Search results for: team member autonomy
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2502

Search results for: team member autonomy

792 Trauma System in England: An Overview and Future Directions

Authors: Raheel Shakoor Siddiqui, Sanjay Narayana Murthy, Manikandar Srinivas Cheruvu, Kash Akhtar

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Major trauma is a dynamic public health epidemic that is continuously evolving. Major trauma care services rely on multi-disciplinary team input involving highly trained pre and in-hospital critical care teams. Pre-hospital critical care teams (PHCCTs), major trauma centres (MTCs), trauma units, and rehabilitation facilities all form an efficient and organised trauma system. England comprises 27 MTCs funded by the National Health Service (NHS). Major trauma care entails enhanced resuscitation protocols coupled with the expertise of dedicated trauma teams and rapid radiological imaging to improve trauma outcomes. Literature reports a change in the demographic of major trauma as elderly patients (silver trauma) with injuries sustained from a fall of 2 metres or less commonly present to services. Evidence of an increasing population age with multiple comorbidities necessitates treatment within the first hour of injury (golden hour) to improve trauma survival outcomes. Staffing and funding pressures within the NHS have subsequently led to a shortfall of available physician-led PHCCTs. Thus, there is a strong emphasis on targeted research and funding to appropriately deploy resources to deprived areas. This review article will discuss the current English trauma system whilst critically appraising present challenges, identifying insufficiencies, and recommending aims for an improved future trauma system in England.

Keywords: trauma, orthopaedics, major trauma, trauma system, trauma network

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791 Investigating the Effectiveness of a 3D Printed Composite Mold

Authors: Peng Hao Wang, Garam Kim, Ronald Sterkenburg

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In composite manufacturing, the fabrication of tooling and tooling maintenance contributes to a large portion of the total cost. However, as the applications of composite materials continue to increase, there is also a growing demand for more tooling. The demand for more tooling places heavy emphasis on the industry’s ability to fabricate high quality tools while maintaining the tool’s cost effectiveness. One of the popular techniques of tool fabrication currently being developed utilizes additive manufacturing technology known as 3D printing. The popularity of 3D printing is due to 3D printing’s ability to maintain low material waste, low cost, and quick fabrication time. In this study, a team of Purdue University School of Aviation and Transportation Technology (SATT) faculty and students investigated the effectiveness of a 3D printed composite mold. A steel valve cover from an aircraft reciprocating engine was modeled utilizing 3D scanning and computer-aided design (CAD) to create a 3D printed composite mold. The mold was used to fabricate carbon fiber versions of the aircraft reciprocating engine valve cover. The carbon fiber valve covers were evaluated for dimensional accuracy and quality while the 3D printed composite mold was evaluated for durability and dimensional stability. The data collected from this study provided valuable information in the understanding of 3D printed composite molds, potential improvements for the molds, and considerations for future tooling design.

Keywords: additive manufacturing, carbon fiber, composite tooling, molds

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790 The Mental Health of Indigenous People During the COVID-19 Pandemic: A Scoping Review

Authors: Suzanne L. Stewart, Sarah J. Ponton, Mikaela D. Gabriel, Roy Strebel, Xinyi Lu

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Indigenous Peoples have faced unique barriers to accessing and receiving culturally safe and appropriate mental health care while also facing daunting rates of mental health diagnoses and comorbidities. Indigenous researchers and clinicians have well established the connection of the current mental health issues in Indigenous communities as a direct result of colonization by way of intergenerational trauma throughout Canada’s colonial history. Such mental health barriers and challenges have become exacerbated during the COVID-19 pandemic. Throughout the pandemic, access to mental health, cultural, ceremonial, and community services were severely impacted and restricted; however, it is these same cultural activities and community resources that are key to supporting Indigenous mental health from a traditional and community-based perspective. This research employed a unique combination of a thorough, analytical scoping review of the existent mental health literature of Indigenous mental health in the COVID-19 pandemic, alongside narrative interviews employing an oral storytelling tradition methodology with key community informants that provide comprehensive cultural services to the Indigenous community of Toronto, as well as across Canada. These key informant interviews provided a wealth of insights into virtual transitions of Indigenous care and mental health support; intersections of historical underfunding and current financial navigation in technology infrastructure; accessibility and connection with Indigenous youth in remote locations; as well as maintaining community involvement and traditional practices in a current pandemic. Both the scoping review and narrative interviews were meticulously analyzed for overarching narrative themes to best explore the extent of the literature on Indigenous mental health and services during COVID-19; identify gaps in this literature; identify barriers and supports for the Indigenous community, and explore the intersection of community and cultural impacts to mental health. Themes of the scoping review included: Historical Context; Challenges in Culturally-Based Services; and Strengths in Culturally-Based Services. Meta themes across narrative interviews included: Virtual Transitions; Financial Support for Indigenous Services; Health Service Delivery & Wellbeing; and Culture & Community Connection. The results of this scoping review and narrative interviews provide wide application and contribution to the mental health literature, as well as recommendations for policy, service provision, autonomy in Indigenous health and wellbeing, and crucial insights into the present and enduring mental health needs of Indigenous Peoples throughout the COVID-19 pandemic.

Keywords: indigenous community services, indigenous mental health, indigenous scoping review, indigenous peoples and Covid-19

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789 Optimizing the Location of Parking Areas Adapted for Dangerous Goods in the European Road Transport Network

Authors: María Dolores Caro, Eugenio M. Fedriani, Ángel F. Tenorio

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The transportation of dangerous goods by lorries throughout Europe must be done by using the roads conforming the European Road Transport Network. In this network, there are several parking areas where lorry drivers can park to rest according to the regulations. According to the "European Agreement concerning the International Carriage of Dangerous Goods by Road", parking areas where lorries transporting dangerous goods can park to rest, must follow several security stipulations to keep safe the rest of road users. At this respect, these lorries must be parked in adapted areas with strict and permanent surveillance measures. Moreover, drivers must satisfy several restrictions about resting and driving time. Under these facts, one may expect that there exist enough parking areas for the transport of this type of goods in order to obey the regulations prescribed by the European Union and its member countries. However, the already-existing parking areas are not sufficient to cover all the stops required by drivers transporting dangerous goods. Our main goal is, starting from the already-existing parking areas and the loading-and-unloading location, to provide an optimal answer to the following question: how many additional parking areas must be built and where must they be located to assure that lorry drivers can transport dangerous goods following all the stipulations about security and safety for their stops? The sense of the word “optimal” is due to the fact that we give a global solution for the location of parking areas throughout the whole European Road Transport Network, adjusting the number of additional areas to be as lower as possible. To do so, we have modeled the problem using graph theory since we are working with a road network. As nodes, we have considered the locations of each already-existing parking area, each loading-and-unloading area each road bifurcation. Each road connecting two nodes is considered as an edge in the graph whose weight corresponds to the distance between both nodes in the edge. By applying a new efficient algorithm, we have found the additional nodes for the network representing the new parking areas adapted for dangerous goods, under the fact that the distance between two parking areas must be less than or equal to 400 km.

