Добірка наукової літератури з теми "RD-OPT"

Abstract Introduction: From its emergence in China on 31 st December 2019, the COVID-19 infection has spread to affect more than 185 million people across the world with approximately 4 million deaths. A systematic review and meta-analysis which included various studies across the world showed that the risk of mortality in cancer patients with COVID-19 infection is 21.1% and the risk of severe disease and mortality due to COVID-19 appears to be higher in patients with hematological malignancies likely due to immunosuppression induced by both the underlying disease and intensive treatment. The experts suggest individualization of treatment based on the prevalence of COVID-19 infection, available infrastructure and social support. Guidelines are driven by opinion from a clinician's perspective. There is a need to evaluate a patient's preference in the present situation when they are faced with the dual problem of cancer and a potentially life-threatening infection. Purpose of study: To document the patients preferences and perspectives using a structured questionnaire when they are on cancer-directed chemo/immune or targeted therapy or treatment naive in our hospital during the current COVID-19 pandemic. Objectives: The primary objective was to determine the proportion of patients who opt to continue on full intensity therapy. The secondary objectives were - to study the factors that lead to treatment discontinuation or dose reduction, to study the level of perceived risk at which patients opt for treatment discontinuation or dose reduction, to study the preferences for treatment continuation in different scenarios (COVID-19 adverse event and different relapse risk) (table 2 and 3) and to understand the difference in preferences for therapy between patients and oncologists/hematologists. Material and methods: This prospective survey was conducted between July 10, 2020 and October 16, 2020. A preconceived standard questionnaire was administered to each patient along with their caregivers (Figure 1). Along with this, we subjected the survey questionnaire separately to the set of medical oncologists/hematologists who were not a part of the patient's treating team and the responses were recorded and studied. Sample Size Assuming that 50% of the patients will continue the full intensity therapy, a sample of 203 will produce a two-sided 90% confidence interval with a precision of 12%. Considering a non-response proportion of 5%, a sample size of 213 was required to achieve primary objective. Results: A total of 200 patients were enrolled in this study with male to female ratio of 1.9:1 and a median age of 42 years (15- 78). Most common hematological malignancy in our study is acute leukemia (29%) followed by CML (23%), NHL (22%), multiple myeloma (16%). Baseline details are represented in Table 1. In this study, 47% patients were willing to receive full intensity chemotherapy (95% CI: 40.4 -54.7). Nature of disease (slow growing vs fast growing) and the intent of treatment (cure vs control of disease) were shown to significantly affect preferences of patients. There was no impact of various socio-economic or logistic factors in their preference for therapy. As high as 50% of the patients were willing to accept only 5% risk of covid 19 related complications to receive full intensity therapy. The acceptable risk of relapse over and above the baseline to receive lesser intensity chemotherapy was 5% for almost 1/3 rd of the patients. If covid related complications are mild, 40% of patients are ready to accept only 1 % risk of relapse to receive lesser intensity chemotherapy. As the risk of covid related complications increases from mild to severe, almost 50% of the patients are ready to accept ≥ 20% risk of relapse to receive lesser intensity chemotherapy (table 4). There was a statistically significant disagreement between physician and patient responses at 5%, 20%, 30% and 40% risk of covid related complications to receive full intensity therapy. When we consider the risk of relapse if lesser intensity therapy is opted, patient and physician responses are in good agreement at 1, 5, 10 and 20% risk levels. Conclusion: Almost 50% of patients are willing to opt for reduced intensity therapy because of fear of covid related complications and there is significant disagreement between patient and physician perspectives in certain clinical contexts. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Abstract Introduction: For transplant-eligible patients (pts) with newly diagnosed multiple myeloma (NDMM), autologous stem cell transplant (ASCT) is the standard of care treatment (tx). However, ASCT, which includes a standard melphalan conditioning regimen that is associated with systemic toxicity, is not always feasible due to various reasons including advanced age, co-morbidities, and pt frailty. ASCT-eligible pts may also opt to defer the procedure as initial therapy. For pts with NDMM who are ineligible or unwilling to pursue ASCT, the VRd regimen is an effective tx option; however, pts continue to have inferior outcomes, and there is a need for more effective tx strategies, including ones with a curative intent. Ciltacabtagene autoleucel (cilta-cel) is a chimeric antigen receptor T cell (CAR-T) therapy with 2 B-cell maturation antigen (BCMA)-targeting single-domain antibodies. In the phase 1b/2 CARTITUDE-1 study, a single infusion of cilta-cel resulted in deep