Room For Error Research Articles

Lung Nodules Localization and Report Analysis from Computerized Tomography (CT) Scan Using a Novel Machine Learning Approach

A lung nodule is a tiny growth that develops in the lung. Non-cancerous nodules do not spread to other sections of the body. Malignant nodules can spread rapidly. One of the numerous dangerous kinds of cancer is lung cancer. It is responsible for taking the lives of millions of individuals each year. It is necessary to have a highly efficient technology capable of analyzing the nodule in the pre-cancerous phases of the disease. However, it is still difficult to detect nodules in CT scan data, which is an issue that has to be overcome if the following treatment is going to be effective. CT scans have been used for several years to diagnose nodules for future therapy. The radiologist can make a mistake while determining the nodule’s presence and size. There is room for error in this process. Radiologists will compare and analyze the images obtained from the CT scan to ascertain the nodule’s location and current status. It is necessary to have a dependable system that can locate the nodule in the CT scan images and provide radiologists with an automated report analysis that is easy to comprehend. In this study, we created and evaluated an algorithm that can identify a nodule by comparing multiple photos. This gives the radiologist additional data to work with in diagnosing cancer in its earliest stages in the nodule. In addition to accuracy, various characteristics were assessed during the performance assessment process. The final CNN algorithm has 84.8% accuracy, 90.47% precision, and 90.64% specificity. These numbers are all relatively close to one another. As a result, one may argue that CNN is capable of minimizing the number of false positives through in-depth training that is performed frequently.

The Importance of Using Generic Names of Medications

Most medications have both a brand name and a generic name. The brand name medications are usually more expensive because the brand name company usually needs to spend more money than generic brand companies for completing additional required testing and trials. The FDA will approve generic forms of medications if they have the same safety, effectiveness, strength, stability, and quality as the brand name [1]. In medical school, students spend hours learning drug names, classes, mechanisms of action, side effects, and much more; however, when they get to the hospitals, students quickly notice that many of the drug names being used in the hospital are different than what they were taught in school. Many doctors refer to drugs by their brand names rather than their generic names [2]. They may do this because they find it more convenient or because of behavior modeled by their attending physicians. Additionally, some physicians are skeptical about generic medications in general, and that is why they use brand names [3]. Regardless, calling medications by their brand names has many detrimental side effects. These issues will be discussed in this article. There are several disadvantages to referring to medications by their brand names. 1: It can result in higher health care costs: The doctor may tell the patient that they should get a particular brand name medication; patients often do not realize that there may be a generic for the prescribed medication or may think that the doctor is telling them to specifically get the exact brand that they are mentioning. The patient will then go buy the brand-name medication which is usually more expensive, thereby adding to their healthcare cost [2,4]. 2: It is confusing to medical students and residents: In medical school student physicians are taught the generic names of medications, and the medical board exams only test using generic names of medications. Because many student doctors and residents are more familiar with generic names of medications, when attending physicians in the hospital use brand names of medications it can cause confusion and potentially lead to errors. This may ultimately result in adverse events and worse patient outcomes. 3: There are several brand name medications that have similar abbreviations: Several brand name medications have similar abbreviations and can be confused with each other. Additionally, doctors sometimes use brand names and other times use generic names, this adds even more room for error. For example, an attending may ask for levo and they may mean Levothyroxine, Levocetirizine, Levofloxacin, Levorphanol, Levodopa or Levophed. 4: It is unprofessional: When the patient hears their doctor refer to a medication by its brand name it elevates the brand in their eyes. Physicians should not be using their position as healthcare professionals to advertise brand-name medications, even unintentionally. 5: Newer practitioners don’t associate the mechanism of action of medication with the brand name medication: A study in Australia found that when Physicians/health care workers and medical students were asked about the mechanism of action for brand name medications they did not know it very well [5]. 6: International communication: Generic names are understood internationally while brand names are more widely known and used in specific countries [6]. Due to the reasons enumerated above, it is the conclusion of the authors of this paper that physicians should try to use the generic names of medications. Additionally, hospitals should educate incoming physicians on this topic and emphasize the importance of using the generic names of medication.