Keywords: trans-european transport network, dangerous goods, parking areas, graph-based modeling

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788 Directivity in the Dramatherapeutic Process for People with Addictive Behaviour

Authors: Jakub Vávra, Milan Valenta, Petr Kosek

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This article presents a perspective on the conduct of the dramatherapy process with persons with addictive behaviours with regard to the directiveness of the process. Although drama therapy as one of the creative arts approaches is rather non-directive in nature, depending on the clientele, there may be a need to structure the process more and, depending on the needs of the clients, to guide the process more directive. The specificity for people with addictive behaviours is discussed through the prism of the dramatherapeutic perspective, where we can find both a psychotherapeutic component as well as a component touching on expression and art, which is rather non-directive in nature. Within the context of practice with clients, this theme has repeatedly emerged and dramatherapists themselves have sought to find ways of coping with clients' demands and needs for structure and guidance within the dramatherapy process. Some of the outcomes from the supervision work also guided the research. Based on this insight, the research questions were approached. The first research question asks: in what ways is directive in dramatherapy manifested and manifested in the process? The second research question then complements the first and asks: to which phenomena are directivity in dramatherapy linked? In relation to the research questions, data were collected using focus groups and field notes. The qualitative approach of Content analysis and Relational analysis was chosen as the methodology. For analyzing qualitative research, we chose an Inductive coding scheme: Open coding, Axial coding, Pattern matching, Member checking, and Creating a coding scheme. In the presented partial research results, we find recurrent schemes related to directive coding in drama therapy. As an important element, directive leadership emerges in connection with safety for the client group, then in connection with the clients' order and also the department of the facility, and last but not least, to the personality of the drama therapist. By careful analysis and looking for patterns in the research results, we can see connections that are impossible to interpret at this stage but already provide clues to our understanding of the topic and open up further avenues for research in this area.

Keywords: dramatherapy, directivity, personal approach, aims of dramatherapy process, safetyness

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787 Knowledge Transfer among Cross-Functional Teams as a Continual Improvement Process

Authors: Sergio Mauricio Pérez López, Luis Rodrigo Valencia Pérez, Juan Manuel Peña Aguilar, Adelina Morita Alexander

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The culture of continuous improvement in organizations is very important as it represents a source of competitive advantage. This article discusses the transfer of knowledge between companies which formed cross-functional teams and used a dynamic model for knowledge creation as a framework. In addition, the article discusses the structure of cognitive assets in companies and the concept of "stickiness" (which is defined as an obstacle to the transfer of knowledge). The purpose of this analysis is to show that an improvement in the attitude of individual members of an organization creates opportunities, and that an exchange of information and knowledge leads to generating continuous improvements in the company as a whole. This article also discusses the importance of creating the proper conditions for sharing tacit knowledge. By narrowing gaps between people, mutual trust can be created and thus contribute to an increase in sharing. The concept of adapting knowledge to new environments will be highlighted, as it is essential for companies to translate and modify information so that such information can fit the context of receiving organizations. Adaptation will ensure that the transfer process is carried out smoothly by preventing "stickiness". When developing the transfer process on cross-functional teams (as opposed to working groups), the team acquires the flexibility and responsiveness necessary to meet objectives. These types of cross-functional teams also generate synergy due to the array of different work backgrounds of their individuals. When synergy is established, a culture of continuous improvement is created.

Keywords: knowledge transfer, continuous improvement, teamwork, cognitive assets

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786 Noise Mitigation Techniques to Minimize Electromagnetic Interference/Electrostatic Discharge Effects for the Lunar Mission Spacecraft

Authors: Vabya Kumar Pandit, Mudit Mittal, N. Prahlad Rao, Ramnath Babu

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TeamIndus is the only Indian team competing for the Google Lunar XPRIZE(GLXP). The GLXP is a global competition to challenge the private entities to soft land a rover on the moon, travel minimum 500 meters and transmit high definition images and videos to Earth. Towards this goal, the TeamIndus strategy is to design and developed lunar lander that will deliver a rover onto the surface of the moon which will accomplish GLXP mission objectives. This paper showcases the various system level noise control techniques adopted by Electrical Distribution System (EDS), to achieve the required Electromagnetic Compatibility (EMC) of the spacecraft. The design guidelines followed to control Electromagnetic Interference by proper electronic package design, grounding, shielding, filtering, and cable routing within the stipulated mass budget, are explained. The paper also deals with the challenges of achieving Electromagnetic Cleanliness in presence of various Commercial Off-The-Shelf (COTS) and In-House developed components. The methods of minimizing Electrostatic Discharge (ESD) by identifying the potential noise sources, susceptible areas for charge accumulation and the methodology to prevent arcing inside spacecraft are explained. The paper then provides the EMC requirements matrix derived from the mission requirements to meet the overall Electromagnetic compatibility of the Spacecraft.

Keywords: electromagnetic compatibility, electrostatic discharge, electrical distribution systems, grounding schemes, light weight harnessing

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785 Virtual Process Hazard Analysis (Pha) Of a Nuclear Power Plant (Npp) Using Failure Mode and Effects Analysis (Fmea) Technique

Authors: Lormaine Anne A. Branzuela, Elysa V. Largo, Monet Concepcion M. Detras, Neil C. Concibido

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The electricity demand is still increasing, and currently, the Philippine government is investigating the feasibility of operating the Bataan Nuclear Power Plant (BNPP) to address the country’s energy problem. However, the lack of process safety studies on BNPP focused on the effects of hazardous substances on the integrity of the structure, equipment, and other components, have made the plant operationalization questionable to the public. The three major nuclear power plant incidents – TMI-2, Chernobyl, and Fukushima – have made many people hesitant to include nuclear energy in the energy matrix. This study focused on the safety evaluation of possible operations of a nuclear power plant installed with a Pressurized Water Reactor (PWR), which is similar to BNPP. Failure Mode and Effects Analysis (FMEA) is one of the Process Hazard Analysis (PHA) techniques used for the identification of equipment failure modes and minimizing its consequences. Using the FMEA technique, this study was able to recognize 116 different failure modes in total. Upon computation and ranking of the risk priority number (RPN) and criticality rating (CR), it showed that failure of the reactor coolant pump due to earthquakes is the most critical failure mode. This hazard scenario could lead to a nuclear meltdown and radioactive release, as identified by the FMEA team. Safeguards and recommended risk reduction strategies to lower the RPN and CR were identified such that the effects are minimized, the likelihood of occurrence is reduced, and failure detection is improved.

