Articles de revues sur le sujet « HI. Electronic Media »

Background:Few investigations have assessed in adolescent girls the cross-sectional and longitudinal associations between elevated exposure to electronic media (EM) and activity-related outcomes such as compliance with physical activity (PA) standards or cardiorespiratory fitness (CRF).Methods:Four-hundred thirty-seven white and African American girls were assessed at the 8th, 9th, and 12th grades. PA and EM (TV/video watching, electronic games, Internet use) were self-reported, and CRF was estimated using a cycle-ergometer test. Hi EM exposure was defined as ≥four 30-minute blocks/d.Results:8th-, 9th-, and 12th-grade girls in the Hi EM group showed lower compliance with PA standards and had lower CRF than the Low EM group (P ≤ .03). Girls reporting Hi EM exposure at 8th and 9th grades had lower vigorous PA and CRF levels at 12th grade than girls reporting less EM exposure (P ≤ .03).Conclusion:Girls reporting exposure to EM for 2 or more hours per day are more likely to exhibit and maintain low PA and CRF levels throughout adolescence. These results enhance the scientific basis for current public health recommendations to limit adolescent girls’ daily exposure to television, electronic games, and Internet use to a combined maximum of 2 hours.

Crimes against women include many crimes, but this research paper focuses on rape cases and seeks to find out when television channels cover rape cases, what are the consequences of it, how they affect the Islamic society and what has been said about it in the light of Qur'an and Hadith? This topic is also important because no significant research paper on this subject has been written in Pakistan before and no clear picture has emerged. The pamphlet assumes that the broadcasting of incidents of rape of women on television channels is having a negative impact on the society, which has been investigated in every possible way. In this regard, various incidents of rape from 2012 to 2014 have been studied in the broadcasts of two television channels. A survey was also conducted to gauge public opinion, which revealed a variety of views. The survey included all kinds of questions that cover the entire subject. On the other hand, an interview with a victim has been conducted to find out the opinion of the rape survivor; while an interview with an individual associated with electronic media and a psychologist is also part of this pamphlet. The study found that news channels do not pay attention to a single statement while covering rape incidents, while on the other hand, the identity of the victim is revealed, which is also denied by our religion Islam and the Qur'an. According to the findings, more research is needed in the near future, and television channels need to collaborate with researchers and give them access to content. Similarly, there is a need for a large-scale comprehensive study in which data from all over the country is collected so that a complete picture can emerge.

Abstract Background The aim of the study was to develop and assess a technique for the optimization of breast electronic tissue compensation (ECOMP) treatment plans based on the breast radius and separation. Materials and methods Ten ECOMP plans for 10 breast cancer patients delivered at our institute were collected for this work. Pre-treatment CT-simulation images were anonymized and input to a framework for estimation of the breast radius and separation for each axial slice. Optimal treatment fluence was estimated based on the breast radius and separation, and a total beam fluence map for both medial and lateral fields was generated. These maps were then imported into the Eclipse Treatment Planning System and used to calculate a dose distribution. The distribution was compared to the original treatment hand-optimized by a medical dosimetrist. An additional comparison was performed by generating plans assuming a single tissue penetration depth determined by averaging the breast radius and separation over the entire treatment volume. Comparisons between treatment plans used the dose homogeneity index (HI; lower number is better). Results HI was non-inferior between our algorithm (HI = 12.6) and the dosimetrist plans (HI = 9.9) (p-value > 0.05), and was superior than plans obtained using a single penetration depth (HI = 17.0) (p-value < 0.05) averaged over the 10 collected plans. Our semi-supervised algorithm takes approximately 20 seconds for treatment plan generation and runs with minimal user input, which compares favorably with the dosimetrist plans that can take up to 30 minutes of attention for full optimization. Conclusions This work indicates the potential clinical utility of a technique for the optimization of ECOMP breast treatments.

1. Bilal, A. Jourabloo, M. Ye, X. Liu, and L. Ren. Do Convolutional Neural Networks Learn Class Hierarchy? IEEE Transactions on Visualization and Computer Graphics, 24(1):152–162, Jan. 2018. 2. M. Carney, B. Webster, I. Alvarado, K. Phillips, N. Howell, J. Griffith, J. Jongejan, A. Pitaru, and A. Chen. Teachable Machine: Approachable Web-Based Tool for Exploring Machine Learning Classification. In Extended Abstracts of the 2020 CHI Conference on Human Factors in Computing Systems, CHI ’20. ACM, Honolulu, HI, USA, 2020. 3. A. Karpathy. CS231n Convolutional Neural Networks for Visual Recognition, 2016 4. M. Kahng, N. Thorat, D. H. Chau, F. B. Viegas, and M. Wattenberg. GANLab: Understanding Complex Deep Generative Models using Interactive Visual Experimentation. IEEE Transactions on Visualization and Computer Graphics, 25(1):310–320, Jan. 2019. 5. J. Yosinski, J. Clune, A. Nguyen, T. Fuchs, and H. Lipson. Understanding Neural Networks Through Deep Visualization. In ICML Deep Learning Workshop, 2015 6. M. Kahng, P. Y. Andrews, A. Kalro, and D. H. Chau. ActiVis: Visual Exploration of Industry-Scale Deep Neural Network Models. IEEE Transactions on Visualization and Computer Graphics, 24(1):88–97, Jan. 2018. 7. https://cs231n.github.io/convolutional-networks/ 8. https://www.analyticsvidhya.com/blog/2020/02/learn-imageclassification-cnn-convolutional-neural-networks-3-datasets/ 9. https://towardsdatascience.com/understanding-cnn-convolutionalneural- network-69fd626ee7d4 10. https://medium.com/@birdortyedi_23820/deep-learning-lab-episode-2- cifar- 10-631aea84f11e 11. J. Gu, Z. Wang, J. Kuen, L. Ma, A. Shahroudy, B. Shuai, T. Liu, X. Wang, G. Wang, J. Cai, and T. Chen. Recent advances in convolutional neural networks. Pattern Recognition, 77:354–377, May 2018. 12. Hamid, Y., Shah, F.A. and Sugumaram, M. (2014), ―Wavelet neural network model for network intrusion detection system‖, International Journal of Information Technology, Vol. 11 No. 2, pp. 251-263 13. G Sreeram , S Pradeep, K SrinivasRao , B.Deevan Raju , Parveen Nikhat , ― Moving ridge neuronal espionage network simulation for reticulum invasion sensing‖. International Journal of Pervasive Computing and Communications.https://doi.org/10.1108/IJPCC-05- 2020-0036 14. E. Stevens, L. Antiga, and T. Viehmann. Deep Learning with PyTorch. O’Reilly Media, 2019. 15. J. Yosinski, J. Clune, A. Nguyen, T. Fuchs, and H. Lipson. Understanding Neural Networks Through Deep Visualization. In ICML Deep Learning Workshop, 2015. 16. Aman Dureja, Payal Pahwa, ―Analysis of Non-Linear Activation Functions for Classification Tasks Using Convolutional Neural Networks‖, Recent Advances in Computer Science , Vol 2, Issue 3, 2019 ,PP-156-161 17. https://missinglink.ai/guides/neural-network-concepts/7-types-neuralnetwork-activation-functions-right/

Abstract Introduction: The optimum number of cycles and dose of Cytarabine consolidation in older patients (age 60 and above) with AML in first remission remains unclear. Methods: We retrospectively reviewed electronic medical records of patients. We identified 81 patients that were diagnosed with AML ( at age 60 and above) and received induction chemotherapy followed by Cytarabine consolidation between 2008 and 2017. Results: We reviewed the outcomes of 81 patients and report overall survival (OS) and relapse free survival (RFS) for the 69 patients reaching a landmark of 120 days from diagnosis without relapse or death (to exclude patients who would not be amenable to extended consolidation). Median follow up was 19.4 months (range 4.2-105.7). The median age at diagnosis was 65 (range 60-77); 86% were White. The majority were men (66%) ; 60% received daunorubicin-based induction [dose range 45 mg - 90 mg/m2] and 19% received re-induction chemotherapy. The cytogenetics based on ELN 2017 criteria were 71% intermediate, 13% favorable,10% adverse and for 6% not available (N/A.) From the 69 patients 16 were documented to be FLT3 ITD positive and 17 NPM1 positive. Twenty out of 69 patients (29%) received allogeneic hematopoietic cell transplantation (alloHCT). From those transplanted 5 patients were transplanted at CR2, one patient with relapse disease and the rest at CR1. Thirty patients relapsed and 27 patients died. At time of last follow up or death 56% of patients were on CR1, 13% on CR2 while the rest had relapsed disease [up to 3 relapses]. The median number of Cytarabine consolidation cycles was 2 (range 1-4 cycles) with Cytarabine total dose per cycle ranging between 6 gr/m2-18 gr/m2. The median cumulative dose from all cycles of consolidation was 18 gr/m2. We considered a cumulative dose ≤18 gr/m2 to be "low intensity (LI)" and > 18 gr/m2 "high intensity (HI)". OS was superior for HI patients [(Median not reached vs. 20.3 months, P=0.04), Figure 1a]. However there was no difference in RFS between groups [ median 14.3 Vs 14.8 months, p=0.6, Figure 1b]. When data were censored at the time of alloHCT, the OS advantage for HI was no longer statistically significant (p=0.07). In multivariate analysis for OS HI consolidation, intermediate and favorable risk cytogenetics had a favorable impact. Black race was associated with inferior OS. Since HI was associated with improved OS but not RFS we hypothesized that HI had better post relapse survival. In fact, there was a trend towards better post relapse survival among HI patients (N=15) compared to LI patients (N=15) [( median 12.4 vs. 5.2 months, p=0.070), Figure 1c]. Conclusion: The intensity of Cytarabine consolidation for older AML patients in CR1 was associated with improved OS but not RFS. Although the selection of LI or HI by the treating physician did not affect risk of relapse, our data suggest that HI consolidation is likely a surrogate for factors that make patients more amenable to successful post relapse therapy. Figure 1. Figure 1. Disclosures Costa: Amgen: Honoraria, Research Funding; Abbvie: Research Funding; Janssen: Research Funding; Karyopharm: Research Funding; BMS: Research Funding; Celgene: Honoraria, Research Funding; Sanofi: Honoraria. Erba:Janssen: Research Funding; Daiichi Sankyo: Consultancy, Research Funding; MacroGenics: Consultancy; Seattle Genetics: Consultancy, Research Funding; Astellas: Research Funding; Novartis: Consultancy, Speakers Bureau; Incyte: Consultancy, Speakers Bureau; Juno: Research Funding; Immunogen: Consultancy, Research Funding; Takeda/Millenium: Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Seattle Genetics: Consultancy, Research Funding; MacroGenics: Consultancy; MacroGenics: Consultancy; Celgene: Consultancy, Speakers Bureau; Agios: Consultancy, Speakers Bureau; Astellas: Research Funding; Juno: Research Funding; Seattle Genetics: Consultancy, Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Takeda/Millenium: Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Jazz: Consultancy, Speakers Bureau; Janssen: Research Funding; Jazz: Consultancy, Speakers Bureau; Immunogen: Consultancy, Research Funding; Pfizer: Consultancy, Other: grant; Novartis: Consultancy, Speakers Bureau; Takeda/Millenium: Research Funding; Seattle Genetics: Consultancy, Research Funding; Pfizer: Consultancy, Other: grant; Agios: Consultancy, Speakers Bureau; Amgen: Research Funding; Agios: Consultancy, Speakers Bureau; Incyte: Consultancy, Speakers Bureau; Amgen: Research Funding; Incyte: Consultancy, Speakers Bureau; Jazz: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Immunogen: Consultancy, Research Funding; Novartis: Consultancy, Speakers Bureau; Jazz: Consultancy, Speakers Bureau; Celgene: Consultancy, Speakers Bureau; Pfizer: Consultancy, Other: grant; Immunogen: Consultancy, Research Funding; Pfizer: Consultancy, Other: grant; Celgene: Consultancy, Speakers Bureau; Takeda/Millenium: Research Funding; MacroGenics: Consultancy; Juno: Research Funding; Juno: Research Funding; Agios: Consultancy, Speakers Bureau; Incyte: Consultancy, Speakers Bureau; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Celgene: Consultancy, Speakers Bureau; Daiichi Sankyo: Consultancy, Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Daiichi Sankyo: Consultancy, Research Funding. Papadantonakis:Agios pharmaceuticals: Honoraria, Other: advisory board.

