Search results for: query complexity

Authors: Roseanne Sharon Borromeo, Mariana Carvalho, Mariia Karizhenskaia

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Healthcare providers need to comprehend cultural diversity for optimal patient-centered care, especially near the end of life. Although a universal method for navigating cultural differences would be ideal, culture’s high complexity makes this strategy impossible. Adding cultural humility, a process of self-reflection to understand personal and systemic biases and humbly acknowledging oneself as a learner when it comes to understanding another's experience leads to a meaningful process in palliative care generating respectful, honest, and trustworthy relationships. This study is a systematic review of the literature on cultural humility in palliative care research and best practices. Race, religion, language, values, and beliefs can affect an individual’s access to palliative care, underscoring the importance of culture in palliative care. Cultural influences affect end-of-life care perceptions, impacting bereavement rituals, decision-making, and attitudes toward death. Cultural factors affecting the delivery of care identified in a scoping review of Canadian literature include cultural competency, cultural sensitivity, and cultural accessibility. As the different parts of the world become exponentially diverse and multicultural, healthcare providers have been encouraged to give culturally competent care at the bedside. Therefore, many organizations have made cultural competence training required to expose professionals to the special needs and vulnerability of diverse populations. Cultural competence is easily standardized, taught, and implemented; however, this theoretically finite form of knowledge can dangerously lead to false assumptions or stereotyping, generating poor communication, loss of bonds and trust, and poor healthcare provider-patient relationship. In contrast, Cultural humility is a dynamic process that includes self-reflection, personal critique, and growth, allowing healthcare providers to respond to these differences with an open mind, curiosity, and awareness that one is never truly a “cultural” expert and requires life-long learning to overcome common biases and ingrained societal influences. Cultural humility concepts include self-awareness and power imbalances. While being culturally competent requires being skilled and knowledgeable in one’s culture, being culturally humble involves the sometimes-uncomfortable position of healthcare providers as students of the patient. Incorporating cultural humility emphasizes the need to approach end-of-life care with openness and responsiveness to various cultural perspectives. Thus, healthcare workers need to embrace lifelong learning in individual beliefs and values on suffering, death, and dying. There have been different approaches to this as well. Some adopt strategies for cultural humility, addressing conflicts and challenges through relational and health system approaches. In practice and research, clinicians and researchers must embrace cultural humility to advance palliative care practices, using qualitative methods to capture culturally nuanced experiences. Cultural diversity significantly impacts patient-centered care, particularly in end-of-life contexts. Cultural factors also shape end-of-life perceptions, impacting rituals, decision-making, and attitudes toward death. Cultural humility encourages openness and acknowledges the limitations of expertise in one’s culture. A consistent self-awareness and a desire to understand patients’ beliefs drive the practice of cultural humility. This dynamic process requires practitioners to learn continuously, fostering empathy and understanding. Cultural humility enhances palliative care, ensuring it resonates genuinely across cultural backgrounds and enriches patient-provider interactions.

Keywords: cultural competency, cultural diversity, cultural humility, palliative care, self-awareness

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Authors: Jennifer Wheeldon, Nick de Viggiani, Nikki Cotterill

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Background: Urinary and fecal incontinence affect a significant proportion of older adults aged 65 and over who permanently reside in residential and nursing home facilities. Incontinence symptoms have been linked to comorbidities, an increased risk of infection and reduced quality of life and mental wellbeing of residents. However, continence care provision can often be poor, further compromising the health and wellbeing of this vulnerable population. Objectives: To identify experiences and perceptions of continence care provision in older adult residential care settings and to identify factors that help or hinder good continence care provision. Settings included both residential care homes and nursing homes for older adults. Methods: A qualitative evidence synthesis using systematic review methodology established the current evidence-base. Data from 20 qualitative and mixed-method studies was appraised and synthesized. Following the review process, 10* qualitative interviews with staff working in older adult residential care settings were conducted across six* sites, which included registered managers, registered nurses and nursing/care assistants/aides. Purposive sampling recruited individuals from across England. Both evidence synthesis and interview data was analyzed thematically, both manually and with NVivo software. Results: The evidence synthesis revealed complex barriers and facilitators for continence care provision at three influencing levels: macro (structural and societal external influences), meso (organizational and institutional influences) and micro (day-to-day actions of individuals impacting service delivery). Macro-level barriers included negative stigmas relating to incontinence, aging and working in the older adult social care sector, restriction of continence care resources such as containment products (i.e. pads), short staffing in care facilities, shortfalls in the professional education and training of care home staff and the complex health and social care needs of older adult residents. Meso-level barriers included task-centered organizational cultures, ageist institutional perspectives regarding old age and incontinence symptoms, inadequate care home management and poor communication and teamwork among care staff. Micro-level barriers included poor knowledge and negative attitudes of care home staff and residents regarding incontinence symptoms and symptom management and treatment. Facilitators at the micro-level included proactive and inclusive leadership skills of individuals in management roles. Conclusions: The findings of the evidence synthesis study help to outline the complexities of continence care provision in older adult care homes facilities. Macro, meso and micro level influences demonstrate problematic and interrelated barriers across international contexts, indicating that improving continence care in this setting is extremely challenging due to the multiple levels at which care provision and services are impacted. Both international and national older adult social care policy-makers, researchers and service providers must recognize this complexity, and any intervention seeking to improve continence care in older adult care home settings must be planned accordingly and appreciatively of the complex and interrelated influences. It is anticipated that the findings of the qualitative interviews will shed further light on the national context of continence care provision specific to England; data collection is ongoing*. * Sample size is envisaged to be between 20-30 participants from multiple sites by Spring 2023.