Keywords: PHA, FMEA, nuclear power plant, bataan nuclear power plant

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784 Nation Building versus Self Determination: Thai State’s Response to Insurgency in South

Authors: Sunaina Sunaina

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The emergence of Thailand as a modern nation was amalgamation of several minority groups. Eventually, the nation tried to mitigate these diversities in the name of nationalism in the backdrop of colonial powers presence in neighboring nations. However, the continued imposition of modern nation building processes (which is a western concept) in the post-colonial era deepen the feelings of alienation among the minority groups and leads to separatist conflicts. It is significant that whatever form these conflicts take, will impact the security of nation as well as the region of Southeast Asia. This paper tries to explore the possible factors behind the state policies adopted by the government of Thailand to manage the insurgency in Southern provinces in the south. The protracted insurgency in the South has historical roots as Pattani kingdom had glorious period whether it was trade or commerce or education and its assimilation was never accepted by the leaders of these areas. But after assimilation of southern provinces in the state, it has been the state policy as an important factor in promoting or mitigating the insurgency. Initial protests from the elite class of southern provinces inflated into a more organized and violent uprising after Second World War. It was only the decade of 1990s that a relative peace could prevail for some time. The violence reemerged in 2004 with more intensity and till today this area is suffering with violence. Period of different Prime Ministers dealt this insurgency in different ways sometimes very hard line approach had been adopted especially under Primeminstership of Thaksin Shinawatra. Recently, the peace talks which were started during the period of Yinglunck Shinawatra and were carried forward by Junta government also halted. And again, the region stays in a very volatile state. Violence in these provinces not only questions the capability of government to provide political solution to the problem, but also emerges as a major threat to the internal security of the state. The current era where global terrorism is spreading fast, such vulnerable areas may work as a new ground for its proliferation in Southeast Asia. The paper attempts to understand how Thailand’s historical experience of security determines a different approach to national unity which limits the prospects for autonomy in the South. In conjunction with this experience it is nature of national politics and leadership that influences the nature of policies on the ground in Southern Thailand. The paper also tries to bring out conflict between state sovereignty and self-determination as demanded by many in the southern provinces.

Keywords: insurgency, southern Thailand, security, nation building

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783 A BIM-Based Approach to Assess COVID-19 Risk Management Regarding Indoor Air Ventilation and Pedestrian Dynamics

Authors: T. Delval, C. Sauvage, Q. Jullien, R. Viano, T. Diallo, B. Collignan, G. Picinbono

Abstract:

In the context of the international spread of COVID-19, the Centre Scientifique et Technique du Bâtiment (CSTB) has led a joint research with the French government authorities Hauts-de-Seine department, to analyse the risk in school spaces according to their configuration, ventilation system and spatial segmentation strategy. This paper describes the main results of this joint research. A multidisciplinary team involving experts in indoor air quality/ventilation, pedestrian movements and IT domains was established to develop a COVID risk analysis tool based on Building Information Model. The work started with specific analysis on two pilot schools in order to provide for the local administration specifications to minimize the spread of the virus. Different recommendations were published to optimize/validate the use of ventilation systems and the strategy of student occupancy and student flow segmentation within the building. This COVID expertise has been digitized in order to manage a quick risk analysis on the entire building that could be used by the public administration through an easy user interface implemented in a free BIM Management software. One of the most interesting results is to enable a dynamic comparison of different ventilation system scenarios and space occupation strategy inside the BIM model. This concurrent engineering approach provides users with the optimal solution according to both ventilation and pedestrian flow expertise.

Keywords: BIM, knowledge management, system expert, risk management, indoor ventilation, pedestrian movement, integrated design

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782 The Effects of Organizational Apologies for Some Members’ Annoying Behavior on Other Members’ Appraisal of Their Organization

Authors: Chikae Isobe, Toshihiko Souma, Yoshiya Furukawa

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In Japan, an organization is sometimes asked for responsibility and apology toward the organization for the annoying behavior of employees, even though the behavior is not relevant to the organization. Our studies have repeatedly shown that it is important for organizational evaluation to organization propose compensatory behavior for such annoying behavior, even though the behavior is not relevant to the organization. In this study, it was examined how such an organizational response (apology) was likely to evaluate by members of the organization who were not related to the annoying behavior. Three independent variables were manipulated that is organization emotion (guilt and shame), compensation (proposal or not), and the relation between organization and the annoying behavior (relate or not). And the effects of organizational identity (high and low) were also examined. We conducted an online survey for 240 participants through a crowdsourcing company. Participants were asked to imagine a situation in which an incident in which some people in your company did not return an important document that they borrowed privately (vs. at work) became the topic of discussion, and the company responded. For the analysis,189 data (111 males and 78 females, mean age = 40.6) were selected. The results of ANOVA of 2 by2 on organizational appraisal, perceived organizational responsibility, and so on were conducted. Organization appraisal by members was also higher when the organization proposed compensatory behavior. In addition, when the annoying behavior was related to their work (than no related), for those who were high in organization identity (than low), organization appraisal was high. The interaction between relatedness and organizational identity was significant. Differences in relatedness between the organization and annoying behavior were significant in those with low organizational identity but not in those with high organizational identity. When the organization stated not taking compensatory action, members were more likely to perceive the organization as responsible for the annoying behavior. However, the interaction results indicated this tendency was limited to when the annoying behavior was not related to the organization. Furthermore, it tended to be perceived as responsible for the organization when the organization made a statement that felt shame for the annoying behavior not related to the organization and would compensate for the annoying behavior. These results indicate that even members of the organization do not consider the organization's compensatory actions to be unjustified. In addition, because those with high organizational identity perceived the organization to be responsible when it showed strong remorse (shame and compensation), they would be a tendency to make judgments that are consistent with organizational judgments. It would be considered that the Japanese have the norm that even if the organization is not at fault for a member's disruptive behavior, it should respond to it.

Keywords: appraisal for organization, annoying behavior, group shame and guilt, compensation, organizational apologies

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781 A New Multi-Target, Multi-Agent Search and Rescue Path Planning Approach

Authors: Jean Berger, Nassirou Lo, Martin Noel

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Perfectly suited for natural or man-made emergency and disaster management situations such as flood, earthquakes, tornadoes, or tsunami, multi-target search path planning for a team of rescue agents is known to be computationally hard, and most techniques developed so far come short to successfully estimate optimality gap. A novel mixed-integer linear programming (MIP) formulation is proposed to optimally solve the multi-target multi-agent discrete search and rescue (SAR) path planning problem. Aimed at maximizing cumulative probability of successful target detection, it captures anticipated feedback information associated with possible observation outcomes resulting from projected path execution, while modeling agent discrete actions over all possible moving directions. Problem modeling further takes advantage of network representation to encompass decision variables, expedite compact constraint specification, and lead to substantial problem-solving speed-up. The proposed MIP approach uses CPLEX optimization machinery, efficiently computing near-optimal solutions for practical size problems, while giving a robust upper bound obtained from Lagrangean integrality constraint relaxation. Should eventually a target be positively detected during plan execution, a new problem instance would simply be reformulated from the current state, and then solved over the next decision cycle. A computational experiment shows the feasibility and the value of the proposed approach.

