Safety Consequences Research Articles

Abusive supervision and workplace safety: The uncertainty and identity perspectives

Drawing from uncertainty management theory and the social identity perspective, we examine how and when abusive supervision predicts safety behavior and safety performance. We argue that trait self- uncertainty exacerbates the adverse relationship between abusive supervision and safety behavior, and that chronic collective identity weakens the moderating effect of self-uncertainty. In a two-wave survey study of 468 manufacturing technicians (Study 1) and a three- wave survey study of 590 airline pilots using multisource data (Study 2), we found converging support for these hypotheses. Study 2 extends Study 1 by examining objective safety performance over time as a consequence of abusive supervision through the mediation of safety behavior. We discuss implications for future research and consider possible ways to reduce the safety consequences of abusive supervision.

Performance Monitoring Applied to System Supervision.

Nowadays, automation is present in every aspect of our daily life and has some benefits. Nonetheless, empirical data suggest that traditional automation has many negative performance and safety consequences as it changed task performers into task supervisors. In this context, we propose to use recent insights into the anatomical and neurophysiological substrates of action monitoring in humans, to help further characterize performance monitoring during system supervision. Error monitoring is critical for humans to learn from the consequences of their actions. A wide variety of studies have shown that the error monitoring system is involved not only in our own errors, but also in the errors of others. We hypothesize that the neurobiological correlates of the self-performance monitoring activity can be applied to system supervision. At a larger scale, a better understanding of system supervision may allow its negative effects to be anticipated or even countered. This review is divided into three main parts. First, we assess the neurophysiological correlates of self-performance monitoring and their characteristics during error execution. Then, we extend these results to include performance monitoring and error observation of others or of systems. Finally, we provide further directions in the study of system supervision and assess the limits preventing us from studying a well-known phenomenon: the Out-Of-the-Loop (OOL) performance problem.

Multiscale Spatial Density Smoothing: An Application to Large-Scale Radiological Survey and Anomaly Detection

ABSTRACTWe consider the problem of estimating a spatially varying density function, motivated by problems that arise in large-scale radiological survey and anomaly detection. In this context, the density functions to be estimated are the background gamma-ray energy spectra at sites spread across a large geographical area, such as nuclear production and waste-storage sites, military bases, medical facilities, university campuses, or the downtown of a city. Several challenges combine to make this a difficult problem. First, the spectral density at any given spatial location may have both smooth and nonsmooth features. Second, the spatial correlation in these density functions is neither stationary nor locally isotropic. Finally, at some spatial locations, there are very little data. We present a method called multiscale spatial density smoothing that successfully addresses these challenges. The method is based on recursive dyadic partition of the sample space, and therefore shares much in common with other multiscale methods, such as wavelets and Pólya-tree priors. We describe an efficient algorithm for finding a maximum a posteriori (MAP) estimate that leverages recent advances in convex optimization for nonsmooth functions.We apply multiscale spatial density smoothing to real data collected on the background gamma-ray spectra at locations across a large university campus. The method exhibits state-of-the-art performance for spatial smoothing in density estimation, and it leads to substantial improvements in power when used in conjunction with existing methods for detecting the kinds of radiological anomalies that may have important consequences for public health and safety.

An Auto-regressive Model for an Arterial Continuous Glucose Monitoring Sensor

Continuous glucose monitoring (CGM) devices have the potential to reduce nurse workload in the ICU while improving glycaemic control (GC). However, larger point accuracy errors that are inherent in these devices can lead to adverse consequences for GC performance and safety. There is a need to characterize this error, caused by drift and sensor noise, to evaluate the impact it would have on GC when using CGM devices instead of intermittent blood glucose (BG) measurements. This paper presents an auto-regressive model to model the drift and sensor noise, which can then be used to simulate further CGM sensor traces. Validation by comparison between the original clinical data and the simulated sensor data is used to provide qualitative and quantitative assurance of model accuracy. The auto-regressive model and simulated CGM sensor traces are found to represent the Glysure CGM sensor well, and capture all necessary sensor behaviors.

