Search results for: strategic focus
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6575

Search results for: strategic focus

275 Tracing Graduates of Vocational Schools with Transnational Mobility Experience: Conclusions and Recommendations from Poland

Authors: Michal Pachocki

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This study investigates the effects of mobility in the context of a different environment and work culture through analysing the learners perception of their international work experience. Since this kind of professional training abroad is becoming more popular in Europe, mainly due to the EU funding opportunities, it is of paramount importance to assess its long-term impact on educational and career paths of former students. Moreover, the tracer study aimed at defining what professional, social and intercultural competencies were gained or developed by the interns and to which extent those competences proved to be useful meeting the labor market requirements. Being a populous EU member state which actively modernizes its vocational education system (also with European funds), Poland can serve as an illustrative case study to investigate the above described research problems. However, the examined processes are most certainly universal, wherever mobility is included in the learning process. The target group of this research was the former mobility participants and the study was conducted using quantitative and qualitative methods, such as the online survey with over 2 600 questionnaires completed by the former mobility participants; -individual in-depth interviews (IDIs) with 20 Polish graduates already present in the labour market; - 5 focus group interviews (FGIs) with 60 current students of the Polish vocational schools, who have recently returned from the training abroad. As the adopted methodology included a data triangulation, the collected findings have also been supplemented with data obtained by the desk research (mainly contextual information and statistical summary of mobility implementation). The results of this research – to be presented in full scope within the conference presentation – include the participants’ perception of their work mobility. The vast majority of graduates agrees that such an experience has had a significant impact on their professional careers and claims that they would recommend training abroad to persons who are about to enter the labor market. Moreover, in their view, such form of practical training going beyond formal education provided them with an opportunity to try their hand in the world of work. This allowed them – as they accounted for them – to get acquainted with a work system and context different from the ones experienced in Poland. Although the work mobility becomes an important element of the learning process in the growing number of Polish schools, this study reveals that many sending institutions suffer from a lack of the coherent strategy for planning domestic and foreign training programmes. Nevertheless, the significant number of graduates claims that such a synergy improves the quality of provided training. Despite that, the research proved that the transnational mobilities exert an impact on their future careers and personal development. However, such impact is, in their opinion, dependant on other factors, such as length of the training period, the nature and extent of work, recruitment criteria and the quality of organizational arrangement and mentoring provided to learners. This may indicate the salience of the sending and receiving institutions organizational capacity to deal with mobility.

Keywords: learning mobility, transnational training, vocational education and training graduates, tracer study

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274 Inhabitants’ Adaptation to the Climate's Evolutions in Cities: a Survey of City Dwellers’ Climatic Experiences’ Construction

Authors: Geraldine Molina, Malou Allagnat

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Entry through meteorological and climatic phenomena, technical knowledge and engineering sciences has long been favored by the research and local public action to analyze the urban climate, develop strategies to reduce its changes and adapt their spaces. However, in their daily practices and sensitive experiences, city dwellers are confronted with the climate and constantly deal with its fluctuations. In this way, these actors develop knowledge, skills and tactics to regulate their comfort and adapt to climatic variations. Therefore, the empirical observation and analysis of these living experiences represent major scientific and social challenges. This contribution proposes to question these relationships of the inhabitants to urban climate. It tackles the construction of inhabitants’ climatic experiences to answer a central question: how do city dwellers’ deal with the urban climate and adapt to its different variations? Indeed, the city raises the question of how populations adapt to different spatial and temporal climatic variations. Local impacts of global climate change are combined with the urban heat island phenomenon and other microclimatic effects, as well as seasonal, daytime and night-time fluctuations. To provide answers, the presentation will be focused on the results of a CNRS research project (Géraldine Molina), part of which is linked to the European project Nature For Cities (H2020, Marjorie Musy, Scientific Director). From a theoretical point of view, the contribution is based on a renewed definition of adaptation centered on the capacity of individuals and social groups, a recently opened entry from a theoretical point of view by social scientists. The research adopts a "radical interdisciplinary" approach to shed light on the links between social dynamics of climate (inhabitants’ perceptions, representations and practices) and physical processes that characterize urban climate. To do so, it relied on a methodological combination of different survey techniques borrowed from the social sciences (geography, anthropology, sociology) and linked to the work, methodologies and results of the engineering sciences. From 2016 to 2019, a survey was carried out in two districts of Lyon whose morphological, micro-climatic and social characteristics differ greatly, namely the 6th arrondissement and the Guillotière district. To explore the construction of climate experiences over the long term by putting it into perspective with the life trajectories of individuals, 70 semi-directive interviews were conducted with inhabitants. In order to also punctually survey the climate experiments as they unfold in a given time and moment, observation and measurement campaigns of physical phenomena and questionnaires have been conducted in public spaces by an interdisciplinary research team1. The contribution at the ICUC 2020 will mainly focus on the presentation of the presentation of the qualitative survey conducted thanks to the inhabitants’ interviews.

Keywords: sensitive experiences, ways of life, thermal comfort, radical interdisciplinarity

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273 The Influence of Perinatal Anxiety and Depression on Breastfeeding Behaviours: A Qualitative Systematic Review

Authors: Khulud Alhussain, Anna Gavine, Stephen Macgillivray, Sushila Chowdhry

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Background: Estimates show that by the year 2030, mental illness will account for more than half of the global economic burden, second to non-communicable diseases. Often, the perinatal period is characterised by psychological ambivalence and a mixed anxiety-depressive condition. Maternal mental disorder is associated with perinatal anxiety and depression and affects breastfeeding behaviors. Studies also indicate that maternal mental health can considerably influence a baby's health in numerous aspects and impact the newborn health due to lack of adequate breastfeeding. However, studies reporting factors associated with breastfeeding behaviors are predominantly quantitative. Therefore, it is not clear what literature is available to understand the factors affecting breastfeeding and perinatal women’s perspectives and experiences. Aim: This review aimed to explore the perceptions and experiences of women with perinatal anxiety and depression, as well as how these experiences influence their breastfeeding behaviours. Methods: A systematic literature review of qualitative studies in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). Four electronic databases (CINAHL, PsycINFO, Embase, and Google Scholar) were explored for relevant studies using a search strategy. The search was restricted to studies published in the English language between 2000 and 2022. Findings from the literature were screened using a pre-defined screening criterion and the quality of eligible studies was appraised using the Walsh and Downe (2006) checklist. Findings were extracted and synthesised based on Braun and Clark. The review protocol was registered on PROSPERO (Ref: CRD42022319609). Result: A total of 4947 studies were identified from the four databases. Following duplicate removal and screening 16 studies met the inclusion criteria. The studies included 87 pregnant and 302 post-partum women from 12 countries. The participants were from a variety of economic, regional, and religious backgrounds, mainly from the age of 18 to 45 years old. Three main themes were identified: Barriers to breastfeeding, breastfeeding facilitators, emotional disturbance, and breastfeeding. Seven subthemes emerged from the data: expectation versus reality, uncertainly about maternal competencies, body image and breastfeeding, lack of sufficient breastfeeding support for family and caregivers’ support, influences positive breastfeeding practices, breastfeeding education, and causes of mental strain among breastfeeding women. Breastfeeding duration is affected in women with mental health disorders, irrespective of their desire to breastfeed. Conclusion: There is significant empirical evidence that breastfeeding behaviour and perinatal mental disturbance are linked. However, there is a lack of evidence to apply the findings to Saudi women due to lack of empirical qualitative information. To improve the psychological well-being of mothers, it is crucial to explore and recognise any concerns with their mental, physical, and emotional well-being. Therefore, robust research is needed so that breastfeeding intervention researchers and policymakers can focus on specifically what needs to be done to help mentally distressed perinatal women and their new-born.

Keywords: pregnancy, perinatal period, anxiety, depression, emotional disturbance, breastfeeding

Procedia PDF Downloads 63
272 Organizational Resilience in the Perspective of Supply Chain Risk Management: A Scholarly Network Analysis

Authors: William Ho, Agus Wicaksana

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Anecdotal evidence in the last decade shows that the occurrence of disruptive events and uncertainties in the supply chain is increasing. The coupling of these events with the nature of an increasingly complex and interdependent business environment leads to devastating impacts that quickly propagate within and across organizations. For example, the recent COVID-19 pandemic increased the global supply chain disruption frequency by at least 20% in 2020 and is projected to have an accumulative cost of $13.8 trillion by 2024. This crisis raises attention to organizational resilience to weather business uncertainty. However, the concept has been criticized for being vague and lacking a consistent definition, thus reducing the significance of the concept for practice and research. This study is intended to solve that issue by providing a comprehensive review of the conceptualization, measurement, and antecedents of operational resilience that have been discussed in the supply chain risk management literature (SCRM). We performed a Scholarly Network Analysis, combining citation-based and text-based approaches, on 252 articles published from 2000 to 2021 in top-tier journals based on three parameters: AJG ranking and ABS ranking, UT Dallas and FT50 list, and editorial board review. We utilized a hybrid scholarly network analysis by combining citation-based and text-based approaches to understand the conceptualization, measurement, and antecedents of operational resilience in the SCRM literature. Specifically, we employed a Bibliographic Coupling Analysis in the research cluster formation stage and a Co-words Analysis in the research cluster interpretation and analysis stage. Our analysis reveals three major research clusters of resilience research in the SCRM literature, namely (1) supply chain network design and optimization, (2) organizational capabilities, and (3) digital technologies. We portray the research process in the last two decades in terms of the exemplar studies, problems studied, commonly used approaches and theories, and solutions provided in each cluster. We then provide a conceptual framework on the conceptualization and antecedents of resilience based on studies in these clusters and highlight potential areas that need to be studied further. Finally, we leverage the concept of abnormal operating performance to propose a new measurement strategy for resilience. This measurement overcomes the limitation of most current measurements that are event-dependent and focus on the resistance or recovery stage - without capturing the growth stage. In conclusion, this study provides a robust literature review through a scholarly network analysis that increases the completeness and accuracy of research cluster identification and analysis to understand conceptualization, antecedents, and measurement of resilience. It also enables us to perform a comprehensive review of resilience research in SCRM literature by including research articles published during the pandemic and connects this development with a plethora of articles published in the last two decades. From the managerial perspective, this study provides practitioners with clarity on the conceptualization and critical success factors of firm resilience from the SCRM perspective.

