Organizational Flexibility Research Articles

Управление метагеосистемами региона на основе идентификации, анализа и мониторинга рисков

The article presents a solution to the problem of introducing spatial data infrastructures (SDI) and geoportal systems as a tool for solving the problem of integration, distribution and visualization of geospatial information. The role of geoportals is proved as a tool to support managerial decision-making in the field of ensuring the conditions for sustainable development. It is proposed to organize the SDI implementation process on the basis of identification, analysis and monitoring of risks. The risk management process can be integrated into the process of iterative implementation and use of the SDI as an input to the requirements analysis stage. The results of assessing the strength of risk events make it possible to form a set of controllable risks in the management of territorial systems. In this case, the results of the risk assessment stage become the starting point in solving the problem of designing functional and qualitative requirements for the infrastructure of spatial data as a tool for managing spatially distributed systems. The solution of the problem of optimizing the processes of using spatial data for solving management problems should be focused on achieving the target effects of SDI, while assessing and controlling the resource intensity and complexity of management processes. It is shown that an important feature of the approach is the focus on flexible organization of the process of developing geoinformation systems. The solution to the problem of effective iterative development of SDI is possible based on the observance of the SOLID principles, which determine the expediency of implementing the basic principles of object-oriented programming and design.

Methodology for Constructing a Knowledgebase for Plant Gene Regulation Information.

The amount of biological data is growing at a rapid pace as many high-throughput omics technologies and data pipelines are developed. This is resulting in the growth of databases for DNA and protein sequences, gene expression, protein accumulation, structural, and localization information. The diversity and multi-omics nature of such bioinformatic data requires well-designed databases for flexible organization and presentation. Besides general-purpose online bioinformatic databases, users need narrowly focused online databases to quickly access a meaningful collection of related data for their research. Here, we describe the methodology used to implement a plant gene regulatory knowledgebase, with data, query, and tool features, as well as the ability to expand to accommodate future datasets. We exemplify this methodology for the GRASSIUS knowledgebase, but it is applicable to developing and updating similar plant gene regulatory knowledgebases. GRASSIUS organizes and presents gene regulatory data from grass species with a central focus on maize (Zea mays). The main class of data presented include not only the families of transcription factors (TFs) and co-regulators (CRs) but also protein-DNA interaction data, where available.

COVID-19-related uncertainty: fertility staff experiences of its sources, processing, responses, and consequences.