Keywords: search path planning, search and rescue, multi-agent, mixed-integer linear programming, optimization

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780 Improving Customer Service through Empathy

Authors: Abiola Olukemi Ogunyemi

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Many organizations would like to gain customer loyalty, and to achieve this they invest in customer management systems which help them to learn and anticipate the customers’ needs, get feedback from them and serve them. One of the most elementary ways to achieve customer loyalty is for employees to be able to empathize with their customers, and to be able to feel what they feel when the company betrays their trust, which usually otherwise shown in patronage and loyalty. Unfortunately, the staff and management of organizations do not always realize the negative impact of treating customers badly, because they do not stop to think how these customers feel. If they did, they would be more careful and more respectful of these people who are human beings just like they are. They would be wiser, since this would ultimately make them more profitable businesses. This paper looks at thirteen descriptions of situations in which customers felt treated badly by organizations they trusted, and focuses on the feelings of these customers. If the organization (made of people) could empathize with the customer, then customer service would be surely enhanced. It is expected that these stories, real experiences narrated by young professionals working in Nigeria, can awaken greater empathy for consumers within organizations. Thus, they may help the organization to learn empathy and to incorporate it into their foundational principles for ethical behavior. The paper’s contents contribute to a heightened appreciation of empathy as an organizing mechanism by showing how putting one in the consumer’s shoes can help managers to understand how he or she feels. This will lead organizations to be even more innovative in finding ways to meet their customers’ needs and to deserve and win their loyalty. It addresses an issue that cuts across cultures, and therefore can be quite thought-provoking for every business owner or for team leads within organizations. By trying to stimulate empathy across the seller-buyer divide, it necessarily contributes to a deeper understanding of empathy as a building block for a sustainable society.

Keywords: customer service, empathy, ethical behavior, respectfulness

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779 Health and Safety of Red Cross Workers in Long-Term Homes during Early Days of the COVID-19 Pandemic: A Human Performance Perspective

Authors: Douglas J. Kube

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At the beginning of the COVID-19 pandemic, the Canadian Red Cross deployed workers into long-term care homes across Canada to support our most vulnerable citizens. It began by recruiting and training small teams of workers to provide non-clinical services for facilities in outbreak. Deployed workers were trained on an approach based on successful Red Cross deployments used with Ebola in which zones were established, levels of protection used, and strict protocols followed to prevent exposure. This paper addresses aspects of human performance through a safety culture lens. The Red Cross deployments highlight valuable insights and are an excellent case study in the principles of human performance and organizational culture. This paper looks at human performance principles, including human fallibility, predictability of error-likely situations, avoiding events by understanding reasons mistakes occur, and the influence on behaviour by organizational factors. This study demonstrates how the Red Cross’s organizational culture and work design positively influenced performance to protect workers and residents/clients. Lastly, this paper shares lessons that can be applied in many workplaces to improve worker health and safety and safety culture. This critical examination is based on the author’s experience as a Senior Occupational Health and Safety Advisor with the Red Cross during the pandemic as part of the team responsible for developing and implementing biological safety practices in long-term care deployments.

Keywords: COVID, human performance, organizational culture, work design

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778 The Recovery Experience Study of People with Bipolar Disorder

Authors: Sudkhanoung Ritruechai, Somrak Choovanichwong, Kruawon Tiengtom, Peanchanan Leeudomwong

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The purposes of this qualitative research were to study the recovery experience of people with bipolar disorder and also to propose a development approach to the Bipolar Friends Club. The participants were eight people with bipolar disorder for six to twenty years (four women and four men). They have been members of the Bipolar Friends Club for two to ten years. They have no mental symptoms in order to provide sufficient information about their recovery experiences and have returned to everyday life with their family, community, and work. The data were collected by doing an in-depth interview. Two interviews were done, each from 45-90 minutes and four to five weeks apart. The researcher sent the results of the preliminary data analysis to the participants two to three days beforehand. Confirmation of the results of the preliminary data analysis from the first interview was done at the second interview. The research study found that the participants had a positive experience of being a Bipolar Club member. The club continued its activities following Recovery Oriented Service: ROS to the participants. As a result, they recovered in eight areas as follows. 1) Intellectual: The wisdom of joining the group has brought knowledge and experiences from an exchange with others in self-care as well as a positive thinking in life. 2) Social: The participants have set up a group to take care of each other and to do activities which have brought warmth. Their social network which was normally little has also been increased. 3) Spiritual: The concept of religion has been used to lead the life of the participants. 4) Occupational: One participant is a student while the others do work. All of them have done well. 5) Environmental: The participants would be able to adapt to the environment and cope with their problems better. 6) Physical: Most female participants have difficulties with losing weight which leads them saying that they are ‘not fully recovered’. 7) Emotional: The participants feel calmer than before entering the club. They have also developed more tolerance to problems. 8) Financial: The participants would be able to control their spending by themselves and with the help of their family members. The people with bipolar disorder have suggested that the services of the club are perfect and should be continued. The results of the study encourage the Bipolar Friends Club, as well as other clubs/associations that support the recovery of patients. Consideration of the recovery has highlighted the need for ongoing and various life-enhancing programs for the caregivers and their loved ones with bipolar disorder. Then, they would be able to choose the program that suits their needs to improve their life.

Keywords: people with bipolar disorder, recovery, club, experience

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777 Structure of the Working Time of Nurses in Emergency Departments in Polish Hospitals

Authors: Jadwiga Klukow, Anna Ksykiewicz-Dorota

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An analysis of the distribution of nurses’ working time constitutes vital information for the management in planning employment. The objective of the study was to analyze the distribution of nurses’ working time in an emergency department. The study was conducted in an emergency department of a teaching hospital in Lublin, in Southeast Poland. The catalogue of activities performed by nurses was compiled by means of continuous observation. Identified activities were classified into four groups: Direct care, indirect care, coordination of work in the department and personal activities. Distribution of nurses’ working time was determined by work sampling observation (Tippett) at random intervals. The research project was approved by the Research Ethics Committee by the Medical University of Lublin (Protocol 0254/113/2010). On average, nurses spent 31% of their working time on direct care, 47% on indirect care, 12% on coordinating work in the department and 10% on personal activities. The most frequently performed direct care tasks were diagnostic activities – 29.23% and treatment-related activities – 27.69%. The study has provided information on the complexity of performed activities and utilization of nurses’ working time. Enhancing the effectiveness of nursing actions requires working out a strategy for improved management of the time nurses spent at work. Increasing the involvement of auxiliary staff and optimizing communication processes within the team may lead to reduction of the time devoted to indirect care for the benefit of direct care.