Keywords: supply chain risk management, organizational resilience, scholarly network analysis, systematic literature review

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271 Wetland Community and Their Livelihood Opportunities in the Face of Changing Climatic Condition in Southwest Bangladesh

Authors: Mohsina Aktar, Bishawjit Mallick

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Bangladesh faces the multidimensional manifestations of climate change e.g. flood, cyclone, sea level rise, drainage congestion, salinity, etc. This study aimed at to find out the community’s perception of the perceived impact of climate change on their wetland resource based livelihood, to analyze their present livelihood scenario and to find out required institutional setup to strengthen present livelihood scenario. Therefore, this study required both quantitative analysis like quantification of wetland resources, occupation, etc. and also exploratory information like policy and institutional reform. For quantitative information 200 questionnaire survey and in some cases observation survey and for socially shareable qualitative and quantitative issues case study and focus group discussion were conducted. In-Depth interview was conducted for socially non-shareable qualitative issues. The overall findings of this study have been presented maintaining a sequence- perception about climate change effect, livelihood scenario and required institutional support of the wetland community. Flood has been ranked where cyclone effect is comparatively less disastrous in this area. Heavy rainfall comes after the cyclone. Female members responded almost same about the ranking and effects of frequently occurred and devastating effects of climate change. People are much more aware of the impact of climate change. Training of Care in RVCC project helps to increase their knowledge level. If the level of education can be increased, people can fight against calamity and poverty with more confidence. People seem to overcome the problems of water logging and thus besides involving in Hydroponics (33.3%) as prime occupation in monsoon; they are also engaged in other business related activities. January to May is the low-income season for the farmers. But some people don’t want to change their traditional occupation and their age is above 45. The young earning member wants to utilize their lean income period by alternative occupation. People who do not have own land and performing water transportation or other types of occupation are now interested about Hydroponics. People who give their land on rent are now thinking about renting their land in monsoon as through that they can earn a sound amount rather than get nothing. What they require is just seed, training, and capital. Present marketing system faces the problem of communication. So this sector needed to be developed. Involvement of women in income earning activity is very low (5.1%), and 100% women are housewives. They became inferior due to their educational level and dominance of their husband. Only one NGO named BCAS (Bangladesh Center for Advanced Studies) has been found engage training facilities and advocacy for this purpose. Upazilla agricultural extension office like other GO remains inactive to give support the community for extension and improvement of Hydroponics agriculture. If the community gets proper support and inspiration, they can fight against crisis of low-income and climate change, with the Hydroponics cultivation system successfully.

Keywords: wetland community, hydroponics, climate change adaptation, livelihood

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270 Physiological Effects on Scientist Astronaut Candidates: Hypobaric Training Assessment

Authors: Pedro Llanos, Diego García

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This paper is addressed to expanding our understanding of the effects of hypoxia training on our bodies to better model its dynamics and leverage some of its implications and effects on human health. Hypoxia training is a recommended practice for military and civilian pilots that allow them to recognize their early hypoxia signs and symptoms, and Scientist Astronaut Candidates (SACs) who underwent hypobaric hypoxia (HH) exposure as part of a training activity for prospective suborbital flight applications. This observational-analytical study describes physiologic responses and symptoms experienced by a SAC group before, during and after HH exposure and proposes a model for assessing predicted versus observed physiological responses. A group of individuals with diverse Science Technology Engineering Mathematics (STEM) backgrounds conducted a hypobaric training session to an altitude up to 22,000 ft (FL220) or 6,705 meters, where heart rate (HR), breathing rate (BR) and core temperature (Tc) were monitored with the use of a chest strap sensor pre and post HH exposure. A pulse oximeter registered levels of saturation of oxygen (SpO2), number and duration of desaturations during the HH chamber flight. Hypoxia symptoms as described by the SACs during the HH training session were also registered. This data allowed to generate a preliminary predictive model of the oxygen desaturation and O2 pressure curve for each subject, which consists of a sixth-order polynomial fit during exposure, and a fifth or fourth-order polynomial fit during recovery. Data analysis showed that HR and BR showed no significant differences between pre and post HH exposure in most of the SACs, while Tc measures showed slight but consistent decrement changes. All subjects registered SpO2 greater than 94% for the majority of their individual HH exposures, but all of them presented at least one clinically significant desaturation (SpO2 < 85% for more than 5 seconds) and half of the individuals showed SpO2 below 87% for at least 30% of their HH exposure time. Finally, real time collection of HH symptoms presented temperature somatosensory perceptions (SP) for 65% of individuals, and task-focus issues for 52.5% of individuals as the most common HH indications. 95% of the subjects experienced HH onset symptoms below FL180; all participants achieved full recovery of HH symptoms within 1 minute of donning their O2 mask. The current HH study performed on this group of individuals suggests a rapid and fully reversible physiologic response after HH exposure as expected and obtained in previous studies. Our data showed consistent results between predicted versus observed SpO2 curves during HH suggesting a mathematical function that may be used to model HH performance deficiencies. During the HH study, real-time HH symptoms were registered providing evidenced SP and task focusing as the earliest and most common indicators. Finally, an assessment of HH signs of symptoms in a group of heterogeneous, non-pilot individuals showed similar results to previous studies in homogeneous populations of pilots.

Keywords: slow onset hypoxia, hypobaric chamber training, altitude sickness, symptoms and altitude, pressure cabin

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269 Interdisciplinary Method Development - A Way to Realize the Full Potential of Textile Resources

Authors: Nynne Nørup, Julie Helles Eriksen, Rikke M. Moalem, Else Skjold

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Despite a growing focus on the high environmental impact of textiles, textile waste is only recently considered as part of the waste field. Consequently, there is a general lack of knowledge and data within this field. Particularly the lack of a common perception of textiles generates several problems e.g., to recognize the full material potential the fraction contains, which is cruel if the textile must enter the circular economy. This study aims to qualify a method to make the resources in textile waste visible in a way that makes it possible to move them as high up in the waste hierarchy as possible. Textiles are complex and cover many different types of products, fibers and combinations of fibers and production methods. In garments alone, there is a great variety, even when narrowing it to only undergarments. However, textile waste is often reduced to one fraction, assessed solely by quantity, and compared to quantities of other waste fractions. Disregarding the complexity and reducing textiles to a single fraction that covers everything made of textiles increase the risk of neglecting the value of the materials, both with regards to their properties and economical. Instead of trying to fit textile waste into the current primarily linear waste system where volume is a key part of the business models, this study focused on integrating textile waste as a resource in the design and production phase. The study combined interdisciplinary methods for determining replacement rates used in Life Cycle Assessments and Mass Flow Analysis methods with the designer’s toolbox to hereby activate the properties of textile waste in a way that can unleash its potential optimally. It was hypothesized that by activating Denmark's tradition for design and high level of craftsmanship, it is possible to find solutions that can be used today and create circular resource models that reduce the use of virgin fibers. Through waste samples, case studies, and testing of various design approaches, this study explored how to functionalize the method so that the product after the end-use is kept as a material and only then processed at fiber level to obtain the best environmental utilization. The study showed that the designers' ability to decode the properties of the materials and understanding of craftsmanship were decisive for how well the materials could be utilized today. The later in the life cycle the textiles appeared as waste, the more demanding the description of the materials to be sufficient, especially if to achieve the best possible use of the resources and thus a higher replacement rate. In addition, it also required adaptation in relation to the current production because the materials often varied more. The study found good indications that part of the solution is to use geodata i.e., where in the life cycle the materials were discarded. An important conclusion is that a fully developed method can help support better utilization of textile resources. However, it stills requires a better understanding of materials by the designers, as well as structural changes in business and society.

Keywords: circular economy, development of sustainable processes, environmental impacts, environmental management of textiles, environmental sustainability through textile recycling, interdisciplinary method development, resource optimization, recycled textile materials and the evaluation of recycling, sustainability and recycling opportunities in the textile and apparel sector

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268 Barriers to Business Model Innovation in the Agri-Food Industry

Authors: Pia Ulvenblad, Henrik Barth, Jennie Cederholm BjöRklund, Maya Hoveskog, Per-Ola Ulvenblad

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The importance of business model innovation (BMI) is widely recognized. This is also valid for firms in the agri-food industry, closely connected to global challenges. Worldwide food production will have to increase 70% by 2050 and the United Nations’ sustainable development goals prioritize research and innovation on food security and sustainable agriculture. The firms of the agri-food industry have opportunities to increase their competitive advantage through BMI. However, the process of BMI is complex and the implementation of new business models is associated with high degree of risk and failure. Thus, managers from all industries and scholars need to better understand how to address this complexity. Therefore, the research presented in this paper (i) explores different categories of barriers in research literature on business models in the agri-food industry, and (ii) illustrates categories of barriers with empirical cases. This study is addressing the rather limited understanding on barriers for BMI in the agri-food industry, through a systematic literature review (SLR) of 570 peer-reviewed journal articles that contained a combination of ‘BM’ or ‘BMI’ with agriculture-related and food-related terms (e.g. ‘agri-food sector’) published in the period 1990-2014. The study classifies the barriers in several categories and illustrates the identified barriers with ten empirical cases. Findings from the literature review show that barriers are mainly identified as outcomes. It can be assumed that a perceived barrier to growth can often be initially exaggerated or underestimated before being challenged by appropriate measures or courses of action. What may be considered by the public mind to be a barrier could in reality be very different from an actual barrier that needs to be challenged. One way of addressing barriers to growth is to define barriers according to their origin (internal/external) and nature (tangible/intangible). The framework encompasses barriers related to the firm (internal addressing in-house conditions) or to the industrial or national levels (external addressing environmental conditions). Tangible barriers can include asset shortages in the area of equipment or facilities, while human resources deficiencies or negative willingness towards growth are examples of intangible barriers. Our findings are consistent with previous research on barriers for BMI that has identified human factors barriers (individuals’ attitudes, histories, etc.); contextual barriers related to company and industry settings; and more abstract barriers (government regulations, value chain position, and weather). However, human factor barriers – and opportunities - related to family-owned businesses with idealistic values and attitudes and owning the real estate where the business is situated, are more frequent in the agri-food industry than other industries. This paper contributes by generating a classification of the barriers for BMI as well as illustrating them with empirical cases. We argue that internal barriers such as human factors barriers; values and attitudes are crucial to overcome in order to develop BMI. However, they can be as hard to overcome as for example institutional barriers such as governments’ regulations. Implications for research and practice are to focus on cognitive barriers and to develop the BMI capability of the owners and managers of agri-industry firms.

