit connects the circulation of information on social media with monetary transactions and the accumulation of debt. While memory in common parlance is normally associated with acts of remembrance and commemoration, digital memory refers to an address for storage and retrieval. Wendy Chun argues that software conflates storage with memory as the computer stores files in its memory (Chun). Furthermore, digital memory only endures through ephemeral processes of regeneration and degeneration. Even as our computational devices move towards planned obsolescence, digital memory paradoxically promises perpetual storage. The images of dusty and obsolete computers in MIHMIH recall the materiality of the devices whose databases formerly stored many prosthetic memories. For Wolfgang Ernst, digital archives displace cultural memory from a literary-based narrativised framework to a calculative and mathematical one as digital media environments increasingly control how a culture remembers. As Jussi Parikka notes “we are miniarchivists ourselves in this information society, which could be more aptly called an information management society” (2). While traditional archives required the prudent selection and curation of important objects that will be preserved for future use on a macro temporal scale, the Internet is an agglomerative storage and retrieval database that records information on a micro temporal scale. The proliferation of agglomerative mini archives also create anxieties about clutter where the miniarchivists of the “information-management society” must contend with the effects of our ever-expanding digital trail. It is useful to note how processes of selection and curation that remain central to minimalist decluttering can be connected with the design of a personal archive. Ernst further argues that digital memory cannot be visualised as a place where objects lay in static rest but is better understood as a collection of mini archives in motion that become perceptible because of dynamic signal-based processing. In MIHMIH, memory inscription is associated with the “minimalist” yearbook that Mary was trying to create along with the bills where she documents her tweets/thoughts. At one point, Mary tries to carefully arrange her overflowing bills across her wall in a pattern to make sense of her growing emotional crisis. Yet, she is overwhelmed by the impossibility of this task. Networked media’s storage of prosthetic memory also makes self-representation ambiguous and messy. As a result, Mary’s story does align with cathartic and linear narrativisation but a messy agglomerative database. Happy Old Year: Decluttering to Mend Prosthetic Memories Kylie Cardell argues that the KonMari method connects tidiness to the self-conscious design of a curated personal archive. Marie Kondo associates decluttering with self-representation. "As Kondo is acutely aware, making memories is not simply about recuperating and preserving symbolic objects of the past, but is a future-oriented process that positions subjects in a peculiar way" (Cardell 2). This narrative formation of personal identity involves carefully storing a limited number of physical artefacts that will spark joy for the future self. Yet, we must segregate these affectively charged objects from clutter. Kondo encourages us to make intuitive judgments of conviction by overcoming ambivalent feelings and attachments about the past that are distributed over a wide set of material possessions. Notably, this form of decluttering involves archiving the prosthetic memories that dwell in our (analogue) material possessions. In Happy Old Year, Jean struggles to curate her personal archive as she becomes painfully aware of the memories that reside in her belongings. Interestingly, the film’s Thai title loosely translates as “How to Dump”. Jean has an urgent deadline to declutter her home so that it can be designed into a minimalist home office. Nevertheless, she gradually realises that she cannot coldly “dump” all her things and decides to return some of the borrowed objects to her estranged friends. This form of decluttering helps assuage her guilt about letting go of the past and allows her to (awkwardly and) elegantly honour her prosthetic memories. HOY reverses the clichéd before-after progression of events since we begin with the minimalist home and go back in flashbacks to observe its inundated and messy state. HOY’s after-before narrative along with its peculiar title that substitutes ‘new’ with ‘old’ alludes to the clashing temporalities that Jean is caught up within. She is conflicted between deceptive nostalgic remembrance and her desire to start over with a minimalist-blank slate that is purged of her past regrets. In many remarkable moments, HOY instantiates movement on computational screens to mirror digital media’s dizzying speeds of circulation and storage. Significantly, the film begins with the machinic perspective of a phone screen capturing a set of minimalist designs from a book. Jean refuses to purchase (and store) the whole book since she only