Keywords: emergency nurses, nursing care, workload, work sampling

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776 Applied Behavior Analysis and Speech Language Pathology Interprofessional Practice to Support Autistic Children with Complex Communication Needs

Authors: Kimberly Ho, Maeve Donnelly

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In this paper, a speech-language pathologist (SLP) and Board Certified Behavior Analysts® (BCBA) with a combined professional experience of almost 50 years will discuss their experiences working with individuals on the autism spectrum. Some autistic children require augmentative and alternative communication (AAC) to meet their communication needs. These learners present with unique strengths and challenges, often requiring intervention from a team of professionals to generalize skills across environments. Collaboration between SLPs and BCBAs will be discussed in terms of strengths and challenges. Applied behavior analysis (ABA) will be defined and explained in the context of the treatment of learners on the autism spectrum with complex communication needs (CCN). The requirement for collaboration will be discussed by the governing boards for both BCBAs and SLPs. The strengths of each discipline will be compared along with difficulties faced when professionals experience disciplinary centrism. The challenges in teaching autistic learners with CCN will be reviewed. Case studies will be shared in which BCBAs and SLPs engage in interprofessional practice to support autistic children who use AAC to participate in a social skills group. Learner outcomes will be shared and assessed through both an SLP and BCBA perspective. Finally, ideas will be provided to promote the interprofessional practice, including establishing a shared framework, avoiding professional jargon and moving towards common terminology, and focusing on the data to ensure the efficacy of treatment.

Keywords: autism, cross disciplinary collaboration, augmentative and alternative communication, generalization

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775 Online Consortium of Independent Colleges and Universities (OCICU): Using Cluster Analysis to Grasp Student and Institutional Value of Consolidated Online Offerings in Higher Education

Authors: Alex Rodriguez, Adam Guerrero

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Purpose: This study is designed to examine the institutions that comprise the Online Consortium of Independent Colleges and Universities (OCICU) to understand better the types of higher education institutions that comprise their membership. The literature on this topic is extensive in analyzing the current economic environment around higher education, which is largely considered to be negative for independent, tuition-driven institutions, and is forcing colleges and universities to reexamine how the college-attending population defines value and how institutions can best utilize their existing resources (and those of other institutions) to meet that value expectation. The results from this analysis are intended to give OCICU the ability to target their current customer base better, based on their most notable differences, and other institutions to see how to best approach consolidation within higher education. Design/Methodology: This study utilized k-means cluster analysis in order to explore the possibility that different segments exist within the seventy-one colleges and universities that have comprised OCICU. It analyzed fifty different variables, whose selection was based on the previous literature, collected by the Integrated Postsecondary Education Data System (IPEDS), whose data is self-reported by individual institutions. Findings: OCICU member institutions are partitioned into two clusters: "access institutions" and "conventional institutions” based largely on the student profile they target. Value: The methodology of the study is relatively unique as there are not many studies within the field of higher education marketing that have employed cluster analysis, and this type of analysis has never been conducted on OCICU members, specifically, or that of any higher education consolidated offering. OCICU can use the findings of this study to obtain a better grasp as to the specific needs of the two market segments OCICU currently serves and develop measurable marketing programs around how those segments are defined that communicate the value sought by current and potential OCICU members or those of similar institutions. Other consolidation efforts within higher education can also employ the same methodology to determine their own market segments.

Keywords: Consolidation, Colleges, Enrollment, Higher Education, Marketing, Strategy, Universities

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774 Analysis and Design of Offshore Met Mast Supported on Jacket Substructure

Authors: Manu Manu, Pardha J. Saradhi, Ramana M. V. Murthy

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Wind Energy is accepted as one of the most developed, cost effective and proven renewable energy technologies to meet increasing electricity demands in a sustainable manner. Preliminary assessment studies along Indian Coastline by Ministry of New and Renewable Energy have indicated prospects for development of offshore wind power along Tamil Nadu Coast, India. The commercial viability of a wind project mainly depends on wind characteristics on site. Hence, it is internationally recommended to perform site-specific wind resource assessment based on two years’ wind profile as a part of the feasibility study. Conventionally, guy wire met mast are used onshore for the collection of wind profile. Installation of similar structure in offshore requires complex marine spread and are very expensive. In the present study, an attempt is made to develop 120 m long lattice tower supported on the jacket, piled to the seabed at Rameshwaram, Tamil Nadu, India. Offshore met-masts are subjected to combined wind and hydrodynamic loads, and these lateral loads should be safely transferred to soil. The wind loads are estimated based on gust factor method, and the hydrodynamic loads are estimated by Morison’s equation along with suitable wave theory. The soil is modeled as three nonlinear orthogonal springs based on API standards. The structure configuration and optimum member sizes are obtained for extreme cyclone events. The dynamic behavior of mast under coupled wind and wave loads is also studied. The static responses of a mast with jacket type offshore platform have been studied using a frame model in SESAM. It is found from the study that the maximum displacement at the top of the mast for the random wave is 0.003 m and that of the tower for wind is 0.08 m during the steady state. The dynamic analysis results indicate that the structure is safe against coupled wind and wave loading.

Keywords: offshore wind, mast, static, aerodynamic load, hydrodynamic load

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773 Applicable Law to Intellectual and Industrial Property Agreements According to Turkish Private International Law and Rome I Regulation