Keywords: agri-food, barriers, business model, innovation

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267 Monitoring of Formaldehyde over Punjab Pakistan Using Car Max-Doas and Satellite Observation

Authors: Waqas Ahmed Khan, Faheem Khokhaar

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Air pollution is one of the main perpetrators of climate change. GHGs cause melting of glaciers and cause change in temperature and heavy rain fall many gasses like Formaldehyde is not direct precursor that damage ozone like CO2 or Methane but Formaldehyde (HCHO) form glyoxal (CHOCHO) that has effect on ozone. Countries around the globe have unique air quality monitoring protocols to describe local air pollution. Formaldehyde is a colorless, flammable, strong-smelling chemical that is used in building materials and to produce many household products and medical preservatives. Formaldehyde also occurs naturally in the environment. It is produced in small amounts by most living organisms as part of normal metabolic processes. Pakistan lacks the monitoring facilities on larger scale to measure the atmospheric gasses on regular bases. Formaldehyde is formed from Glyoxal and effect mountain biodiversity and livelihood. So its monitoring is necessary in order to maintain and preserve biodiversity. Objective: Present study is aimed to measure atmospheric HCHO vertical column densities (VCDs) obtained from ground-base and compute HCHO data in Punjab and elevated areas (Rawalpindi & Islamabad) by satellite observation during the time period of 2014-2015. Methodology: In order to explore the spatial distributing of H2CO, various fields campaigns including international scientist by using car Max-Doas. Major focus was on the cities along national highways and industrial region of Punjab Pakistan. Level 2 data product of satellite instruments OMI retrieved by differential optical absorption spectroscopy (DOAS) technique are used. Spatio-temporal distribution of HCHO column densities over main cities and region of Pakistan has been discussed. Results: Results show the High HCHO column densities exceeding permissible limit over the main cities of Pakistan particularly the areas with rapid urbanization and enhanced economic growth. The VCDs value over elevated areas of Pakistan like Islamabad, Rawalpindi is around 1.0×1016 to 34.01×1016 Molecules’/cm2. While Punjab has values revolving around the figure 34.01×1016. Similarly areas with major industrial activity showed high amount of HCHO concentrations. Tropospheric glyoxal VCDs were found to be 4.75 × 1015 molecules/cm2. Conclusion: Results shows that monitoring site surrounded by Margalla hills (Islamabad) have higher concentrations of Formaldehyde. Wind data shows that industrial areas and areas having high economic growth have high values as they provide pathways for transmission of HCHO. Results obtained from this study would help EPA, WHO and air protection departments in order to monitor air quality and further preservation and restoration of mountain biodiversity.

Keywords: air quality, formaldehyde, Max-Doas, vertical column densities (VCDs), satellite instrument, climate change

Procedia PDF Downloads 192
266 The Integration of Apps for Communicative Competence in English Teaching

Authors: L. J. de Jager

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In the South African English school curriculum, one of the aims is to achieve communicative competence, the knowledge of using language competently and appropriately in a speech community. Communicatively competent speakers should not only produce grammatically correct sentences but also produce contextually appropriate sentences for various purposes and in different situations. As most speakers of English are non-native speakers, achieving communicative competence remains a complex challenge. Moreover, the changing needs of society necessitate not merely language proficiency, but also technological proficiency. One of the burning issues in the South African educational landscape is the replacement of the standardised literacy model by the pedagogy of multiliteracies that incorporate, by default, the exploration of technological text forms that are part of learners’ everyday lives. It foresees learners as decoders, encoders, and manufacturers of their own futures by exploiting technological possibilities to constantly create and recreate meaning. As such, 21st century learners will feel comfortable working with multimodal texts that are intrinsically part of their lives and by doing so, become authors of their own learning experiences while teachers may become agents supporting learners to discover their capacity to acquire new digital skills for the century of multiliteracies. The aim is transformed practice where learners use their skills, ideas, and knowledge in new contexts. This paper reports on a research project on the integration of technology for language learning, based on the technological pedagogical content knowledge framework, conceptually founded in the theory of multiliteracies, and which aims to achieve communicative competence. The qualitative study uses the community of inquiry framework to answer the research question: How does the integration of technology transform language teaching of preservice teachers? Pre-service teachers in the Postgraduate Certificate of Education Programme with English as methodology were purposively selected to source and evaluate apps for teaching and learning English. The participants collaborated online in a dedicated Blackboard module, using discussion threads to sift through applicable apps and develop interactive lessons using the Apps. The selected apps were entered on to a predesigned Qualtrics form. Data from the online discussions, focus group interviews, and reflective journals were thematically and inductively analysed to determine the participants’ perceptions and experiences when integrating technology in lesson design and the extent to which communicative competence was achieved when using these apps. Findings indicate transformed practice among participants and research team members alike with a better than average technology acceptance and integration. Participants found value in online collaboration to develop and improve their own teaching practice by experiencing directly the benefits of integrating e-learning into the teaching of languages. It could not, however, be clearly determined whether communicative competence was improved. The findings of the project may potentially inform future e-learning activities, thus supporting student learning and development in follow-up cycles of the project.

Keywords: apps, communicative competence, English teaching, technology integration, technological pedagogical content knowledge

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265 Scientific and Regulatory Challenges of Advanced Therapy Medicinal Products

Authors: Alaa Abdellatif, Gabrièle Breda

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Background. Advanced therapy medicinal products (ATMPs) are innovative therapies that mainly target orphan diseases and high unmet medical needs. ATMP includes gene therapy medicinal products (GTMP), somatic cell therapy medicinal products (CTMP), and tissue-engineered therapies (TEP). Since legislation opened the way in 2007, 25 ATMPs have been approved in the EU, which is about the same amount as the U.S. Food and Drug Administration. However, not all of the ATMPs that have been approved have successfully reached the market and retained their approval. Objectives. We aim to understand all the factors limiting the market access to very promising therapies in a systemic approach, to be able to overcome these problems, in the future, with scientific, regulatory and commercial innovations. Further to recent reviews that focus either on specific countries, products, or dimensions, we will address all the challenges faced by ATMP development today. Methodology. We used mixed methods and a multi-level approach for data collection. First, we performed an updated academic literature review on ATMP development and their scientific and market access challenges (papers published between 2018 and April 2023). Second, we analyzed industry feedback from cell and gene therapy webinars and white papers published by providers and pharmaceutical industries. Finally, we established a comparative analysis of the regulatory guidelines published by EMA and the FDA for ATMP approval. Results: The main challenges in bringing these therapies to market are the high development costs. Developing ATMPs is expensive due to the need for specialized manufacturing processes. Furthermore, the regulatory pathways for ATMPs are often complex and can vary between countries, making it challenging to obtain approval and ensure compliance with different regulations. As a result of the high costs associated with ATMPs, challenges in obtaining reimbursement from healthcare payers lead to limited patient access to these treatments. ATMPs are often developed for orphan diseases, which means that the patient population is limited for clinical trials which can make it challenging to demonstrate their safety and efficacy. In addition, the complex manufacturing processes required for ATMPs can make it challenging to scale up production to meet demand, which can limit their availability and increase costs. Finally, ATMPs face safety and efficacy challenges: dangerous adverse events of these therapies like toxicity related to the use of viral vectors or cell therapy, starting material and donor-related aspects. Conclusion. As a result of our mixed method analysis, we found that ATMPs face a number of challenges in their development, regulatory approval, and commercialization and that addressing these challenges requires collaboration between industry, regulators, healthcare providers, and patient groups. This first analysis will help us to address, for each challenge, proper and innovative solution(s) in order to increase the number of ATMPs approved and reach the patients

Keywords: advanced therapy medicinal products (ATMPs), product development, market access, innovation

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264 Company's Orientation and Human Resource Management Evolution in Technological Startup Companies