Three-dimensional printing of composites reinforced by continuous fiber and based on heat-resistant materials requires a prepreg compatible with these plastics. This kind of a prepreg, in its turn, would necessarily have to be similar to these plastics in terms of its chemistry and operational thermal range. This work was an investigation of factors relevant for the strength of adhesion between carbon fiber and polymeric binder. The authors managed to develop the compounds (coupling agents) facilitating fiber impregnation with polymer and improving fiberbinder adhesion. To obtain a thermoplastic binder various polyimide matrices have been synthesized. The properties of polymers thus created were studied as per the methods of thermogravimetric analysis (TGA) and Differential Scanning Calorimetry (DSC), as well as measurement of limiting wetting angle. Then these materials were subject to solution impregnation so as to obtain prepreg samples suitable for 3D printing. Impregnation quality of these samples was studied by means of scanning electronic microscopy. The most promising prepreg samples were used for 3D printing of try-out product specimens. Composites based on the plastics reinforced by continuous fibers (glass, carbon, polymeric, etc.) are widely used in special fields of today’s technology [1–4]. They have already become indispensable for rocketry or aircraft industries, and they are steadily gaining ground in other industries, too, like machine engineering, shipbuilding, civil engineering, etc. Polymeric composite have become so popular because they are quite strong [5, 6] and light [7] at the same time. Today, manufacturing of fiber-reinforced composites is quite tedious and only allows a limited scope of geometries for final products [8] because fiber impregnation with viscous solutions/melts of polymers is a difficult process. Besides, final product takes time to harden, so until it happens it needs a moulding cast or skeleton to maintain its shape. This tedious process of product manufacturing from the parts reinforced with continuous fiber might proceed much easier and with greater automation thanks to 3D printing as per fused deposition modeling (FDM) technique that uses a filament of preimpregnated fiber [9]. In particular, one of the techniques steadily improving today is 3D printing with continuous carbon fiber and prepregs based on epoxy binders. Final products manufactured as per this technology and reinforced by continuous carbon fiber feature stable size and complex shape. However, prepregs based on epoxy resins will work only with the materials that have good adhesion with them, otherwise final composites will be too weak. Current materials can only be used for the products with low operational temperatures whereas hi-tech applications require strong and heat-resistant materials. To meet this requirement, it is necessary to develop prepregs based on heat-resistant compounds, as well as filaments based on heat-resistant plastics compatible with these prepregs. Polyimides as a class of compounds have long been known to remain stable at high temperatures. Therefore, prepregs based on them, as well as polyimide matrices fit for FDM 3D printing technique will pave way to the products simultaneously featuring high thermal resistance and good strength. The purpose of this work was to develop prepregs based on carbon fiber and polyimides featuring good resistance to high temperatures and aggressive media, as well as to develop thermoplastic polyimide matrices fit for 3D printing.

Background In myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML) and acute myeloid leukemia (AML), achievement of morphologic complete response (CR) is a prerequisite for potential cure. In AML, CR is deemed the major outcome associated with improved overall survival (OS); patients (pts) without CR are considered non-responders, and hematologic improvement (HI) without bone marrow blast (BMB) clearance is considered treatment (trt) failure (Cheson 2003). Evidence suggests that these definitions may not be applicable to older pts treated with hypomethylating agents (HMA), and that achievement of CR may not be necessary for prolonged OS (Pleyer 2013, 2014, 2015; Schuh 2015; Bloomfield 2018). IWG response criteria for HI do not differentiate between pts who qualify for response (QFR) vs those that do not. Pts with 'normal' blood counts at trt start are per definition HI non-responders. This may obscure potential survival benefits of responding pts. Aims 1) Assess the impact of HI irrespective of BMB clearance and excluding immortal time bias via landmark analyses. 2) Differentiate between pts who QFR, and those with 'normal' baseline values (not-QFR) defined according to IWG prerequisites for CR. 3) Introduce 3 new categories of HI: peripheral blood blasts (PBB), elevated white blood cells (WBC), and PB-CR (defined as Hb ≥11 g/dl, ANC ≥1.0 G/l, WBC <15 G/l, PB blasts: 0%) in analogy to the concept of complete hematologic response in chronic myelogenous leukemia. Methods 1301 consecutive pts with azacitidine (AZA) trt were analyzed (NCT01595295). Data cut-off 26.07.19. HI was assessed according to IWG criteria (Cheson 2006) and the definitions specified in 3) above. More recent proposals of revision for low-risk MDS pts included in trials (Platzbecker 2018) remain largely idem. Human errors in HI assessment for each AZA cycle and lineage were excluded by automated computational calculation from electronic case report form (eCRF) data. Landmark analyses were performed at 3 months (mo) (HI requires ≥8 weeks response duration) and 6 mo (91, 92 and 88% of MDS, CMML and AML pts respond by cycle 6 [Silverman 2011; Pleyer 2013, 2014]). Statistics were performed by Unidata Geodesign GmbH using DeployR Open 8.0.0. Results In total, 462, 113, and 720 pts had MDS, CMML and AML (n=6 unknown). At AZA start, median age was 73 (range 23-93) years. One, 2 or 3 cytopenias were present in 25, 41 and 29% of pts and 46% were transfusion dependent. 55% received AZA 1st line (26% of whom received prior growth factors or iron chelators). Median AZA dose was 889 mg/cycle and 73 mg/m2/day. Median time to 1st response was 3.0 mo and 95% of pts responded by cycle 6. During AZA trt 1091 BM evaluations (BME) were performed in 599 (46%) pts. At the 3 (6) mo landmark, 44% (47%) of pts with BME achieved CR or CR with incomplete blood count recovery (CRi). Early mortality was 5.6 and 10.3% at 30 and 60 days. Of 932 (598) pts that met the 3 (6) mo landmark, a total of 39% (25%) had no BME. The impact of HI on OS became smaller the later the landmark (Tables 1 and 2). The impact of response on OS was 0.4-4.4 mo longer and significance at the 6 mo landmark was retained using IWG criteria with (Table 1) vs without (Table 2) differentiating between pts who did or did not QFR. Pts who did not QFR had similar or better OS compared with responders. At the 3 mo landmark, proposed additional response parameters HI-PBB, HI-elevated WBC and PB-CR were assoc. with a survival benefit of +7.4, +5.0 and +12.9 mo (Table 1, Fig 1A-C). Conclusions 1) The impact of HI on OS is overestimated without landmark analyses. Median time to 1st response was 3.0 mo and ≥8 weeks response duration required. We therefore suggest using a 3 mo landmark when assessing HI. 2) Using IWG criteria for HI assessment underestimates the impact of response, as non-responders are diluted by pts who do not QFR. Distinguishing QFR/not-QFR seems necessary. 3) Proposed additional HI categories (HI-PBB, HI-elevated WBC, PB-CR) add value to current response criteria. It is often the case that BME are not performed in elderly pts in real-world settings (Dinmohamed 2015; current study). Achievement of HI in any lineage and especially PB-CR might be used as a surrogate for response in pts unable or unwilling to undergo BME for response assessment. This large and growing database is suitable to allow future validation of potential novel response criteria. Disclosures Pleyer: Celgene: Other: Advisory board; Novartis: Other: Advisory board; Inflection Point Biomedical Advisors: Other: Advisory board; Agios: Other: Advisory board; Abbvie: Other: Advisory board. Pfeilstocker:Novartis: Consultancy, Honoraria; Janssen-Cilag: Honoraria; Celgene: Consultancy, Honoraria. Stauder:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Teva (Ratiopharm): Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Advisory board, Research Funding. Heibl:Daiichi Sankyo: Honoraria; Pfizer: Honoraria; Mundipharma: Honoraria; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; AOP Orphan Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Sill:Astex: Other: Advisory board; Novartis: Other: Advisory board; AbbVie: Other: Advisory board; Astellas: Other: Advisory board. Girschikofsky:Pfizer: Honoraria, Research Funding; Mundipharma: Consultancy, Honoraria. Petzer:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Roche: Other: Personal fees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Vallet:MSD: Honoraria; Pfizer: Honoraria; Roche Pharmaceuticals: Consultancy. Geissler:Abbvie: Honoraria; Pfizer: Honoraria; Amgen: Honoraria; AstraZeneca: Honoraria; AOP: Honoraria; Celgene: Honoraria; Novartis: Honoraria; Roche: Honoraria; Ratiopharm: Honoraria. Sperr:Novartis: Honoraria; Celgene: Consultancy, Honoraria. Leisch:Novartis: Honoraria, Other: Travel support; Celgene: Other: Travel support; Bristol-Myers-Squibb: Honoraria. Egle:Celgene: Honoraria, Other: Advisory board and Travel support. Melchardt:MSD: Honoraria; Merck: Honoraria, Research Funding; Takeda: Honoraria; Janssen-Cilag: Honoraria; Roche: Honoraria; Novartis: Honoraria; Cephalon: Research Funding. Piringer:Amgen: Research Funding; Roche: Other: Travel support; Merck: Other: Travel support; Bayer: Research Funding. Zebisch:Roche: Honoraria; Novartis: Honoraria, Other: Advisory board; Celgene: Honoraria; AbbVie: Other: Advisory board. Machherndl-Spandl:Celgene: Other: Advisory board. Wolf:Celgene: Honoraria, Research Funding; Abbvie: Honoraria. Keil:Bionorica: Honoraria, Research Funding; Roche: Honoraria; Pfizer: Honoraria; Celgene: Honoraria; AbbVie: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Daiichi Sankyo: Honoraria; Novartis: Honoraria; Merck: Honoraria, Research Funding; Takeda: Honoraria, Research Funding. Greil:Ratiopharm: Research Funding; MSD: Consultancy, Honoraria, Other: Travel/accomodation expenses, Research Funding; Novartis: Consultancy, Honoraria, Other: Travel/accomodation expenses, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Cephalon: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Other: Travel/accomodation expenses, Research Funding; Gilead: Consultancy, Honoraria, Other: Travel/accomodation expenses, Research Funding; Pfizer: Honoraria, Research Funding; Bristol-Myers-Squibb: Consultancy, Honoraria, Other: Travel/accomodation expenses, Research Funding; Genentech: Honoraria, Research Funding; Merck: Consultancy, Honoraria, Research Funding; Eisai: Honoraria; Mundipharma: Honoraria, Research Funding; Sanofi Aventis: Honoraria; Takeda: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria, Other: Travel/accomodation expenses, Research Funding; GSK: Research Funding; Sandoz: Honoraria; Daiichi Sankyo: Consultancy, Honoraria; Janssen-Cilag: Honoraria; Amgen: Consultancy, Honoraria, Other: Travel/accomodation expenses, Research Funding; Roche: Consultancy, Honoraria, Other: Travel/accomodation expenses, Research Funding; Boehringer Ingelheim: Honoraria. OffLabel Disclosure: Azacitidine is not approved for the treatment of MP-CMML, CMML with <10% BM blasts and IPSS low-risk MDS in the EU

