Middlesex University Research Articles

1510P - Delayed onset immune related adverse effects (IRAEs) of pembrolizumab in non-small cell lung cancer

BackgroundThe humanised PD1 antibody, Pembrolizumab, is used as monotherapy in the 1st and 2nd line setting for patients with advanced non-small cell lung cancer (NSCLC). There is a lack of data about the delayed onset of IRAEs which is important as patients can be on prolonged treatment. MethodsThis is a retrospective study of NSCLC patients treated with pembrolizumab across 4 institutions in London (North Middlesex University Hospital, Princess Alexandra Hospital, St. Bartholomew’s Hospital and University College London Hospital). IRAEs recorded on clinic letters from start of treatment until March 2019 were categorised as early (<180 days from first dose) or delayed (>180 days). Results139 patients (60% male) with advanced NSCLC were treated with pembrolizumab. Median age was 67 years and 75% (104/139) were adenocarcinoma. Median follow up was 191 days with 3 patients completing 2 years of treatment. IRAEs were reported in 53% (73/139) with patients experiencing up to five different IRAEs. 34% (40/116) of all IRAEs were delayed and colitis was the most common (54%) late IRAE, followed by skin & mucosal toxicities (Table). There were no differences in the grade of severity (P=0.37) or number of toxicities requiring permanent discontinuation of pembrolizumab between early and delayed IRAEs (P=0.31). All patients with pneumonitis, 88% with hepatitis and 87% with colitis were treated with steroids. In 88% (35/40) of patients with delayed IRAEs, toxicities resolved or became asymptomatic. All but 2 cases of endocrinopathy required chronic hormone replacement therapy. 19 cases of treating through toxicity with maintenance low dose corticosteroid were identified. Of these, only one developed progressive disease with the remainder continuing to receive pembrolizumab.Table1510PTableIRAEsEarlyDelayedGeneral e.g. Fatigue172Rash/Pruritis2311Colitis1112Hypo/Hyperthyroidism73Hepatitis53Pneumonitis53Hypophysitis22Arthritis13Blepharitis/Conjunctivitis31Polymyalgia/Myositis21Nephritis01TOTAL76 (66%)40 (34%) ConclusionsDelayed onset IRAEs are common and exhibit a different profile of toxicities compared to early onset. They are no more severe than early IRAEs and can be effectively managed to allow patients to continue their treatment. Legal entity responsible for the studyNorth Middlesex University Hospital, Princess Alexandra Hospital, St. Bartholomew’s Hospital and University College London Hospital. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Evaluating students experiences using a virtual learning environment: satisfaction and preferences

Virtual learning environments (VLEs) are web-based software systems that enable students to interact with their teachers and classmates, access learning resources without restriction of time and place, and use cutting-edge Information and Communication Technologies. Nevertheless, VLEs are costly to develop and maintain. Clearly, many features of VLEs may not be as useful to learners as designers and stakeholders might think, resulting in waste of resources. With this possibility in mind, the purpose of this study was to evaluate the effectiveness of the features of the VLE employed at Middlesex University. To that end, first, a scale with 11 items and 3 sub-dimensions was developed and tested through exploratory and confirmatory factor analyses to identify student perceptions of the (1) benefit, (2) satisfaction, and (3) guidance, aiming at identifying student views on how beneficial the system was, whether they were satisfied with it, and how they perceived the guidance provided through it, respectively. Next, the scale was administered to a sample of 278 students to determine whether the perceptions differed depending on campus location, and grade level. Finally, questions were also asked to pinpoint the features of the VLE that the students found most useful and beneficial. Data were analysed through ANOVA, correlation, and rank analyses. Results show that the students’ perception of the VLE did not significantly differ based on campus location or grade level. Two features of the VLE—lecture capture and key concept videos—were the most beneficial resources for the students, whereas “lecture capture with PowerPoint slides and audio only,” discussion forums, and chat rooms, were not preferred. The students were not much enthusiastic to have access to blogs, audio/video conferencing facilities, wikis, or chat either.