What are fertility staff experiences of managing COVID-19-related uncertainty after fertility clinics re-opened? Staff identified many COVID-19-related uncertainty sources, the main being the COVID-19 health threat, to which most clinics and staff responded effectively by implementing safety protocols and building strong collaborative environments that facilitated the acquisition and application of information to guide organizational responses during a rapidly changing situation, but with costs for staff and patients. COVID-19 created significant disruption in fertility care delivery, including temporary clinic closure and treatment delay. Patients experienced significant distress, including concerns regarding the impact of COVID-19 and its vaccine on fertility and pregnancy. Multiple studies show that COVID-19-related uncertainty is a major threat and burden for healthcare staff, but this has not been investigated in reproductive medicine. A cross-sectional, online mixed-method bilingual (English, Spanish) survey (active 25 January-23 May 2021) was distributed to fertility staff across the UK, Latin America, and Africa. Eligibility criteria were being a healthcare worker at a fertility clinic that had re-opened since its COVID-19-related closure, 18 years of age or older and ability to respond in English or Spanish. The survey was created in English, translated to Spanish, made available using Qualtrics, and consisted of four parts: (i) background and physical and mental wellbeing, (ii) open-ended questions regarding COVID-19 uncertainty, (iii) appraisal items regarding perceptions and impact of uncertainty, and (iv) changes in the workplace. The British Fertility Society and the African Network and Registry of Assisted Reproduction circulated the survey across the UK and Africa via email hyperlinks and social media platforms. The Argentinian Society of Reproductive Medicine and the Latin American Network of Assisted Reproduction distributed the survey across Latin America in the same manner. Thematic analysis was performed on responses from open-ended question to produce basic codes. Deductive coding grouped sub-themes across questions into themes related to the theory of uncertainty management. Descriptive statistics and repeated measures analysis of variance were used on the quantitative data. In total, 382 staff consented to the survey, 107 did not complete (28% attrition), and 275 completed. Sixty-three percent were women, 69% were physicians, and 79% worked at private clinics. Thematic analysis produced 727 codes, organized in 92 sub-themes, and abstracted into 18 themes and one meta-theme reflecting that uncertainty is stressful but manageable. The types of uncertainties related to the threat of COVID-19 (20.6%), unpredictability of the future (19.5%), failure of communication (11.4%), and change in the workplace (8.4%). Staff appraisals of negative and positive impact of uncertainty were significantly lower (P < 0.001) than appraisals of stress, controllability, and having what it takes to cope with uncertainty. To process uncertainty, clinics focused on information dissemination (30.8%) and building a collaborative work environment (5.8%), while staff employed proactive coping (41.8%) and emotional and cognitive processing (9.6%). Main organizational responses consisted on work restructuring (41.3%, e.g. safety protocols), adapting to adversity (9.5%, e.g. supplies, preparation), and welfare support (13.8%), though staff perceived lack of support (17.5%). Negative consequences of uncertainty were worse self- and patient welfare (12.1%) and worse communication due to virtual medicine and use of mask (9.6%). Positive consequences were work improvements (8.3%), organizational adaptation (8.3%), improved relationships (5.6%), and individual adaptation (3.2%). Ninety-two percent of participants thought changes experienced in the workplace due to COVID-19 were negative, 9.1% nor negative nor positive, and 14.9% positive. Most staff thought that their physical (92.4%) and mental health (89.5%) were good to excellent. Participants were self-selected, and most were physicians and embryologists working at private clinics based in Latin America. The study did not account for how variability in national and regional COVID-19 policy shaped staff experiences of uncertainty. To address COVID-19 uncertainty, clinics need to promote collaborative (clinic, staff, patients) processing of uncertainty, clear team coordination and communication, organizational flexibility, and provision of support to staff and patients, with an emphasis on cognitive coping to decrease threat of and increase tolerance to uncertainty. Uncertainty management interventions bespoke to fertility care that integrate these components may increase clinics resilience to COVID-19-related and other types of uncertainty. Cardiff University funded this research. S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International, and Gedeon Richter, and grants from Merck Serono Ltd. F.Z.-H. reports speaker fees from Ferring Pharmaceuticals A/S and that he is a chair of the Latin American Registry of ART, Committee of Ethic and Public Policies, and Chilean Society of Obstetrics and Gynecology and a vice chair of the International Committee for monitoring ART. K.A., N.C., G.B., and J.B. report no conflict in relation to this work. N/A.

IT Capabilities, Strategic Flexibility and Organizational Resilience in SMEs Post-COVID-19: A Mediating and Moderating Role of Big Data Analytics Capabilities.

This research provides a novel progression to the existing research about big data analytics capabilities (BDAC) by investigating and measuring its influence on organizational resilience and strategic flexibility. Toward that end, 400 different SMEs in Saudi Arabia were approached. Data were collected via questionnaire. Results confirm that the ability to handle big data analytics totally mediates the relationship between IT capabilities and strategic flexibility. Big data infrastructure flexibility has a negative effect on strategic flexibility. Big data personal expertise not only negatively affects the relationship between IT capabilities and strategic flexibility but also stimulates and reinforces the relationship between strategic flexibility and organizational resilience. The critical pathway developed and tested the trend to make the organization as an immune system able to make the best of the worst. This implies the urgent need for policymakers and managers to adopt and comprehend the concept of BDAC instead of IT capabilities to define oriented plans specifically formulated for stimulating strategic flexibility and organizational resilience. By adopting the proposed model, SMEs can interact more effectively internally and externally.