and durable responses in heavily pretreated patients with relapsed/refractory multiple myeloma with a manageable safety profile (Berdeja, Lancet, 2021). At a median follow-up of 18 months (mo), the overall response rate was 98% (80% with stringent complete response), and the 18-mo overall survival (OS) rate was 81%. Objective: The randomized phase 3 CARTITUDE-5 study (NCT04923893) will compare the efficacy of VRd induction followed by cilta-cel versus VRd induction followed by Rd maintenance in pts with NDMM for whom ASCT is not planned as initial therapy. Methods: Eligible pts (target recruitment: N=650) are ≥18 years of age with documented MM diagnosis per International Myeloma Working Group criteria, measurable disease at screening, and Eastern Cooperative Oncology Group performance status ≤1. Pts are eligible 1) if they are not candidates for high-dose chemotherapy with ASCT due to advanced age or comorbidities that are likely to have a negative impact on tolerability of this procedure or 2) if they choose to defer high-dose chemotherapy with ASCT as initial treatment. Pts with a frailty index ≥2 based on the Myeloma Geriatric Assessment Score, prior CAR-T or BCMA-targeting therapy, or any prior therapy for MM or smoldering myeloma (with the exception of a short course of steroids or one cycle of VRd) will be excluded. All enrolled pts will receive five to six 21-day (d) cycles of the VRd regimen (one cycle allowed prior to screening): 1.3 mg/m 2 subcutaneous bortezomib on d 1, 4, 8 and 11; 25 mg oral lenalidomide on d 1-14; and 20 mg oral dexamethasone on d 1, 2, 4, 5, 8, 9, 11, and 12. Pts without disease progression will then be randomized 1:1 to the cilta-cel arm or Rd maintenance (control) arm (Figure). In the cilta-cel arm, pts will undergo apheresis and receive two more 21-d cycles of VRd as bridging therapy; pts will then be administered cilta-cel (target dose: 0.75×10 6 CAR+ viable T cells/kg) 5-7 d after lymphodepletion chemotherapy (intravenous cyclophosphamide 300 mg/m 2 and fludarabine 30 mg/m 2 daily for 3 d) followed by a tx-free observation phase. In the control arm, pts will receive two additional 21-d cycles of VRd followed by Rd maintenance in 28-d cycles (25 mg oral lenalidomide on d 1-21 and 40 mg oral dexamethasone on d 1, 8, 15, and 22) until disease progression or unacceptable toxicity. The primary endpoint is progression-free survival (PFS). Secondary endpoints include sustained minimal residual disease (MRD)-negative complete response (CR), as assessed by next-generation sequencing; MRD-negative CR rate at 9 mo; overall MRD-negative CR rate; OS; proportion of pts who achieve ≥CR; time to subsequent anti-myeloma therapy; PFS on next-line therapy (PFS2); incidence and severity of adverse events; pharmacokinetic and pharmacodynamic markers; and changes in health-related quality of life. Results from this study will provide insights into the efficacy and safety of VRd followed by cilta-cel in pts with NDMM. Additionally, VRd tx followed by a single infusion of cilta-cel vs continuous tx with Rd until disease progression may offer pts the benefit of a tx-free period. Figure 1 Figure 1. Disclosures Dytfeld: Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen Cilag: Consultancy, Current Employment, Honoraria, Membership on an entity's Board of Directors or advisory committees. Manier: Celgene/BMS: Research Funding; Abbvie: Research Funding; Janssen: Research Funding; Novartis: Research Funding; Amgen: Research Funding. Delforge: Amgen, Celgene, Janssen, Sanofi: Honoraria, Research Funding. Kuppens: Janssen: Current Employment. Afifi: Janssen: Current Employment. Deraedt: Janssen: Current Employment. Taraseviciute-Morris: Janssen: Current Employment. Schecter: Janssen: Current Employment, Current holder of stock options in a privately-held company. Gilbert: Janssen: Current Employment. Yalniz: Janssen: Current Employment. Florendo: Legend Biotech: Current Employment. Pacaud: Legend Biotech: Current Employment. Hungria: Abbvie: Honoraria; Takeda: Honoraria; Sanofi: Honoraria, Other: Support for attending meetings/travel ; Amgen, BMS, Celgene, Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings/travel . Usmani: Janssen: Consultancy, Research Funding, Speakers Bureau; EdoPharma: Consultancy; Sanofi: Consultancy, Research Funding, Speakers Bureau; Merck: Consultancy, Research Funding; Takeda: Consultancy, Research Funding, Speakers Bureau; Janssen Oncology: Consultancy, Research Funding; SkylineDX: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Bristol-Myers Squibb: Research Funding; GSK: Consultancy, Research Funding; Celgene/BMS: Consultancy, Research Funding, Speakers Bureau; Array BioPharma: Consultancy, Research Funding; Abbvie: Consultancy; Amgen: Consultancy, Research Funding, Speakers Bureau. Mateos: AbbVie: Honoraria; Sea-Gen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Honoraria; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Honoraria; Regeneron: Honoraria, Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: 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; Celgene - Bristol Myers Squibb: 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; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bluebird bio: Honoraria; Janssen: 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. OffLabel Disclosure: At the time of abstract submission, cilta-cel is being investigated for the treatment of multiple myeloma but is not yet approved.