Against Futility Judgments for Patients with Prolonged Disorders of Consciousness

Against Futility Judgments for Patients with Prolonged Disorders of Consciousness

EFFICIENCY OF EVOLUTIONARY ALGORITHMS IN SOLVING OPTIMIZATION PROBLEMS ON THE EXAMPLE OF THE FINTECH INDUSTRY

The pandemic forced companies to rebuild business processes in an accelerated mode. Now they pay more attention to web products and work with customers in the virtual space [1].The financial technology market (FinTech) is getting bigger and more diverse every day. Financial news website Market Screener reports that the global FinTech market will be worth $26.5 trillion by 2022, with a compound annual growth rate of 6%. In Europe alone, the use of FinTech increased by 72% in 2020. The competition in this market segment is also growing. In the first eleven months of 2021, more than 26,300 startups have joined the fray, more than double the number of new entrants just three years earlier [2]. As the competition for customer engagement and loyalty heats up, FinTech players need to reach out to a much larger audience optimally distributed across ever-growing geographies. Monitoring and managing business operations is becoming increasingly complex as the number of customer accounts and financial transactions continues to grow. Therefore, more solutions are needed to address the challenges associated with financial IT. Therefore, the focus should be on algorithms and methods that help FinTech companies optimize all stages of their activities, from customer acquisition to payment processing and payout forecasting. In all aspects of a business, there is little room for errors, unexpected failures, or downtime. Performance optimization is the key to success in this industry. The explosion of activity caused by all these companies generates a huge amount of Structured and Unstructured Big Financial Data about customers and payments, as well as information about the underlying business processes [3]. The deep analytics hidden in this data can help companies optimize payment approval rates, transaction costs and reduce the risk of fraud, as well as customer retention and accelerate revenue growth. The above determines the acquisition of competitive advantages not only for FinTech corporations and companies, both regionally and globally, which is especially true in times of crisis. The article comprehensively explores the following topical issues: problems, features and prospects of effective optimization tasks in modern conditions, critical issues of theory and practice of Evolutionary Computations (including financial management), the specifics of effective use of Genetic Algorithms in information systems of FinTech companies. The above trends and peculiarities of the application of Evolutionary Computations in general and Genetic Algorithms in particular should be taken into account in further research and practical projects and real projects of effective implementation and use of Data Mining and Artificial Inelligence technologies in FinTech information systems. The obtained results are relevant and applicable not only for local companies та організацій, but also for international applications in the context of global, national and regional (not only economic, but also pandemic, military, natural disaster etc) crisis phenomena.

Who has room for error? The effects of political scandal for minority candidates

It is well established that voters often hold politicians accountable for misbehavior. But are minority (Black, gay, and/or female) candidates sanctioned more severely for their transgressions? Using a vignette experiment (N = 4129) in the United States, we find that gay candidates (regardless of gender and race) are indeed less likely to win elected office than their more “traditional” counterparts in the aftermath of scandal. However, contrary to the existing literature, the mechanism for this lessened electability does not lie in greater penalties. Instead, we find evidence that it originates in lower pre-scandal vote shares, an effect driven by Republican voters. Sharply lower starting points mean that gay candidates are less able to prevail in an election, even in the face of potentially diminished penalties. In what we term the “Room for Error” hypothesis, we document how even facially neutral accountability structures can have discriminatory effects.

Exploring technologies to better link physical evidence and digital information for disaster victim identification