Authors: Sema Cortoglu Koca

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Intellectual and industrial property rules, have a substantial effect on the sustainable development. Intellectual and industrial property rights, as temporary privileges over the products of intellectual activity, determine the supervision of information and technology. The level and scope of intellectual property protection thus influence the flow of technology between developed and developing countries. In addition, intellectual and industrial property rights are based on the notion of balance. Since they are time-limited rights, they reconcile private and public benefits. That is, intellectual and industrial property rights respond to both private interests and public interests by rewarding innovators and by promoting the dissemination of ideas, respectively. Intellectual and industrial property rights can, therefore, be a tool for sustainable development. If countries can balance their private and public interests according to their particular context and circumstances, they can ensure the intellectual and industrial property which promotes innovation and technology transfer relevant for them. People, enterprises and countries who need technology, can transfer developed technology which is acquired by people, enterprises and countries so as to decrease their technological necessity and improve their technology. Because of the significance of intellectual and industrial property rights on the technology transfer law as mentioned above, this paper is confined to intellectual and industrial property agreements especially technology transfer contracts. These are license contract, know-how contract, franchise agreement, joint venture agreement, management agreement, research and development agreement. In Turkey, technology transfer law is still a developing subject. For developing countries, technology transfer regulations are very important for their private international law because these countries do not know which technology transfer law is applicable when conflicts arise. In most technology transfer contracts having international elements, the parties choose a law to govern their contracts. Where the parties do not choose a law, either expressly or impliedly, and matters which is not excluded in party autonomy, the court has to determine the applicable law to contracts in a matter of capacity, material, the formal and essential validity of contracts. For determining the proper law of technology transfer contracts, it is tried to build a rule for applying all technology transfer contracts. This paper is confined to the applicable law to intellectual and industrial property agreements according to ‘5718 Turkish Act on Private International Law and Civil Procedure’ and ‘Regulation (EC) No 593/2008 of the European Parliament and of the Council of 17 June 2008 on the law applicable to contractual obligations (Rome I)’. Like these complex contracts, to find a rule can be really difficult. We can arrange technology transfer contracts in groups, and we can determine the rule and connecting factors to these groups. For the contracts which are not included in these groups, we can determine a special rule considering the characteristics of the contract.

Keywords: intellectual and industrial property agreements, Rome I regulation, technology transfer, Turkish act on private international law and civil procedure

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772 China's Role in Promoting Regionalism in East Asia in Post-Maoist Era: An Analysis through Uneven and Combined Development

Authors: Ali Jibran

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China was considered as a revisionist state by the countries of East Asia during Maoist era; but China’s role changed from a revisionist state to a constructive member of East Asian Community in post-Maoist era. This research will mainly investigate the two phenomena: what were reasons of behavioral change of China in East Asia and what role has China played to promote regionalism in East Asia since Open Door Policy of Deng Xiaoping. To understand these two phenomena, this study applies the international relations theory of Uneven and Combined Development (U&CD). The central finding of this study is that ‘whip of external necessity’ posed by the Western dominance during the Chinese ‘century of ignominy’ resulted in a Maoist regime in China in 1948 which was hostile to its neighbors due to ideological tensions. Maoist regime in China could not solve the challenges posed by the ‘international’; therefore after Mao’s death, a new economic approach was introduced in China to deal with the challenges postured by the ‘international’. Due to Deng Xiaoping’s 'Open Door Policy' era, China used its ‘privilege of historic backwardness’ and witnessed unprecedented economic growth. As the societies are multiple and exist in real time, therefore interaction among societies is pertinent. Export oriented domestic policy pushed China to concentrate less on class struggle and improve its relations with its neighbors in East Asia. As China soon become a global hub of trade after market oriented reforms, therefore friendly relations with the states of East Asia was pertinent. This study will investigate Chinese role in regionalism in East Asia in three area: Chinese role in promoting regionalism in East Asia, China’s role in economic integration in East Asia and China’s role in combatting terrorism in East Asia. This study will be divided in two section. The first section will deal with the transformation in Chinese behavior in East Asia in post Maoist era, and the second section will analyze China’s role in East Asia by looking at Chinese role in institutional mechanism, economic integration and combatting terrorism in East Asia.

Keywords: East Asia, regionalism, institutionlism, economic integration

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771 Social Mentoring: Towards Formal and Informal Deployment in the Structures of the Social and Solidarity Economy

Authors: Vanessa Casadella, Mourad Chouki, Agnès Ceccarelli, Sofiane Tahi

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Mentoring is positioned in an interpersonal and intergenerational perspective, serving the transmission of interpersonal skills and organizational culture. It echoes orientation, project, self-actualization, guidance, transmission, and filiation. It is available using a formal or informal approach. The formal dimension refers to a privileged relationship between a senior and a junior. Informal mentoring is unplanned and emerges naturally between two people who choose each other. However, it remains more difficult to understand. To study the link between formal and informal mentoring and to define the notion of “social” mentoring, we conducted a qualitative study of an exploratory nature with around ten SSE organizations located in the southeast region of Tunisia. The wealth of this territory has pushed residents to found SSE organizations with a view to creating jobs but also to preserving traditions and preserving nature. These organizations developed spontaneously to solve various local problems, such as the revitalization of deserted rural areas, environmental degradation, and the reskilling and professional reintegration of people marginalized in the labor market. This research, based on semi-structured interviews in order to obtain exhaustive and sensitive data, involves an interview guide with few questions mobilized to let the respondents, leaders of the different structures, express themselves freely. The guide includes questions on activities, methods of sharing knowledge, and difficulties in understanding between stakeholders. The interviews, lasting 30 to 60 minutes, were recorded using a dictaphone and then transcribed in full. The results are as follows: 1. We see two iterative mentoring loops. A first loop can be considered a type of formal mentoring. It highlights the support organized (in the form of training) by social enterprises with the aim of developing the autonomy, know-how, and interpersonal skills of members. A second loop concerns informal mentoring. This is non-formalized support provided by members or with other members of the entourage. This informal mentoring is mainly based on the observation of good practices and learning by doing. 2. We notice an intersection between the two loops. If the first loop is not done, the second will not take place. The knowledge acquired in the first loop is used to feed the second. 3. We note a form of reluctance on the part of some members to share their knowledge for reasons of competition. Ultimately, we retain the notion of “social” mentoring as a hybridization of formal and informal mentoring while dimensioning the “social” perspective by emphasizing the reciprocal character, solidarity, confidence, and trust between the mentor and the mentee.

Keywords: social innovation, social mentoring, social and solidarity economy, informal mentoring

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770 Nutritional Status of Surgical and Orthopedic Patients: 3B Ward

Authors: Jitaree Tantiyasawatdikul, Bantita Jadnok, Sarunya Tijana

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Background: Nutritional status is an important factor before, during, and after an operation. It can help wound healing. If the patients have good nutritional status before and after an operation, wound healing can occur more easily. It can strengthen the immune system leading to decreased infection, reduced length of stay, and reducing the cost to patients and caregivers. Therefore, screening to evaluate the nutritional status of patients in 3B becomes the database for further developing the treatment and also will lead to excellent service from the interdisciplinary team. Objective: To study the nutritional status of patients in surgical ward 3B at Surgical and Orthopedics Nursing Division, Srinagarind Hospital. Method: A descriptive study, to evaluate the nutritional status of 86 patients admitted in 3B between October 2014 and March 2015.The instruments used in this study consisted of two parts: 1) personal data, 2) Screening nutritional status. The data were analyzed by percentage and mean. Results: A sample population of 86 patients aged 22-81 years old, mean age 52.59years, 90.69% are married, female were 55.81%, regular diet 70.93%, patients with no problem oral cavity was 87.21%.The sample population had high incidence of CA 47.67% and secondly cardiovascular disease 36.05 %. Patients with high-risk nutrition was 12.79 % including 45.45% cardiovascular disease and 36.36% CA. Screening of nutritional status of high-risk nutrition was 39.36% severe triceps skinfold (TSF), severe mid-arm muscle circumference(MAMC) 9.09% and severe total lymphocyte 39.36%. Conclusion: The result of nutritional status screening of surgical ward 3B found 12.79% patients with high-risk nutrition including 45.45% with cardiovascular disease .There was no problem with oral cavity and eating.