Keywords: continence care, residential and nursing homes, evidence synthesis, qualitative

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Authors: Gospel Iyioku, Jana Mazancova, Jiri Hejkrlik

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The “Agricultural Promotion Policy (2016–2020)” represents a strategic initiative by the Nigerian government to address domestic food shortages and the challenges in exporting products at the required quality standards. Hindered by an inefficient system for setting and enforcing food quality standards, coupled with a lack of market knowledge, the Federal Ministry of Agriculture and Rural Development (FMARD) aims to enhance support for the production and activities of key crops like cashew. By collaborating with farmers, processors, investors, and stakeholders in the cashew sector, the policy seeks to define and uphold high-quality standards across the cashew value chain. Given the challenges and opportunities faced by Nigerian cashew farmers, active participation in cashew marketing groups becomes imperative. These groups serve as essential platforms for farmers to collectively navigate market intricacies, access resources, share knowledge, improve output quality, and bolster their overall bargaining power. Through engagement in these cooperative initiatives, farmers not only boost their economic prospects but can also contribute significantly to the sustainable growth of the cashew industry, fostering resilience and community development. This study explores the perceptions and intentions of farmers regarding their involvement in cashew marketing cooperatives, utilizing an expanded version of the Theory of Planned Behaviour. Drawing insights from a diverse sample of 321 cashew farmers in Southwest Nigeria, the research sheds light on the factors influencing decision-making in cooperative participation. The demographic analysis reveals a diverse landscape, with a substantial presence of middle-aged individuals contributing significantly to the agricultural sector and cashew-related activities emerging as a primary income source for a substantial proportion (23.99%). Employing Structural Equation Modelling (SEM) with Maximum Likelihood Robust (MLR) estimation in R, the research elucidates the associations among latent variables. Despite the model’s complexity, the goodness-of-fit indices attest to the validity of the structural model, explaining approximately 40% of the variance in the intention to join cooperatives. Moral norms emerge as a pivotal construct, highlighting the profound influence of ethical considerations in decision-making processes, while perceived behavioural control presents potential challenges in active participation. Attitudes toward joining cooperatives reveal nuanced perspectives, with strong beliefs in enhanced connections with other farmers but varying perceptions on improved access to essential information. The SEM analysis establishes positive and significant effects of moral norms, perceived behavioural control, subjective norms, and attitudes on farmers’ intention to join cooperatives. The knowledge construct positively affects key factors influencing intention, emphasizing the importance of informed decision-making. A supplementary analysis using partial least squares (PLS) SEM corroborates the robustness of our findings, aligning with covariance-based SEM results. This research unveils the determinants of cooperative participation and provides valuable insights for policymakers and practitioners aiming to empower and support this vital demographic in the cashew industry.

Keywords: marketing cooperatives, theory of planned behaviour, structural equation modelling, cashew farmers

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Authors: Rowan Moore, Kai Scheffler, Eugen Damoc, Jennifer Sutton, Aaron Bailey, Stephane Houel, Simon Cubbon, Jonathan Josephs