Abstract Background: Patients with classical Hodgkin lymphoma (cHL) who progress after brentuximab vedotin (BV) have a poor prognosis. cHL frequently harbors genetic alterations at the 9p24.1 locus, resulting in the overexpression of the PD-L1 and PD-L2 immune checkpoint ligands. Pembrolizumab is a humanized monoclonal antibody that blocks the interaction between the PD-1 receptor and PD-L1/PD-L2, and can restore antitumor immune activity in several different tumors. Based on its likely genetically driven dependence on PD-1, cHL was included as an independent expansion cohort in the KEYNOTE-013 study (NCT01953692), a multicenter, multicohort phase 1b trial of pembrolizumab in patients with hematologic malignancies. Updated results from this cohort, including long-term efficacy, are presented. Methods: Key eligibility criteria for the cHL cohort of KEYNOTE-013 included relapse after or ineligibility for autologous stem cell transplantation (ASCT), and relapse after or refractory to BV treatment. Pembrolizumab was administered intravenously at a dose of 10 mg/kg every 2 weeks for up to 2 years or until confirmed progression or unacceptable toxicity. Response was assessed at week 12 and every 8 weeks thereafter according to the International Harmonization Project 2007 criteria. The primary end points were safety and complete remission (CR) rate (CRR); secondary end points included overall response rate (ORR) and duration of response (DOR). Patients who achieved a CR could opt to stop treatment after 24 weeks provided that they received at least 2 doses after CR. This report includes CRR, ORR, and DOR by blinded independent central review (BICR). Results: At the time of data cutoff on June 3, 2016, 31 patients were enrolled, and all were evaluable for analysis. Median follow-up duration was 24.9 months (range, 7.0-29.7 months). The median number of prior lines of therapy was 5 (range, 2-15), 74% of patients had failed prior ASCT, and by design 100% had failed prior BV. Per investigator review, ORR was 65%, and CRR was 19%. Per BICR, ORR was 58% (18/31), with 6 patients (19%) achieving CR and 12 (39%) partial remission; 7 patients (23%) had stable disease as their best response. Median DOR was not reached, with a range of 0.0+ to 21.4+ months (95% CI, 3.7 months to not reached) (Figure). An analysis with hierarchical mutually exclusive categories of refractory disease (RD; defined as no response to ≥1 prior line of therapy) or relapse after ≥3 prior lines of therapy (Re ≥3) was conducted. Per BICR, the ORR was 56% in RD (n = 27 patients) and 75% in Re ≥3 (n = 4). As of the data cutoff date, 3 patients (10%) remained on treatment, 5 (16%) completed 2 years of treatment, and 23 (74%) discontinued treatment: 3 (10%) for toxicity, 14 (45%) for progressive disease, 3 (10%) per physician decision (all ultimately underwent allogeneic SCT), 1 in CR (underwent allogeneic SCT), 1 for clinical progression, and 1 who withdrew consent. Per BICR, median progression-free survival (PFS) was 11.4 months; 6-month and 12-month PFS rates were 66% and 48%, respectively. Median overall survival (OS) was not reached; 6-month and 12-month OS rates were 100% and 87%, respectively. Conclusions: With nearly 2.5 years of median follow-up, the present results demonstrate that a subset of heavily pretreated patients who failed BV therapy can achieve a long-term response with single-agent pembrolizumab, without consolidative therapy. PD-1 blockade may offer a new treatment paradigm for patients with relapsed/refractory cHL, supporting the hypothesis that this tumor has a genetic dependence on the PD-1 pathway. Figure Figure. Disclosures Armand: BMS: Consultancy, Research Funding; Sequenta: Research Funding; Roche: Research Funding; Infinity: Consultancy; Merck & Co., Inc.: Consultancy, Research Funding; Sigma Tau: Research Funding; Tensha: Research Funding; Otsuka: Research Funding. Shipp:Cell Signaling: Honoraria; Bayer: Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Merck, Gilead, Takeda: Other: Scientific Advisory Board. Ribrag:Incyte: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Nanostring: Membership on an entity's Board of Directors or advisory committees; ArgenX: Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees; Infinity: Membership on an entity's Board of Directors or advisory committees; Pharmamar: Membership on an entity's Board of Directors or advisory committees; Esai: Membership on an entity's Board of Directors or advisory committees. Michot:Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees. Zinzani:Celgene: 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; Gilead: 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; TG Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Infinity: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Sandoz: Membership on an entity's Board of Directors or advisory committees; Millennium: Membership on an entity's Board of Directors or advisory committees. Kuruvilla:Gilead: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Amgen: Honoraria; Celgene: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Merck: Honoraria; Roche Canada: Consultancy, Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria; Lundbeck: Honoraria. Zhu:Merck: Employment. Ricart:Merck & Co.: Employment; Pfizer: Equity Ownership. Balakumaran:Merck & Co.: Employment, Other: stock, stock options. Moskowitz:Pharmacyclics: Research Funding; Merck: Consultancy, Research Funding; Genentech: Consultancy; Seattle Genetics: Consultancy, Research Funding; Celgene: Consultancy.