Abstract 2116: Combining the power of different profiling approaches to better understand the activity of kinase inhibitor drugs

Abstract Profiling of inhibitors for eventual therapeutic use is an essential part of drug discovery and development. Evaluating the in vitro potency of kinase inhibitors in a wide panel of enzyme assays is critical, not only to guiding SAR knowledge for improving drug design, but also for assessing selectivity, which has long-reaching consequences for both biological activity and safety. Evaluation of the same inhibitors in cellular models yields information on the activity of these inhibitors in a more physiologically relevant environment. However, while some selective kinase inhibitors show predictably selective profiles in cell proliferation assays, others do not. Thus, the biological context in which a kinase inhibitor functions, and the signaling networks influenced by inhibition of both the desired target and off-target activities, help to define how that inhibitor will work in a cellular setting and, ultimately, in a therapeutic application. We demonstrate the power of profiling several well-known kinase inhibitors in complementary panel assays, to predict behavior that has implications for clinical activity. The in vitro profiles of selective (trametinib, vemurafenib) and less selective (dasatinib, sorafenib) kinase inhibitors are shown and compared. With careful evaluation of their in vitro enzyme activity profiles in Eurofins’ KinaseProfiler™ panel, cellular response profiles in OncoPanel™, and predictive biomarker identification by univariate genomic analysis, a fuller picture of these inhibitors’ biological activity can be generated, and may be applied to predicting the therapeutic potential of such inhibitors. While, in some cases, clinical response is seen as expected, this kind of comprehensive analysis opens up the possibility for expanding clinical utility of an asset by potential repurposing for other indications. Collectively, this demonstrates not only the need to understand an inhibitor’s fundamental activity(ies) at its designated target(s), but also the importance of considering cellular context, when assessing its maximum potential clinical utility. Citation Format: Alastair J. King, Jesse J. Parry, Samantha C. Burkart, Lee R. Cavedine, Alyssa M. Cracchiolo, Brogan A. Epkins, Steven M. Garner, Timothy J. Sindelar, Charles R. Wageman, Stephen P. Davies, Andrew Plater, Anna M. Woodward, Usha Warrior. Combining the power of different profiling approaches to better understand the activity of kinase inhibitor drugs [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2116. doi:10.1158/1538-7445.AM2017-2116

Impact of Active Control on Passive Safety Response Characteristics of Sodium-Cooled Fast Reactors: I—Theoretical Background

The interaction of the active control system with passive safety behavior is investigated for sodium-cooled fast reactors. A claim often made of advanced reactors is that they are passively safe against unprotected upset events. In practice, such upset events are not analyzed in the context of the plant control system, but rather the analyses are performed without considering the normally programmed response of the control system (open-loop approach). This represents an oversimplification of the safety case. The issue of passive safety override arises since the control system commands actuators whose motions have safety consequences. Depending on the upset involving the control system (operator error, active control system failure, or inadvertent control system override), an actuator does not necessarily go in the same direction as needed for safety. So neglecting to account for control system action during an unprotected upset is nonconservative from a safety standpoint. It is important then, during the design of the plant, to consider the potential for the control system to work against the inherent and safe regulating effects of purposefully engineered temperature feedbacks.

Bridge Expansion Joint in Road Transition Curve: Effects Assessment on Heavy Vehicles

Properly-designed road surfaces provide a durable surface on which traffic can pass smoothly and safely. In fact, the main causes that determine the structural decay of the pavement and its parts are the traffic loads. These repeated actions can create undesirable unevennesses on the road surface, which induce vertical accelerations on vehicles, up to hindering contact between pavement and tire, with dangerous consequences on traffic safety. The dynamic actions transmitted by the vehicles depend on these irregularities: often, a bridge expansion joint (BEJ), introducing a necessary discontinuity between different materials, determines from the beginning a geometric irregularity in the running surface. Besides, some structural conditions could emphasize the problem (e.g., local cracking due to the settlement of the subgrade near the abutment or the discontinuity of stiffness due to the presence of different materials). When the BEJ is located in a transition curve, an inevitable vertical irregularity between road and joint can reach values of some centimeters, with serious consequences for the road safety. This paper deals with the analysis of a case study of a BEJ. Several test surveys were performed in order to fully characterize the effects on both vehicles and pavement. The three-dimensional representation of the pavement surface and the acceleration measurements on a heavy test vehicle were performed to analyze the joint behavior under traffic. Finally, a finite element model was implemented to evaluate the stress contribution on vehicle components induced by the vertical irregularities.