Educational Marketing Mix and Student Satisfaction in Private Universities in Dubai

Marketing of higher education has become a strategic competitive tool due to the emergence of private universities. The purpose of this paper is to identify the important factors that influence students’ satisfaction at the higher education institutions (HEIs) and to measure the level of students’ satisfaction with respect to the educational marketing mix (EMM) being offered by the universities. Data was collected through questionnaires from randomly selected 324 students from Middlesex University and Wollongong University in Dubai. SPSS program was used to analyze the data. The study found that ‘People’ was the most important factor that influence students’ satisfaction level while ‘Program’ was the least. The satisfaction level of students was high; and this indicates the good performance of the universities in Dubai. The paper recommended conducting a further research that compares between student satisfaction in both public and private universities. Keywords: Student Satisfaction, Educational Marketing Mix, Higher Education, Student’s Choice, Dubai. DOI : 10.7176/EJBM/11-24-15 Publication date : August 31 st 2019

Editorial introductions

Editorial introductions

‘Wright-ing the Somatic: Narrating the Bodily’

This special issue emerged from the two-day Symposium Wright-ing the Somatic: dancing & writing Professional Practice that we curated at Middlesex University in August 2016 https://vimeo.com/274485377 . This symposium was the first in a trilogy we have subsequently curated (Narrating the Somatic: gathering voices, sharing practices https://vimeo.com/274482762 in Feb 2018, and the forthcoming Queering the Somatic: interrupting the narrative in November 2019). The Symposiums have been clustered around an interest in how we move through, between, and across the communication of dance practices in order to share our processes for, and understanding of, the moving body. The Symposiums respond to calls to find resonant ways to share the embodied/emplaced perspectives and knowing(s) that the somatic practice of dance gives to artist-scholars as they engage with dance, become dance, or witness dancing. [Editorial]

Adoption of a single-page best practice algorithm improves outcomes in patients with acute atrial fibrillation: a multi-disciplinary quality improvement project

Introduction: In response to a serious incident involving an atrial fibrillation (AF) associated stroke, a quality improvement project was established to examine and improve all aspects of patient care for individuals presenting with acute AF to London’s North Middlesex University Hospital (NMUH).Materials and Methods: The presenting complaint was examined for 2,105 consecutive medical admissions to identify 100 patients (4.7%) with acute AF. For each patient, 36 indices and performance indicators were collected and analysed against international standards. Deficiencies were identified in documentation, risk stratification, anticoagulation and arrhythmia management decisions. With cross-specialty collaboration, a single-page AF management algorithm was established using sequential PDSA methodology, and a further 100 consecutive patients with acute AF were analysed prospectively. A composite end-point of adverse outcomes (AF-associated readmission, stroke, cardiac death or major bleeding) was examined.Results: Algorithm implementation significantly reduced the proportion of patients exposed to unnecessary stroke risk (30% vs 4%, p<0.0001); improved identification and documentation of thromboembolic potential (50% vs 88%, p<0.0001), reduced incorrect drug decisions (12% vs 2%, p=0.01), reduced contraindicated rhythm control (8% vs 0%, p=0.007), and increased direct oral anticoagulant (DOAC) prescribing (38% vs 86%, p<0.0001) over warfarin. After a mean follow-up of 248 +/- 91 days, there was a significant reduction in composite adverse outcomes (22% vs 6%, p=0.0018).Conclusion: Using established quality improvement methodology and cost-neutral multi-disciplinary expertise, this novel management algorithm has significantly improved the quality and safety of care for patients with acute AF at NMUH.

Support for an adoptive family with a disabled child ─ examples of foreign solutions

The aim of the paper is to present comprehensive and innovative solutions used in the UK and the Flemish part of Belgium in the support of families adopting a child with disabilities. The material was collected on the basis of in-depth interviews conducted with Dr Lucille Allain from Middlesex University (UK) and Dr Prakash Goossens from Fracarita International, study visits, as well as analysis of documents available in the informational materials of ministries and non-governmental organizations. The tendencies present in the practice of both countries and selected forms of support, such as adoption leave with remuneration, financial assistance, accommodation adjustment, provision of care and therapy and help in becoming independent provided directly to people with disabilities were described. The analysis of the examples of both countries shows that families who have adopted disabled children can benefit from the privileges and allowances available for families with a disabled child (e.g. allowance for disabled persons, care allowance) and additional benefits resulting from the adoption of a child (e.g. adoption leave, Adoption Support Fund). In both countries, comprehensive and personalized solutions are implemented, including health, care, educational and therapeutic services, planned based on a multidisciplinary diagnosis. In addition, non-governmental and private organizations, apart from the state institutions, are systemically included in implementation of these solutions. In both countries, a number of practical solutions (e.g. personal budget) have been adopted to empower people with disabilities and their independent living in the local environment, ensuring, if needed, provision of the individualized support.

Impacts of maltreatment in adolescence

The aim of this focus is to bring together the first of a lifespan series of papers from the Centre of Abuse and Trauma Studies (Middlesex University) to extend the understanding of the long term impacts of child maltreatment in different age groups...