Abstract Background HIV prevention, diagnosis, treatment and care services might be hampered by inaccurate risk assessment. This study aimed to investigate the extent of and factors associated with the discordance between perceived risk and actual risky sexual behaviors among undergraduates in mainland China, guided by the Anderson's behavioral model. Methods This study involved a secondary analysis of cross-sectional data collected during the fall semester of 2018–2019 academic year. The present analysis was restricted to 8808 undergraduates with low risk perception. Those who had low perceived risk but actually engaged in risky sexual behaviors were categorized as risk discordance (RD). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with RD. Results Overall, the discordance rate between perceived and actual risk was 8.5% (95% CI: 7.9%-9.1%). Multivariate Logistic regression analysis indicated that non-heterosexual women (AOR = 0.41, 95% CI:0.27–0.60), heterosexual men (AOR = 0.45, 95% CI:0.33–0.61) and women (AOR = 0.26, 95% CI:0.19–0.35) were less likely to exhibit RD, when compared with non- heterosexual men. Furthermore, non-freshmen (AOR = 1.57, 95% CI:1.30–1.90), early initiators of sexual intercourse (AOR = 5.82, 95% CI:4.10–8.26), and those who had lower levels of HIV knowledge (AOR = 1.28, 95% CI:1.08–1.51), displayed higher levels of stigma against PLHIV (AOR = 1.50, 95% CI:1.26–1.77) and had ever been tested for HIV (AOR = 1.36, 95% CI:1.04–1.77) were more prone to reporting RD. Those with more enabling resources [i.e., displaying high levels of condom use self-efficacy (AOR = 0.70, 95% CI:0.59–0.84) and being knowledge of local testing center (AOR = 0.71, 95% CI:0.60–0.83)] were less likely to report RD. However, spending more than 2000 Yuan a month on basic needs (AOR = 2.55, 95% CI:2.07–3.14), residing in urban areas (AOR = 1.35, 95% CI:1.15–1.59) and being knowledgeable of the national AIDS policy (AOR = 1.40,95% CI:1.18–1.66) increased the chance of exhibiting RD. Conclusions Comprehensive interventions, including targeting students with high-risk characteristics, improving the acceptability of PrEP and PEP, conducting health education, enhancing self-efficacy for using condoms and making opt-out HIV testing routine in college campus, should be taken to reduce the discordance between perceived and actual HIV risk and finally to reach the goal of Zero AIDS.

Uma das problemáticas da ortodontia é finalizar o tratamento com a presença de diastemas, no entanto, é possível solucionar de várias maneiras, uma delas é a confecção de restaurações indiretas, como os laminados cerâmicos. O crescente desenvolvimento tecnológico dos materiais odontológicos reabilitadores, em especial os cimentos e sistemas adesivos, vem melhorando adesividade ao esmalte/dentina fazendo união química e mecânica e aumentandotambém a resistência estrutural, conferindo características mais estéticas, duradouras e confiáveis dessas restaurações. O presente trabalho relata um caso clínico de fechamento de diastemas múltiplos, pós tratamento ortodôntico, utilizando lentes de contato dental em dissilicato de lítio. O resultado foi satisfatório esteticamente além de solucionar os problemas como: fechamentodos diastemas resultantes da ortodontia, pontos de contatos, fonética e satisfação pessoal do paciente.Descritores: Diastema; Estética Dentária; Facetas Dentárias.ReferênciasSoares PV, Zeola LF, Souza PG, Pereira FA, Milito GA, Machado AC. Reabilitação Estética do Sorriso com Facetas Cerâmicas Reforçadas por Dissilicato de Lítio. Rev Odontol Bras Central. 2012;21(58):538-43.Pena CE, Ortega LF, Soares RD, Coelho AS, Falchi F. A importância do planejamento multidisciplinar em casos de uso de cerâmicas com pouco ou nenhum desgaste em área estética: relato de caso clínico. J Clin Dent Res. 2017;14(1):60-7.Angrisani Neto S, Pereira MA, Cunha LF, Garcia PP. Tratamentos estéticos conservadores para o fechamento de diastemas: resinas compostas e cerâmicas odontológicas. Rev Dental Press Estét. 2013;10(4):94-106.Nishimori LE, Yokoyama AK, Marson FC, Silva CO, Corrêa GO. Lentes de contato: solução para diastemas anteriores. Rev Dental Press Estét. 2014;11(1):94-101.Araújo LG, Bolognese MA. Diastema interincisal x freio labial anormal. Rev Bras Odontol. 1983;5:20-8.Okida RC, Filho AJ, Barao VA, dos Santos DM, Goiato MC. The use of fragments of thin veneers as a restorative therapy for anterior teeth disharmony: a case report with 3 years of follow-up. J Contemp Dent Pract. 2012;13(3):416-20.Kina S. Cerâmicas dentárias. Rev Dental Press Estét. 2005;2(2):111-28.Amoroso AP, Ferreira MB, Torcato LB, Pellizzer EP, Mazaro JVQ, Filho GH. Cerâmicas odontológicas: propriedades, indicações e considerações clínicas. Rev Odontol Araçatuba. 2012;33(2):19-25.Savaris DI, Vermudt A, Ghizoni JS, Pamato S, Pereira JR. Lentes de contato harmonização e estética com preparos conservadores. J Res Dent. 2018;6(4):91-7.Cardoso PC, Cardoso LC, Decurcio RA, Monteiro LJE. Restabelecimento Estético Funcional com Laminados Cerâmicos. 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In: Cardoso RJA, Gonçalves EAN (COORD). Oclusão/ATM, Prótese, Prótese sobre implantes e Prótese Bucomaxilofacial. São Paulo: Artes Médicas; 2002. cap. 15.Bottino MA. Estética em Reabilitação Oral Metal Free. São Paulo: Artes Médicas; 2001.Sensi L, Baratieri LN, Monteiro Junior S. Cimentos Resinosos. In:Kina S, Brugrera A. Invisível: Restaurações estéticas cerâmicas. Maringá: Dental Press; 2007. p. 303-19. 36.Karaagaclioglu L, Yilmaz B. Influence of cement shade andwater storage on the final color of leucite-reinforced ceramics. Oper Dent. 2008;22(4):286-91.Aquino APT, Cardoso PC, Rodrigues MB, Takano AE, Porfírio W. Facetas de Porcelana: Solução Estética e Funcional. International J Braz Dent. 2009;5(2):142-52.Zavanelli AC, Zavanelli RA, Quinellimazaro JV, de Paula WN, Borges MA, Bagio DM. Associação de preparos minimamente invasivos e plástica gengival: relato de caso clínico. Arch Health Invest. 2015;4(3):1-9.Sene F. 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Introdução: A endodontia é uma especialidade odontológica que visa promover a saúde dentária por meio da eliminação de micro-organismos capazes de causar agressões pulpares. A terapia fotodinâmica antimicrobiana, apresenta-se como uma alternativa coadjuvante ao tratamento endodôntico convencional para eliminação dos micro-organismos resistentes ao preparo-químico-mecânico. Objetivo: Explorar a literatura dando enfoque ao mecanismo de ação e aplicabilidade da aPDT na eliminação do Enterococcus faecalis. Material e método: Realizou-se uma revisão de literatura conduzida através do acesso às bases de dados eletrônicos Medline/Pubmed e Scielo utilizando isoladamente ou em associação as palavras-chaves “Photodynamic Therapy”, “Enterococcus faecalis” e “Endodontic”, no período de 2007 a 2017, totalizando 392 artigos. Resultados: A eliminação de forma eficaz de bacterias, Enterococcus faecalis, são vantagens atribuídas à terapia fotodinâmica, no entanto, a literatura evidencia a necessidade de utiliza-la associada a outras formas de tratamento. Conclusão: É necessária a padronização dos protocolos para que se obtenha dados mais esclarecedores sobre a eficácia da terapia fotodinâmica na eliminação do Enterococcus faecalis.Descritores: Endodontia; Fotoquimioterapia; Enterococcus faecalis.ReferênciasSiqueira JF, Rôças I. Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod 2008; 34(11):1291-301 e 3. Fouad AF, Zerella J, Barry J, Spangberg LS. Molecular detection of Enterococcus species in root canals of therapy-resistant endodontic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(1):112–18.Amaral RR, AmorimJCF, Nunes E, Soares JÁ, Silveira FF. Terapia fotodinâmica na endodontia: revisão de literatura. 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Quantitative and qualitative analysis of microorganisms in root-filled teeth with persistent infection: monitoring of the endodontic retreatment. Eur J Dent. 2013;7(3):302-9.Morrison D, Woodford N, Cookson B. Enterococci as emerging pathogens of humans. Soc Appl Bacteriol Symp Ser. 1997;26:89S-99S.Poeschl PW, Spusta L, Russmueller G, Seemann R, Hirschl A, Poeschl E et al. Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110(2):151-56.Skucaite N, Peciuliene V, Vitkauskiene A, Machiulskiene V. Susceptibility of endodontic pathogens to antibiotics in patients with symptomatic apical periodontitis. J Endod. 2010;36(10):1611-16.Endo MS, Signoretti FG, Kitayama VS, Marinho AC, Martinho FC, Gomes BPFA. 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Introduction Many social media tools and services are free to use. This fact often leads users to the mistaken presumption that the associated data generated whilst utilising these tools and services is without value. Users often focus on the social and presumed ephemeral nature of communication – imagining something that happens but then has no further record or value, akin to a telephone call – while corporations behind these tools tend to focus on the media side, the lasting value of these traces which can be combined, mined and analysed for new insight and revenue generation. This paper seeks to explore this social media contradiction in two ways. Firstly, a cursory examination of Google and Facebook will demonstrate how data mining and analysis are core practices for these corporate giants, central to their functioning, development and expansion. Yet the public rhetoric of these companies is not about the exchange of personal information for services, but rather the more utopian notions of organising the world’s information, or bringing everyone together through sharing. The second section of this paper examines some of the core ramifications of death in terms of social media, asking what happens when a user suddenly exists only as recorded media fragments, at least in digital terms. Death, at first glance, renders users (or post-users) without agency or, implicitly, value to companies which data-mine ongoing social practices. Yet the emergence of digital legacy management highlights the value of the data generated using social media, a value which persists even after death. The question of a digital estate thus illustrates the cumulative value of social media as media, even on an individual level. The ways Facebook and Google approach digital death are examined, demonstrating policies which enshrine the agency and rights of living users, but become far less coherent posthumously. Finally, along with digital legacy management, I will examine the potential for posthumous digital legacies which may, in some macabre ways, actually reanimate some aspects of a deceased user’s presence, such as the Lives On service which touts the slogan “when your heart stops beating, you'll keep tweeting”. Cumulatively, mapping digital legacy management by large online corporations, and the affordances of more focussed services dealing with digital death, illustrates the value of data generated by social media users, and the continued importance of the data even beyond the grave. Google While Google is universally synonymous with search, and is the world’s dominant search engine, it is less widely understood that one of the core elements keeping Google’s search results relevant is a complex operation mining user data. Different tools in Google’s array of services mine data in different ways (Zimmer, “Gaze”). Gmail, for example, uses algorithms to analyse an individual’s email in order to display the most relevant related advertising. This form of data mining is comparatively well known, with most Gmail users knowingly and willingly accepting more personalised advertising in order to use Google’s email service. However, the majority of people using Google’s search engine are unaware that search, too, is increasingly driven by the tracking, analysis and refining of results on the basis of user activity (Zimmer, “Externalities”). As Alexander Halavais (160–180) quite rightly argues, recent focus on the idea of social search – the deeper integration of social network information in gauging search results – is oxymoronic; all search, at least for Google, is driven by deep analysis of personal and aggregated social data. Indeed, the success of Google’s mining of user data has led to concerns that often invisible processes of customisation and personalisation will mean that the supposedly independent or objective algorithms producing Google’s search results will actually yield a different result for every person. As Siva Vaidhyanathan laments: “as users in a diverse array of countries train Google’s algorithms to respond to specialized queries with localised results, each place in the world will have a different list of what is important, true, or ‘relevant’ in response to any query” (138). Personalisation and customisation are not inherently problematic, and frequently do enhance the relevance of search results, but the main objection raised by critics is not Google’s data mining, but the lack of transparency in the way data are recorded, stored and utilised. Eli Pariser, for example, laments the development of a ubiquitous “filter bubble” wherein all search results are personalised and subjective but are hidden behind the rhetoric of computer-driven algorithmic objectivity (Pariser). While data mining informs and drives many of Google’s tools and services, the cumulative value of these captured fragments of information is best demonstrated by the new service Google Now. Google Now is a mobile app which delivers an ongoing stream of search results but without the need for user input. Google Now extrapolates the rhythms of a person’s life, their interests and their routines in order to algorithmically determine what information will be needed