Authors: Yael Livneh, Shay Tzafrir, Ilan Meshoulam

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Technological startup companies have been recognized as bearing tremendous potential for business and economic success. However, many entrepreneurs who produce promising innovative ideas fail to implement them as successful businesses. A key argument for such failure is the entrepreneurs' lack of competence in adaptation of the relevant level of formality of human resource management (HRM). The purpose of the present research was to examine multiple antecedents and consequences of HRM formality in growing startup companies. A review of the research literature identified two central components of HRM formality: HR control and professionalism. The effect of three contextual predictors was examined. The first was an intra-organizational factor: the development level of the organization. We based on a differentiation between knowledge exploration and knowledge exploitation. At a given time, the organization chooses to focus on a specific mix of these orientations, a choice which requires an appropriate level of HRM formality, in order to efficiently overcome the challenges. It was hypothesized that the mix of orientations of knowledge exploration and knowledge exploitation would predict HRM formality. The second predictor was the personal characteristics the organization's leader. According the idea of blueprint effect of CEO's on HRM, it was hypothesized that the CEO's cognitive style would predict HRM formality. The third contextual predictor was an external organizational factor: the level of investor involvement. By using the agency theory, and based on Transaction Cost Economy, it was hypothesized that the level of investor involvement in general management and HRM would be positively related to the HRM formality. The effect of formality on trust was examined directly and indirectly by the mediation role of procedural justice. The research method included a time-lagged field study. In the first study, data was obtained using three questionnaires, each directed to a different source: CEO, HR position-holder and employees. 43 companies participated in this study. The second study was conducted approximately a year later. Data was recollected using three questionnaires by reapplying the same sample. 41 companies participated in the second study. The organizations samples included technological startup companies. Both studies included 884 respondents. The results indicated consistency between the two studies. HRM formality was predicted by the intra-organizational factor as well as the personal characteristics of the CEO, but not at all by the external organizational context. Specifically, the organizational orientations was the greatest contributor to both components of HRM formality. The cognitive style predicted formality to a lesser extent. The investor's involvement was found not to have any predictive effect on the HRM formality. The results indicated a positive contribution to trust in HRM, mainly via the mediation of procedural justice. This study contributed a new concept for technological startup company development by a mixture of organizational orientation. Practical implications indicated that the level of HRM formality should be matched to that of the company's development. This match should be challenged and adjusted periodically by referring to the organization orientation, relevant HR practices, and HR function characteristics. A relevant matching could enhance further trust and business success.

Keywords: control, formality, human resource management, organizational development, professionalism, technological startup company

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263 Assessing Sexual and Reproductive Health Literacy and Engagement Among Refugee and Immigrant Women in Massachusetts: A Qualitative Community-Based Study

Authors: Leen Al Kassab, Sarah Johns, Helen Noble, Nawal Nour, Elizabeth Janiak, Sarrah Shahawy

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Introduction: Immigrant and refugee women experience disparities in sexual and reproductive health (SRH) outcomes, partially as a result of barriers to SRH literacy and to regular healthcare access and engagement. Despite the existing data highlighting growing needs for culturally relevant and structurally competent care, interventions are scarce and not well-documented. Methods: In this IRB-approved study, we used a community-based participatory research approach, with the assistance of a community advisory board, to conduct a qualitative needs assessment of SRH knowledge and service engagement with immigrant and refugee women from Africa or the Middle East and currently residing in Boston. We conducted a total of nine focus group discussions (FGDs) in partnership with medical, community, and religious centers, in six languages: Arabic, English, French, Somali, Pashtu, and Dari. A total of 44 individuals participated. We explored migrant and refugee women’s current and evolving SRH care needs and gaps, specifically related to the development of interventions and clinical best practices targeting SRH literacy, healthcare engagement, and informed decision-making. Recordings of the FGDs were transcribed verbatim and translated by interpreter services. We used open coding with multiple coders who resolved discrepancies through consensus and iteratively refined our codebook while coding data in batches using Dedoose software. Results: Participants reported immigrant adaptation experiences, discrimination, and feelings of trust, autonomy, privacy, and connectedness to family, community, and the healthcare system as factors surrounding SRH knowledge and needs. The context of previously learned SRH knowledge was commonly noted to be in schools, at menstruation, before marriage, from family members, partners, friends, and online search engines. Common themes included empowering strength drawn from religious and cultural communities, difficulties bridging educational gaps with their US- born daughters, and a desire for more SRH education from multiple sources, including family, health care providers, and religious experts & communities. Regarding further SRH education, participants’ preferences varied regarding ideal platform (virtual vs. in-person), location (in religious and community centers or not), smaller group sizes, and the involvement of men. Conclusions: Based on these results, empowering SRH initiatives should include both community and religious center-based, as well as clinic-based, interventions. Interventions should be composed of frequent educational workshops in small groups involving age-grouped women, daughters, and (sometimes) men, tailored SRH messaging, and the promotion of culturally, religiously, and linguistically competent care.

Keywords: community, immigrant, religion, sexual & reproductive health, women's health

Procedia PDF Downloads 101
262 Optimizing Data Transfer and Processing in Multi-Cloud Environments for Big Data Workloads

Authors: Gaurav Kumar Sinha

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In an era defined by the proliferation of data and the utilization of cloud computing environments, the efficient transfer and processing of big data workloads across multi-cloud platforms have emerged as critical challenges. This research paper embarks on a comprehensive exploration of the complexities associated with managing and optimizing big data in a multi-cloud ecosystem.The foundation of this study is rooted in the recognition that modern enterprises increasingly rely on multiple cloud providers to meet diverse business needs, enhance redundancy, and reduce vendor lock-in. As a consequence, managing data across these heterogeneous cloud environments has become intricate, necessitating innovative approaches to ensure data integrity, security, and performance.The primary objective of this research is to investigate strategies and techniques for enhancing the efficiency of data transfer and processing in multi-cloud scenarios. It recognizes that big data workloads are characterized by their sheer volume, variety, velocity, and complexity, making traditional data management solutions insufficient for harnessing the full potential of multi-cloud architectures.The study commences by elucidating the challenges posed by multi-cloud environments in the context of big data. These challenges encompass data fragmentation, latency, security concerns, and cost optimization. To address these challenges, the research explores a range of methodologies and solutions. One of the key areas of focus is data transfer optimization. The paper delves into techniques for minimizing data movement latency, optimizing bandwidth utilization, and ensuring secure data transmission between different cloud providers. It evaluates the applicability of dedicated data transfer protocols, intelligent data routing algorithms, and edge computing approaches in reducing transfer times.Furthermore, the study examines strategies for efficient data processing across multi-cloud environments. It acknowledges that big data processing requires distributed and parallel computing capabilities that span across cloud boundaries. The research investigates containerization and orchestration technologies, serverless computing models, and interoperability standards that facilitate seamless data processing workflows.Security and data governance are paramount concerns in multi-cloud environments. The paper explores methods for ensuring data security, access control, and compliance with regulatory frameworks. It considers encryption techniques, identity and access management, and auditing mechanisms as essential components of a robust multi-cloud data security strategy.The research also evaluates cost optimization strategies, recognizing that the dynamic nature of multi-cloud pricing models can impact the overall cost of data transfer and processing. It examines approaches for workload placement, resource allocation, and predictive cost modeling to minimize operational expenses while maximizing performance.Moreover, this study provides insights into real-world case studies and best practices adopted by organizations that have successfully navigated the challenges of multi-cloud big data management. It presents a comparative analysis of various multi-cloud management platforms and tools available in the market.

Keywords: multi-cloud environments, big data workloads, data transfer optimization, data processing strategies

Procedia PDF Downloads 42
261 Measuring Urban Sprawl in the Western Cape Province, South Africa: An Urban Sprawl Index for Comparative Purposes

Authors: Anele Horn, Amanda Van Eeden

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The emphasis on the challenges posed by continued urbanisation, especially in developing countries has resulted in urban sprawl often researched and analysed in metropolitan urban areas, but rarely in small and medium towns. Consequently, there exists no comparative instrument between the proportional extent of urban sprawl in metropolitan areas measured against that of small and medium towns. This research proposes an Urban Sprawl Index as a possible tool to comparatively analyse the extent of urban sprawl between cities and towns of different sizes. The index can also be used over the longer term by authorities developing spatial policy to track the success or failure of specific tools intended to curb urban sprawl. In South Africa, as elsewhere in the world, the last two decades witnessed a proliferation of legislation and spatial policies to limit urban sprawl and contain the physical expansion and development of urban areas, but the measurement of the successes or failures of these instruments intending to curb expansive land development has remained a largely unattainable goal, largely as a result of the absence of an appropriate measure of proportionate comparison. As a result of the spatial political history of Apartheid, urban areas acquired a spatial form that contributed to the formation of single-core cities with far reaching and wide-spreading peripheral development, either in the form of affluent suburbs or as a result of post-Apartheid programmes such as the Reconstruction and Development Programme (1995) which, in an attempt to assist the immediate housing shortage, favoured the establishment of single dwelling residential units for low income communities on single plots on affordable land at the urban periphery. This invariably contributed to urban sprawl and even though this programme has since been abandoned, the trend towards low density residential development continues. The research area is the Western Cape Province in South Africa, which in all aspects exhibit the spatial challenges described above. In academia and popular media the City of Cape Town (the only Metropolitan authority in the province) has received the lion’s share of focus in terms of critique on urban development and spatial planning, however, the smaller towns and cities in the Western Cape arguably received much less public attention and were spared the naming and shaming of being unsustainable urban areas in terms of land consumption and physical expansion. The Urban Sprawl Index for the Western Cape (USIWC) put forward by this research enables local authorities in the Western Cape Province to measure the extent of urban sprawl proportionately and comparatively to other cities in the province, thereby acquiring a means of measuring the success of the spatial instruments employed to limit urban expansion and inefficient land consumption. In development of the USIWC the research made use of satellite data for reference years 2001 and 2011 and population growth data extracted from the national census, also for base years 2001 and 2011.