Attitudes towards attrition among UK trainees in obstetrics and gynaecology

Physician dissatisfaction in the workplace has consequences for patient safety. Currently in the UK, 1 in 5 doctors who enter specialist training in obstetrics and gynaecology leave the programme before completion. Trainee attrition has implications for workforce planning, organization of health-care services and patient care. The authors conducted a survey of current trainees' and former trainees' views concerning attrition and 'peri-attrition' - a term coined to describe the trainee who has seriously considered leaving the specialty. The authors identified six key themes which describe trainees' feelings about attrition in obstetrics and gynaecology: morale and undermining; training processes and paperwork; support and supervision; work-life balance and realities of life; NHS environment; and job satisfaction. This article discusses themes of an under-resourced health service, bullying, lack of work-life balance and poor personal support.

Multi-mode operation of principal component analysis with k-nearest neighbor algorithm to monitor compressors for liquefied natural gas mixed refrigerant processes

LNG mixed refrigeration (MR) process is usually used for liquefying natural gas. The compressors for refrigerant compression are associated with the high-speed rotating parts to create a high-pressure. However, any malfunction in the compressors can lead to significant process downtime, catastrophic damage to equipment and potential safety consequences. The existing methodology assumes that the process has a single mode of operation, which makes it difficult to distinguish between a malfunction of the process and a change in mode of operation. Therefore, k-nearest neighbor algorithm (k-NN) is employed to classify the operation modes, which is integrated into multi-mode principal component analysis (MPCA) for process monitoring and fault detection. When the fault detection performance is evaluated with real LNG MR process data, the proposed methodology shows more accurate and early detection capability than conventional PCA. Consequently, proposed k-NN integrated multi-mode PCA methodology will play an important role in monitoring the LNG process.

New Types of Electric Pedal-Assisted Cycles (EPACs) As a Form of Active Mobility: Consequences for Traffic Safety and Sustainable Mobility

Background Many countries in Europe are today grappling with the sudden appearance of many types of pedal-assisted electric bicycles on the market (different maximum speeds, and power of the motor as the primary differentiating features). An “ordinary” EPAC, also often known as a pedelec has a maximum pedal-assist speed of 25 km/h after which the motor cuts off, while faster EPACs, often referred to as speed-pedelecs can have a pedal-assist up to 45 km/h. Different countries classify these vehicles differently (e.g. as bicycles and different types of mopeds), and have resultant differing applicable legislation. Consideration of these vehicles needs to be made both to support the use of pedal-assisted electric bicycles for promoting active mobility, but also to reduce any possible negative consequences for traffic safety. Method This study focused on the traffic safety impacts of three classes of EPACs: pedelecs, speed-pedelecs and powered cycles. Different methods to collect information included a literature review in scientific and grey literature and expert interviews performed in Sweden, the Netherlands, Germany and Switzerland. Additionally, a survey was distributed to bicycle dealers in Sweden to get a better understanding of the market and of how well Swedish bicycle dealers know about existing legislation, and a workshop was held gathering industry, bicycle experts, local and regional authorities and legislative authority in Sweden. Results According to our study, faster and more powerful EPACs result in an increased risk of injury compared to normal bicycles and pedelecs. According to interviewed experts, these vehicles also seem to becoming more popular in Europe Sweden, the Netherlands and Germany have similar legislation relating to different categories of vehicles, while Switzerland legislation differs. The most important conclusion was that we need to find out and spread more knowledge about these vehicles and their traffic safety impacts. Additionally, although different categories of EPACs have different technical capabilities and will likely travel with different speeds and acceleration on roads, the vehicles all look the same to other road users. Conclusions Questions remain as to how legislation regarding helmet use and vehicle registration can be applied, and what infrastructure is best used (road or cycle lane?). At the same time, EPACs have been shown to really shift car trips to active mobility trips, and can be seen to provide a promising way to promote active mobility.

A MODELLING APPROACH TO UNDERSTAND CHARGE DISCHARGE DIFFERENCES IN THERMAL BEHAVIOUR IN LITHIUM IRON PHOSPHATE – GRAPHITE BATTERY

Lithium iron phosphate is a promising positive electrode material. It shows apparent asymmetry between charge and discharge affecting not only the electrochemical but also the thermal behaviour. Physics based models for batteries are usually parameterized for discharge behaviour, which can lead to inaccuracies in prediction of battery behaviour during charging or dynamic conditions, especially in the case of this battery chemistry. This has consequences for battery modelling and safety. A pseudo 2D electrochemical – 3D thermal model is parameterized for charging using experimental data. Substantial differences in parameters between charge and discharge are seen in the validated model. The model is used to quantify the thermal differences during charging and discharging and separate the contribution of the different battery layers. Reversible heat losses are seen to be the main cause for the difference between charge and discharge while graphite electrode are seen to have a much higher heat contribution compared to lithium iron phosphate electrode.

Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2013-2016: A Review.

Novel psychoactive substances (NPS) represent significant analytical and interpretive challenges to forensic and clinical toxicologists. Timely access to case reports and reports of adverse incidents of impairment or toxicity is imperative to clinical diagnosis and treatment, as well as to interpretation of forensic results. Delays in identifying the presence of a novel intoxicating agent have significant consequences for public health and public safety. Adverse effects of intoxications with novel cannabinoids, stimulants, hallucinogens, benzodiazepines and opioids spanning January 2013 through December 2016 as reported in emergency departments, death investigations, impaired driving cases and other forensic contexts are the subject of this review. Discussion of the chemistry, pharmacology and adverse events associated with novel drug classes is summarized and described within. Adverse effects or symptoms associated with ingestion of more than 45 NPS have been abstracted and summarized in tables, including demographics, case history, clinical or behavioral symptoms, autopsy findings and drug confirmations with quantitative results when provided. Based on these findings and gaps in the available data, we provide recommendations for future toxicological testing of these evolving substances. These include development and management of a national monitoring program to provide real-time clinical and toxicological data, confirmed analytically, on emerging drugs and their known toxidromes and side effect profiles. Increased efforts should be made to analytically confirm the agents responsible for clinical intoxications involving adverse events in emergency department admissions or hospitalizations. Evidence-based community preparedness among analytical laboratories gained through active communication and sharing of toxicological findings and trends in NPS is imperative to assist in enabling early detection of new drugs in forensic and clinical populations.

Localized shape abnormalities in the thalamus and pallidum are associated with secondarily generalized seizures in mesial temporal lobe epilepsy.

Mesial temporal lobe epilepsy (mTLE) is a common type of drug-resistant epilepsy and secondarily generalized tonic-clonic seizures (sGTCS) have devastating consequences for patients' safety and quality of life. To probe the mechanism underlying the genesis of sGTCS, we investigated the structural differences between patients with and without sGTCS in a cohort of mTLE with radiologically defined unilateral hippocampal sclerosis. We performed voxel-based morphometric analysis of cortex and vertex-wise shape analysis of subcortical structures (the basal ganglia and thalamus) on MRI of 39 patients (21 with and 18 without sGTCS). Comparisons were initially made between sGTCS and non-sGTCS groups, and subsequently made between uncontrolled-sGTCS and controlled-sGTCS subgroups. Regional atrophy of the ipsilateral ventral pallidum (cluster size=450 voxels, corrected p=0.047, Max voxel coordinate=107, 120, 65), medial thalamus (cluster size=1128 voxels, corrected p=0.049, Max voxel coordinate=107, 93, 67), middle frontal gyrus (cluster size=60 voxels, corrected p<0.05, Max voxel coordinate=-30, 49.5, 6), and contralateral posterior cingulate cortex (cluster size=130 voxels, corrected p<0.05, Max voxel coordinate=16.5, -57, 27) was found in the sGTCS group relative to the non-sGTCS group. Furthermore, the uncontrolled-sGTCS subgroup showed more pronounced atrophy of the ipsilateral medial thalamus (cluster size=1240 voxels, corrected p=0.014, Max voxel coordinate=107, 93, 67) than the controlled-sGTCS subgroup. These findings indicate a central role of thalamus and pallidum in the pathophysiology of sGTCS in mTLE.

Prevalence and incidence of drug use among college students: an 8-year longitudinal analysis

ABSTRACTBackground: Drug use among college students is associated with adverse academic and health outcomes and risks to personal safety. Objectives: This study utilized data from a longitudinal study to estimate annual prevalence, cumulative lifetime prevalence, and incidence of ten types of drug use during the eight years after college entry and the average age of onset of each drug used. Methods: Participants (N = 1,253; 52% female) were young adults who were originally enrolled as first-time, first-year students at a university in the mid-Atlantic US. Annual personal interviews gathered data about the use of seven illicit drugs and three prescription drugs used nonmedically. Annual follow-up rates ranged from 76 to 91%. Results: Marijuana was the most commonly used drug in every year of the study, with the highest annual prevalence estimates in Year 3 (47%wt). In Year 8, when the modal age of participants was 25, 29%wt used marijuana during the past year. Nonmedical use of prescription drugs was more prevalent during college than in the later years of the study. Although the prevalence of cocaine and ecstasy use was low (cumulative prevalence estimates of 17%wt and 13%wt, respectively), incidence for these drugs was particularly high in the later years of the study. Conclusion: Drug use is prevalent among college students, and drug use persists among young adults, even after many have graduated college. More attention should be directed at identifying and intervening with students at risk for drug use to mitigate possible academic, health, and safety consequences.