Abstract Abstract 2931 Background: The incidence of sMDS is increasing due to improved survival of patients (pts) treated with chemotherapy (CT) or radiotherapy (RT) for other cancers. While studies have demonstrated hematologic improvement (HI) and survival benefits of AZA in pts with primary MDS (pMDS) (Lancet Oncol 2009;10:223), the effects of AZA in sMDS, considered rarer (5-10% of MDS diagnoses) (J Natl Cancer Inst 2008;100:1542) and more difficult to treat, are unknown. AVIDA, a longitudinal, US, multicenter, prospective registry of pts in community-based clinics receiving AZA, is the largest database of AZA-treated pts in the world and includes a large cohort of sMDS pts. We compared the tolerability of and response rates to AZA in sMDS vs pMDS pts in the AVIDA database. Methods: MDS pt data were collected at registry entry (baseline), and then quarterly using electronic data capture, between October, 2006 and July, 2010. Treating physicians determined AZA dose, dosing schedule, and treatment duration. Baseline characteristics of sMDS and pMDS pts were evaluated but formal statistical tests comparing cohorts were intentionally not performed to avoid Type I errors. Rates of IWG-2000-defined HI or possibly better responses (HI+) were assessed centrally and compared between sMDS and pMDS cohorts (each assessment included only pts eligible for improvement). RBC and platelet transfusion independence (TI) were also evaluated between groups using logistic regression analyses with patients stratified by International Prognostic Scoring System (IPSS) scores (higher [score >1] vs lower [score ≤1]) and transfusion status at baseline, with age and months since diagnosis included as covariates. Odds ratios (sMDS to pMDS) and 95% confidence intervals (CI) were reported from these models. Results: At data cut-off in July 2010, 37/417 pts (8.9%) in the registry had sMDS associated with exposure to RT, CT, or radioiodine (n=33), benzene (n=2), or radiation (n=2). Median times since diagnosis for pts with sMDS and pMDS were 1 month (range 0 – 69) and 3 months (0 – 207), and median ages were 71 years (range 41 – 86) and 75 years (29 – 91), respectively. At baseline, for pts with available IPSS scores, a larger proportion of pts with sMDS than pts with pMDS had IPSS higher-risk scores (55% vs 30%) and IPSS poor cytogenetics (59% vs 17%). Additionally, a higher proportion of sMDS vs pMDS pts had chromosome 7 abnormalities (47% vs 11%), 2–3 cytopenias (76% vs 62%), and infections requiring IV antibiotics (41% vs 16%); but similar proportions had >10% blasts (18% of both cohorts) and were dependent on RBC (57% vs 52%) and platelet (22% vs 13%) transfusions at baseline. Median follow-up was 5.9 months (range 0.2 – 24) in the sMDS and 6.7 months (0.1 – 37) in the pMDS cohorts, and median numbers of AZA treatment cycles were 4 (range 1 – 21) and 5 (1 – 26), respectively. In both the sMDS and pMDS groups, the most common treatment dose and schedules were 75 mg/m2 AZA (91% and 83%, respectively) for 5 consecutive days (46% and 55%) in ≤28-day cycles (45% and 54%). Pts with sMDS had a high rate of HI+, which was comparable to that in pts with pMDS (Table). Rates of RBC TI in baseline RBC transfusion-dependent pts with sMDS vs pMDS were 57% vs 61%, and of platelet TI for baseline platelet transfusion-dependent sMDS vs pMDS pts were 50% vs 64% (Table). Odds ratios from the logistic regression models were 1.4 (95%CI: 0.6, 3.5; p=0.47) and 0.6 (95%CI: 0.2, 1.4; p=0.23) for RBC TI and platelet TI, respectively, after adjusting for the other covariates in the model. Grade 3 or 4 adverse events were similar in the 2 groups, with the exception of higher frequencies of thrombocytopenia (27% vs 11%) and infections (24% vs. 12%) in sMDS vs pMDS pts, respectively. Conclusion: Pts with sMDS treated with AZA had rates of HI or better responses comparable to those of pMDS patients, despite worse pretreatment disease characteristics. AZA was well tolerated by pts with sMDS and pMDS. A diagnosis of sMDS alone should not preclude treatment with the disease-modifying drug, azacitidine. Disclosures: Sekeres: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Off Label Use: Azacitidine is approved in the US for treatment of patients with the FAB myelodysplastic syndrome (MDS) subtypes: Refractory anemia (RA) or refractory anemia with ringed sideroblasts (RARS) (if accompanied by neutropenia or thrombocytopenia or requiring transfusions), refractory anemia with excess blasts (RAEB), refractory anemia with excess blasts in transformation (RAEB-T), and chronic myelomonocytic leukemia (CMML); and is approved in the EU for IPSS Int-2 and High risk MDS, CMML with 10–29 percent marrow blasts without myeloproliferative disorder, and AML with 20–30% blasts and multi-lineage dysplasia, according to WHO classification. This abstract describes azacitidine use in secondary MDS. Komrokji:Celgene: Research Funding, Speakers Bureau. Maciejewski:Celgene: Research Funding; Eisai: Research Funding; Alexion: Consultancy. List:Celgene: Research Funding. Street:Celgene: Employment. Swern:Celgene Corporation: Employment. Sullivan:Celgene: Employment, Equity Ownership. Grinblatt:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Abstract Background In myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML) and acute myeloid leukemia (AML) achievement of complete remission (CR) is a prerequisite for potential cure. In AML, CR/CR with incomplete recovery (CRi) is deemed the major outcome associated with improved overall survival (OS); patients (pts) without CR/CRi are considered non-responders, and hematologic improvement (HI) without (assessment of) bone marrow (BM) blast clearance is considered treatment (trt) failure. Achievement of CR may not be necessary for prolonged OS in pts treated with azacitidine (AZA) (Pleyer L, Annals Hematol 2014, 1825; Schuh AC, ASH 2015, P575). Outside of clinical trials, BM evaluations (BME) are only performed in ~50% of pts (Dinmohamed, Leuk Res 2015, 177) when either response or progression are obvious from peripheral blood (PB) values, or when pts are unable or unwilling to have BME. Aims To assess of the impact of response type on AZA trt outcomes in multivariate adjusted analyses (MVA). Methods 1441 pts included in the Austrian Azacitidine Registry were analyzed (NCT01595295). Data cut-off was 1 July 21. Marrow response was assessed for MDS/CMML and AML at each BME; HI was assessed on day 1 of each AZA cycle (Döhner H, Blood 2017, 424; Cheson BD, Blood 2006, 419; Pleyer L, ASH 2019, P3821); peripheral blood complete remission (PB-CR) was defined as hemoglobin ³11 g/dL, platelet count ≥100 G/L, neutrophil count ³1.0 G/L, white blood cell count &lt;15 G/L, PB blasts =0%, and no transfusions. Response types were calculated from electronic case report form data. To identify which response type achieved by which AZA cycle had the highest impact on time-to-event endpoints, likelihood ratios (LR) of the Cox-regression model for OS or time to next treatment (TTNT) were calculated using the respective response types as covariates. Baseline characteristics with univariate p&lt;0·10 (n=23) for association with OS were included in the multivariate regression. After stepwise selection n=17 variables remained and were used for MVA. Assign Data Management and Biostatistics GmbH performed statistical analyses with SAS® 9.4. Results In total, 521, 135, and 785 pts had MDS, CMML and AML. Median year of initial diagnosis was 2012, median time to AZA start was 3·0 (IQR 1·0-13·2) months (mo), median follow-up time from AZA start was 10.6 (IQR 4·0-21·1) mo, 894 pts received AZA as first line trt, median age at AZA start was 73 (range 23-99) years. In total, 13956 AZA cycles were applied, median duration of AZA trt was 5·0 (IQR 1·9-12·1) mo, median AZA dose was 875 (IQR 700-1000) mg/cycle, AZA was applied for a median of 7 (IQR 5-7) days. Median time to best response was 3·7 (IQR 2·0-5·9) months. Early mortality was 5.5% within 30 days. During AZA trt 1225 BM evaluations (BME) were performed in 697 (48·4%) of pts. Of these, 204 achieved CR/CRi. Irrespective of BME, 622 (43%) of 1441 pts achieved an HI and 264 (18·3%) of 1441 pts achieved a PB-CR. Pts achieving CR had longer adjusted OS (23·7 vs 19·7 mo, p=0·0227; HR=0·621 [0·413-0·936]) and TTNT (19·4 vs 15·7 mo, p=0·0262; HR=0·644 [0·436-0·949]) than pts achieving CRi. Among pts achieving CR, those additionally achieving PB-CR had longer adjusted OS (24·8 vs 16·3; p=0·0040; HR=0·256 [0·101-0·647]; Fig 1A) and TTNT (21·2 vs 11·0; p=0·0005; HR=0·219 [0·094-0·513]; Fig 1B) than those who did not. Among pts not achieving CR, those additionally achieving PB-CR had longer adjusted OS (20·8 vs 14·1; p&lt;0·0001; HR=0·510 [0·397-0·657]; Fig 1A) and TTNT (17·7 vs 10·9; p&lt;0·0001; HR=0·485 [0·357-0·589]; Fig 1B) than those who did not. Among all pts, irrespective of BM blast count, achievement of PB-CR resulted in longer adjusted OS (21·7 vs 10·0 mo; p&lt;·0001; HR 0·363; Fig 1C) and TTNT (18.5 vs 7.8 mo; p&lt;0.0001; HR=0.346; Fig 1D) and provided added value to CR and CR/CRi. Among all response types and after MVA, the highest prognostic impact on both OS and TTNT was observed when achieving PB-CR or CR/CRi by cycle 9 or 10 (Fig 2A-B). Conclusions Above data indicate that achievement of PB-CR is a strong predictor of OS and TTNT that provides additional information to current response criteria. Inclusion of PB-CR in updated response criteria of pts with MDS, CMML or AML receiving non-intensive trt should be considered. The greatest advantage of PB-CR is that it can be easily, nearly painlessly and quickly assessed. Inclusion of PB-CR as an endpoint in clinical trials would be desirable for validation of these results. Figure 1 Figure 1. Disclosures Pleyer: AbbVie, BMS, Novartis: Honoraria, Other: Travel Sport. Pfeilstocker: BMS: Honoraria. Stauder: Celgene/BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Heibl: BMS: Honoraria. Sill: Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees. Hartmann: Celgene, Amgene, Janssen, AbbVie: Honoraria. Petzer: Kite-Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astra Zeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Saegen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Daiichi Sankyo: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sandoz: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene-BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees. Geissler: BMS: Honoraria. Sperr: AbbVie, BMS-Celgene, Daiichi Sankyo, Deciphera, Incyte, Jazz, Novartis, Pfizer, StemLine, Thermo Fisher: Honoraria, Research Funding. Leisch: Honoraria from BMS, Celgene, Gilead, Takeda and Novartis; Travel support: Celgene and Novartis: Honoraria, Other: Travel support. Melchardt: Abbvie, Celgene, Novartis: Honoraria. Zebisch: Novartis: Consultancy; AbbVie: Consultancy; Celgene: Consultancy, Honoraria. Machherndl-Spandl: AbbVie, Celgene, BMS, Pfizer: Honoraria. Wolf: Roche: Honoraria, Research Funding; MSD: Honoraria, Research Funding; BMS-Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Takeda: Honoraria; Gilead: Honoraria; Incyte: Honoraria; GEMOAB: Honoraria. Greil: Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; AstraZeneca: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; MSD: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Daiichi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Sankyo: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding; Sandoz: Honoraria, Research Funding. OffLabel Disclosure: Azacitidine is approved for all types of MDS and CMML as well as low blast count AML by FDA, but not for all subtypes of MDS and CMML by EMA.