Keywords: nutritional status, screening, surgical patients, 3B ward, Srinagarind Hospital

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769 Bekaadendang: A Principles-Focused Evaluation

Authors: Erin Brands-Saliba

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In this evaluation study, we explore the efficacy and implementation of the five guiding principles of Bekaadendang “Being Peaceful,” a suite of services facilitated by our Anti-Human Trafficking Team, and a pivotal component of the Holistic Prevention Services department at NCFST. The guiding principles—trauma-informed care, cultural safety, 4-quadrant medicine wheel approach, harm reduction, and after-care peer support—are the foundation of Bekaadendang's mission to support at-risk individuals and survivors of human trafficking. This evaluation is of paramount importance given the profound impact of human trafficking on these communities and aims to ensure that Bekaadendang's principles are not only understood by staff but experienced by community members in a purposeful and meaningful manner. The issues at the heart of this evaluation are deeply entrenched in the historical and contemporary challenges faced by Indigenous communities, with a particular emphasis on Indigenous women and 2SLGBTQQIA+ individuals. Well-documented reports like the National Inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG) have cast a glaring light on the disproportionately high rates of violence, exploitation, and trafficking experienced by these communities. The MMIWG report underlines the pressing need for holistic, culturally informed interventions like Bekaadendang. Furthermore, the research efforts of scholars, both Indigenous and non-Indigenous, shed light on the persistent systemic issues that make Indigenous individuals more vulnerable to trafficking and exploitation. Recognizing this broader context is crucial to truly grasp the importance of evaluating the guiding principles that underpin Bekaadendang's service model.

Keywords: human trafficking, indigenous healing, MMIWG, program evaluation

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768 Responsibility of International Financial Institutions for Harmful Environmental Consequences Arising from Their Development Interventions

Authors: Reham Barakat

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Over the last few decades, the influence of International Financial Institutions (IFIs), especially the World Bank (WB), has significantly increased. Since the early 1980s, IFIs have assumed greater role, especially in developing countries; their total lending has dramatically increased, affecting billions of people in their Borrower States. Though the purpose of the development assistance provided by IFIs is to alleviate poverty and promote economic and social development in their member countries, IFIs have been subject to massive criticism by civil society institutions, international NGOs and local communities for the harmful environmental, social and economic impacts resulting from their development interventions in borrower countries, such as deforestation, displacement of indigenous peoples, and unemployment. While the role of IFIs has expanded over time, affecting billions of people, their accountability mechanisms remained behind and were criticized for lacking sufficient independency and enforceability. The serious adverse environmental impacts of the World Bank’s funded projects, along with their weak accountability mechanisms, raises the question of 'To what extent IFIs should be held internationally responsible for the harmful environmental consequences arising from their development interventions?'. This paper argues that IFIs are legally responsible for the harmful environmental consequences arising from their development interventions. The study (i) identifies the applicable laws and relevant primary rules from which the international environmental obligations of IFIs towards their borrower countries are derived (ii) assesses the World Bank’s compliance to the principles of the International Environmental Law including the precautionary principle, the polluter pays principle, and the principle of Good-Neighborliness, (iii) assesses the World Bank’s current internal accountability mechanisms for harmful environmental impacts resulting from the World Bank’s funded projects, and finally (iv) identifies the appropriate dispute settlement mechanisms to which states and non-state actors could raise their claims against IFIs for harmful environmental consequences arising from their interventions.

Keywords: international environmental law, international financial institutions, international responsibility, world bank, environmental and social safeguards

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767 Human Pressure Threaten Swayne’s Hartebeest to Point of Local Extinction from the Savannah Plains of Nech Sar National Park, South Rift Valley, Ethiopia

Authors: Simon Shibru, Karen Vancampenhout, Jozef Deckers, Herwig Leirs

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We investigated the population size of the endemic and endangered Swayne’s Hartebeest (Alcelaphus buselaphus swaynei) in Nech Sar National Park from 2012 to 2014 and document the major threats why the species is on the verge of local extinction. The park was once known for its abundant density of Swayne’s Hartebeest. We used direct total count methods for a census. We administered semi-structured interviews and open-ended questionnaires with senior scouts who are the member of the local communities. Historical records were obtained to evaluate the population trends of the animals since 1974. The density of the animal decreased from 65 in 1974 to 1 individual per 100 km2 in 2014 with a decline of 98.5% in the past 40 years. The respondents agreed that the conservation status of the park was in its worst condition ever now with only 2 Swayne’s Hartebeest left, with a rapid decline from 4 individuals in 2012 and 12 individuals in 2009. Mainly hunting and habitat loss, but also the unsuitable season of reproduction and shortage of forage as minor factors were identified as threats for a local extinction of the Swayne’s Hartebeests. On the other hand, predation, fire, disease, and ticks were not considered a cause for the declining trend. Hunting happens mostly out of some kind of revenge since the local community thought that they were pushed out from the land because of the presence of Swayne's Hartebeest in the area. Respondents agreed that the revenge action of the local communities was in response to their unwillingness to be displaced from the park in 1982/3. This conflict situation is resulting from the exclusionary wildlife management policy of the country. We conclude that the human interventions in general and illegal hunting, in particular, pushed the Swayne’s Hartebeest to a point of local extinction. Therefore, we recommend inclusive wildlife management approach for continuing existence of the park together with its natural resources so that sustainable use of the resources is in place.

Keywords: hunting, habitat destruction, local extinction, Nech Sar National Park, Swayne’s Hartebeest

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766 Optimizing Campaign Effectiveness: Identifying Target Customers via Recommender Engine

Authors: Nikita Katyal, Shubham Jain

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In today’s competitive business environment, the success of campaigns relies not only on their creation but also on effectively reaching the right customers. Campaigns often feature products that customers may not have considered or are unaware of, including popular items. This research aims to enhance retailer sales by leveraging an efficient recommender system that reminds targeted customers to purchase their preferred products and suggests additional items they hadn’t initially considered during a campaign. Our focus is on utilizing the recommender system to identify potential customers for a curated set of products selected by the marketing team for a specific campaign. Communicating with all customers can be time-consuming and costly, and irrelevant messages may harm customer loyalty. Therefore, the primary objective is to strategically select the right customers for a campaign, increasing sales and reducing communication costs. This paper provides valuable insights into connecting with the right customer segments to optimize revenue generation for businesses. The analysis shows that high-value customers (those generating the highest revenue) contributed to increases in average basket size, while win-back customers (with low engagement) and about to churn customers (those at risk of attrition) improved the effectiveness of marketing contacts by increasing engagement and reducing churn. Targeted communication, focused on revenue, also enhanced the quality of the relationship between the customer and the firm, helping to lower churn rates by engaging customers with suitable campaigns. This research provides empirical evidence supporting the theoretical benefits of targeting the right customers for a campaign.