Exploring Analytical Model to Performance Optimization for Mobile Application Using End-to-End Network Slicing in Cloud-Based Vehicular Networks

Today, many large usages of cloud-based vehicular networks and applications have rapidly increased. This rapid increase causes the requirement of systems to be reliable to share their resources without delay in order to ensure a better quality of service (QoS) for mobile users. Hence, network slicing is considered one of the key concepts to enhance QoS in 5G networks. At present, new architectures attempt to provide support for end-to-end server quality mechanisms. A key mechanism of network slicing supported by such modern architectures is able to either handover to better network or migrate services closer to the users as they move around. This can be done by advanced handover and server localization techniques. These sorts of advanced handover and server localization help to maintain the QoS for mobile application in heterogeneous environments. In order to obtain QoS measurements and get the network conditions in a specific area, a cloud-based vehicular network slicing management framework is proposed using an analytical modeling approach. The analytical model results obtained considering real scenarios from a Middlesex University VANET testbed. Using this framework, the mobile users will make a decision on which situation is better suited to obtain the service based on the latencies as well as queuing capacities of the networks.

Multimodality, visual methods and lived experience

Paula Reavey is Professor of Psychology and Mental Health at London South Bank University. This interview took place at the Qualitative Methods in Psychology (QMiP) and History &amp; Philosophy of Psychology (HPP) joint 2019 conference at Cardiff Metropolitan University, where Paula led a workshop on visual methods and delivered a keynote speech. Best known for her pathbreaking work on visual methods and multimodality (Reavey, 2011), she has also distinguished herself with her innovative, interdisciplinary work in the field of mental health, space and embodiment. Susanne Langer (Senior Lecturer in Psychology, MMU) and Deborah Bailey-Rodriguez (Lecturer in Psychology, Middlesex University), who are both associate editors of the QMiP Bulletin asked the questions.

Flipped Classroom Versus Traditional Teaching and Learning from Students’ Perspective at Interdisciplinary Level, Case: Middlesex University Mauritius

Flipped Classroom Versus Traditional Teaching and Learning from Students’ Perspective at Interdisciplinary Level, Case: Middlesex University Mauritius

Living in Space and Young Innovators Programme

SMASHfestUK with: Middlesex University, The Refinery, Deptford Green School, Haberdashers' Aske's Hatcham College Sixth Form, Christ the King Sixth Form, AstroCymru, Monster Paw Games, Little Inventors, University of Greenwich, Science and Technology Facilities Council, Royal Academy of Engineering, UK Space Agency

FLIPPED CLASSROOM TEACHING IN HIGHER EDUCATION: AN ASSUMPTION OR AN INEVITABLE TOOL

The conventional face-to-face lectures was effective decades ago in Higher Education. However, its efficacy is being questioned, nowadays, for the Generation Z and Millenials. The latter are technology-savvy and ‘always connected.’ It is becoming more and more challenging to retain students’ attention using traditional lectures as they are ‘known’ to be multi-tasking. Often, when one would be delivering a lecture, one can notice students getting bored, or diverted by their smartphones. This paper addresses a potential way of increasing students’ engagement in class by introducing Flipped classroom in Higher Education, particularly for the BA (Hons) Advertising, Public Relations and Media at the Middlesex University. Flipped classroom was chosen as recent studies (Steen-Utheim and Foldness, 2018; Gilboy et al, 2015; Pierce and Fox, 2002) had proved beneficial. A simple model of Action Research methodology (Dan, 1996), that consisted of planning, acting, observing and reflecting, was used. Video lectures were sent to students, for them to watch outside the classroom setting. During the actual face-to-face time, they were given practical exercises so that they had more hands-on experience. An observation of the practical session followed by a reflection on the feedback from the student lead to some critical findings. Most of them enjoyed the flipped classroom as they were able to watch the videos ‘several times’ and they learnt ‘innovatively’. Nevertheless, the major drawback was that there were some students who were not watching the video lectures at home. These led to future scope of research in the field.

The Disoeuvre: an Argument in 4 Voices (WASL Table); version 4:27

The Disoeuvre: an Argument in 4 Voices (WASL Table); version 4:27 contributes to Felicity Allen’s long-term project, The Disoeuvre. Allen first invented, named and explored the concept of The Disoeuvre in her PhD, “Creating the Disoeuvre: Interpreting Feminist Interventions as an Expanded Artistic Practice in Negotiation with Art’s Institutions”. The four voices of The Disoeuvre: an Argument in 4 Voices (WASL Table); version 4:27 work across and down each page in four strands: (1) photograph, (2) diaristic/album note, (3) didactic argument shifting through multiple pronoun positions from pronounced objectivity to pronounced subjectivity, and (4) quotations from texts read by the artist who has given herself permission to make no more than 27 variations of this work. In 1978, Allen was a founder member of the Women Artists Slide Library (WASL) in London, and decades later her Middlesex University supervisors suggested that her WASL work might be presented in her PhD (completed in 2016). However, she and the other early founders of the library had preserved hardly any documentation of their activism. The table on which she continues to work, originally passed on to her for WASL in 1978 but too big for WASL’s first public office in 1982, is perhaps an equivalent to documentation; staying with her throughout her career, the table also suggests undercurrents in her own Disoeuvre.