BackgroundPatients with rheumatic and musculoskeletal diseases (RMDs) require a tailored follow-up that is limited by the capacity of healthcare professionals. Innovative tools need to be implemented effectively in the clinical care of patients with RMDs.ObjectivesTo test the feasibility of a Precision Digital Companion Platform™ for real-time monitoring of disease outcomes in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).MethodsDigireuma was a prospective study including patients with RA and SpA, using the digital Precision Digital Companion Platform, Adhera for Rheumatology (ISRCTN11896540). During a follow-up of 3 months, patients were asked to report disease specific electronic patient reported outcomes (ePROs) on a regular basis in the mobile solution. Two rheumatologists monitored these ePROs and, patients were contacted for online or face-to-face interventions when deemed necessary by clinicians (Figure 1). Assessment measures included patient global assessment (PGA) of disease activity, tender joint count (TJC), swollen joint count (SJC), Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), for patients with RA; VAS, PGA, TJC, SJC, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and ASAS Health Index (ASAS-HI), for patients with SpA. In addition, flares, changes in medication and recent infections were asked. Usability of the digital solution was measured by the Net-Promoter Score (NPS).Figure 1.Digital monitoring in the study powered by Adhera for Rheumatology. Screenshots in top depict the mobile interface (left) and clinical web application (right)ResultsForty-six patients were recruited of whom 22 had RA and 24 SpA. Mean age was 48 ± 12 and 42 ± 9 years in the RA and SpA groups, respectively. 18/22 (82%) patients with RA and 9/24 (38%) with SpA were female. Among the total included patients, 41 (89%) completed the onboarding (18/22 (82%) RA, 23/24 (96%) SpA) and 37 (80%) submitted at least one entry. In the RA group who completed the onboarding (n=18) there were a total of 4019 total interactions (2178 questionnaire items, 648 accesses to educational units, 105 quizzes, 1088 rated messages), while patients with SpA (n=23) had a total of 3160 interactions (1637 questionnaire items, 684 accesses to educational units, 77 quizzes, 762 rated messages). ePROs measurements completion rates for RA and SpA patients that completed any data during follow-up are shown in Table 1. Patients with RA completed a median of 9.5 ePROs during follow-up, whereas patients with SpA completed a median of 3. Regarding alerts, 15 patients generated a total of 26 alerts, of which 24 were flares (10 RA, 14 SpA) and 2 were problems with the medication (1 RA, 1 SpA). 18 (69%) of the alerts were managed remotely, 5 (19%) required a face-to-face intervention and in 3 (12%) patients did not respond before the consultation. Regarding usability and patient satisfaction, 14 patients provided feedback. According to the NPS, 9/14 were considered promoters, 4/14 passives and 1/14 detractor. The overall rating of these 14 patients for the app was 4.3 out of 5 stars.Table 1.Onboarded patient engagement with regards to e-PROsRheumatoid Arthritis (n=18)PGATJCSJCVASHAQTotalePROs completed1.5 (0.25, 3)2 (0.25, 3)2 (0.25, 3)2 (0, 3)2 (1, 3)9.5 (4.3, 15.8)Patients with ≥ 1 entry13 (72.2)13 (72.2)13 (72.2)12 (66.7)16 (88.9)16 (88.9)Spondyloarthritis (n=23)PGATJCSJCBASDAIASAS-HITotalePROs completed1 (0,3)1 (0,3)1 (0,3)1 (0,2)1 (0,2)3 (1, 12)Patients with ≥ 1 entry16 (69.5)16 (69.5)16 (69.5)14 (60.8)14 (60.8)21 (91.3)Follow-up period was 3 months. Results are expressed in median (Q1, Q3) and n (%)ConclusionThis study shows that the use of a digital health solution is feasible in clinical practice. Based on these preliminary results, the next step will be to further implement the Precision Digital Companion Platform, Adhera for Rheumatology, in a multicentric setting to analyze the added value for monitoring patients.AcknowledgementsThis study was funded with an unrestricted grant from Abbvie.Disclosure of InterestsDiego Benavent Speakers bureau: Jannsen, Roche, Grant/research support from: Novartis, Abbvie, Francisco J. Núñez-Benjumea Employee of: AdheraHealth Inc, Luis Fernández-Luque Employee of: AdheraHealth Inc, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis, María Sanz: None declared, Enrique Calvo Aranda Speakers bureau: Abbvie, LETICIA LOJO: None declared, Alejandro Balsa Speakers bureau: Pfizer, Abbvie, Lilly, Galapagos, BMS, Sandoz, Nordic Pharma, Gebro, Roche, Sanofi, UCB, Consultant of: Pfizer, Abbvie, Lilly, Galapagos, BMS, Nordic Pharma, Sanofi, UCB, Grant/research support from: Pfizer, Abbvie, BMS, Nordic Pharma, Gebro, Roche, UCB, Chamaida Plasencia Speakers bureau: Pfizer, Abbvie, Lilly, Sandoz, Sanofi, Biogen, Roche, Novartis, Grant/research support from: Pfizer y Abbvie

Health informatics (HI) has become a significant research area due to the massive generation of digital health and medical data by biomedical and health research organizations. The health data sources are available in different forms namely electronic health records (EHRs), biomedical imaging, bio-signals, sensor data, genomic data, medical history, social media data, and so on. The structured health data can be utilized for HI and effective predictive modeling of health data assists in the decision-making process. The recently developed artificial intelligence (AI), machine learning (ML), and deep learning (DL) techniques pave a way for effective predictive modeling on health data. Numerous existing works have been presented in the literature depending upon the ML and DL based HI for various applications. With this motivation, this study aims to review the recent state of art ML and DL based predictive models for health sector. This survey primarily identifies the difference between the ML and DL architectures with their significance in health sector. In addition, the existing works are extensively reviewed and compared in terms of different aspects such as objectives, underlying methodology, input source, dataset used, performance validation, metrics, and so on. Finally, the open challenges and future scope of the HI are examined in detail. At the end of the survey, the readers find it useful to identify the present research and possible future scope of the ML and DL based predictive models for HI.

Introduction: The lack of information can affect the level of knowledge, attitudes, and practices for dengue control. The purpose of this study was to measure knowledge, attitudes, and practices associated with the larvae density of Aedes sp. Study Design: This study used a cross-sectional design by sampling as many as 250 households. Data measurements were carried out quantitatively using questionnaires and direct observation. Results: The variable knowledge, attitudes, practices, family income, and door-to-door health promotion associated with Aedes larvae density. People who eradicated mosquito breeding sites were mothers (74.4%), draining mosquito breeding sites routinely once a week (43%). The media favored direct counseling (53%), television as much as (34%). The preferred electronic media was interactive interviews (78.8%). The Aedes sp entomology survey results were house index (HI): 31.2%, container index (CI): 20.4%, and breteau index (BI): 103.6%. Conclusion: The knowledge, attitude, practice, family income, and door-to-door health promotion variables were associated with the density of Aedes larvae. Education programs in the community could increase awareness of controlling dengue vectors.