Keywords: urban sprawl, index, Western Cape, South Africa

Procedia PDF Downloads 306
260 Consumers and Voters’ Choice: Two Different Contexts with a Powerful Behavioural Parallel

Authors: Valentina Dolmova

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What consumers choose to buy and who voters select on election days are two questions that have captivated the interest of both academics and practitioners for many decades. The importance of understanding what influences the behavior of those groups and whether or not we can predict or control it fuels a steady stream of research in a range of fields. By looking only at the past 40 years, more than 70 thousand scientific papers have been published in each field – consumer behavior and political psychology, respectively. From marketing, economics, and the science of persuasion to political and cognitive psychology - we have all remained heavily engaged. The ever-evolving technology, inevitable socio-cultural shifts, global economic conditions, and much more play an important role in choice-equations regardless of context. On one hand, this makes the research efforts always relevant and needed. On the other, the relatively low number of cross-field collaborations, which seem to be picking up only in more in recent years, makes the existing findings isolated into framed bubbles. By performing systematic research across both areas of psychology and building a parallel between theories and factors of influence, however, we find that there is not only a definitive common ground between the behaviors of consumers and voters but that we are moving towards a global model of choice. This means that the lines between contexts are fading which has a direct implication on what we should focus on when predicting or navigating buyers and voters’ behavior. Internal and external factors in four main categories determine the choices we make as consumers and as voters. Together, personal, psychological, social, and cultural create a holistic framework through which all stimuli in relation to a particular product or a political party get filtered. The analogy “consumer-voter” solidifies further. Leading academics suggest that this fundamental parallel is the key to managing successfully political and consumer brands alike. However, we distinguish additional four key stimuli that relate to those factor categories (1/ opportunity costs; 2/the memory of the past; 3/recognisable figures/faces and 4/conflict) arguing that the level of expertise a person has determines the prevalence of factors or specific stimuli. Our efforts take into account global trends such as the establishment of “celebrity politics” and the image of “ethically concerned consumer brands” which bridge the gap between contexts to an even greater extent. Scientists and practitioners are pushed to accept the transformative nature of both fields in social psychology. Existing blind spots as well as the limited number of research conducted outside the American and European societies open up space for more collaborative efforts in this highly demanding and lucrative field. A mixed method of research tests three main hypotheses, the first two of which are focused on the level of irrelevance of context when comparing voting or consumer behavior – both from the factors and stimuli lenses, the third on determining whether or not the level of expertise in any field skews the weight of what prism we are more likely to choose when evaluating options.

Keywords: buyers’ behaviour, decision-making, voters’ behaviour, social psychology

Procedia PDF Downloads 133
259 Disposal Behavior of Extreme Poor People Living in Guatemala at the Base of the Pyramid

Authors: Katharina Raab, Ralf Wagner

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With the decrease of poverty, the focus on the solid waste challenge shifts away from affluent, mostly Westernized consumers to the base of the pyramid. The relevance of considering the disposal behavior of impoverished people arises from improved welfare, leading to an increase in consumption opportunities and, consequently, of waste production. In combination with the world’s growing population the relevance of the topic increases, because solid waste management has global impacts on consumers’ welfare. The current annual municipal solid waste generation is estimated to 1.9 billion tonnes, 30% remains uncollected. As for the collected 70% is landfilling and dumping, 19% is recycled or recovered, 11% is led to energy recovery facilities. Therefore, aim is to contribute by adding first insights about poor people's disposal behaviors, including the framing of their rationalities, emotions and cognitions. The study provides novel empirical results obtained from qualitative semi-structured in-depth interviews near Guatemala City. In the study’s framework consumers have to choose from three options when deciding what to do with their obsolete possessions: Keeping the product: The main reason for this is the respondent´s emotional attachment to a product. Further, there is a willingness to use the same product under a different scope when it loses its functionality–they recycle their belongings in a customized and sustainable way. Permanently disposing of the product: The study reveals two dominant disposal methods: burning in front of their homes and throwing away in the physical environment. Respondents clearly recognized the disadvantages of burning toxic durables, like electronics. Giving a product away as a gift supports the integration of individuals in their peer networks of family and friends. Temporarily disposing of the product: Was not mentioned–to be specific, rent or lend a product to someone else was out of question. Contrasting the background to which extend poor people are aware of the consequences of their disposal decisions and how they feel about and rationalize their actions were quite unexpected. Respondents reported that they are worried about future consequences with impacts they cannot anticipate now–they are aware that their behaviors harm their health and the environment. Additionally, they expressed concern about the impact this disposal behavior would have on others’ well-being and are therefore sensitive to the waste that surrounds them. Concluding, the BoP-framed life and Westernized consumption, both fit in a circular economy pattern, but the nature of how to recycle and dispose separates these two societal groups. Both systems own a solid waste management system, but people living in slum-type districts and rural areas of poor countries are less interested in connecting to the system–they are primarily afraid of the costs. Further, it can be said that a consumer’s perceived effectiveness is distinct from environmental concerns, but contributes to forecasting certain pro-ecological behaviors. Considering the rationales underlying disposal decisions, thoughtfulness is a well-established determinant of disposition behavior. The precipitating events, emotions and decisions associated with the act of disposing of products are important because these decisions can trigger different results for the disposal process.

Keywords: base of the pyramid, disposal behavior, poor consumers, solid waste

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258 Increasing Adherence to Preventative Care Bundles for Healthcare-Associated Infections: The Impact of Nurse Education

Authors: Lauren G. Coggins

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Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) are among the most common healthcare-associated infections (HAI), contributing to prolonged lengths of stay, greater costs of patient care, and increased patient mortality. Evidence-based preventative care bundles exist to establish consistent, safe patient-care practices throughout an entire organization, helping to ensure the collective application of care strategies that aim to improve patient outcomes and minimize complications. The cardiac intensive care unit at a nationally ranked teaching and research hospital in the United States exceeded its annual CAUTI and CLABSI targets in the fiscal year 2019, prompting examination into the unit’s infection prevention efforts that included preventative care bundles for both HAIs. Adherence to the CAUTI and CLABSI preventative care bundles was evaluated through frequent audits conducted over three months, using standards and resources from The Joint Commission, a globally recognized leader in quality improvement in healthcare and patient care safety. The bundle elements with the lowest scores were identified as the most commonly missed elements. Three elements from both bundles, six elements in total, served as key content areas for the educational interventions targeted to bedside nurses. The CAUTI elements included appropriate urinary catheter order, appropriate continuation criteria, and urinary catheter care. The CLABSI elements included primary tubing compliance, needleless connector compliance, and dressing change compliance. An integrated, multi-platform education campaign featured content on each CAUTI and CLABSI preventative care bundle in its entirety, with additional reinforcement focused on the lowest scoring elements. One-on-one educational materials included an informational pamphlet, badge buddy, a presentation to reinforce nursing care standards, and real-time application through case studies and electronic health record demonstrations. A digital hub was developed on the hospital’s Intranet for quick access to unit resources, and a bulletin board helped track the number of days since the last CAUTI and CLABSI incident. Audits continued to be conducted throughout the education campaign, and staff were given real-time feedback to address any gaps in adherence. Nearly every nurse in the cardiac intensive care unit received all educational materials, and adherence to all six key bundle elements increased after the implementation of educational interventions. Recommendations from this implementation include providing consistent, comprehensive education across multiple teaching tools and regular audits to track adherence. The multi-platform education campaign brought focus to the evidence-based CAUTI and CLABSI bundles, which in turn will help to reduce CAUTI and CLABSI rates in clinical practice.

Keywords: education, healthcare-associated infections, infection, nursing, prevention

Procedia PDF Downloads 88
257 The Analgesic Effect of Electroacupuncture in a Murine Fibromyalgia Model

Authors: Bernice Jeanne Lottering, Yi-Wen Lin

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Introduction: Chronic pain has a definitive lack of objective parameters in the measurement and treatment efficacy of diseases such as Fibromyalgia (FM). Persistent widespread pain and generalized tenderness are the characteristic symptoms affecting a large majority of the global population, particularly females. This disease has indicated a refractory tendency to conventional treatment ventures, largely resultant from a lack of etiological and pathogenic understanding of the disease development. Emerging evidence indicates that the central nervous system (CNS) plays a critical role in the amplification of pain signals and the neurotransmitters associated therewith. Various stimuli have been found to activate the channels existent on nociceptor terminals, thereby actuating nociceptive impulses along the pain pathways. The transient receptor potential vanalloid 1 (TRPV1) channel functions as a molecular integrator for numerous sensory inputs, such as nociception, and was explored in the current study. Current intervention approaches face a multitude challenges, ranging from effective therapeutic interventions to the limitation of pathognomonic criteria resultant from incomplete understanding and partial evidence on the mechanisms of action of FM. It remains unclear whether electroacupuncture (EA) plays an integral role in the functioning of the TRPV1 pathway, and whether or not it can reduce the chronic pain induced by FM. Aims: The aim of this study was to explore the mechanisms underlying the activation and modulation of the TRPV1 channel pathway in a cold stress model of FM applied to a murine model. Furthermore, the effect of EA in the treatment of mechanical and thermal pain, as expressed in FM was also to be investigated. Methods: 18 C57BL/6 wild type and 6 TRPV1 knockout (KO) mice, aged 8-12 weeks, were exposed to an intermittent cold stress-induced fibromyalgia-like pain model, with or without EA treatment at ZusanLi ST36 (2Hz/20min) on day 3 to 5. Von Frey and Hargreaves behaviour tests were implemented in order to analyze the mechanical and thermal pain thresholds on day 0, 3 and 5 in control group (C), FM group (FM), FM mice with EA treated group (FM + EA) and FM in KO group. Results: An increase in mechanical and thermal hyperalgesia was observed in the FM, EA and KO groups when compared to the control group. This initial increase was reduced in the EA group, which directs focus at the treatment efficacy of EA in nociceptive sensitization, and the analgesic effect EA has attenuating FM associated pain. Discussion: An increase in the nociceptive sensitization was observed through higher withdrawal thresholds in the von Frey mechanical test and the Hargreaves thermal test. TRPV1 function in mice has been scientifically associated with these nociceptive conduits, and the increased behaviour test results suggest that TRPV1 upregulation is central to the FM induced hyperalgesia. This data was supported by the decrease in sensitivity observed in results of the TRPV1 KO group. Moreover, the treatment of EA showed a decrease in this FM induced nociceptive sensitization, suggesting TRPV1 upregulation and overexpression can be attenuated by EA at bilateral ST36. This evidence compellingly implies that the analgesic effect of EA is associated with TRPV1 downregulation.

