Myeloma: A Lot of Progress, Still a Long Way to Go

It was Bart Barlogie who made a clear point by stating in one of his lectures that any myeloma that is not cured will eventually turn into a resistant disease with aggressive clinical behaviour [...]

935. A Hospital Cluster of the Emerging Drug-resistant Yeast Saprochaete clavata

Background Saprochaete clavata, an ascomycetous yeast intrinsically resistant to echinocandins, is a rare yet emerging pathogen associated with invasive infections in immunosuppressed patients, particularly those with haematological malignancies. It is commonly misidentified as the closely-related S. capitata. Outbreaks have been associated with a high mortality rate of >50%, due in part to delayed diagnosis and resistance to commonly-used antifungals. Environmental source identification is challenging, although dishwashers and milk flasks have been implicated in previous hospital clusters. Methods We describe a cluster of five haematology-oncology patients with disseminated S. clavata infections between April 2020 and April 2021 following current or recent admissions to the same ward. Results All had prolonged (median=24 days, range=9-210) and profound immunosuppression from chemotherapy and/or stem cell transplantation for acute myeloid leukaemia (n=3) or lymphoma (n=2) at the time of culture positivity. Four were severely neutropaenic (median=0.08/mm3, range=0.01-0.26). Median patient age was 62 years (range=58-73). S. clavata was isolated from blood (n=3), urine (n=2), and liver tissue (n=1) samples. Whole genome sequencing of these isolates was performed to confirm the presence of an outbreak. All patients received empirical treatment with intravenous caspofungin before culture-guided therapy with intravenous liposomal amphotericin B +/- oral flucytosine. Two of the five patients died although both had advanced refractory malignancy. Detailed environmental sampling of fridges/freezers, drains, and vents in patient rooms and clean areas for handling or storage of food and medication failed to identify a clear point source despite isolation of multiple environmental organisms. No further cases have emerged after intensification of the cleaning regimen in these areas. Conclusion Our experience highlights the emerging threat of drug-resistant yeasts particularly in the immunocompromised. Management of such outbreaks requires a multidisciplinary approach incorporating antifungal stewardship, infection control, and environmental microbiology, alongside close clinical liaison between haemato-oncologists and infection specialists. Disclosures All Authors: No reported disclosures

The mechanism between mortality, population growth and ageing of the population in the European lower and upper middle income countries

This paper analyses the effect of mortality rates (under-five and adult mortality) and population growth on the population ageing in a pooled sample of nine lower and upper middle European countries. Therefore, the main goal of this research is to investigate the ageing process of the population in the context of mortality mechanisms (under five and adult mortality) and of population growth in nine European LUMIs. The analysis is implemented in terms of Pooled least squares with cross-section fixed effects methodology. The novelty used within this research is White two-way cluster standard errors & covariance. This study is based on a database from the World Bank and UN covering the period 1995–2019. The expected results are making available quantitative analysis and insights in the context of mechanisms between the ageing process of population, mortality and population growth across these European LUMIs. Results are consistent with the notion that the increasing ageing process within these countries may be a consequence of the negative impact of population growth and from the influence of adult mortality for both sexes. The research results confirm the presence of solid ties of the mechanism between mortality, population growth and population ageing. Therefore, a clear point was provided that mortality acceleration will depend primarily on the level of population growth.

Escaping Tree-Support (ET-Sup): minimizing contact points for tree-like support structures in additive manufacturing

Purpose Support structures are often needed in additive manufacturing (AM) to print overhangs. However, they are the extra materials that must be removed afterwards. When the supports have many contacts to the model or are even enclosed inside some concavities, removing them is very challenging and has a risk of damaging the part. Therefore, the purpose of this paper is to develop a new type of tree-support, named Escaping Tree-Support (ET-Sup), which tries to build all the supports onto the build plate to minimize the number of contact points. Design/methodology/approach The methodology is to first classify the support points into three categories: clear, obstructed and enclosed. A clear point has nothing between it and the build plate; an obstructed point is not clear, but there exists a path for it to reach the build plate; and an enclosed point has no way to reach the build plate. With this classification, the path for the obstructed points to come clear can be found through linking them to the clear points. All the operations are performed efficiently with the help of a ray representation. Findings The method is tested on different overhang features, including a lattice ball and a mushroom shape with a concave cap. All the supports generated for the examples can find their way to the build plate, which looks like they are escaping from the model. The computation time is around one second for these cases. Originality/value This is the first time truly realizing this “escaping” property in the generation of tree-like support structures. With this ET-Sup, it is expected that the AM industries can reduce the manufacturing lead time and save much labor work in post-processing.