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Purpose: MS analysis of monoclonal antibodies (mAbs) at the protein and peptide levels is critical during development and production of biopharmaceuticals. The compositions of current generation therapeutic proteins are often complex due to various modifications which may affect efficacy. Intact proteins analyzed by MS are detected in higher charge states that also provide more complexity in mass spectra. Protein analysis in native or native-like conditions with zero or minimal organic solvent and neutral or weakly acidic pH decreases charge state value resulting in mAb detection at higher m/z ranges with more spatial resolution. Methods: Three commercially available mAbs were used for all experiments. Intact proteins were desalted online using size exclusion chromatography (SEC) or reversed phase chromatography coupled on-line with a mass spectrometer. For streamlined use of the LC- MS platform we used a single SEC column and alternately selected specific mobile phases to perform separations in either denaturing or native-like conditions: buffer A (20 % ACN, 0.1 % FA) with Buffer B (100 mM ammonium acetate). For peptide analysis mAbs were proteolytically digested with and without prior reduction and alkylation. The mass spectrometer used for all experiments was a commercially available Thermo Scientific™ hybrid Quadrupole-Orbitrap™ mass spectrometer, equipped with the new BioPharma option which includes a new High Mass Range (HMR) mode that allows for improved high mass transmission and mass detection up to 8000 m/z. Results: We have analyzed the profiles of three mAbs under reducing and native conditions by direct infusion with offline desalting and with on-line desalting via size exclusion and reversed phase type columns. The presence of high salt under denaturing conditions was found to influence the observed charge state envelope and impact mass accuracy after spectral deconvolution. The significantly lower charge states observed under native conditions improves the spatial resolution of protein signals and has significant benefits for the analysis of antibody mixtures, e.g. lysine variants, degradants or sequence variants. This type of analysis requires the detection of masses beyond the standard mass range ranging up to 6000 m/z requiring the extended capabilities available in the new HMR mode. We have compared each antibody sample that was analyzed individually with mixtures in various relative concentrations. For this type of analysis, we observed that apparent native structures persist and ESI is benefited by the addition of low amounts of acetonitrile and formic acid in combination with the ammonium acetate-buffered mobile phase. For analyses on the peptide level we analyzed reduced/alkylated, and non-reduced proteolytic digests of the individual antibodies separated via reversed phase chromatography aiming to retrieve as much information as possible regarding sequence coverage, disulfide bridges, post-translational modifications such as various glycans, sequence variants, and their relative quantification. All data acquired were submitted to a single software package for analysis aiming to obtain a complete picture of the molecules analyzed. Here we demonstrate the capabilities of the mass spectrometer to fully characterize homogeneous and heterogeneous therapeutic proteins on one single platform. Conclusion: Full characterization of heterogeneous intact protein mixtures by improved mass separation on a quadrupole-Orbitrap™ mass spectrometer with extended capabilities has been demonstrated.

Keywords: disulfide bond analysis, intact analysis, native analysis, mass spectrometry, monoclonal antibodies, peptide mapping, post-translational modifications, sequence variants, size exclusion chromatography, therapeutic protein analysis, UHPLC

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Authors: Brennan Lodge

Abstract:

Cybersecurity professionals have long been embroiled in a digital arms race, confronting increasingly sophisticated threats with innovative solutions. The field of cybersecurity is in an unending race against malicious adversaries. As threats evolve in complexity, the tools used to defend against them need to advance even faster. Burdened with a vast arsenal of tools and an expansive scope of threat intelligence, analysts frequently navigate a complex web, trying to discern patterns amidst information overload. Herein lies the potential of Retrieval Augmented Generation (RAG). By combining the capabilities of Large Language Models (LLMs) with a generative AI facet, RAG brings to the table an unparalleled ability for real-time cross-referencing, bridging the gap between raw data and actionable insights. Imagine an analyst named Sarah working at a global Fortune 500 company. Every day, Sarah navigates a maze of diverse knowledge bases, real-time threat intelligence, and her company's vast proprietary data, from network specifics to intricate technical blueprints. One day, she's challenged by a potential breach through a personal device due to the company's global "Bring Your Own Device" policy. With the clock ticking, Sarah has mere minutes to trace the malware's origin, all while considering complex regional regulations. As she races against the benchmark of Mean Time To Resolution (MTTR), she wonders: Could "Cozy Bear" with its notorious malware tactic, HAMMERTOSS, be behind this? Balancing policy intricacies, global network considerations, and ever-emerging cyber threats, Sarah's role epitomizes the intense challenges faced by today's cybersecurity analysts. While analysts grapple with this array of intricate, time-sensitive challenges, the necessity for precision and efficiency is key. RAG technology—a cutting-edge advancement in Gen AI—is a promising solution. Designed to assimilate diverse data sources such as cyber advisory notices, phishing email sentiment, secure and insecure code examples, information security policy documentation, and the MITRE ATT&CK framework, RAG equips analysts with real-time querying capabilities through a vector database and a cross referenced concise response from a Gen AI model. Traditional relational databases often necessitate a tedious process of filtering through numerous entries. Now, with the synergy of vector databases and Gen AI models, analysts can rapidly access both contextually or semantically akin data points. This augmented approach equips analysts with a comprehensive understanding of the prevailing cyber threats, elevating the robustness of cybersecurity defenses and upskilling the analyst and team, too. Vector databases underpin the knowledge translation in Gen AI. They bridge the gap between raw data and translation into meaningful insights, ensuring that analysts are equipped with comprehensive and relevant information. This superior capability of the RAG framework, with its impressive depth and precision, finds application across a broad spectrum of cybersecurity challenges. Let's delve into some use cases where its potential becomes particularly evident: Phishing Email Sentiment Analysis: Phishing remains a predominant vector for cybersecurity breaches. Leveraging RAG's capabilities, analysts can not only assess the potential malevolence of an email but can also understand the context behind it. By cross-referencing patterns from varied data sources in real-time, the detection process evolves from a mere content evaluation to a holistic understanding of attacker tactics, behaviors, and evolving profiles. This allows for the identification of nuanced phishing strategies that might otherwise go undetected. Insecure Code Analysis: Software vulnerabilities form a critical entry point for cyber adversaries. With RAG, the process of code evaluation undergoes a transformation. Instead of manual code reviews, the system pulls insights from vector databases and historical code snippets marked as insecure, enabling detection of vulnerabilities based on historical patterns, emerging threat vectors, and even predictive threat modeling. This ensures that even the most obfuscated or embedded vulnerabilities are identified, and corrective measures can be promptly implemented. Vulnerability and Upskill Advisory: In the fast-paced world of cybersecurity, staying updated is paramount. Through RAG's capabilities, analysts are not only made aware of real-time vulnerabilities but are also guided on the necessary skills and tools needed to combat them. By dynamically sourcing data through vulnerability advisories, news on advanced persistent threats, and tactics to defend, RAG ensures that analysts are not only reactive to threats but are also proactively upskilled, thereby bolstering their defense mechanisms. Information Security Policies for Compliance Teams: Compliance remains at the heart of many organizational cybersecurity strategies. However, with ever-shifting regulatory landscapes, staying compliant becomes a moving target. RAG's ability to source real-time data ensures that compliance teams always have access to the latest policy changes, guidelines, and best practices. This not only facilitates adherence to current standards but also anticipates future shifts, assists with audits, and ensures that organizations remain ahead of the compliance curve. Fusing a RAG architecture with platforms like Slack amplifies its practical utility. Slack, known for its real-time communication prowess, seamlessly evolves into more than just a messaging platform in this context. Cybersecurity analysts can pose intricate queries within Slack and, almost instantaneously, receive comprehensive feedback powered by the harmonious interplay of RAG and Gen AI. This integration effectively transforms Slack into an AI-augmented chatbot-like assistant for cybersecurity professionals, always ready to provide informed insights on-demand, making it an indispensable ally in the ever-evolving cyber battlefield. Navigating the vast landscape of cybersecurity, analysts often encounter unfamiliar terminologies and techniques., analysts require tools that not only detect or inform them of threats, like CISA (U.S Cybersecurity Infrastructure Security Agency) Advisories, but also interpret and communicate them effectively. Consider a junior cybersecurity analyst named Alex, who comes across the term "Kerberoasting" while reviewing a network log. Unfamiliar with its intricacies, Alex turns to Slack to pose a query: "chat explain is Kerberoasting, using CISA." Almost instantaneously, Slack, powered by the harmonious interplay of RAG and Gen AI, provides a detailed response, cross-referencing a recent cyber advisory on the technique. It explains how attackers can exploit the Kerberos Ticket Granting Service to decipher service account passwords, potentially compromising a network. In this dynamic realm of cybersecurity, the blend of RAG and Generative AI represents more than just a technological leap. It embodies a paradigm shift, promising a future where human expertise and AI-driven precision join forces. As cyber threats continue their relentless advance, this synergy ensures that defenders are equipped with an arsenal that's not just reactive, but also profoundly insightful. No longer should analysts be submerged in a deluge of data without direction. Instead, they should be empowered, to discern, act, and preempt with unparalleled clarity and confidence. By harmoniously intertwining human discernment with AI capabilities, we should chart a path towards a future where cybersecurity is not just about defense, but about achieving a strategic advantage, paving the way for a safer, informed and a more secure digital horizon.

Keywords: cybersecurity, gen AI, retrieval augmented generation, cybersecurity defense strategies

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