Keywords: fibromyalgia, electroacupuncture, TRPV1, nociception

Procedia PDF Downloads 120
256 Recurrent Neural Networks for Classifying Outliers in Electronic Health Record Clinical Text

Authors: Duncan Wallace, M-Tahar Kechadi

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In recent years, Machine Learning (ML) approaches have been successfully applied to an analysis of patient symptom data in the context of disease diagnosis, at least where such data is well codified. However, much of the data present in Electronic Health Records (EHR) are unlikely to prove suitable for classic ML approaches. Furthermore, as scores of data are widely spread across both hospitals and individuals, a decentralized, computationally scalable methodology is a priority. The focus of this paper is to develop a method to predict outliers in an out-of-hours healthcare provision center (OOHC). In particular, our research is based upon the early identification of patients who have underlying conditions which will cause them to repeatedly require medical attention. OOHC act as an ad-hoc delivery of triage and treatment, where interactions occur without recourse to a full medical history of the patient in question. Medical histories, relating to patients contacting an OOHC, may reside in several distinct EHR systems in multiple hospitals or surgeries, which are unavailable to the OOHC in question. As such, although a local solution is optimal for this problem, it follows that the data under investigation is incomplete, heterogeneous, and comprised mostly of noisy textual notes compiled during routine OOHC activities. Through the use of Deep Learning methodologies, the aim of this paper is to provide the means to identify patient cases, upon initial contact, which are likely to relate to such outliers. To this end, we compare the performance of Long Short-Term Memory, Gated Recurrent Units, and combinations of both with Convolutional Neural Networks. A further aim of this paper is to elucidate the discovery of such outliers by examining the exact terms which provide a strong indication of positive and negative case entries. While free-text is the principal data extracted from EHRs for classification, EHRs also contain normalized features. Although the specific demographical features treated within our corpus are relatively limited in scope, we examine whether it is beneficial to include such features among the inputs to our neural network, or whether these features are more successfully exploited in conjunction with a different form of a classifier. In this section, we compare the performance of randomly generated regression trees and support vector machines and determine the extent to which our classification program can be improved upon by using either of these machine learning approaches in conjunction with the output of our Recurrent Neural Network application. The output of our neural network is also used to help determine the most significant lexemes present within the corpus for determining high-risk patients. By combining the confidence of our classification program in relation to lexemes within true positive and true negative cases, with an inverse document frequency of the lexemes related to these cases, we can determine what features act as the primary indicators of frequent-attender and non-frequent-attender cases, providing a human interpretable appreciation of how our program classifies cases.

Keywords: artificial neural networks, data-mining, machine learning, medical informatics

Procedia PDF Downloads 104
255 Production of Medicinal Bio-active Amino Acid Gamma-Aminobutyric Acid In Dairy Sludge Medium

Authors: Farideh Tabatabaee Yazdi, Fereshteh Falah, Alireza Vasiee

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Introduction: Gamma-aminobutyric acid (GABA) is a non-protein amino acid that is widely present in organisms. GABA is a kind of pharmacological and biological component and its application is wide and useful. Several important physiological functions of GABA have been characterized, such as neurotransmission and induction of hypotension. GABA is also a strong secretagogue of insulin from the pancreas and effectively inhibits small airway-derived lung adenocarcinoma and tranquilizer. Many microorganisms can produce GABA, and lactic acid bacteria have been a focus of research in recent years because lactic acid bacteria possess special physiological activities and are generally regarded as safe. Among them, the Lb. Brevis produced the highest amount of GABA. The major factors affecting GABA production have been characterized, including carbon sources and glutamate concentration. The use of food industry waste to produce valuable products such as amino acids seems to be a good way to reduce production costs and prevent the waste of food resources. In a dairy factory, a high volume of sludge is produced from a separator that contains useful compounds such as growth factors, carbon, nitrogen, and organic matter that can be used by different microorganisms such as Lb.brevis as carbon and nitrogen sources. Therefore, it is a good source of GABA production. GABA is primarily formed by the irreversible α-decarboxylation reaction of L-glutamic acid or its salts, catalysed by the GAD enzyme. In the present study, this aim was achieved for the fast-growing of Lb.brevis and producing GABA, using the dairy industry sludge as a suitable growth medium. Lactobacillus Brevis strains obtained from Microbial Type Culture Collection (MTCC) were used as model strains. In order to prepare dairy sludge as a medium, sterilization should be done at 121 ° C for 15 minutes. Lb. Brevis was inoculated to the sludge media at pH=6 and incubated for 120 hours at 30 ° C. After fermentation, the supernatant solution is centrifuged and then, the GABA produced was analyzed by the Thin Layer chromatography (TLC) method qualitatively and by the high-performance liquid chromatography (HPLC) method quantitatively. By increasing the percentage of dairy sludge in the culture medium, the amount of GABA increased. Also, evaluated the growth of bacteria in this medium showed the positive effect of dairy sludge on the growth of Lb.brevis, which resulted in the production of more GABA. GABA-producing LAB offers the opportunity of developing naturally fermented health-oriented products. Although some GABA-producing LAB has been isolated to find strains suitable for different fermentations, further screening of various GABA-producing strains from LAB, especially high-yielding strains, is necessary. The production of lactic acid, bacterial gamma-aminobutyric acid, is safe and eco-friendly. The use of dairy industry waste causes enhanced environmental safety. Also provides the possibility of producing valuable compounds such as GABA. In general, dairy sludge is a suitable medium for the growth of Lactic Acid Bacteria and produce this amino acid that can reduce the final cost of it by providing carbon and nitrogen source.

Keywords: GABA, Lactobacillus, HPLC, dairy sludge

Procedia PDF Downloads 106
254 Preliminary Study Investigating Trunk Muscle Fatigue and Cognitive Function in Event Riders during a Simulated Jumping Test

Authors: Alice Carter, Lucy Dumbell, Lorna Cameron, Victoria Lewis

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The Olympic discipline of eventing is the triathlon of equestrian sport, consisting of dressage, cross-country and show jumping. Falls on the cross-country are common and can be serious even causing death to rider. Research identifies an increased risk of a fall with an increasing number of obstacles and for jumping efforts later in the course suggesting fatigue maybe a contributing factor. Advice based on anecdotal evidence suggests riders undertake strength and conditioning programs to improve their ‘core’, thus improving their ability to maintain and control their riding position. There is little empirical evidence to support this advice. Therefore, the aim of this study is to investigate truck muscle fatigue and cognitive function during a simulated jumping test. Eight adult riders participated in a riding test on a Racewood Event simulator for 10 minutes, over a continuous jumping programme. The SEMG activity of six trunk muscles were bilaterally measured at every minute, and normalised root mean squares (RMS) and median frequencies (MDF) were computed from the EMG power spectra. Visual analogue scales (VAS) measuring Fatigue and Pain levels and Cognitive Function ‘tapping’ tests were performed before and after the riding test. Average MDF values for all muscles differed significantly between each sampled minute (p = 0.017), however a consistent decrease from Minute 1 and Minute 9 was not found, suggesting the trunk muscles fatigued and then recovered as other muscle groups important in maintaining the riding position during dynamic movement compensated. Differences between the MDF and RMS of different muscles were highly significant (H=213.01, DF=5, p < 0.001), supporting previous anecdotal evidence that different trunk muscles carry out different roles of posture maintenance during riding. RMS values were not significantly different between the sampled minutes or between riders, suggesting the riding test produced a consistent and repeatable effect on the trunk muscles. MDF values differed significantly between riders (H=50.8, DF = 5, p < 0.001), suggesting individuals may experience localised muscular fatigue of the same test differently, and that other parameters of physical fitness should be investigated to provide conclusions. Lumbar muscles were shown to be important in maintaining the position, therefore physical training program should focus on these areas. No significant differences were found between pre- and post-riding test VAS Pain and Fatigue scores or cognitive function test scores, suggesting the riding test was not significantly fatiguing for participants. However, a near significant correlation was found between time of riding test and VAS Pain score (p = 0.06), suggesting somatic pain may be a limiting factor to performance. No other correlations were found between the factors of participant riding test time, VAS Pain and Fatigue, however a larger sample needs to be tested to improve statistical analysis. The findings suggest the simulator riding test was not sufficient to provoke fatigue in the riders, however foundations for future studies have been laid to enable methodologies in realistic eventing settings.

Keywords: eventing, fatigue, horse-rider, surface EMG, trunk muscles

Procedia PDF Downloads 169
253 Comparison of Nutritional Status of Asthmatic vs Non-asthmatic Adults

Authors: Ayesha Mushtaq

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Asthma is a pulmonary disease in which blockade of the airway takes place due to inflammation as a response to certain allergens. Breathing troubles, cough, and dyspnea are one of the few symptoms. Several studies have indicated a significant effect on asthma due to changes in dietary routines. Certain food items, such as oily foods and other materials, are known to cause an increase in the symptoms of asthma. Low dietary intake of fruits and vegetables may be important in relation to asthma prevalence. The objective of this study is to assess and compare the nutritional status of asthmatic and non-asthmatic patients. The significance of this study lies in the factor that it will help nutritionists to arrange a feasible dietary routine for asthmatic patients. This research was conducted at the Pulmonology Department of the Pakistan Institute of Medical Science Islamabad. About thirty hundred thirty-four million people are affected by asthma worldwide. Pakistan is on the verge of being an uplifted urban population and asthma cases are increasingly high these days. Several studies suggest an increase in the Asthmatic patient population due to improper diet. Other studies conducted at different institutions have conducted research on similar topics. These studies have suggested that there is a substantial alteration in the nutritional status of asthmatic and non-Asthmatic patients. This is a cross-sectional study aimed at assessing the nutritious standing of Asthmatic and non-asthmatic patients. This research took place at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The research included asthmatic and non-asthmatic patients coming to the pulmonology department clinic at the Pakistan Institute of Medical Sciences (PIMS). These patients were aged between 20-60 years. A questionnaire was developed for these patients to estimate their dietary plans in these patients. The methodology included four sections. The first section was the Socio-Demographic profile, which included age, gender, monthly income and occupation. The next section was anthropometric measurements which included the weight, height and body mass index (BMI) of the individual. The next section, section three, was about the biochemical attributes, such as for biochemical profiling, pulmonary function testing (PFT) was performed. In the next section, Dietary habits, which were assessed by using a food frequency questionnaire (FFQ) through food habits and consumption pattern, was assessed. The next section life style data, in which the person's level of physical activity, sleep and smoking habits were assessed. The next section was statistical analysis. All the data obtained from the study were statistically analyzed and assessed. Most of the asthma Patients were females, with weight more than normal or even obese. Body Mass Index (BMI) was higher in asthma Patients than those in non-Asthmatic ones. When the nutritional Values were assessed, we came to know that these patients were low on certain nutrients and their diet included more junk and oily food than healthy vegetables and fruits. Beverages intake was also included in the same assessment. It is evident from this study that nutritional status has a contributory effect on asthma. So, patients on the verge of developing asthma or those who have developed asthma should focus on their diet, maintain good eating habits and take healthy diets, including fruits and vegetables rather than oily foods. Proper sleep may also contribute to the control of asthma.