Motherhood and Mentoring Networks: The Unequal Impact of Overwork on Women’s Workplace Mentoring Networks

Using longitudinal data on 1,711 female managers in South Korean firms, this study examines how time, culture, and workplace structure affect women’s mentoring networks. Our analyses demonstrate that women with fewer time constraints and who work longer hours are more likely to have a male mentor. However, when motherhood status is considered, work hours and time constraints are not significant predictors of having a mentor for mothers. Rather, organizational flexibility and work-life policies influence whether mothers have mentors, but those mothers who work long hours and display minimal domestic commitments benefit the most from the availability of flexibility. Findings suggest that long work hours and time constraints affect women’s marginalization in workplace relationships, and corporate practices mitigating work hour expectations can alleviate this impact for women with children.

The COVID-19 pandemic and food assistance organizations' responses in New York's Capital District.

This research examines the impact of COVID-19 on food security in New York state and the innovative approaches employed by food assistance organizations to help address the changing and increasing demand for their services from March 2020 to May 2021. We examine the case study of New York's Capital District region through a qualitative approach. We find that there was a sharp increase in utilization of emergency services during spring of 2020, which tapered off in the summer and fall of 2020 but remained above the levels of need seen the previous year. Food assistance organizations quickly adapted to the increased demand for their services and changing conditions to reduce gaps in local food distribution chains: They reorganized and tapped into new sources for volunteers, networked with public and private organizations, and coordinated work with other regional food pantries for maximum impact. The flexibility of food assistance organizations to address the disruptions brought about by the COVID-19 pandemic highlights their critical roles in the U.S. food security environment. While organizations are aware of their shortcomings, constraints, and overall role in the American food system, the majority also expressed that the pandemic presented an opportunity to treat a complex problem together and to enact change. Several stakeholders also shared their hope that strengthening their networks and innovations may facilitate post-pandemic recovery, bring about systemic changes to address root causes of food insecurity, and better serve the communities most vulnerable to hunger and service disruptions.

Governance and Organisational Flexibility at the Junction of African MFIs’ Sustainability Issues

It is unfortunate to acknowledge the phenomenon of Africa’s Microfinance Institutions (MFIs) bankruptcies only a few years after their creation. The instability of technical, economic, commercial and cultural environments, which play an important role on MFI’s sustainability, explains this recurrence of bankruptcies. These crises, both in West and Central Africa, have highlighted the role of organisational flexibility in MFIs’ sustainability. This paper aims at examining the effects of flexible governance that contribute to Economic and Monetary Community of Central Africa’s (EMCCA) MFIs sustainability. In this regard, we have chosen qualitative method which is a multi-modal research including a naturalist interpretation approach emphasising on entities’ qualities. We have carried out semi-directive interviews among (14) MFIs in Cameroon, Congo, Gabon and Chad. We have made use of data collected with NVIVO to carry out content analysis process. The study’s results show that EMCCA’s MFIs sustainability is a matter of the flexibility of organisational dynamism of governance mechanisms, innovations and technological opportunities.

Scandiatransplant acceptable mismatch program—10 years with an effective strategy for transplanting highly sensitized patients

In March 2009, the Scandiatransplant acceptable mismatch program (STAMP) was introduced as a strategy toward improving kidney allocation to highly sensitized patients. Patients with a transplantability score ≤ 2% are potential candidates for the program. Samples are analyzed and acceptable antigens (HLA-A, B, C, DRB1, DRB3/4/5, DQB1, DQA1, DPB1, DPA1) are defined by the local tissue typing laboratory and finally evaluated by a steering committee. In the matching algorithm, patients have the highest priority when the donor's antigens are all among the recipient's own or acceptable HLA antigens. In the period from 2009 to 2020, we have transplanted 278 highly sensitized kidney patients through the program. The graft survival of the STAMP patients was compared with 9002 deceased donor kidney-transplanted patients, transplanted in the same time period. The 10-year graft survival was 73.4% (95% CI: 60.3-90.0) for STAMP and 82.9% (95% CI: 81.6-84.3) for the reference group. (p= .2). In conclusion, the 10-year allograft survival demonstrates that the STAMP allocation algorithm is immunological safe. The program is continuously monitored and evaluated, and the introduction of matching for all HLA loci is a huge improvement to the program and demonstrate technical adaptability as well as clinical flexibility in a de-centralized organization.