Frequency and Duration of Fecal Shedding of Salmonella Enteritidis by Experimentally Infected Laying Hens Housed in Enriched Colony Cages at Different Stocking Densities.

Human infections with Salmonella Enteritidis are often attributed to the consumption of contaminated eggs, so the prevalence of this pathogen in egg-laying poultry is an important public health risk factor. Numerous and complex environmental influences on Salmonella persistence and transmission are exerted by management practices and housing facilities used in commercial egg production. In recent years, the animal welfare implications of poultry housing systems have guided the development of alternatives to traditional cage-based housing, but their food safety consequences are not yet fully understood. The present study assessed the effects of different bird stocking densities on the frequency and duration of fecal shedding of S. Enteritidis in groups of experimentally infected laying hens housed in colony cages enriched with perching and nesting areas. In two trials, groups of laying hens were distributed at two stocking densities (648 and 973 cm2/bird) into enriched colony cages and (along with a group housed in conventional cages at 648 cm2/bird) orally inoculated with doses of 1.0 × 108 cfu of S. Enteritidis. At 10 weekly postinoculation intervals, samples of voided feces were collected from beneath each cage and cultured to detect S. Enteritidis. Fecal shedding of S. Enteritidis was detected for up to 10 weeks postinoculation by hens in all three housing treatment groups. The overall frequency of positive fecal cultures was significantly (P < 0.05) greater from conventional cages than from enriched colony cages (at the lower stocking density) for the total of all sampling dates (45.0 vs. 33.3%) and also for samples collected at 4–9 weeks postinfection. Likewise, the frequency of S. Enteritidis isolation from feces from conventional cages was significantly greater than from enriched colony cages (at the higher hen stocking density) for the sum of all samples (45.0 vs. 36.7%) and at 6 weeks postinoculation. Moreover, the frequency of S. Enteritidis fecal recovery from enriched colony cages at the higher hen stocking was significantly greater than from similar cages at the lower stocking density for all 10 sampling dates combined (39.4 vs. 33.3%). These results suggest that stocking density can affect S. Enteritidis intestinal colonization and fecal shedding in laying hens, but some other difference between conventional and enriched colony cage systems appears to exert an additional influence.

Food Effect on Oral Bioavailability: Old and New Questions.

Food Effect on Oral Bioavailability: Old and New Questions.

Smartwatches vs. Smartphones

This work seeks to understand whether the unique features of a smartwatch, compared to a smartphone, mitigate or exacerbate driver distraction due to notifications, and to provide insights about drivers' perceptions of the risks associated with using smartwatches while driving. As smartwatches are gaining popularity among consumers, there is a need to understand how smartwatch use may influence driving performance. Previous driving research has examined voice calling on smartwatches, but not interactions with notifications, a key marketed feature. Engaging with notifications (e.g., reading and texting) on a handheld device is a known distraction associated with increased crash risks. Two driving simulator studies compared smartwatch to smartphone notifications. Experiment I asked participants to read aloud brief text notifications and Experiment II had participants manually select a response to arithmetic questions presented as notifications. Both experiments investigated the resulting glances to and physical interactions with the devices, as well as self-reported risk perception. Experiment II also investigated driving performance and self-reported knowledge/expectation about legislation surrounding the use of smart devices while driving. Experiment I found that participants were faster to visually engage with the notification on the smartwatch than the smartphone, took longer to finish reading aloud the notifications, and exhibited more glances longer than 1.6 s. Experiment II found that participants took longer to reply to notifications and had longer overall glance durations on the smartwatch than the smartphone, along with longer brake reaction times to lead vehicle braking events. Compared to the no device baseline, both devices increased lane position variability and resulted in higher self-reported perceived risk. Experiment II participants also considered that smartwatch use while driving deserves penalties equal to or less than smartphone use. The findings suggest that smartwatches may have road safety consequences. Given the common view among participants to associate smartwatch use with equal or less traffic penalties than smartphone use, there may be a disconnect between drivers' actual performance and their perceptions about smartwatch use while driving.