Keywords: NUTRI, BMI, asthma, food

Procedia PDF Downloads 49
252 A Study on Aquatic Bycatch Mortality Estimation Due to Prawn Seed Collection and Alteration of Collection Method through Sustainable Practices in Selected Areas of Sundarban Biosphere Reserve (SBR), India

Authors: Samrat Paul, Satyajit Pahari, Krishnendu Basak, Amitava Roy

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Fishing is one of the pivotal livelihood activities, especially in developing countries. Today it is considered an important occupation for human society from the era of human settlement began. In simple terms, non-target catches of any species during fishing can be considered as ‘bycatch,’ and fishing bycatch is neither a new fishery management issue nor a new problem. Sundarban is one of the world’s largest mangrove land expanding up to 10,200 sq. km in India and Bangladesh. This largest mangrove biome resource is used by the local inhabitants commercially to run their livelihood, especially by forest fringe villagers (FFVs). In Sundarban, over-fishing, especially post larvae collection of wild Penaeus monodon, is one of the major concerns, as during the collection of P. monodon, different aquatic species are destroyed as a result of bycatch mortality which changes in productivity and may negatively impact entire biodiversity, of the ecosystem. Wild prawn seed collection gear like a small mesh sized net poses a serious threat to aquatic stocks, where the collection isn’t only limited to prawn seed larvae. As prawn seed collection processes are inexpensive, require less monetary investment, and are lucrative; people are easily engaged here as their source of income. Wildlife Trust of India’s (WTI) intervention in selected forest fringe villages of Sundarban Tiger Reserve (STR) was to estimate and reduce the mortality of aquatic bycatches by involving local communities in newly developed release method and their time engagement in prawn seed collection (PSC) by involving them in Alternate Income Generation (AIG). The study was conducted for their taxonomic identification during the period of March to October 2019. Collected samples were preserved in 70% ethyl alcohol for identification, and all the preserved bycatch samples were identified morphologically by the expertise of the Zoological Survey of India (ZSI), Kolkata. Around 74 different aquatic species, where 11 different species are molluscs, 41 fish species, out of which 31 species were identified, and 22 species of crustacean collected, out of which 18 species were identified. Around 13 different species belong to a different order, and families were unable to identify them morphologically as they were collected in the juvenile stage. The study reveals that for collecting one single prawn seed, eight individual life of associated faunas are being lost. Zero bycatch mortality is not practical; rather, collectors should focus on bycatch reduction by avoiding capturing, allowing escaping, and mortality reduction, and must make changes in their fishing method by increasing net mesh size, which will avoid non-target captures. But as the prawns are small in size (generally 1-1.5 inches in length), thus increase net size making economically less or no profit for collectors if they do so. In this case, returning bycatches is considered one of the best ways to a reduction in bycatch mortality which is a more sustainable practice.

Keywords: bycatch mortality, biodiversity, mangrove biome resource, sustainable practice, Alternate Income Generation (AIG)

Procedia PDF Downloads 117
251 Rapid Building Detection in Population-Dense Regions with Overfitted Machine Learning Models

Authors: V. Mantey, N. Findlay, I. Maddox

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The quality and quantity of global satellite data have been increasing exponentially in recent years as spaceborne systems become more affordable and the sensors themselves become more sophisticated. This is a valuable resource for many applications, including disaster management and relief. However, while more information can be valuable, the volume of data available is impossible to manually examine. Therefore, the question becomes how to extract as much information as possible from the data with limited manpower. Buildings are a key feature of interest in satellite imagery with applications including telecommunications, population models, and disaster relief. Machine learning tools are fast becoming one of the key resources to solve this problem, and models have been developed to detect buildings in optical satellite imagery. However, by and large, most models focus on affluent regions where buildings are generally larger and constructed further apart. This work is focused on the more difficult problem of detection in populated regions. The primary challenge with detecting small buildings in densely populated regions is both the spatial and spectral resolution of the optical sensor. Densely packed buildings with similar construction materials will be difficult to separate due to a similarity in color and because the physical separation between structures is either non-existent or smaller than the spatial resolution. This study finds that training models until they are overfitting the input sample can perform better in these areas than a more robust, generalized model. An overfitted model takes less time to fine-tune from a generalized pre-trained model and requires fewer input data. The model developed for this study has also been fine-tuned using existing, open-source, building vector datasets. This is particularly valuable in the context of disaster relief, where information is required in a very short time span. Leveraging existing datasets means that little to no manpower or time is required to collect data in the region of interest. The training period itself is also shorter for smaller datasets. Requiring less data means that only a few quality areas are necessary, and so any weaknesses or underpopulated regions in the data can be skipped over in favor of areas with higher quality vectors. In this study, a landcover classification model was developed in conjunction with the building detection tool to provide a secondary source to quality check the detected buildings. This has greatly reduced the false positive rate. The proposed methodologies have been implemented and integrated into a configurable production environment and have been employed for a number of large-scale commercial projects, including continent-wide DEM production, where the extracted building footprints are being used to enhance digital elevation models. Overfitted machine learning models are often considered too specific to have any predictive capacity. However, this study demonstrates that, in cases where input data is scarce, overfitted models can be judiciously applied to solve time-sensitive problems.

Keywords: building detection, disaster relief, mask-RCNN, satellite mapping

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250 Understanding the Impact of Background Experience from Staff in Diversion Programs: The Voices of a Community-Based Diversion Program

Authors: Ana Magana

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Youth are entering the juvenile justice system at alarming rates. For the youth of color entering the system, the outcomes are far worse than for their white counterparts. In fact, the youth of color are more likely to be arrested and sentenced for longer periods of time than white youth. Race disproportionality in the juvenile justice system is evident, but what happens to the youth that exit the juvenile justice system? Who supports them after they are incarcerated and who can prevent them from re-offending? There are several diversion programs that have been implemented in the US to aid the reduction of juvenile incarceration and help reduce recidivism. The program interviewed for this study is a community-based diversion program (CBDP). The CBDP is a pre-filing diversion non-profit organization based in South Seattle. The objective of this exploratory research study is to provide a space and platform for the CBDP team to speak about their background experiences and the influence their background has on their current approach and practice with juveniles. A qualitative, exploratory study was conducted. Interviews were conducted with staff and provided oral consent. The interview included six open-ended, semi-structured questions. Interviews were digitally recoded and transcribed. The aim of this study was to understand how the influence of the participant’s backgrounds and previous experiences impact their current practice approaches with the CBDP youth and young adults. Ecological systems theory was the guiding framework for analysis. After careful analysis, three major themes emerged: 1) strong influence of participant’s background, 2) participants belonging to community and 3) strong self-identity with the CBDP. Within these three themes, subthemes were developed based on participant’s responses. It was concluded that the participant’s approach is influenced by their background experiences. This corresponds to the ecological systems theory and the community-based lens which underscores theoretical analysis. The participant’s approach is grounded in interpersonal relationships within the client’s systems, meaning that the participants understand and view their clients within an ecological systems perspective. When choosing participants that reflect the population being served, the clients receive a balanced, inclusive and caring approach. Youth and young adults are searching for supportive adults to be there for them, it is essential for diversion programs to provide a space for shared background experiences and have people that hold similar identities. Grassroots organizations such as CBDP have the tools and experience to work with marginalized populations that are constantly being passed on. While articles and studies focus on the reduction of recidivism and re-offending it is important to question the reasons behind this data. For instance, there can be a reduction in statistics, but at whose expense. Are the youth and young adults truly being supported? Or is it just a requirement that they are completing in order to remove their charge? This research study can serve as the beginning of a series of studies conducted at CBDP to further understand and validate the need to employ individuals with similar backgrounds as the participants CBDP serves.