Model SOP IT Service Desk Berdasarkan Framework ITIL V3

IT services are critical to organizational success because of their ability to increase organizational competitiveness and flexibility. In managing quality IT services, IT Service Management (ITSM) is needed. ITSM is the implementation and management of quality IT services to meet business needs. To guarantee and support ITSM, an IT Service Desk (ITSD) function is required. ITSD is a functional unit consisting of a number of staff who are responsible for handling various IT service activities. The function of ITSD is to record and manage and resolve all incidents, problems, IT service requests, and IT service access rights by providing a central point of contact. Therefore, ITSD becomes very important in ensuring and supporting the management of IT services. In carrying out this ITSD function, it is necessary to develop standard operating procedures (SOPs) so that the implementation of work is more structured and measurable. Based on this, the researcher created an ITSD SOP model based on the ITIL V3 framework with a case study in the Pengembangan dan Penerapan Teknologi Informasi (PPTI) section at Universitas Dinamika. This ITSD SOP model produces 3 SOP which includes recording requests and complaints for IT services, analysis and actions, reviewing actions with descriptions of 7 Work Instructions, and 26 Work Records. This ITSD SOP model can serve as a guide in recording, managing, and resolving requests and IT service access management as well as problem-solving both incidents and IT service problems for the organization.

Early Intervention Services for youth at Clinical High-Risk for Psychosis: The Reggio Emilia At-Risk Mental State (ReARMS) experience

Between 2012-2017, 300 individuals completed the baseline assessment, 205 of them met criteria for CHR-P or First-Episode Psychosis, and 154 accepted the enrolment in the ReARMS for treatment and follow-up. Empirical contributions based on the ReARMS dataset involved the structure of assessment and intervention, the Italian validation of ad-hoc instruments of assessment, clinical features of enrolled individuals (anhedonia, aberrant salience, suicidality and metacognition) and longitudinal trajectories in terms of outcome and response to treatments. age between adolescence and young adulthood, being effective in intercepting an early and usually enduring psychopathological suffering, independently from the transition to psychosis. Rather than being rigidly focused on homotypic trajectories from CHR-P to psychosis, increasing evidence on heterotypic trajectories starting from CHR-P to multiple psychopathological outcomes suggest to update early intervention services toward increased organizational flexibility, for example in therapeutic options.

Can we help older adults to feel at home in a residential care facility? What we can learn from health care personnel.

Most older adults wish to age in place—living, and ultimately dying, in their own home. However, at some point, some older adults need to move to a residential care facility (RCF), such as a nursing home or an assisted living facility, due to the worsening of their physical and/or cognitive conditions, the loss of family relationships, or the inability of their family members to take care of them. Moving to an RCF is a critical moment in an older adult’s life, as it separates them from significant people and objects in their life, disrupts their habits, and breaks their connection with their local community. These changes can negatively affect the physical, psychological, social, and spiritual well-being of older adults if they fail to create a new home in the novel environment.1 For older adults, feeling a sense of being “at home” is a multifactorial phenomenon influenced by several psychological, social, and built-environmental aspects.2 Health care personnel who provide care in RCFs, and the directors and managers responsible for organization of care and resource allocation, have an important role in fostering the sense of “home” for older adults residing in RCFs, as highlighted by the qualitative systematic review published in this issue of JBI Evidence Synthesis.3 This review synthesized the evidence derived from 7 qualitative studies from Europe and North America that explored the experiences of health care personnel in promoting a sense of home for older adults in RCFs using a meta-aggregative approach, which is the method endorsed by JBI for qualitative synthesis. This approach enables the creation of generalizable statements in the form of recommendations to guide practitioners and policy-makers.4 We learned from this review that physical factors (eg, building structure, design), work organizational features, and care culture of the RCFs, as well as national, regional, and local regulations, can influence the creation of a sense of home in older adults residing in these settings.3 If we want to make older adults feel at home in a care facility, we must create a home-like environment and not a hospital-like environment. This involves offering large, private rooms with en-suite bathrooms for each resident and common areas that resemble domestic spaces, such as private or common kitchens, television lounges, sitting rooms, dining rooms, and accessible outdoor spaces. We should allow older residents to bring furniture or other personal artefacts to foster familiarity with the place and continuity of life. These environmental standards should be included in national and local regulations and guidelines, along with safety standards to guarantee that the creation of a sense of home is assured in all RCFs. Moreover, we should replace a hospital-like work model with a home-like work model, which includes flexible organization of daily activities that respects residents’ autonomy, freedom of choice, and personal habits. Participation in domestic and recreational activities should be promoted according to residents’ preferences to make them feel like active members of the facility community. The maintenance of meaningful, reciprocal relationships between residents and family members, staff, and other residents creates a sense of familiarity and belonging to a larger community. We should embrace a person-centered rather than a patient-centered care model in RCFs. Residents should not be thought of as sick patients requiring medical care and assistance, but as persons with wishes and the potentiality of further growth who want to live a meaningful life, regardless of physical or cognitive impairments. If we want to make older adult residents feel at home in RCFs, we must not only provide a shelter, but we must listen to the experiences of health care personnel and help create an ambience that promotes meaningful relationships, a sense of purpose, and a fulfilling community. This review3 presents the available evidence on the sentiments of health care personnel regarding older people aging in RCFs. Although the level of confidence in the findings was classified as low due to dependability and credibility issues, evidence from this review seemingly reflects many of our own views about getting older and living our best lives, and supports a realistic and empathic way forward.