The unexpected benefits of reflection: a case study in university-business collaboration

Purpose The purpose of this paper is to present an overview of the development process and outcomes from a six-year collaboration between Halifax Bank (part of the Lloyds Banking Group) and Middlesex University between 2010 and 2016 in the UK. The collaboration involved the construction of work-integrated higher education programmes that were, from the outset, predicated on clear return on investment criteria for the Bank. One unexpected outcome from the collaboration was the emergence of critical reflection as a valued business benefit that, it is argued, has the potential for significant cultural change within the organisation. Design/methodology/approach This case study discuses how “productive reflection” can lead to an integrated approach to organisational learning. The study is located in the context of Halifax’s specific organisational objectives established following the banking crash of 2008. Quantitative and qualitative evidence is considered to illustrate the extent to which the “return on investment” criteria established by Halifax have been achieved. Findings The case study indicates that the challenging business context of the financial crash of 2008 provided the impetus for a sustained collaborative development that allowed the potential pitfalls of restricted learning opportunities to be addressed resulting in an integrated approach to organisational learning. In addition to the organisation’s return on investment criteria being met, there is evidence that the work-integrated approach has raised the prospect of productive reflection becoming part of an emerging learning culture. Originality/value The scale and sustained period of the university-business collaboration is unique and provides valuable insight into how an organisation’s learning culture can be affected by a work-integrated approach. In demonstrating the perceived business value of productive reflection, the case presented illustrates how learning can start to become considered as a normal aspect of working life.

Study reveals home music impact

A group of researchers from Middlesex University and Goldsmiths University of London have developed a new tool to assess the influence of the home musical environment in early childhood.

Be as Upright as Possible When Squatting: Reply

London Sport Institute, Middlesex University, London, United Kingdom Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

The use of MOOCs in social enterprise education: an evaluation of a North–South collaborative FutureLearn program

This study contributes to the literature on technology and entrepreneurship education, and in particularly to the discussion on massive open online courses (MOOCs) in social enterprise education. Using the Freeth/Kirkpatrick's evaluation model, this paper examines the effectiveness of a social enterprise MOOC program – The FutureLearn (FL) Social Enterprise Program – created in a collaboration between Middlesex University, Living in Minca Ltd in London and the Jindal Centre for Social Innovation and Entrepreneurship at O.P. Jindal Global University in Delhi, India. To date, there is no evidence of previous work evaluating the effectiveness of a MOOC in social enterprise education, particularly one designed in collaboration between institutions from the global North and South countries. Our findings revealed that the FutureLearn Social Enterprise Program was perceived as positive, and we identified evidence of changes in behavior, as well as, benefits and opportunities for both individuals and organizations. The results provide insights into alternative forms of collaboration for the creation and implementation of enterprise education courses, and specifically for collaborations in the design of social enterprise MOOC programs done between global North and South countries.

Exploring the experiences of trainee mental health workers: moving from theory to practice

PurposeThe Trainee Mental Health Worker (TMHW) Programme is an initiative developed collaboratively between Middlesex University and local NHS Mental Health Trusts in response to national workforce requirements for flexible clinical personnel. The purpose of this paper is to explore the experience of this new category of mental health workers and to address the feedback given by previous cohorts of TMHWs.Design/methodology/approachThis qualitative study comprised of three focus groups who met over their year-long training. In total, 20 participants self-selected from a population of 60 TMHWs, and their expectations of the TMHW role prior to starting the programme and following each of two practice placements were explored.FindingsThe thematic analysis identified five domains: identity, career strategy, functioning in the system, status and responsibility; the TMHWs demonstrated notable changes in their attitude and behaviour as they progressed. The findings demonstrate the challenges of integrating a new type of workforce into the rigid systems of the health care service.Research limitations/implicationsFocus groups by their nature are not always representative, and this programme is limited in its number of students.Practical implicationsThis study has led to a greater understanding of the experiences of trainees across a variety of clinical settings.Social implicationsThe results from this study will assist employing trusts in recruitment and retention by helping them to understand this phenomenon and the role itself.Originality/valueThis study’s value lies in the insight it offers into the experience of a new kind of worker moving from novice status to practitioner outside the constraint of a professional registration.

Incorporating motivational interviewing into rheumatology care.

Deborah Palmer, Advanced Nurse Practitioner, North Middlesex University Hospital, and Yasser El Miedany, Consultant Rheumatologist, discuss ways to close the gap between disease control and patient empowerment.