next, and automatically displays it on a user’s mobile device. Clearly Google Now is an extremely valuable and clever tool, and the more information a user shares, the better the ongoing customised results will be, demonstrating the direct exchange value of personal data: total personalisation requires total transparency. Each individual user will need to judge whether they wish to share with Google the considerable amount of personal information needed to make Google Now work. The pressing ethical question that remains is whether Google will ensure that users are sufficiently aware of the amount of data and personal privacy they are exchanging in order to utilise such a service. Facebook Facebook began as a closed network, open only to students at American universities, but has transformed over time to a much wider and more open network, with over a billion registered users. Facebook has continually reinvented their interface, protocols and design, often altering both privacy policies and users’ experience of privacy, and often meeting significant and vocal resistance in the process (boyd). The data mining performed by social networking service Facebook is also extensive, although primarily aimed at refining the way that targeted advertising appears on the platform. In 2007 Facebook partnered with various retail loyalty services and combined these records with Facebook’s user data. This information was used to power Facebook’s Beacon service, which added details of users’ retail history to their Facebook news feed (for example, “Tama just purchased a HTC One”). The impact of all of these seemingly unrelated purchases turning up in many people’s feeds suddenly revealed the complex surveillance, data mining and sharing of these data that was taking place (Doyle and Fraser). However, as Beacon was turned on, without consultation, for all Facebook users, there was a sizable backlash that meant that Facebook had to initially switch the service to opt-in, and then discontinue it altogether. While Beacon has been long since erased, it is notable that in early 2013 Facebook announced that they have strengthened partnerships with data mining and profiling companies, including Datalogix, Epsilon, Acxiom, and BlueKai, which harness customer information from a range of loyalty cards, to further refine the targeting ability offered to advertisers using Facebook (Hof). Facebook’s data mining, surveillance and integration across companies is thus still going on, but no longer directly visible to Facebook users, except in terms of the targeted advertisements which appear on the service. Facebook is also a platform, providing a scaffolding and gateway to many other tools and services. In order to use social games such as Zynga’s Farmville, Facebook users agree to allow Zynga to access their profile information, and use Facebook to authenticate their identity. Zynga has been unashamedly at the forefront of user analytics and data mining, attempting to algorithmically determine the best way to make virtual goods within their games attractive enough for users to pay for them with real money. Indeed, during a conference presentation, Zynga Vice President Ken Rudin stated outright that Zynga is “an analytics company masquerading as a games company” (Rudin). I would contend that this masquerade succeeds, as few Farmville players are likely to consider how their every choice and activity is being algorithmically scrutinised in order to determine what virtual goods they might actually buy. As an instance of what is widely being called ‘big data’, the data miing operations of Facebook, Zynga and similar services lead to a range of ethical questions (boyd and Crawford). While users may have ostensibly agreed to this data mining after clicking on Facebook’s Terms of Use agreement, the fact that almost no one reads these agreements when signing up for a service is the Internet’s worst kept secret. Similarly, the extension of these terms when Facebook operates as a platform for other applications is a far from transparent process. While examining the recording of user data leads to questions of privacy and surveillance, it is important to note that many users are often aware of the exchange to which they have agreed. Anders Albrechtslund deploys the term ‘social surveillance’ to usefully emphasise the knowing, playful and at times subversive approach some users take to the surveillance and data mining practices of online service providers. Similarly, E.J. Westlake notes that performances of self online are often not only knowing but deliberately false or misleading with the aim of exploiting the ways online activities are tracked. However, even users well aware of Facebook’s data mining on the site itself may be less informed about the social networking company’s mining of offsite activity. The introduction of ‘like’ buttons on many other Websites extends Facebook’s reach considerably. The various social plugins and ‘like’ buttons expand both active recording of user activity (where the like button is actually clicked) and passive data mining (since a cookie is installed or updated regardless of whether a button is actually pressed) (Gerlitz and Helmond). Indeed, because cookies – tiny packets of data exchanged and updated invisibly in browsers – assign each user a unique identifier, Facebook can either combine these data with an existing user’s profile or create profiles about non-users. If that person even joins Facebook, their account is connected with the existing, data-mined record of their Web activities (Roosendaal). As with Google, the significant issue here is not users knowingly sharing their data with Facebook, but the often complete lack of transparency in terms of the ways Facebook extracts and mines user data, both on Facebook itself and increasingly across applications using Facebook as a platform and across the Web through social plugins. Google after Death While data mining is clearly a core element in the operation of Facebook and Google, the ability to scrutinise the activities of users depends on those users being active; when someone dies, the question of the value and ownership of their digital assets becomes complicated, as does the way companies manage posthumous user information. For Google, the Gmail account of a deceased person becomes inactive; the stored email still takes up space on Google’s servers, but with no one using the account, no advertising is displayed and thus Google can earn no revenue from the account. However, the process of accessing the Gmail account of a deceased relative is an incredibly laborious one. In order to even begin the process, Google asks that someone physically mails a series of documents including a photocopy of a government-issued ID, the death certificate of the deceased person, evidence of an email the requester received from the deceased, along with other personal