Food for the Dogs: Consumption and Wealth Inequality in Bong Joon-Ho's Parasite

Bong Joon-Ho’s film Parasite was remarkable for being a foreign film that took home multiple Academy Awards in February of 2020, making waves for its potent message about class divide and wealth inequality in South Korea. Bong Joon-Ho makes a very clear point throughout the film of emphasizing this class inequality, especially through the production and consumption of food by either party. In this essay, I analyze the ways in which food throughout the film symbolizes the divide between rich and poor, then take these scenes and use contemporary research to further build on how food is a signifier of class and wealth universally. From the Kim family sitting around a small kitchen table eating what looks like food from a vending machine, to using a fruit someone is allergic to as a weapon against them, there is a clear indication consistently throughout the film of food as a signifier of status and class. From this point, I will take this divide and analyze its significance to the modern culture and society of South Korea, then further apply this to its relevancy in a modern United States wherein this current wealth gap is also increasingly apparent. Parasite was a foreign film that flourished in American society—both are countries wherein a capitalist ‘meritocracy’ rules for the most part, and an analysis of the culture around the film will show the ways in which the cultures that consumed this media are similar in their class divides.

Media and Mapping Practices in the Middle East and North Africa

A few months into the popular uprisings in the Middle East and North Africa (2009-2001), the promises of social media, including its ability to influence a participatory governance model, grassroots civic engagement, new social dynamics, inclusive societies and new opportunities for businesses and entrepreneurs, became more evident than ever. Simultaneously, cartography received new considerable interest as it merged with social media platforms. In an attempt to rearticulate the relationship between media and mapping practices, whilst also addressing new and social media, this interdisciplinary book abides by one relatively clear point: space is a media product. The overall focus of this book is accordingly not so much on the role of new technologies and social networks as it is on how media and mapping practices expand the very notion of cultural engagement, political activism, popular protest and social participation.

Change of Good

In the postmodern era, concepts, notions, even ideologies that used to be concrete lost their precision. On the contrary to the clear point of view of modernism with linearity, postmodernism is circular and holistic. Thus, concepts like good and evil must not be seen as a total contrast. With the holistic approach of postmodernism, there can be evil in good and good in evil. In the popular fantasy texts that have been made especially in the last decade, this change easily can be seen in the characters. In this part, change of the good and the evil concepts in the fantasy genre will be examined in the context of postmodernism and developments in these concepts will be approached with the roles as hero, villain, anti-hero, anti-villain.

Conflict and Authority: William of Saint-Thierry and Peter Abelard as Readers of Origen

This study compares how two prominent twelfth-century Latin authors and theological opponents, namely the monastic author William of Saint-Thierry (c. 1080–1148) and the school master Peter Abelard (1079–1142), variously understood the authority of the controversial yet influential Greek author Origen (c. 184–253) in their works. Modern scholars who study the reception of Origen in the twelfth-century Latin West have, to this point, spoken of an Origenian revival in this period, concluding that Origen was especially popular in the cloister, among Cistercian monks, such as Bernard of Clairvaux and his followers, like William of Saint-Thierry, based on the assumption that as monks they found his writings more relevant. This study seeks to challenge this scholarly narrative by focusing on two authors who are perceived as typifying two different strands of theology, one of a contemplative character developed in the cloister (William) and one making use of dialectics and developed in the emerging schools (Abelard). By demonstrating that the schoolmaster Abelard drew on Origen to a greater degree and in a more transparent manner than his monastic opponent, this study will show that Origen’s popularity in the cloisters was not, as such, a clear point of distinction between them and schools in the way that has usually been claimed by modern scholarship.

Anarcha, Betsey, Lucy, and the women whose names were not recorded: The legacy of J Marion Sims

In April 2018, a statue commemorating J Marion Sims was removed from Central Park, New York, and relocated to Green-Wood Cemetery in Brooklyn, where he is buried. In 1849, Sims developed a repeatable surgical solution for obstetric fistula, a debilitating condition caused by prolonged, obstructed labour, which damages the vaginal wall, resulting in permanent leakage via the vagina from either the bowel or bladder and sometimes both. Initially, Sims appears worthy of widespread adulation. There are several commemorative statues of him, he has been afforded the title of the ‘father of modern gynaecology’, and for 37 years, the American Urogynecological Society held an annual eponymous lecture, among other honours. Obstetric fistula rendered women social pariahs, unable to engage fully in either domestic or public life. Sims was able to create a reliably repeatable surgical solution but did so through ongoing experimentation on enslaved women. One of these women, Anarcha, was operated on at least 30 times without the use of anaesthesia over a four-year period, despite the availability of anaesthesia for the majority of the experimentation period. Over 170 years later, Sims’ story retains its relevance because it represents a clear point at which race, gender and class intersect with medicine. This paper will use Sims’ own account to drive the narrative, then examine matters of agency, ethics and consent that come from it, to show that his work, and subsequent renown, were only possible because of the inherent violence of chattel slavery and other systemic forms of oppression.

When there is meaning in design? Two dimensions of the practice of designing (communication)

John Thackara emphasised that 80% of the negative impact on the natural environment has its origin in design and the randomness of its application. Considering the entirety of design practices, one would have a hard time disputing this. In contemporary times, design understood as design practices has assumed a servile role in relation to big corporations. One can observe the consequences of such practices in real time: social exclusion, the lack of design consideration or consideration of end users, the failure of branding, and the polarisation of entire societies – these are only some dimensions of the current applications of design (including graphic design). Instead of the current applications, we need a change in the paradigm of both the theory of design and practical applications. Design needs a new code of application which would not only look good in social media, but would also be a clear point of reference in the design practice.