In the contemporary era, media spectacle organizes and mobilizes economic life, political conflict, social interactions, culture, and everyday life. My recently published book Media Spectacle explores a profusion of developments in hi-tech culture, media-driven society, and spectacle politics. Spectacle culture involves everything from film and broadcasting to Internet cyberculture and encompasses phenomena ranging from elections to terrorism and to the media dramas of the moment. For ‘Logo’, I am accordingly sketching out briefly a terrain I probe in detail in the book from which these examples are taken.1 During the past decades, every form of culture and significant forms of social life have become permeated by the logic of the spectacle. Movies are bigger and more spectacular than ever, with high-tech special effects expanding the range of cinematic spectacle. Television channels proliferate endlessly with all-day movies, news, sports, specialty niches, re-runs of the history of television, and whatever else can gain an audience. The rock spectacle reverberates through radio, television, CDs, computers networks, and extravagant concerts. The Internet encircles the world in the spectacle of an interactive and multimedia cyberculture. Media culture excels in creating megaspectacles of sports championships, political conflicts, entertainment, "breaking news" and media events, such as the O.J. Simpson trial, the Death of Princess Diana, or the sex or murder scandal of the moment. Megaspectacle comes as well to dominate party politics, as the political battles of the day, such as the Clinton sex scandals and impeachment, the 36 Day Battle for the White House after Election 2000, and the September 11 terrorist attacks and subsequent Terror War. These dramatic media passion plays define the politics of the time, and attract mass audiences to their programming, hour after hour, day after day. The concept of "spectacle" derives from French Situationist theorist Guy Debord's 1972 book Society of the Spectacle. "Spectacle," in Debord's terms, "unifies and explains a great diversity of apparent phenomena" (Debord 1970: #10). In one sense, it refers to a media and consumer society, organized around the consumption of images, commodities, and spectacles. Spectacles are those phenomena of media culture which embody contemporary society's basic values, and dreams and nightmares, putting on display dominant hopes and fears. They serve to enculturate individuals into its way of life, and dramatize its conflicts and modes of conflict resolution. They include sports events, political campaigns and elections, and media extravaganzas like sensational murder trials, or the Bill Clinton sex scandals and impeachment spectacle (1998-1999). As we enter a new millennium, the media are becoming ever more technologically dazzling and are playing an increasingly central role in everyday life. Under the influence of a postmodern image culture, seductive spectacles fascinate the denizens of the media and consumer society and involve them in the semiotics of a new world of entertainment, information, a semiotics of a new world of entertainment, information, and drama, which deeply influence thought and action. For Debord: "When the real world changes into simple images, simple images become real beings and effective motivations of a hypnotic behavior. The spectacle as a tendency to make one see the world by means of various specialized mediations (it can no longer be grasped directly), naturally finds vision to be the privileged human sense which the sense of touch was for other epochs; the most abstract, the most mystifiable sense corresponds to the generalized abstraction of present day society" (#18). Today, however, I would maintain it is the multimedia spectacle of sight, sound, touch, and, coming to you soon, smell that constitutes the multidimensional sense experience of the new interactive spectacle. For Debord, the spectacle is a tool of pacification and depoliticization; it is a "permanent opium war" (#44) which stupefies social subjects and distracts them from the most urgent task of real life -- recovering the full range of their human powers through creative praxis. The concept of the spectacle is integrally connected to the concept of separation and passivity, for in passively consuming spectacles, one is separated from actively producing one's life. Capitalist society separates workers from the products of their labor, art from life, and consumption from human needs and self-directing activity, as individuals passively observe the spectacles of social life from within the privacy of their homes (#25 and #26). The situationist project by contrast involved an overcoming of all forms of separation, in which individuals would directly produce their own life and modes of self-activity and collective practice. Since Debord's theorization of the society of the spectacle in the 1960s and 1970s, spectacle culture has expanded in every area of life. In the culture of the spectacle, commercial enterprises have to be entertaining to prosper and as Michael J. Wolf (1999) argues, in an "entertainment economy," business and fun fuse, so that the E-factor is becoming major aspect of business.2 Via the "entertainmentization" of the economy, television, film, theme parks, video games, casinos, and so forth become major sectors of the national economy. In the U.S., the entertainment industry is now a $480 billion industry, and consumers spend more on having fun than on clothes or health care (Wolf 1999: 4).3 In a competitive business world, the "fun factor" can give one business the edge over another. Hence, corporations seek to be more entertaining in their commercials, their business environment, their commercial spaces, and their web sites. Budweiser ads, for instance, feature talking frogs who tell us nothing about the beer, but who catch the viewers' attention, while Taco Bell deploys a talking dog, and Pepsi uses Star Wars characters. Buying, shopping, and dining out are coded as an "experience," as businesses adopt a theme-park style. Places like the Hard Rock Cafe and the House of Blues are not renowned for their food, after all; people go there for the ambience, to buy clothing, and to view music and media memorabilia. It is no longer good enough just to have a web site, it has to be an interactive spectacle, featuring not only products to buy, but music and videos to download, games to play, prizes to win, travel information, and "links to other cool sites." To succeed in the ultracompetitive global marketplace, corporations need to circulate their image and brand name so business and advertising combine in the promotion of corporations as media spectacles. Endless promotion circulates the McDonald’s Golden Arches, Nike’s Swoosh, or the logos of Apple, Intel, or Microsoft. In the brand wars between commodities, corporations need to make their logos or “trademarks” a familiar signpost in contemporary culture. Corporations place their logos on their products, in ads, in the spaces of everyday life, and in the midst of media spectacles like important sports events, TV shows, movie product placement, and wherever they can catch consumer eyeballs, to impress their brand name on a potential buyer. Consequently, advertising, marketing, public relations and promotion are an essential part of commodity spectacle in the global marketplace. Celebrity too is manufactured and managed in the world of media spectacle. Celebrities are the icons of media culture, the gods and goddesses of everyday life. To become a celebrity requires recognition as a star player in the field of media spectacle, be it sports, entertainment, or politics. Celebrities have their handlers and image managers to make sure that their celebrities continue to be seen and positively perceived by publics. Just as with corporate brand names, celebrities become brands to sell their Madonna, Michael Jordan, Tom Cruise, or Jennifer Lopez product and image. In a media culture, however, celebrities are always prey to scandal and thus must have at their disposal an entire public relations apparatus to manage their spectacle fortunes, to make sure their clients not only maintain high visibility but keep projecting a positive image. Of course, within limits, “bad” and transgressions can also sell and so media spectacle contains celebrity dramas that attract public attention and can even define an entire period, as when the O.J. Simpson murder trials and Bill Clinton sex scandals dominated the media in the mid and late 1990s. Entertainment has always been a prime field of the spectacle, but in today's infotainment society, entertainment and spectacle have entered into the domains of the economy, politics, society, and everyday life in important new ways. Building on the tradition of spectacle, contemporary forms of entertainment from television to the stage are incorporating spectacle culture into their enterprises, transforming film, television, music, drama, and other domains of culture, as well as producing spectacular new forms of culture such as cyberspace, multimedia, and virtual reality. For Neil Gabler, in an era of media spectacle, life itself is becoming like a movie and we create our own lives as a genre like film, or television, in which we become "at once performance artists in and audiences for a grand, ongoing show" (1998: 4). On Gabler’s view, we star in our own "lifies," making our lives into entertainment acted out for audiences of our peers, following the scripts of media culture, adopting its role models and fashion types, its style and look. Seeing our lives in cinematic terms, entertainment becomes for Gabler "arguably the most pervasive, powerful and ineluctable force of our time--a force so overwhelming that it has metastasized into life" to such an extent that it is impossible to distinguish between the two (1998: 9). As Gabler sees it, Ralph Lauren is our fashion expert; Martha Stewart designs our sets; Jane Fonda models our shaping of our bodies; and Oprah Winfrey advises us on our personal problems.4 Media spectacle is indeed a culture of celebrity who provide dominant role models and icons of fashion, look, and personality. In the world of spectacle, celebrity encompasses every major social domain from entertainment to politics to sports to business. An ever-expanding public relations industry hypes certain figures, elevating them to celebrity status, and protects their positive image in the never-ending image wars and dangers that a celebrity will fall prey to the machinations of negative-image and thus lose celebrity status, and/or become figures of scandal and approbation, as will some of the players and institutions that I examine in Media Spectacle (Kellner 2003). Sports has long been a domain of the spectacle with events like the Olympics, World Series, Super Bowl, World Soccer Cup, and NBA championships attracting massive audiences, while generating sky-high advertising rates. These cultural rituals celebrate society's deepest values (i.e. competition, winning, success, and money), and corporations are willing to pay top dollar to get their products associated with such events. Indeed, it appears that the logic of the commodity spectacle is inexorably permeating professional sports which can no longer be played without the accompaniment of cheerleaders, giant mascots who clown with players and spectators, and raffles, promotions, and contests that feature the products of various sponsors. Sports stadiums themselves contain electronic reproduction of the action, as well as giant advertisements for various products that rotate for maximum saturation -- previewing environmental advertising in which entire urban sites are becoming scenes to boost consumption spectacles. Arenas, like the United Center in Chicago, America West Arena in Phoenix, on Enron Field in Houston are named after corporate sponsors. Of course, after major corporate scandals or collapse, like the Enron spectacle, the ballparks must be renamed! The Texas Ranger Ballpark in Arlington, Texas supplements its sports arena with a shopping mall, office buildings, and a restaurant in which for a hefty price one can watch the athletic events while eating and drinking.5 The architecture of the Texas Rangers stadium is an example of the implosion of sports and entertainment and postmodern spectacle. A man-made lake surrounds the stadium, the corridor inside is modeled after Chartes Cathedral, and the structure is made of local stone that provides the look of the Texas Capitol in Austin. Inside there are Texas longhorn cattle carvings, panels of Texas and baseball history, and other iconic signifiers of sports and Texas. The merging of sports, entertainment, and local spectacle is now typical in sports palaces. Tropicana Field in Tampa Bay, Florida, for instance, "has a three-level mall that includes places where 'fans can get a trim at the barber shop, do their banking and then grab a cold one at the Budweiser brew pub, whose copper kettles rise three stories. There is even a climbing wall for kids and showroom space for car dealerships'" (Ritzer 1998: 229). Film has long been a fertile field of the spectacle, with "Hollywood" connoting a world of glamour, publicity, fashion, and excess. Hollywood film has exhibited grand movie palaces, spectacular openings with searchlights and camera-popping paparazzi, glamorous Oscars, and stylish hi-tech film. While epic spectacle became a dominant genre of Hollywood film from early versions of The Ten Commandments through Cleopatra and 2001 in the 1960s, contemporary film has incorporated the mechanics of spectacle into its form, style, and special effects. Films are hyped into spectacle through advertising and trailers which are ever louder, more glitzy, and razzle-dazzle. Some of the most popular films of the late 1990s were spectacle films, including Titanic, Star Wars -- Phantom Menace, Three Kings, and Austin Powers, a spoof of spectacle, which became one of the most successful films of summer 1999. During Fall 1999, there was a cycle of spectacles, including Topsy Turvy, Titus, Cradle Will Rock, Sleepy Hollow, The Insider, and Magnolia, with the latter featuring the biblical spectacle of the raining of frogs in the San Fernando Valley, in an allegory of the decadence of the entertainment industry and deserved punishment for its excesses. The 2000 Academy Awards were dominated by the spectacle Gladiator, a mediocre film that captured best picture award and best acting award for Russell Crowe, thus demonstrating the extent to which the logic of the spectacle now dominates Hollywood film. Some of the most critically acclaimed and popular films of 2001 are also hi-tech spectacle, such as Moulin Rouge, a film spectacle that itself is a delirious ode to spectacle, from cabaret and the brothel to can-can dancing, opera, musical comedy, dance, theater, popular music, and film. A postmodern pastiche of popular music styles and hits, the film used songs and music ranging from Madonna and the Beatles to Dolly Parton and Kiss. Other 2001 film spectacles include Pearl Harbor, which re-enacts the Japanese attack on the U.S. that propelled the country to enter World War II, and that provided a ready metaphor for the September 11 terror attacks. Major 2001 film spectacles range from David Lynch’s postmodern surrealism in Mulholland Drive to Steven Spielberg’s blending of his typically sentimental spectacle of the family with the formalist rigor of Stanley Kubrick in A.I. And the popular 2001 military film Black-Hawk Down provided a spectacle of American military heroism which some critics believed sugar-coated the actual problems with the U.S. military intervention in Somalia, causing worries that a future U.S. adventure by the Bush administration and Pentagon would meet similar problems. There were reports, however, that in Somalian cinemas there were loud cheers as the Somalians in the film shot down the U.S. helicopter, and pursued and killed American soldiers, attesting to growing anti-American sentiment in the Muslim world against Bush administration policies. Television has been from its introduction in the 1940s a promoter of consumption spectacle, selling cars, fashion, home appliances, and other commodities along with consumer life-styles and values. It is also the home of sports spectacle like the Super Bowl or World Series, political spectacles like elections (or more recently, scandals), entertainment spectacle like the Oscars or Grammies, and its own spectacles like breaking news or special events. Following the logic of spectacle entertainment, contemporary television exhibits more hi-tech glitter, faster and glitzier editing, computer simulations, and with cable and satellite television, a fantastic array of every conceivable type of show and genre. TV is today a medium of spectacular programs like The X-Files or Buffy, the Vampire Slayer, and spectacles of everyday life such as MTV's The Real World and Road Rules, or the globally popular Survivor and Big Brother series. Real life events, however, took over TV spectacle in 2000-2001 in, first, an intense battle for the White House in a dead-heat election, that arguably constitutes one of the greatest political crimes and scandals in U.S. history (see Kellner 2001). After months of the Bush administration pushing the most hardright political agenda in memory and then deadlocking as the Democrats took control of the Senate in a dramatic party re-affiliation of Vermont’s Jim Jeffords, the world was treated to the most horrifying spectacle of the new millennium, the September 11 terror attacks and unfolding Terror War that has so far engulfed Afghanistan and Iraq. These events promise an unending series of deadly spectacle for the foreseeable future.6 Hence, we are emerging into a new culture of media spectacle that constitutes a novel configuration of economy, society, politics, and everyday life. It involves new cultural forms, social relations, and modes of experience. It is producing an ever-proliferating and expanding spectacle culture with its proliferating media forms, cultural spaces, and myriad forms of spectacle. It is evident in the U.S. as the new millennium unfolds and may well constitute emergent new forms of global culture. Critical social theory thus faces important challenges in theoretically mapping and analyzing these emergent forms of culture and society and the ways that they may contain novel forms of domination and oppression, as well as potential for democratization and social justice. Works Cited Debord, Guy. Society of the Spectacle. Detroit: Black and Red, 1967. Gabler, Neil. Life the Movie. How Entertainment Conquered Reality. New York: Alfred A. Knopf, 1998. Kellner, Douglas. Grand Theft 2000. Lanham, Md.: Rowman and Littlefield, 2001. Kellner, Douglas. From 9/11 to Terror War: Dangers of the Bush Legacy. Lanham, Md.: Rowman and Littlefield, 2003. Kellner, Douglas. Media Spectacle. London and New York: Routledge, 2003. Ritzer, George. The McDonaldization Thesis: Explorations and Extensions. Thousand Oaks, Cal. and London: Sage, 1998. Wolf, Michael J. Entertainment Economy: How Mega-Media Forces are Transforming Our Lives. New York: Times Books, 1999. Notes 1 See Douglas Kellner, Media Spectacle. London and New York: Routledge, 2003. 2 Wolf's book is a detailed and useful celebration of the "entertainment economy," although he is a shill for the firms and tycoons that he works for and celebrates them in his book. Moreover, while entertainment is certainly an important component of the infotainment economy, it is an exaggeration to say that it drives it and is actually propelling it, as Wolf repeatedly claims. Wolf also downplays the negative aspects of the entertainment economy, such as growing consumer debt and the ups and downs of the infotainment stock market and vicissitudes of the global economy. 3 Another source notes that "the average American household spent $1,813 in 1997 on entertainment -- books, TV, movies, theater, toys -- almost as much as the $1,841 spent on health care per family, according to a survey by the US Labor Department." Moreover, "the price we pay to amuse ourselves has, in some cases, risen at a rate triple that of inflation over the past five years" (USA Today, April 2, 1999: E1). The NPD Group provided a survey that indicated that the amount of time spent on entertainment outside of the home –- such as going to the movies or a sport event – was up 8% from the early to the late 1990s and the amount of time in home entertainment, such as watching television or surfing the Internet, went up 2%. Reports indicate that in a typical American household, people with broadband Internet connections spend 22% more time on all-electronic media and entertainment than the average household without broadband. See “Study: Broadband in homes changes media habits” (PCWORLD.COM, October 11, 2000). 4 Gabler’s book is a synthesis of Daniel Boorstin, Dwight Macdonald, Neil Poster, Marshall McLuhan, and other trendy theorists of media culture, but without the brilliance of a Baudrillard, the incisive criticism of an Adorno, or the understanding of the deeper utopian attraction of media culture of a Bloch or Jameson. Likewise, Gabler does not, a la cultural studies, engage the politics of representation, or its economics and political economy. He thus ignores mergers in the culture industries, new technologies, the restructuring of capitalism, globalization, and shifts in the economy that are driving the impetus toward entertainment. Gabler does get discuss how new technologies are creating new spheres of entertainment and forms of experience and in general describes rather than theorizes the trends he is engaging. 5 The project was designed and sold to the public in part through the efforts of the son of a former President, George W. Bush. Young Bush was bailed out of heavy losses in the Texas oil industry in the 1980s by his father's friends and used his capital gains, gleaned from what some say as illicit insider trading, to purchase part-ownership of a baseball team to keep the wayward son out of trouble and to give him something to do. The soon-to-be Texas governor, and future President of the United States, sold the new stadium to local taxpayers, getting them to agree to a higher sales tax to build the stadium which would then become the property of Bush and his partners. This deal allowed Bush to generate a healthy profit when he sold his interest in the Texas Rangers franchise and to buy his Texas ranch, paid for by Texas tax-payers (for sources on the scandalous life of George W. Bush and his surprising success in politics, see Kellner 2001 and the further discussion of Bush Jr. in Chapter 6). 6 See Douglas Kellner, From 9/11 to Terror War: Dangers of the Bush Legacy. Lanham, Md.: Rowman and Littlefield Citation reference for this article Substitute your date of access for Dn Month Year etc... MLA Style Kellner, Douglas. "Engaging Media Spectacle " M/C: A Journal of Media and Culture< http://www.media-culture.org.au/0306/09-mediaspectacle.php>. APA Style Kellner, D. (2003, Jun 19). Engaging Media Spectacle . M/C: A Journal of Media and Culture, 6,< http://www.media-culture.org.au/0306/09-mediaspectacle.php>