information. After Google have received and verified this information, they state that they might proceed to a second stage where further documents are required. Moreover, if at any stage Google decide that they cannot proceed in releasing a deceased relative’s Gmail account, they will not reveal their rationale. As their support documentation states: “because of our concerns for user privacy, if we determine that we cannot provide the Gmail content, we will not be able to share further details about the account or discuss our decision” (Google, “Accessing”). Thus, Google appears to enshrine the rights and privacy of individual users, even posthumously; the ownership or transfer of individual digital assets after death is neither a given, nor enshrined in Google’s policies. Yet, ironically, the economic value of that email to Google is likely zero, but the value of the email history of a loved one or business partner may be of substantial financial and emotional value, probably more so than when that person was alive. For those left behind, the value of email accounts as media, as a lasting record of social communication, is heightened. The question of how Google manages posthumous user data has been further complicated by the company’s March 2012 rationalisation of over seventy separate privacy policies for various tools and services they operate under the umbrella of a single privacy policy accessed using a single unified Google account. While this move was ostensibly to make privacy more understandable and transparent at Google, it had other impacts. For example, one of the side effects of a singular privacy policy and single Google identity is that deleting one of a recently deceased person’s services may inadvertently delete them all. Given that Google’s services include Gmail, YouTube and Picasa, this means that deleting an email account inadvertently erases all of the Google-hosted videos and photographs that individual posted during their lifetime. As Google warns, for example: “if you delete the Google Account to which your YouTube account is linked, you will delete both the Google Account AND your YouTube account, including all videos and account data” (Google, “What Happens”). A relative having gained access to a deceased person’s Gmail might sensibly delete the email account once the desired information is exported. However, it seems less likely that this executor would realise that in doing so all of the private and public videos that person had posted on YouTube would also permanently disappear. While material possessions can be carefully dispersed to specific individuals following the instructions in someone’s will, such affordances are not yet available for Google users. While it is entirely understandable that the ramification of policy changes are aimed at living users, as more and more online users pass away, the question of their digital assets becomes increasingly important. Google, for example, might allow a deceased person’s executor to elect which of their Google services should be kept online (perhaps their YouTube videos), which traces can be exported (perhaps their email), and which services can be deleted. At present, the lack of fine-grained controls over a user’s digital estate at Google makes this almost impossible. While it violates Google’s policies to transfer ownership of an account to another person, if someone does leave their passwords behind, this provides their loved ones with the best options in managing their digital legacy with Google. When someone dies and their online legacy is a collection of media fragments, the value of those media is far more apparent to the loved ones left behind rather than the companies housing those media. Facebook Memorialisation In response to users complaining that Facebook was suggesting they reconnect with deceased friends who had left Facebook profiles behind, in 2009 the company instituted an official policy of turning the Facebook profiles of departed users into memorial pages (Kelly). Technically, loved ones can choose between memorialisation and erasing an account altogether, but memorialisation is the default. This entails setting the account so that no one can log into it, and that no new friends (connections) can be made. Existing friends can access the page in line with the user’s final privacy settings, meaning that most friends will be able to post on the memorialised profile to remember that person in various ways (Facebook). Memorialised profiles (now Timelines, after Facebook’s redesign) thus become potential mourning spaces for existing connections. Since memorialised pages cannot make new connections, public memorial pages are increasingly popular on Facebook, frequently set up after a high-profile death, often involving young people, accidents or murder. Recent studies suggest that both of these Facebook spaces are allowing new online forms of mourning to emerge (Marwick and Ellison; Carroll and Landry; Kern, Forman, and Gil-Egui), although public pages have the downside of potentially inappropriate commentary and outright trolling (Phillips). Given Facebook has over a billion registered users, estimates already suggest that the platform houses 30 million profiles of deceased people, and this number will, of course, continue to grow (Kaleem). For Facebook, while posthumous users do not generate data themselves, the fact that they were part of a network means that their connections may interact with a memorialised account, or memorial page, and this activity, like all Facebook activities, allows the platform to display advertising and further track user interactions. However, at present Facebook’s options – to memorialise or delete accounts of deceased people – are fairly blunt. Once Facebook is aware that a user has died, no one is allowed to edit that person’s Facebook account or Timeline, so Facebook literally offers an all (memorialisation) or nothing (deletion) option. Given that Facebook is essentially a platform for performing identities, it seems a little short-sighted that executors cannot clean up or otherwise edit the final, lasting profile of a deceased Facebook user. As social networking services and social media become more ingrained in contemporary mourning practices, it may be that Facebook will allow more fine-grained control, positioning a digital executor also as a posthumous curator, making the final decision about what does and does not get kept in the memorialisation process. Since Facebook is continually mining user activity, the popularity of mourning as an activity on Facebook will likely mean that more attention is paid to the question of digital legacies. While the user themselves can no longer be social, the social practices of mourning, and the recording of a user as a media entity highlights the fact that social media can be about interactions which in significant ways include deceased users. Digital