Current Situation and Hotspot Analysis of Blended Teaching based on Bibliometrics

With the rapid development of information technology and data science, blended teaching has received widespread attention. It has both the dual advantages of offline traditional teaching and online learning, and its flexible organization, diversified resource forms and interactive ways are favored by many educational researchers at home and abroad. In order to understand the development status and hot spots of blended learning more intuitively and clearly, this paper takes the research papers of blended learning in the recent ten years from the Web of Science database as samples to quantitatively analyze the literature quantity distribution and development situation of blended learning. The bibliometric tool CiteSpace was used for visual analysis, and the evolution trend of blended teaching research content was sorted out by keyword co-occurrence analysis and cluster analysis. This paper further summarizes the development hotspots of blended learning.

A more equal deal? Employer-employee flexibility, gender and parents' work-family tensions in Sweden.

The potential of flexible scheduling to alleviate work-family tensions and replace female part-time work has not been thoroughly explored. Specifically, research has not acknowledged that employees' schedule control may be conditioned by organizational demands for availability and commitment. We examine the links between flexibility and gendered patterns of work-family reconciliation by considering how work arrangements balance employer demands and employee control and how they relate to work-family tensions. Using mixed-methods, we combine a survey of Swedish parents (n = 2320) with interviews of survey respondents (n = 40). First, we identify clusters of flexible work arrangements and explore differences between mothers and fathers. Second, we analyze the relationship between flexible work arrangements and work-family tensions. Finally, the qualitative data are used to explore how flexibility/lack of flexibility enter into parents' work-family tensions and negotiations. Three types of flexible work arrangements are found. Boundaryless jobs, which combine high levels of control with high requirements for organizational flexibility, are more common among fathers and highly educated. Confined jobs have low levels of both employee- and employer-oriented flexibility, but high demands, and are common among mothers and in female-dominated workplaces. Despite higher levels of control, boundaryless jobs are not associated with less work-family conflict. In malleable jobs, control is relatively high and demands low and work-family tensions are less noticeable. Employer- and employee-oriented flexibility go hand in hand, but work arrangements differ radically between groups. High flexibility does not alleviate work-family tensions, and part-time work remains an important work-family strategy for mothers.

Lean and Industry 4.0: A bibliometric analysis, opportunities for future research directions

Lean is a philosophy that helps organizations develop a continuous improvement culture by eliminating waste and minimizing the use of resources. On the other hand, Industry 4.0 is a complex high-tech model that contributes to flexible organizations using different technologies such as IoT, cloud computing, blockchain, virtual reality, and Artificial Intelligence. The concept of integrating Lean Principles and Industry 4.0 is still very recent and limited, and the literature lacks a bibliometric perspective. The integration is challenging in terms of contentment-wise and is a broad multi-dimensional research area. This study aims to analyze Lean Industry 4.0 or Lean 4.0 and Lean digital transformation literature using bibliometrics, identifying its state of art, benefits, challenges, and scientific gaps. In this study, articles published between 2010 and 2022 from the Scopus database are analyzed to identify significant publications, journals, authors, institutions, and countries based on the number of publications and frequently used keywords and subject areas. This study contributes to developing the state of art of Lean Industry 4.0 and Lean digital transformation and helps researchers and practitioners direct their future studies. The literature performance is measured based on both the number of publications and the number of citations; this bibliometric analysis covers most of the published papers in both research domains.