What could it possibly mean when a journal brazenly announces that its conceptual theme for an issue is the idea of "Renew"? Does it signal the first signs of panic, that M/C no longer has "it", whatever that elusive "it" might be? Could it indicate that M/C is in the first stages of deaththroes? Could it be some Stalinist or perhaps Maoist moment of cultural revolution and cleansing so that the editorial collective emerges more committed than ever to its mission? Or is it just another example of how marketing ploys have invaded all our discourses and made us appeal to idea of change in order to convince you that we are hip (as Dr Evil intoned in Austin Powers) with it and relevant to these crazy mixed-up times. Well, you would all be right. We wanted to renew the mandate of M/C. We still want to move ideas outward in our study of popular culture in all its manifestations and allow the journal to keep straddling the line between the popular and the academic. Although we have on occasion veered to the discourses of academic disciplines, we have tried to maintain a sensibility about how ideas can migrate and not be cloistered behind the professionalisation of cultural knowledge. We have provided a platform for understanding the shifts in contemporary culture as new media become more central to the rearticulation of our cultural experiences. And we have tried to maintain a thematic approach to critical engagement and allowed those concepts and themes to motivate a lateral patterning of thinking for our writers and readers. There is no question that our strategy has been successful. We have a regular and widely international readership. We have an incredibly international list of contributors to M/C which has given the journal an enviable international and national profile in the field of media and cultural studies. But we want more. We want to be more engaging, more widely read and actively making ideas move from the intellectual periphery to the cultural and political hearths. The 'renew' issue underlines this mandate and attempts to reinvigorate the journal with its original style posture and acknowledgement of its now international contributors. Part of this issue is designed as a moment of self-reflection by those first M/C writers, not so much on the journal itself but more generally on the concept of renewal. The other part of the issue is collected from submissions made to this theme from other writers. What we have produced is a powerful double-shot of perceptive ponderings on renewal in and around media and culture. Opening the issue, Adam Dodd's "'Unacceptable Renewals': The Geopolitics of Martian Cartography" uses the Mars face controversy as a looking glass through which to critique the broader science of cartography, the technologies actualising this science, and the politicised discourses of the people who practice Martian cartographies. The article demonstrates that the values of truth ascribed to cartographic objects are realised through practices that are not free-floating, but located and relocated institutionally and politically (amounting to the same thing). The geopolitics of transportation are explored in Felicity Meakins's "Reknowing the Bicycle; Renewing its Space", which considers the early impacts of the bicycle on our land- and cityscapes, before the motor car made its presence felt. With the resurgence of cycling as a means of transportation as well as recreation, Meakins suggests, some of these effects may be renewed. In "Virtual Domesticity: Renewing Cybernetic Living Environments", Nick Caldwell moves from discussing cyberspace in terms of how it manipulates the real to suggesting how the real can "colonise" cyberspace. Caldwell relates the personal computer to metaphors of domestic space, suggesting that we relate to the PC in ways which reflect our own manipulation of living space. He begins by noting the work space/computer space parallels used in the Windows operation system, through filing icons etc., and then moves to the home analogy. The manipulation of the domestic space is explained more specifically in a descriptive comparison between moving house and reinstalling Windows, spring cleaning and defragmenting, and the audio/visual control panels which bear a remarkable resemblance to the average home hi-fi system. In "Dash or Slash?: Renewing the Link between Media and Culture", M/C's outgoing Production Editor Axel Bruns ruminates on some issues that surrounded the naming of the journal nearly three years ago -- looking at the name "M/C" and the implications that pesky "/" has had for information structuring conventions on the World Wide Web and computer systems in general. What does a slash between the terms reveal about our conceptions of media and/or culture, and of the links between them? P. David Marshall's "Renewing Cultural Studies" offers two essays for the price of one. In one of them, he suggests that the project of cultural studies can be described as the study of recombinant culture, which inherently engenders its own renewals of theory, policy and practice. Following on from this, his second essay engages with the study of cultural production as it occurs on the side of the audience. New media technologies are constantly renewing the relationships between 'producer' and 'audience', enabling a far more active audience role, and a stronger focus of cultural studies on this area might also renew cultural studies' own interests. Some of the themes raised in these articles from the original M/C contributors are also taken up in the other submissions that complete this issue. In "One or Many Media?", Steven Maras also uses M/C's title slash to begin a discussion of the tensions between those treacherously similar terms 'medium', 'media', and 'the media'. In an effort to tease out the fine distinctions separating them, he traces the conceptual frameworks attached to each term, uncovering their complex interrelationships. The spirit of Marx's Grundrisse resonates throughout Janin Hadlaw's comparison of the discourses surrounding newer communications technologies with those which accompanied the emergence of the telephone. In "Plus Que Ça Change: The Telephone and the History of the Future", the material and social realities which provide the emergence of new technologies with their historical footing are also mobilised as a legitimate ground from which a notion of ongoing renewal in the field of techno-communications can be advanced. Finally, Steven Mizrach focusses on another ubiquitous form of communications technology in "Natives on the Electronic Frontier". Taking apart an older anthropological position around media and traditional culture -- that media such as television and radio destroy the authenticity and community roots of a society -- the author works through a preliminary reading of how television can be a source for the renewal of the languages and crafts of an Amerindian community. So, at the end of the first three volumes of M/C - A Journal of Media and Culture, this mixed issue with articles from a number of new as well as some of our longest-serving contributors demonstrates that we've achieved a resonance of ideas between our editorial collective and an impressive list of world-wide collaborators -- as well as, hopefully, with our readers. The coming year will see a number of significant changes in M/C, enabling us to face our future with renewed energy and continue on our mission to connect the popular and the academic; we are not going away, although we are constantly renewing ourselves with each issue and we encourage others to join in this continual process of engaged critical analysis of contemporary culture... Team M/C Citation reference for this article MLA style: Team M/C. "Editorial: 'Renew'." M/C: A Journal of Media and Culture 3.6 (2000). [your date of access] <http://www.api-network.com/mc/0012/edit.php>. Chicago style: Team M/C, "Editorial: 'Renew'," M/C: A Journal of Media and Culture 3, no. 6 (2000), <http://www.api-network.com/mc/0012/edit.php> ([your date of access]). APA style: Team M/C. (2000) Editorial: 'Renew'. M/C: A Journal of Media and Culture 3(6). <http://www.api-network.com/mc/0012/edit.php> ([your date of access]).