Legacy Services While the largest online corporations have fairly blunt tools for addressing digital death, there are a number of new tools and niche services emerging in this area which are attempting to offer nuanced control over digital legacies. Legacy Locker, for example, offers to store the passwords to all of a user’s online services and accounts, from Facebook to Paypal, and to store important documents and other digital material. Users designate beneficiaries who will receive this information after the account holder passes away, and this is confirmed by preselected “verifiers” who can attest to the account holder’s death. Death Switch similarly provides the ability to store and send information to users after the account holder dies, but tests whether someone is alive by sending verification emails; fail to respond to several prompts and Death Switch will determine a user has died, or is incapacitated, and executes the user’s final instructions. Perpetu goes a step further and offers the same tools as Legacy Locker but also automates existing options from social media services, allowing users to specify, for example, that their Facebook, Twitter or Gmail data should be downloaded and this archive should be sent to a designated recipient when the Perpetu user dies. These tools attempt to provide a more complex array of choices in terms of managing a user’s digital legacy, providing similar choices to those currently available when addressing material possessions in a formal will. At a broader level, the growing demand for these services attests to the ongoing value of online accounts and social media traces after a user’s death. Bequeathing passwords may not strictly follow the Terms of Use of the online services in question, but it is extremely hard to track or intervene when a user has the legitimate password, even if used by someone else. More to the point, this finely-grained legacy management allows far more flexibility in the utilisation and curation of digital assets posthumously. In the process of signing up for one of these services, or digital legacy management more broadly, the ongoing value and longevity of social media traces becomes more obvious to both the user planning their estate and those who ultimately have to manage it. The Social Media Afterlife The value of social media beyond the grave is also evident in the range of services which allow users to communicate in some fashion after they have passed away. Dead Social, for example, allows users to schedule posthumous social media activity, including the posting of tweets, sending of email, Facebook messages, or the release of online photos and videos. The service relies on a trusted executor confirming someone’s death, and after that releases these final messages effectively from beyond the grave. If I Die is a similar service, which also has an integrated Facebook application which ensures a user’s final message is directly displayed on their Timeline. In a bizarre promotional campaign around a service called If I Die First, the company is promising that the first user of the service to pass away will have their posthumous message delivered to a huge online audience, via popular blogs and mainstream press coverage. While this is not likely to appeal to everyone, the notion of a popular posthumous performance of self further complicates that question of what social media can mean after death. Illustrating the value of social media legacies in a quite different but equally powerful way, the Lives On service purports to algorithmically learn how a person uses Twitter while they are live, and then continue to tweet in their name after death. Internet critic Evgeny Morozov argues that Lives On is part of a Silicon Valley ideology of ‘solutionism’ which casts every facet of society as a problem in need of a digital solution (Morozov). In this instance, Lives On provides some semblance of a solution to the problem of death. While far from defeating death, the very fact that it might be possible to produce any meaningful approximation of a living person’s social media after they die is powerful testimony to the value of data mining and the importance of recognising that value. While Lives On is an experimental service in its infancy, it is worth wondering what sort of posthumous approximation might be built using the robust data profiles held by Facebook or Google. If Google Now can extrapolate what a user wants to see without any additional input, how hard would it be to retool this service to post what a user would have wanted after their death? Could there, in effect, be a Google After(life)? Conclusion Users of social media services have differing levels of awareness regarding the exchange they are agreeing to when signing up for services provided by Google or Facebook, and often value the social affordances without necessarily considering the ongoing media they are creating. Online corporations, by contrast, recognise and harness the informatic traces users generate through complex data mining and analysis. However, the death of a social media user provides a moment of rupture which highlights the significant value of the media traces a user leaves behind. More to the point, the value of these media becomes most evident to those left behind precisely because that individual can no longer be social. While beginning to address the issue of posthumous user data, Google and Facebook both have very blunt tools; Google might offer executors access while Facebook provides the option of locking a deceased user’s account as a memorial or removing it altogether. Neither of these responses do justice to the value that these media traces hold for the living, but emerging digital legacy management tools are increasingly providing a richer set of options for digital executors. While the differences between material and digital assets provoke an array of legal, spiritual and moral issues, digital traces nevertheless clearly hold significant and demonstrable value. For social media users, the death of someone they know is often the moment where the media side of social media – their lasting, infinitely replicable nature – becomes more important, more visible, and casts the value of the social media accounts of the living in a new light. For the larger online corporations and service providers, the inevitable increase in deceased users will likely provoke more fine-grained controls and responses to the question of digital legacies and posthumous profiles. 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The fundamental theoretical techniques of image compression are considered. Their comparative analysis was performed. Approaches of images compression level increasing presented in JPEG format will be investigated. In the practical part, there will be a software implementation of the investigated approaches and a comparative characteristic.