Customer Value-Oriented Business Education in The Post-Covid Era: The Case of MBA Programs in Russia

Purpose of the research: The Covid pandemic has been a time of enormous challenges in the management of education, business education included. Transformation in education technologies has been accompanied by changes in consumer values, which education management and marketing should now focus on. This paper investigates factors and parameters involved in formation of perceived customer value with regard to MBA programmes, using experience of e-learning during the Covid-19 pandemic. Methods: To attain the stated goal, survey-based qualitative and quantitative two-stage research was carried out. This involved MBA students at leading Moscow universities who were studying online during the pandemic in 2020–2021 and for whom part-time learning suddenly turned into online learning for the whole period of study. Key results: The research tested the significance of a theoretical approach to educational values (seen as an array of functional, epistemic, social and emotional values), to be integrated into MBA programmes by educational management. The findings revealed the parameters which currently determine the content of each of these four groups of values in MBA programmes, indicating that the structure of programme choice has already been formed. During the pandemic, the most significant parameters of online education market development have been the reputation of the university, the reputation and e-content of the MBA programme, flexible organization of the study process (based on e-technologies) and the availability of an online educational platform. Quantitative analysis enabled the authors to form a mathematical model of integral consumer assessment of usefulness, taking into account the combination of education value factors and their significance for various sociodemographic groups. The findings proved our hypothesis about the significant dependence between sociodemographic characteristics of MBA students and what they value the most, which needs to be taken into account in knowledge management. This outcome can provide a compass for e-learning knowledge as it points to the most relevant direction: clusterization while positioning business education programmes, and implementation of flexible individual e-learning paths when planning educational content.

Hitting reset: Industry evolution, generational technology cycles, and the dynamic value of firm experience

AbstractResearch SummaryWe study how the value of depth and breadth of experience shifts across generational technology cycles and industry evolution. Experience breadth builds organizational flexibility that is valuable during technology transitions and when the industry is younger, while experience depth builds domain‐specific resources that are important during periods of technology stability and later periods of industry evolution. We test our theory in the console game industry, where publishers face repeated periods of transition and stability across multiple console generations. We find support for most hypotheses, except that the value of breadth correlates with the magnitude of any transition instead of decreasing linearly over time. We contribute to research on the changing value of firm experience and to the understanding of generational technological change during industry evolution.Managerial AbstractMany industries face generational changes. How incumbent firms handle those transitions is important to firm survival and success. We study how the prior experience of video game publishers helps them navigate transitions. First, we find that firms with deep experience in a genre produce more successful games in that genre only during stable periods in the industry. Second, the benefits of deep experience increase over time as some of the experience‐built capabilities of the firm survive technological transitions. Third, broad and diversified firms perform best during generational transitions as they successfully enter new domains made popular by the generational shift. We suggest that the product strategies of video game firms should depend on the relevant experience they possess and the degree of environmental change.

Analysis of Students’ Examination Post Covid-19 Results and Pre Covid-19 Results: Case Study of the International University of Management

Within the COVID-19 move to online instruction, numerous educator teachers have looked for out video conference innovations (such as zoom) pointing to reproduce conventional classrooms online. At confront esteem, synchronous video shows up to offer more prompt replicability of existing face to face synchronous teaching. However, moving academically from one medium to another is not continuously a smooth move. The COVID-19 situation has constrained pressing moves, and without satisfactory openings to plan for a modern medium, a few teaches have struggled. Higher instruction (HE) has seen a developing drift towards online study. Be that as it may, educating is profoundly associated to one’s beliefs, values, and commitments and to connections with understudies. A change in the mode of instruction and instructional method has the potential to disrupt these profound and individual associations giving rise to an emotional reaction. In later times, unsettling influences, such as pandemics, common calamities, and social distress have put colleges in unsteady circumstances, influencing instructive forms. The length of unsteady circumstances is unusual and can be weeks or a long time. In spite of these disturbances, colleges have to be proceed to satisfy their mission to teach youthful individuals. In arrange to examine the relocation to online learning beneath the COVID-19 widespread and look at understudy and workforce recognitions and lessons learned, a writing think about on flexible organizations and scholastic progression and a case study of the International University of Management.