BackgroundDespite an improved understanding of pheochromocytoma and extra-adrenal sympathetic parganglioma (PPGL), including diagnosis and management, some PPGLs are postoperatively diagnosed. Clinical characteristics and intraoperative haemodynamic instability (HI) in postoperatively diagnosed PPGL patients have been poorly defined. Thus, we investigated the clinical characteristics and HI in patients with postoperatively diagnosed PPGLs compared to patients with preoperatively diagnosed PPGLs.MethodsWe obtained clinical and haemodynamic data from the electronic medical records of 256 patients with pathologically confirmed PPGLs at our institution from January 2005 to December 2019. We assessed the intraoperative HI (systolic blood pressure [SBP]&gt;160 mmHg (min) or mean blood pressure [MBP]&lt;60 mmHg (min)) over time.ResultsTwenty-nine patients (11.3%) were diagnosed with PPGLs postoperatively. Hypertension (34.5% vs. 63.0%, P=0.006) and pheochromocytoma (17.2% vs. 81.1%, P&lt;0.001) case rates were lower in postoperatively diagnosed patients than in preoperatively diagnosed patients. Preoperative SBP in the ward was similar between groups, but the use of α-blockers and β-blockers was more frequent in preoperatively diagnosed patients (89.0% vs. 3.4%, P&lt;0.001; 36.3% vs. 6.9%, P=0.003). Considering intraoperative HI, postoperatively diagnosed patients demonstrated a similar percentage of time with SBP&gt;160 mmHg (median [IQR]; 7.9% [2.5; 11.9] % vs. 4.6% [0.0; 11.9], P=0.088) but a significantly lower percentage of time with MBP&lt;60 mmHg (0.0% [0.0; 3.0] vs. 5.6% [0.0, 12.6], P=0.002) compared with preoperatively diagnosed patients.ConclusionsPatients diagnosed with PPGLs postoperatively may have no further higher risk of intraoperative hypertension than those diagnosed preoperatively despite insufficient preoperative management for PPGLs. Further study will be needed to ascertain intrinsic tumour characteristics, and need for universal preoperative use of α- and β-blockers in PPGL patients postoperatively diagnosed or without typical symptoms related PPGLs.