Keywords: recommendation, ALS, marketing campaigns, target customers, churn

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765 Outcomes of Educating Care Giver in Tracheostomy Wound Care for Discharge Planning of Tracheostomy Patients at the Ear, Nose, Throat, and Eye Ward of Songkhla Hospital Thailand

Authors: Kingkan Chumjamras

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There are permanent and temporary tracheostomies, and in a permanent tracheostomy, care giver are important persons to know and be able to care for the tracheostomy patient. The objective of this quasi-experimental study was to evaluate outcomes of educating care giver in tracheostomy wound care for discharge planning of tracheostomy patients. The subjects of the study were relatives who directly cared for tracheostomy patients. Thirty subjects were selected according to specified criteria. The research instruments consisted of practice guidelines, manual for relatives in caring for the tracheostomy wound, an assisted model with a tracheostomy wound, a test, an observation form, and a patient’s relative satisfaction questionnaire. The instrument validity was tested by three experts, and the questionnaire reliability was tested with Cronbach’s alpha, and the reliability coefficient was 0.83; the data were analyzed using descriptive statistics, and paired t-test. The results of the study on educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients revealed that the score for knowledge and ability in caring for the tracheostomy wound before receiving the education was at a low level (M= 19.23, SD= 1.57) compared with the very high score (M= 36.40, SD= 19.23) after receiving the education. The difference was statistically significant (p < .05), and relatives’ satisfaction was at a high level (80 percent). Knowledge and ability in caring for tracheostomy patients among patients’ relatives could cause tracheostomy wound complications for tracheostomy patients. One way to control such complications and returns to hospital from infection, in addition to care by the health care team, is educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients.

Keywords: outcomes, educating, care giver, Tracheostomy Wound Care, discharge planning

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764 Urban Sexual Geographies, Queer Citizenship and the Socio-Economic Status of LGBTIQs in Vienna

Authors: Karin Schoenpflug, Christine M. Klapeer

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In a large study for the Vienna City Council’s Antidiscrimination unit (WASt) an interdisciplinary team (in the fields of economics, sociology and political science) working with urban economics, critical citizenship studies, the sociology of work & inequality and urban political/human geography conducted an online survey asking LGBTIs (lesbians, gays, bisexuals, transgender and intersex people) in Vienna detailed questions on their quality-of-life, happiness and well-being. 3.161 persons responded and provided us with a rich data set concerning: 1) Labor market structures, discrimination, working conditions and employment practices (economic citizenship); 2) access to health care, welfare, education and safety in public spaces (social citizenship); 3) political participation as well as access to legal institutions (political citizenship). All those fields are important dimensions in regards to “full” citizenship and the well-being of the LGBTI population, but are also constitutive for the inclusion of sexual and gender minorities into the city population(s) of Vienna. Our data also allows us to map the sexual geography of Vienna as LGBTI communities are more likely to live in certain districts; some places are considered safe(r) and “friendlier”. In this way our work helps to fill a research gap connecting (urban) spaces and sexuality, and it produces new data and insights on the quality-of-life of this subpopulation. Our findings allow for urban (policy) planning and limiting violence and discrimination and improving the collective wellbeing and social cohesion.

Keywords: urban sexual geographies, LGBTI, socio-economic status, Vienna, sitizenship status

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763 An Intelligent Search and Retrieval System for Mining Clinical Data Repositories Based on Computational Imaging Markers and Genomic Expression Signatures for Investigative Research and Decision Support

Authors: David J. Foran, Nhan Do, Samuel Ajjarapu, Wenjin Chen, Tahsin Kurc, Joel H. Saltz

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The large-scale data and computational requirements of investigators throughout the clinical and research communities demand an informatics infrastructure that supports both existing and new investigative and translational projects in a robust, secure environment. In some subspecialties of medicine and research, the capacity to generate data has outpaced the methods and technology used to aggregate, organize, access, and reliably retrieve this information. Leading health care centers now recognize the utility of establishing an enterprise-wide, clinical data warehouse. The primary benefits that can be realized through such efforts include cost savings, efficient tracking of outcomes, advanced clinical decision support, improved prognostic accuracy, and more reliable clinical trials matching. The overarching objective of the work presented here is the development and implementation of a flexible Intelligent Retrieval and Interrogation System (IRIS) that exploits the combined use of computational imaging, genomics, and data-mining capabilities to facilitate clinical assessments and translational research in oncology. The proposed System includes a multi-modal, Clinical & Research Data Warehouse (CRDW) that is tightly integrated with a suite of computational and machine-learning tools to provide insight into the underlying tumor characteristics that are not be apparent by human inspection alone. A key distinguishing feature of the System is a configurable Extract, Transform and Load (ETL) interface that enables it to adapt to different clinical and research data environments. This project is motivated by the growing emphasis on establishing Learning Health Systems in which cyclical hypothesis generation and evidence evaluation become integral to improving the quality of patient care. To facilitate iterative prototyping and optimization of the algorithms and workflows for the System, the team has already implemented a fully functional Warehouse that can reliably aggregate information originating from multiple data sources including EHR’s, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology PAC systems, Digital Pathology archives, Unstructured Clinical Documents, and Next Generation Sequencing services. The System enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information about patient tumors individually or as part of large cohorts to identify patterns that may influence treatment decisions and outcomes. The CRDW core system has facilitated peer-reviewed publications and funded projects, including an NIH-sponsored collaboration to enhance the cancer registries in Georgia, Kentucky, New Jersey, and New York, with machine-learning based classifications and quantitative pathomics, feature sets. The CRDW has also resulted in a collaboration with the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) at the U.S. Department of Veterans Affairs to develop algorithms and workflows to automate the analysis of lung adenocarcinoma. Those studies showed that combining computational nuclear signatures with traditional WHO criteria through the use of deep convolutional neural networks (CNNs) led to improved discrimination among tumor growth patterns. The team has also leveraged the Warehouse to support studies to investigate the potential of utilizing a combination of genomic and computational imaging signatures to characterize prostate cancer. The results of those studies show that integrating image biomarkers with genomic pathway scores is more strongly correlated with disease recurrence than using standard clinical markers.

Keywords: clinical data warehouse, decision support, data-mining, intelligent databases, machine-learning.

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