Interaction between apolipoprotein E genotypes, excessive daytime sleepiness, and cognitive function in obstructive sleep apnea patients.

Some studies show an association between the apolipoprotein E ε4 allele (ApoEε4) and obstructive sleep apnea syndrome (OSAS), and other studies, an association between ApoEε4 and excessive daytime sleepiness (EDS), but there are no data in the literature on the interaction between EDS, cognitive function, and ApoEε4 in patients with OSA. To examine the cognitive function of adults with and without EDS and with and without ApoEε4. A total of 21 male and female patients aged between 33 and 79 years, underwent a clinical interview, ApoE genotyping, neuropsychological evaluation, polysomnography, and the application of the Epworth Sleepiness Scale. Excessive daytime sleepiness was associated with lower intelligence quotient (IQ; total performance) and worse immediate visual memory, regardless of the ApoE genotype. Patients carrying the ApoEε3/ε4 genotype had a worse performance in divided attention, constructional praxis, perceptual organization, and cognitive flexibility. A combination of the ε4 allele and EDS potentiates the negative effect on cognition, except for immediate visual memory. In this case, patients had a worse performance in terms of processing speed, selective attention, and visuomotor coordination. Excessive daytime sleepiness and the ApoEε3/ε4 genotype are associated with worse cognitive performance in OSA patients. The combination of EDS and ε4 allele potentiates cognitive impairment.

185 CURRENT CHALLENGES IN MANAGING MULTIMORBID OLDER PATIENTS WITH ATRIAL FIBRILLATION – A PAN-EUROPEAN PERSPECTIVE

Abstract Background Atrial Fibrillation (AF) is the most common cardiac arrhythmia and associated with a substantial burden to patients and health systems globally and its prevalence is increasing as the population ages. Methods An online survey was distributed as part of a Horizon 2020 project (EHRA-PATHS) with the aim of evaluating how AF multimorbidity is currently addressed by clinicians, to characterize the treatment structure and to assess current interdisciplinary management of multimorbid AF. The survey included 21 questions and free-text option for comments on detection, assessment and management of AF-related comorbidities. Results A total of 451 responses were received with 339 responses eligible for inclusion with the highest response rate from United Kingdom, Spain and Ireland (n=149, 44%). From all responses, 221 were male (66%), 300 (91.5%) were physicians and 196 (57.8%) were working in academic university teaching hospitals. Half of the respondents managed between 20 to 50 patients per month with multimorbid AF. The survey revealed varying rates of specialist services and referral to these services such as diabetes and heart failure across Europe. Academic university teaching hospitals offered greater numbers of specialist services compared to non-teaching hospitals (e.g. anticoagulation clinic 92 (47%) vs 50 (35%), p&amp;lt;0.03). 67% (n=227) of respondents reported that approximately 40% of patients with multimorbid AF need onwards referral to other specialist clinicians. Barriers to referring to specialist services for AF comorbidities were identified and included lack of integrated care model (n=174, 51%), organisational or institutional issues (n=145, 43%) and issues with patient adherence (n=126, 37%). Respondents identified areas where patient outcomes could be improved: better access to patient lifestyle modifications; improved organisation flexibility to enable innovation; greater access to evidence-based guidelines; and better interdisciplinary collaboration. Conclusion The survey demonstrated the need for systematic, integrated management of AF-related comorbidities in older people and the results will inform the next stage of the EHRA-PATHS project.

Business Organizations' Flexibility as an Innovation Tool: Factors Affecting Flexibility in Organizations

Business Organizations' Flexibility as an Innovation Tool: Factors Affecting Flexibility in Organizations