Image 1: Hasbro/Tiger Electronics 1998 Furby. (Photo credit: Author) Introduction Since the mid-1990s robotic and digital creatures designed to offer social interaction and companionship have been developed for commercial and research interests. Integral to encouraging positive experiences with these creatures has been the use of cute aesthetics that aim to endear companions to their human users. During this time there has also been a growth in online communities that engage in cultural production through fan fiction responses to existing cultural artefacts, including the widely recognised electronic companion, Hasbro’s Furby (image 1). These user stories and Furby’s online representation in general, demonstrate that contrary to the intentions of their designers and marketers, Furbys are not necessarily received as cute, or the embodiment of the helpless and harmless demeanour that goes along with it. Furbys’ large, lash-framed eyes, small, or non-existent limbs, and baby voice are typical markers of cuteness but can also evoke another side of cuteness—monstrosity, especially when the creature appears physically capable instead of helpless (Brzozowska-Brywczynska 217). Furbys are a particularly interesting manifestation of the cute aesthetic because it is used as tool for encouraging attachment to a socially interactive electronic object, and therefore intersects with existing ideas about technology and nonhuman companions, both of which often embody a sense of otherness. This paper will explore how cuteness intersects withand transitions into monstrosity through online representations of Furbys, troubling their existing design and marketing narrative by connecting and likening them to other creatures, myths, and anecdotes. Analysis of narrative in particular highlights the instability of cuteness, and cultural understandings of existing cute characters, such as the gremlins from the film Gremlins (Dante) reinforce the idea that cuteness should be treated with suspicion as it potentially masks a troubling undertone. Ultimately, this paper aims to interrogate the cultural complexities of designing electronic creatures through the stories that people tell about them online. Fan Production Authors of fan fiction are known to creatively express their responses to a variety of media by appropriating the characters, settings, and themes of an original work and sharing their cultural activity with others (Jenkins 88). On a personal level, Jenkins (103) argues that “[i]n embracing popular texts, the fans claim those works as their own, remaking them in their own image, forcing them to respond to their needs and to gratify their desires.” Fan fiction authors are motivated to write not for financial or professional gains but for personal enjoyment and fan recognition, however, their production does not necessarily come from favourable opinions of an existing text. The antifan is an individual who actively hates a text or cultural artefact and is mobilised in their dislike to contribute to a community of others who share their views (Gray 841). Gray suggests that both fan and antifan activity contribute to our understanding of the kinds of stories audiences want: Although fans may wish to bring a text into everyday life due to what they believe it represents, antifans fear or do not want what they believe it represents and so, as with fans, antifan practice is as important an indicator of interactions between the textual and public spheres. (855) Gray reminds that fans, nonfans, and antifans employ different interpretive strategies when interacting with a text. In particular, while fans intimate knowledge of a text reflects their overall appreciation, antifans more often focus on the “dimensions of the moral, the rational-realistic, [or] the aesthetic” (856) that they find most disagreeable. Additionally, antifans may not experience a text directly, but dislike what knowledge they do have of it from afar. As later examples will show, the treatment of Furbys in fan fiction arguably reflects an antifan perspective through a sense of distrust and aversion, and analysing it can provide insight into why interactions with, or indirect knowledge of, Furbys might inspire these reactions. Derecho argues that in part because of the potential copyright violation that is faced by most fandoms, “even the most socially conventional fan fiction is an act of defiance of corporate control…” (72). Additionally, because of the creative freedom it affords, “fan fiction and archontic literature open up possibilities – not just for opposition to institutions and social systems, but also for a different perspective on the institutional and the social” (76). Because of this criticality, and its subversive nature, fan fiction provides an interesting consumer perspective on objects that are designed and marketed to be received in particular ways. Further, because much of fan fiction draws on fictional content, stories about objects like Furby are not necessarily bound to reality and incorporate fantastical, speculative, and folkloric readings, providing diverse viewpoints of the object. Finally, if, as robotics commentators (cf. Levy; Breazeal) suggest, companionable robots and technologies are going to become increasingly present in everyday life, it is crucial to understand not only how they are received, but also where they fit within a wider cultural sphere. Furbys can be seen as a widespread, if technologically simple, example of these technologies and are often treated as a sign of things to come (Wilks 12). The Design of Electronic Companions To compete with the burgeoning market of digital and electronic pets, in 1998 Tiger Electronics released the Furby, a fur-covered, robotic creature that required the user to carry out certain nurturance duties. Furbys expected feeding and entertaining and could become sick and scared if neglected. Through a program that advanced slowly over time regardless of external stimulus, Furbys appeared to evolve from speaking entirely Furbish, their mother tongue, to speaking English. To the user, it appeared as though their interactions with the object were directly affecting its progress and maturation because their care duties of feeding and entertaining were happening parallel to the Furbish to English transition (Turkle, Breazeal, Daste, & Scassellati 314). The design of electronic companions like Furby is carefully considered to encourage positive emotional responses. For example, Breazeal (2002 230) argues that a robot will be treated like a baby, and nurtured, if it has a large head, big eyes, and pursed lips. Kinsella’s (1995) also emphasises cute things need for care as they are “soft, infantile, mammalian, round, without bodily appendages (e.g. arms), without bodily orifices (e.g. mouths), non-sexual, mute, insecure, helpless or bewildered” (226). From this perspective, Furbys’ physical design plays a role in encouraging nurturance. Such design decisions are reinforced by marketing strategies that encourage Furbys to be viewed in a particular way. As a marketing tool, Harris (1992) argues that: cuteness has become essential in the marketplace in that advertisers have learned that consumers will “adopt” products that create, often in their packaging alone, an aura of motherlessness, ostracism, and melancholy, the silent desperation of the lost puppy dog clamoring to be befriended - namely, to be bought. (179) Positioning Furbys as friendly was also important to encouraging a positive bond with a caregiver. The history, or back story, that Furbys were given in the instruction manual was designed to convey their kind, non-threatening nature. Although alive and unpredictable, it was crucial that Furbys were not frightening. As imaginary living creatures, the origin of Furbys required explaining: “some had suggested positioning Furby as an alien, but that seemed too foreign and frightening for little girls. By May, the thinking was that Furbies live in the clouds – more angelic, less threatening” (Kirsner). In creating this story, Furby’s producers both endeared the object to consumers by making it seem friendly and inquisitive, and avoided associations to its mass-produced, factory origins. Monstrous and Cute Furbys Across fan fiction, academic texts, and media coverage there is a tendency to describe what Furbys look like by stringing together several animals and objects. Furbys have been referred to as a “mechanized ball of synthetic hair that is part penguin, part owl and part kitten” (Steinberg), a “cross between a hamster and a bird…” (Lawson & Chesney 34), and “ “owl-like in appearance, with large bat-like ears and two large white eyes with small, reddish-pink pupils” (ChaosInsanity), to highlight only a few. The ambiguous appearance of electronic companions is often a strategic decision made by the designer to avoid biases towards specific animals or forms, making the companion easier to accept as “real” or “alive” (Shibata 1753). Furbys are arguably evidence of this strategy and appear to be deliberately unfamiliar. However, the assemblage, and exaggeration, of parts that describes Furbys also conjures much older associations: the world of monsters in gothic literature. Notice the similarities between the above attempts to describe what Furbys looks like, and a historical description of monsters: early monsters are frequently constructed out of ill-assorted parts, like the griffin, with the head and wings of an eagle combined with the body and paws of a lion. Alternatively, they are incomplete, lacking essential parts, or, like the mythological hydra with its many heads, grotesquely excessive. (Punter & Byron 263) Cohen (6) argues that, metaphorically, because of their strange visual assembly, monsters are displaced beings “whose externally incoherent bodies resist attempts to include them in any systematic structuration. And so the monster is dangerous, a form suspended between forms that threatens to smash distinctions.” Therefore, to call something a monster is also to call it confusing and unfamiliar. Notice in the following fan fiction example how comparing Furby to an owl makes it strange, and there seems to be uncertainty around what Furbys are, and where they fit in the natural order: The first thing Heero noticed was that a 'Furby' appeared to be a childes toy, shaped to resemble a mutated owl. With fur instead of feathers, no wings, two large ears and comical cat paws set at the bottom of its pudding like form. Its face was devoid of fuzz with a yellow plastic beak and too large eyes that gave it the appearance of it being addicted to speed [sic]. (Kontradiction) Here is a character unfamiliar with Furbys, describing its appearance by relating it to animal parts. Whether Furbys are cute or monstrous is contentious, particularly in fan fictions where they have been given additional capabilities like working limbs and extra appendages that make them less helpless. Furbys’ lack, or diminution of parts, and exaggeration of others, fits the description of cuteness, as well as their sole reliance on caregivers to be fed, entertained, and transported. If viewed as animals, Furbys appear physically limited. Kinsella (1995) finds that a sense of disability is important to the cute aesthetic: stubby arms, no fingers, no mouths, huge heads, massive eyes – which can hide no private thoughts from the viewer – nothing between their legs, pot bellies, swollen legs or pigeon feet – if they have feet at all. Cute things can’t walk, can’t talk, can’t in fact do anything at all for themselves because they are physically handicapped. (236) Exploring the line between cute and monstrous, Brzozowska-Brywczynska argues that it is this sense of physical disability that distinguishes the two similar aesthetics. “It is the disempowering feeling of pity and sympathy […] that deprives a monster of his monstrosity” (218). The descriptions of Furbys in fan fiction suggest that they transition between the two, contingent on how they are received by certain characters, and the abilities they are given by the author. In some cases it is the overwhelming threat the Furby poses that extinguishes feelings of care. In the following two excerpts that the revealing of threatening behaviour shifts the perception of Furby from cute to monstrous in ‘When Furbies Attack’ (Kellyofthemidnightdawn): “These guys are so cute,” she moved the Furby so that it was within inches of Elliot's face and positioned it so that what were apparently the Furby's lips came into contact with his cheek “See,” she smiled widely “He likes you.” […] Olivia's breath caught in her throat as she found herself backing up towards the door. She kept her eyes on the little yellow monster in front of her as her hand slowly reached for the door knob. This was just too freaky, she wanted away from this thing. The Furby that was originally called cute becomes a monster when it violently threatens the protagonist, Olivia. The shifting of Furbys between cute and monstrous is a topic of argument in ‘InuYasha vs the Demon Furbie’ (Lioness of Dreams). The character Kagome attempts to explain a Furby to Inuyasha, who views the object as a demon: That is a toy called a Furbie. It's a thing we humans call “CUTE”. See, it talks and says cute things and we give it hugs! (Lioness of Dreams) A recurrent theme in the Inuyasha (Takahashi) anime is the generational divide between Kagome and Inuyasha. Set in feudal-era Japan, Kagome is transported there from modern-day Tokyo after falling into a well. The above line of dialogue reinforces the relative newness, and cultural specificity, of cute aesthetics, which according to Kinsella (1995 220) became increasingly popular throughout the 1980s and 90s. In Inuyasha’s world, where demons and monsters are a fixture of everyday life, the Furby appearance shifts from cute to monstrous. Furbys as GremlinsDuring the height of the original 1998 Furby’s public exposure and popularity, several news articles referred to Furby as “the five-inch gremlin” (Steinberg) and “a furry, gremlin-looking creature” (Del Vecchio 88). More recently, in a review of the 2012 Furby release, one commenter exclaimed: “These things actually look scary! Like blue gremlins!” (KillaRizzay). Following the release of the original Furbys, Hasbro collaborated with the film’s merchandising team to release Interactive ‘Gizmo’ Furbys (image 2). Image 2: Hasbro 1999 Interactive Gizmo (photo credit: Author) Furbys’ likeness to gremlins offers another perspective on the tension between cute and monstrous aesthetics that is contingent on the creature’s behaviour. The connection between Furbys and gremlins embodies a sense of mistrust, because the film Gremlins focuses on the monsters that dwell within the seemingly harmless and endearing mogwai/gremlin creatures. Catastrophic events unfold after they are cared for improperly. Gremlins, and by association Furbys, may appear cute or harmless, but this story tells that there is something darker beneath the surface. The creatures in Gremlins are introduced as mogwai, and in Chinese folklore the mogwai or mogui is a demon (Zhang, 1999). The pop culture gremlin embodied in the film, then, is cute and demonic, depending on how it is treated. Like a gremlin, a Furby’s personality is supposed to be a reflection of the care it receives. Transformation is a common theme of Gremlins and also Furby, where it is central to the sense of “aliveness” the product works to create. Furbys become “wiser” as time goes on, transitioning through “life stages” as they “learn” about their surroundings. As we learn from their origin story, Furbys jumped from their home in the clouds in order to see and explore the world firsthand (Tiger Electronics 2). Because Furbys are susceptible to their environment, they come with rules on how they must be cared for, and the consequences if this is ignored. Without attention and “food”, a Furby will become unresponsive and even ill: “If you allow me to get sick, soon I will not want to play and will not respond to anything but feeding” (Tiger Electronics 6). In Gremlins, improper care manifests in an abrupt transition from cute to monstrous: Gizmo’s strokeable fur is transformed into a wet, scaly integument, while the vacant portholes of its eyes (the most important facial feature of the cute thing, giving us free access to its soul and ensuring its total structability, its incapacity to hold back anything in reserve) become diabolical slits hiding a lurking intelligence, just as its dainty paws metamorphose into talons and its pretty puckered lips into enormous Cheshire grimaces with full sets of sharp incisors. (Harris 185–186) In the Naruto (Kishimoto) fan fiction ‘Orochimaru's World Famous New Year's Eve Party’ (dead drifter), while there is no explicit mention of Gremlins, the Furby undergoes the physical transformation that appears in the films. The Furby, named Sasuke, presumably after the Naruto antagonist Sasuke, and hinting at its untrustworthy nature, undergoes a transformation that mimics that of Gremlins: when water is poured on the Furby, boils appear and fall from its back, each growing into another Furby. Also, after feeding the Furby, it lays eggs: Apparently, it's not a good idea to feed Furbies chips. Why? Because they make weird cocoon eggs and transform into… something. (ch. 5) This sequence of events follows the Gremlins movie structure, in which cute and furry Gizmo, after being exposed to water and fed after midnight, “begins to reproduce, laying eggs that enter a larval stage in repulsive cocoons covered in viscous membranes” (Harris 185). Harris also reminds that the appearance of gremlins comes with understandings of how they should be treated: Whereas cute things have clean, sensuous surfaces that remain intact and unpenetrated […] the anti-cute Gremlins are constantly being squished and disembowelled, their entrails spilling out into the open, as they explode in microwaves and run through paper shredders and blenders. (Harris 186) The Furbys in ‘Orochimaru's World Famous New Year's Eve Party’ meet a similar end: Kuro Furby whined as his brain was smashed in. One of its eyes popped out and rolled across the floor. (dead drifter ch. 6) A horde of mischievous Furbys are violently dispatched, including the original Furby that was lovingly cared for. Conclusion This paper has explored examples from online culture in which different cultural references clash and merge to explore artefacts such as Furby, and the complexities of design, such as the use of ambiguously mammalian, and cute, aesthetics in an effort to encourage positive attachment. Fan fiction, as a subversive practice, offers valuable critiques of Furby that are imaginative and speculative, providing creative responses to experiences with Furbys, but also opening up potential for what electronic companions could become. In particular, the use of narrative demonstrates that cuteness is an unstable aesthetic that is culturally contingent and very much tied to behaviour. As above examples demonstrate, Furbys can move between cute, friendly, helpless, threatening, monstrous, and strange in one story. Cute Furbys became monstrous when they were described as an assemblage of disparate parts, made physically capable and aggressive, and affected by their environment or external stimulus. Cultural associations, such as gremlins, also influence how an electronic animal is received and treated, often troubling the visions of designers and marketers who seek to present friendly, nonthreatening, and accommodating companions. These diverse readings are valuable in understanding how companionable technologies are received, especially if they continue to be developed and made commercially available, and if cuteness is to be used as means of encouraging positive attachment. References Breazeal, Cynthia. Designing Sociable Robots. Cambridge, MA: MIT Press, 2002. Brzozowska-Brywczynska, Maja. "Monstrous/Cute: Notes on the Ambivalent Nature of Cuteness." Monsters and the Monstrous: Myths and Metaphors of Enduring Evil. Ed. Niall Scott. Amsterdam/New York: Rodopi. 2007. 213 - 28. 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Abstract BACKGROUND AND AIMS SARS-CoV-2 pandemic is pressuring healthcare systems worldwide. Disease outcomes in certain subgroups of patients, such as nephropathic patients, are still scarce. Patients with chronic kidney disease (CKD) and on haemodialysis (HD) are at risk of a more severe disease course and worst outcomes. Here, we aimed to describe the characteristics and outcomes of CKD and HD patients with SARS-CoV-2 infection, admitted to the Covid Nephrology Unit in the first three pandemic waves, analysing mortality rate and risk factors for mortality in this subgroup of patients. METHOD A Covid Nephrology Unit was organized in March 2020 to manage the high number of CKD and HD patients with SARS-CoV-2 infection. Several ‘spoke’ units were also set to manage HD asymptomatic patients (Hi Hotel and ‘Villa Luce’ Dialysis Center) or with mild symptoms (‘Miulli Hospital’-Acquaviva delle Fonti and ‘Fallacara Hospital’—Triggiano). Clinical and laboratory data in several timepoints were collected using electronic medical records. Primary outcome was to assess the mortality rate. Moreover, we analysed the trend of inflammatory markers in the first 7 days after hospital admission between survivors and non-survivors; finally, risk factors for mortality were analysed by logistic regression. RESULTS From March 2020 to May 2021, a total of 221 patients were admitted to the Covid Nephrology Unit; among these, 112 patients on chronic haemodialysis, 21 with acute kidney injury (AKI), 58 with CKD, 24 kidney transplant recipients and 6 patients on peritoneal dialysis (PD). Median age was 71 years (IQR 62.5–80), while male gender predominated (61.5%). Main comorbidities were arterial hypertension (81%), diabetes mellitus (41.8%) and cardiovascular disease (CVD, 60.6%). At admission, 13.2% of patients required non-invasive ventilatory (NIV) support (CPAP, BiPAP) and about 60% presented interstitial pneumonia at CT scan. A total of 80 patients (36.1%) died during hospital stay with a medium length of stay of 15.8 days. In the first 7 days, 29 patients presented respiratory failure requiring transfer to ICU. Conversely, 100 patients were discharged at home, while 48 patients were transferred to the spoke units (39 patients at Miulli and Fallacara Hospitals, 9 patients at Hi Hotel). Compared to survivors, patients who died were older (median age 75.5 versus 66 years, P &lt; .001), characterized by more comorbidities (diabetes mellitus 54.5% versus 35.2%, P = .01; CVD 81.1% versus 51.4%, P &lt; .001; chronic obstructive pulmonary disease (COPD, 41.5% versus 19%, P = .01; peripheral vasculopathy 58.4% versus 34.2%, P = .01) and more severe respiratory compromission at hospital admission (patients in NIV, 22.6% versus 8.1%, P = .005). As shown in Table 1, in the first 7 days of hospital stay, a significant increase in WBC (8.29 versus 12.6 × 106P &lt; .001) was described in the non-survivor group; similarly, inflammatory markers such as CRP and IL-6 did not improve in the non-survivors at day 7 (CRP 81.8 versus 85.7 mg/L, P = .62; IL-6 63.1 versus 79.4 pg/mL, P = .84), while they significantly improved in survivors (median CRP 42.5 versus 10.1 mg/L, P &lt; .001; median IL-6 32.3 versus 13.7 pg/mL, P = .01). In a multivariate logistic regression model, age (OR 1.062, 95% CI 1.007–1.119, P = .025), history of CVD (OR 8.308, 95%CI 1.704–40.499, P = .009) and dyspnoea at hospital admission (OR 9.465, 95%CI 1.231–72.79, P = .031) were associated with risk of mortality in this population. CONCLUSION To our knowledge, this is the largest study analyzing characteristics and outcomes of CKD and hemodialysis patients to date. A wide heterogeneity of severity of disease has been documented in our cohort; we documented a higher mortality rate in this cohort of patients compared to general population. The presence of several comorbidities, a more severe disease at hospital admission and the persistence of elevated inflammatory markers during hospital stay are risk factors for mortality.