Pay Matters: The Piece Rate and Health in the Developing World

BackgroundPiece rate pay remains a common form of compensation in developing-world industries. While the piece rate may boost productivity, it has been shown to have unintended consequences for occupational safety and health, including increased accident and injury risk. ObjectivesThis paper explores the relationship between worker pay and physical and emotional health, and questions the modern day business case for piece rate pay in the developing world. MethodsThe relationship between piece rate and self-reported measures of physical and emotional health is estimated using a large survey of garment workers in 109 Vietnamese factories between 2010 and 2014. A random effects logit model controls for factory and year, predicting worker health as a function of pay type, demographics, and factory characteristics. FindingsWorkers paid by the piece report worse physical and emotional health than workers paid by the hour (OR = 1.38-1.81). Wage incentives provide the most consistently significant evidence of all demographic and factory-level variables, including the factory’s own performance on occupational safety and health compliance measures. ConclusionsThese results highlight the importance of how workers are paid to understanding the variability in worker health outcomes. More research is needed to better understand the business case supporting the continued use of piece rate pay in the developing world.

Clinical immunogenicity of the d-amino acid peptide therapeutic etelcalcetide: Method development challenges and anti-drug antibody clinical impact assessments

The immunogenicity risk assessment and bioanalytical strategy for novel therapeutics should account for both unique biophysical properties and potential consequences of immunogenicity. When assessing the immunogenicity risk of etelcalcetide, a peptide agonist of the calcium-sensing receptor, we considered the potential that the d-amino acid ‘backbone’ and biotransformation of etelcalcetide could allow the drug to act as a hapten. As a consequence, we validated and implemented a surface plasmon resonance immunoassay platform with both etelcalcetide and etelcalcetide-‘carrier’ surfaces to detect anti-drug antibodies (ADA). No evidence of in-vitro neutralizing activity with surrogate controls was detected despite multiple immunization approaches and a sensitive cell-based activity assay. Therefore, a neutralizing assay was not implemented for clinical support. We conducted an integrated analysis of immunogenicity data pooled from two pivotal placebo-controlled trials to define the clinical impact of anti-etelcalcetide antibodies. While both pre-existing and developing anti-etelcalcetide antibodies were detected, we show here that they have no consequences for clinical exposure, efficacy, or safety of etelcalcetide.

A Retrospective Analysis of Efficacy and Toxicity of Bevacizumab in Combination with Chemotherapy for the Management of NSCLC in Bangladeshi Population

Background: From the perspective of Bangladesh, it has been scrutinized that patients with advanced NSCLC diseases are being treated with conventional chemotherapy which is too main stream. In addition to this general practice, reports of several clinical trials of targeted therapy i.e. use of Bevacizumab dramatically showed the longest overall survival (OS) in patients.Methods: This is a cross sectional descriptive type of observational study to analyse the responses both positive and negative of metastatic NSCLCA patients treated with Bevacizumab in combination with preferable chemotherapy regimen admitted in Anwer Khan Modern Hospital in Dhaka Bangladesh. The record of the responses of patients from January 2009 to December 2015 was assessed.Results: A total of 35 patients were observed in this study. Patients received 6 cycles of Bevacizumab in combination with platinum based chemotherapy for every three weeks as an induction therapy. Maintenance therapy was given to patients at intervals for a certain period of time. A total of 35 patients were in the assessment who were intermittently checked on a consistent interlude for a median follow up on the basis of response criteria. It was astonishing that each of the patients underwent good tolerance as well as response of Bevacizumab except of 3 which is very sporadic. Despite the enhancement in efficacy and safety consequences with platinum-based chemotherapy, this typical cytotoxic approach has reached a therapeutic plateau, with the prognosis for this clinical condition remaining deplorable.Conclusion: So addition of Bevacizumab as a targeted therapy option along with traditional chemotherapy regimen provides excellent upshot to Bangladeshi Patients diagnosed with metastases NSCLC. These represent the first evidence of improvement in treatment outcomes of chemotherapy with targeted therapies in the first-line treatment of advanced NSCLC.Anwer Khan Modern Medical College Journal Vol. 8, No. 1: Jan 2017, P 10-16