Keywords: background experience, diversion, ecological systems theory, relationships

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249 A Randomized, Controlled Trial to Test Habit Formation Theory for Low Intensity Physical Exercise Promotion in Older Adults

Authors: Patrick Louie Robles, Jerry Suls, Ciaran Friel, Mark Butler, Samantha Gordon, Frank Vicari, Joan Duer-Hefele, Karina W. Davidson

Abstract:

Physical activity guidelines focus on increasing moderate-intensity activity for older adults, but adherence to recommendations remains low. This is despite the fact that scientific evidence finds increasing physical activity is positively associated with health benefits. Behavior change techniques (BCTs) have demonstrated some effectiveness in reducing sedentary behavior and promoting physical activity. This pilot study uses a personalized trials (N-of-1) design, delivered virtually, to evaluate the efficacy of using five BCTs in increasing low-intensity physical activity (by 2,000 steps of walking per day) in adults aged 45-75 years old. The 5 BCTs described in habit formation theory are goal setting, action planning, rehearsal, rehearsal in a consistent context, and self-monitoring. The study recruited health system employees in the target age range who had no mobility restrictions and expressed interest in increasing their daily activity by a minimum of 2,000 steps per day at least five days per week. Participants were sent a Fitbit Charge 4 fitness tracker with an established study account and password. Participants were recommended to wear the Fitbit device 24/7 but were required to wear it for a minimum of ten hours per day. Baseline physical activity was measured by Fitbit for two weeks. Participants then engaged remotely with a clinical research coordinator to establish a “walking plan” that included a time and day interval (e.g., between 7am -8am on Monday-Friday), a location for the walk (e.g., park), and how much time the plan would need to achieve a minimum of 2,000 steps over their baseline average step count (20 minutes). All elements of the walking plan were required to remain consistent throughout the study. In the 10-week intervention phase of the study, participants received all five BCTs in a single, time-sensitive text message. The text message was delivered 30 minutes prior to the established walk time and signaled participants to begin walking when the context (i.e., day of the week, time of day) they pre-selected is encountered. Participants were asked to log both the start and conclusion of their activity session by pressing a button on the Fitbit tracker. Within 30 minutes of the planned conclusion of the activity session, participants received a text message with a link to a secure survey. Here, they noted whether they engaged in the BCTs when prompted and completed an automaticity survey to identify how “automatic” their walking behavior had become. At the end of their trial, participants received a personalized summary of their step data over time, helping them learn more about their responses to the five BCTs. Whether the use of these 5 ‘habit formation’ BCTs in combination elicits a change in physical activity behavior among older adults will be reported. This study will inform the feasibility of a virtually-delivered N-of-1 study design to effectively promote physical activity as a component of healthy aging.

Keywords: aging, exercise, habit, walking

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248 From Indigeneity to Urbanity: A Performative Study of Indian Saang (Folk Play) Tradition

Authors: Shiv Kumar

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In the shifting scenario of postmodern age that foregrounds the multiplicity of meanings and discourses, the present research article seeks to investigate various paradigm shift of contemporary performances concerning Haryanvi Saangs, so-called folk plays, which are being performed widely in the regional territory of Haryana, a northern state of India. Folk arts cannot be studied efficiently by using the tools of literary criticism because it differs from the literature in many aspects. One of the most essential differences is that literary works invariably have an author. Folk works, on the contrary, never have an author. The situation is quite clear: either we acknowledge the presence of folk art as a phenomenon in the social and cultural history of people, or we do not acknowledge it and argue it is a poetical or art of fiction. This paper is an effort to understand the performative tradition of Saang which is traditionally known as Saang, Swang or Svang became a popular source for instruction and entertainment in the region and neighbouring states. Scholars and critics have long been debating about the origin of the word swang/svang/saang and their relationship to the Sanskrit word –Sangit, which means singing and music. But in the cultural context of Haryana, the word Saang means ‘to impersonate’ or ‘to imitate’ or ‘to copy someone or something’. The stories they portray are derived for the most part from the same myths, tales, epics and from the lives of Indian religious and folk heroes. Literally, the use of poetic sense, the implication of prose style and elaborate figurative technique are worthwhile to compile the productivity of a performance. All use music and song as an integral part of the performance so that it is also appropriate to call them folk opera. These folk plays are performed strictly by aboriginal people in the state. These people, sometimes denominated as Saangi, possess a culture distinct from the rest of Indian folk performances. The concerned form is also known with various other names like Manch, Khayal, Opera, Nautanki. The group of such folk plays can be seen as a dynamic activity and performed in the open space of the theatre. Nowadays, producers contributed greatly in order to create a rapidly growing musical outlet for budding new style of folk presentation and give rise to the electronic focus genre utilizing many musicians and performers who had to become precursors of the folk tradition in the region. Moreover, the paper proposes to examine available sources relative to this article, and it is believed to draw some different conclusions. For instance, to be a spectator of ongoing performances will contribute to providing enough guidance to move forward on this root. In this connection, the paper focuses critically upon the major performative aspects of Haryanvi Saang in relation to several inquiries such as the study of these plays in the context of Indian literary scenario, gender visualization and their dramatic representation, a song-music tradition in folk creativity and development of Haryanvi dramatic art in the contemporary socio-political background.

Keywords: folk play, indigenous, performance, Saang, tradition

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247 Smart Services for Easy and Retrofittable Machine Data Collection

Authors: Till Gramberg, Erwin Gross, Christoph Birenbaum

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This paper presents the approach of the Easy2IoT research project. Easy2IoT aims to enable companies in the prefabrication sheet metal and sheet metal processing industry to enter the Industrial Internet of Things (IIoT) with a low-threshold and cost-effective approach. It focuses on the development of physical hardware and software to easily capture machine activities from on a sawing machine, benefiting various stakeholders in the SME value chain, including machine operators, tool manufacturers and service providers. The methodological approach of Easy2IoT includes an in-depth requirements analysis and customer interviews with stakeholders along the value chain. Based on these insights, actions, requirements and potential solutions for smart services are derived. The focus is on providing actionable recommendations, competencies and easy integration through no-/low-code applications to facilitate implementation and connectivity within production networks. At the core of the project is a novel, non-invasive measurement and analysis system that can be easily deployed and made IIoT-ready. This system collects machine data without interfering with the machines themselves. It does this by non-invasively measuring the tension on a sawing machine. The collected data is then connected and analyzed using artificial intelligence (AI) to provide smart services through a platform-based application. Three Smart Services are being developed within Easy2IoT to provide immediate benefits to users: Wear part and product material condition monitoring and predictive maintenance for sawing processes. The non-invasive measurement system enables the monitoring of tool wear, such as saw blades, and the quality of consumables and materials. Service providers and machine operators can use this data to optimize maintenance and reduce downtime and material waste. Optimize Overall Equipment Effectiveness (OEE) by monitoring machine activity. The non-invasive system tracks machining times, setup times and downtime to identify opportunities for OEE improvement and reduce unplanned machine downtime. Estimate CO2 emissions for connected machines. CO2 emissions are calculated for the entire life of the machine and for individual production steps based on captured power consumption data. This information supports energy management and product development decisions. The key to Easy2IoT is its modular and easy-to-use design. The non-invasive measurement system is universally applicable and does not require specialized knowledge to install. The platform application allows easy integration of various smart services and provides a self-service portal for activation and management. Innovative business models will also be developed to promote the sustainable use of the collected machine activity data. The project addresses the digitalization gap between large enterprises and SME. Easy2IoT provides SME with a concrete toolkit for IIoT adoption, facilitating the digital transformation of smaller companies, e.g. through retrofitting of existing machines.

Keywords: smart services, IIoT, IIoT-platform, industrie 4.0, big data

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246 Effect of Renin Angiotensin Pathway Inhibition on the Efficacy of Anti-programmed Cell Death (PD-1/L-1) Inhibitors in Advanced Non-small Cell Lung Cancer Patients- Comparison of Single Hospital Retrospective Assessment to the Published Literature

Authors: Esther Friedlander, Philip Friedlander

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The use of immunotherapy that inhibits programmed death-1 (PD-1) or its ligand PD-L1 confers survival benefits in patients with non-small cell lung cancer (NSCLC). However, approximately 45% of patients experience primary treatment resistance, necessitating the development of strategies to improve efficacy. While the renin-angiotensin system (RAS) has systemic hemodynamic effects, tissue-specific regulation exists along with modulation of immune activity in part through regulation of myeloid cell activity, leading to the hypothesis that RAS inhibition may improve anti-PD-1/L-1 efficacy. A retrospective analysis was conducted that included 173 advanced solid tumor cancer patients treated at Valley Hospital, a community Hospital in New Jersey, USA, who were treated with a PD-1/L-1 inhibitor in a defined time period showing a statistically significant relationship between RAS pathway inhibition (RASi through concomitant treatment with an ACE inhibitor or angiotensin receptor blocker) and positive efficacy to the immunotherapy that was independent of age, gender and cancer type. Subset analysis revealed strong numerical benefit for efficacy in both patients with squamous and nonsquamous NSCLC as determined by documented clinician assessment of efficacy and by duration of therapy. A PUBMED literature search was now conducted to identify studies assessing the effect of RAS pathway inhibition on anti-PD-1/L1 efficacy in advanced solid tumor patients and compare these findings to those seen in the Valley Hospital retrospective study with a focus on NSCLC specifically. A total of 11 articles were identified assessing the effects of RAS pathway inhibition on the efficacy of checkpoint inhibitor immunotherapy in advanced cancer patients. Of the 11 studies, 10 assessed the effect on survival of RASi in the context of treatment with anti-PD-1/PD-L1, while one assessed the effect on CTLA-4 inhibition. Eight of the studies included patients with NSCLC, while the remaining 2 were specific to genitourinary malignancies. Of the 8 studies, two were specific to NSCLC patients, with the remaining 6 studies including a range of cancer types, of which NSCLC was one. Of these 6 studies, only 2 reported specific survival data for the NSCLC subpopulation. Patient characteristics, multivariate analysis data and efficacy data seen in the 2 NSLCLC specific studies and in the 2 basket studies, which provided data on the NSCLC subpopulation, were compared to that seen in the Valley Hospital retrospective study supporting a broader effect of RASi on anti-PD-1/L1 efficacy in advanced NSLCLC with the majority of studies showing statistically significant benefit or strong statistical trends but with one study demonstrating worsened outcomes. This comparison of studies extends published findings to the community hospital setting and supports prospective assessment through randomized clinical trials of efficacy in NSCLC patients with pharmacodynamic components to determine the effect on immune cell activity in tumors and on the composition of the tumor microenvironment.

Keywords: immunotherapy, cancer, angiotensin, efficacy, PD-1, lung cancer, NSCLC

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