requires a few images that can be preserved in her phone’s memory. As noted in the introduction, minimalist organisation can effectively draw on computational storage to declutter physical spaces. In another subplot, Jean is forced to retrieve a photo that she took years ago for a friend. She grudgingly searches through a box of CDs (a cumbersome storage device in the era of clouds) but ultimately finds the image in her ex-boyfriend Aim’s hard disk. As she browses through a folder titled 2013, her hesitant clicks display a montage of happy and intimate moments that the couple shared together. Aim notes how the computer often behaves like a time machine. Unlike Aim, Jean did not carefully organise and store her prosthetic memories and was even willing to discard the box of CDs that were emblematic of defunct and wasteful accumulation. Speaking about how memory is externalised in digital storage, Thamrongrattanarit notes: for me, in the digital era, we just changed the medium, but human relationships stay the same. … It’s just more complicated because we can communicate from a distance, we can store a ton of memories, which couldn’t have ever happened in the past. (emphasis added) When Jean “dumped” Aim to move to Sweden, she blocked him across channels of networked communicational media to avoid any sense of ambient intimacy between them. In digitising our prosthetic memories and maintaining a sense of “connected presence” across social media, micro temporal databases have made it nearly impossible to erase and forget our past actions. Minimalist organisation might help us craft a coherent and stable representation of personal identity through meticulous decluttering. Yet, late-capitalist clutter takes on a different character in our digital archives where the algorithmic unconscious of networked media capitalises on prosthetic storage to make personal identity ambiguous and untidy. It is interesting to note that Jean initially gets in touch with Aim to return his old camera and apologise for their sudden breakup. The camera can record events to “freeze” them in time and space. Later in the film, Jean discovers a happy family photo that makes her reconsider whether she has been too harsh on her father because of how he “dumped” her family. Yet, Jean bitterly finds that her re-evaluation of her material possessions and their dated prosthetic memories is deceptive. In overidentifying with the frozen images and her affectively charged material possessions, she is misled by the overwhelming plenitude of nostalgic remembrance. Ultimately, Jean must “dump” all her things instead of trying to tidy up the jumbled temporal frictions. In the final sequence of HOY, Jean lies to her friend Pink about her relationship with Aim. She states that they are on good terms. Jean then unfriends Aim on Facebook, yet again rupturing any possibility of phatic and ambient intimacy between them. As they sit before her newly emptied house, Pink notes how Jean can do a lot with this expanded space. In a tight close-up, Jean gazes at her empty space with an ambiguous yet pained expression. Her plan to cathartically purge her regrets and fraught memories by recuperating her prosthetic memories failed. With the remnants of her past self expunged as clutter, Jean is left with a set of empty spaces that will eventually resemble the blank slate that we see at the beginning of the film. The new year and blank slate signify a fresh beginning for her future self. However, this reverse transition from a minimalist blank slate to her chaotically inundated childhood home frames a set of deeply equivocal affective sensations. Nonetheless, Jean must mislead Pink to sustain the notion of tidy and narrativised coherence that equivocally masks her fragmented sense of an indefinable loss. Conclusion MIHMIH and HOY explore the unresolvable and conflicting affective tensions that arise in an ecosystem of all-pervasive networked media. Paasonen argues that our ability to control networked technologies concurrently fosters our mundane and prosthetic dependency on them. Both Jean and Mary seek refuge in the simplicity of minimalist design to wrestle control over their overstimulating spaces and to tidy up their personal narratives. It is important to examine contemporary minimalist networks in conjunction with affective formation and aesthetic experience in the era of “total design and internet plenitude”. In an information-management society where prosthetic memories haunt our physical and digital spaces, minimalist decluttering becomes a form of personal archiving that simultaneously empowers unambiguous aesthetic feeling and linear and stable autobiographical representation. The neatness of minimalist decluttering conjugates with an ideal self that can resolve ambivalent affective attachments about the past and have a coherent vision for the future. Yet, we cannot sort the clutter that resides in digital memory’s micro temporal archives and drastically complicates our personal narratives. 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