Disaster victim identification (DVI) entails a protracted process of evidence collection and data matching to reconcile physical remains with victim identity. Technology is critical to DVI by enabling the linkage of physical evidence to information. However, labelling physical remains and collecting data at the scene are dominated by low-technology paper-based practices. We ask, how can technology help us tag and track the victims of disaster? Our response to this question has two parts. First, we conducted a human–computer interaction led investigation into the systematic factors impacting DVI tagging and tracking processes. Through interviews with Australian DVI practitioners, we explored how technologies to improve linkage might fit with prevailing work practices and preferences; practical and social considerations; and existing systems and processes. We focused on tagging and tracking activities throughout the DVI process. Using insights from these interviews and relevant literature, we identified four critical themes: protocols and training; stress and stressors; the plurality of information capture and management systems; and practicalities and constraints. Second, these findings were iteratively discussed by the authors, who have combined expertise across electronics, data science, cybersecurity, human–computer interaction and forensic pathology. We applied the themes identified in the first part of the investigation to critically review technologies that could support DVI practitioners by enhancing DVI processes that link physical evidence to information. This resulted in an overview of candidate technologies matched with consideration of their key attributes. This study recognises the importance of considering human factors that can affect technology adoption into existing practices. Consequently, we provide a searchable table (as Supplementary information) that relates technologies to the key considerations and attributes relevant to DVI practice, for readers to apply to their own context. While this research directly contributes to DVI, it also has applications to other domains in which a physical/digital linkage is required, and particularly within high stress environments with little room for error. Key points: Disaster victim identification (DVI) processes require us to link physical evidence and digital information. While technology could improve this linkage, experience shows that technological “solutions” are not always adopted in practice. Our study of the practices, preferences and contexts of Australian DVI practitioners suggests 10 critical considerations for these technologies. We review and evaluate 44 candidate technologies against these considerations and highlight the role of human factors in adoption.

Room of Errors: Safety in the Nursing Program

Creating a safer healthcare system will depend on the ability of nurses to fully use their expertise, education, and role to identify, interrupt, and correct medical errors to prevent patient harm (Gaffney et al., 2016). The ability to recognize common and preventable errors is important to improve patient outcomes and enhance safety. Errors are actions that fail to meet their desired outcome (Institute of Medicine [IOM], 2000). Errors can range from medication errors to falls or acquiring an infection or pressure ulcer. Errors could result in prolonged hospitalization, death, rise in the cost of care, and increase suffering (Clay et al., 2017). Nurses should link nursing practice to fundamental improvements in patient safety and quality care (IOM, 2011). This teaching project was chosen to help students recognize errors in the clinical setting. A good number of errors are preventable, and increased awareness may decrease errors in practice.

Satisfação e autoconfiança de estudantes na simulação realística e a experiência de perpetuação do saber

Abstract: Introduction: The structure of educational methods is frequently renewed, using different available tools, according to the National Curriculum Guidelines. One of these, the realistic simulation (RS) methodology, is used to create proximity between the student and the real everyday life in a monitored environment, which provides room for error, but not with an actual patient. However, measuring meaningful learning is a complex task and support scales can be used. Based on this challenge, can the perpetuation of knowledge among students from different semesters using the RS tool add knowledge? Objectives: To explain the use of RS among medical students; to compare satisfaction and self-confidence indices in relation to RS using a scale, specifically in CPR (Cardiopulmonary Resuscitation), before and after the learning intervention among students from different semesters; to know the students’ learning process through the in-person teaching post-performance questionnaire. Method: This was a quasi-experimental study with 86 medical students from a private institution, with data collection was carried out in three stages, namely: study guidelines, scenario practice and perpetuation of knowledge to other students. Two questionnaires and an evaluation scale were used as tools and, for comparison, the relative and absolute frequencies, Cronbach’s alpha and the non-parametric Mann-Whitney test were used. Results: Cronbach’s alpha was considered high and the nonparametric test resulted in values between 3.81 and 4.91, indicating agreement in satisfaction and self-confidence in learning, with a significant difference in the answers: I liked the way my teacher taught using the simulation; I am confident that I have mastered the content of the simulation activity to which my teacher introduced me and I know how to use simulation activities to learn skills. Regarding the perpetuation of learning, its fixation and its relevance in training, all students also agreed that 6% still did not consider themselves ready to perform CPR. Conclusion: The study proposal proved to be effective in improving learning and perpetuating knowledge among students.

EFFECT OF STRATEGIC ALLIANCE AND PARTNERSHIP ON THE SURVIVAL OF MSMEs POST COVID-19 PANDEMIC

Research background: This study was conducted as a result of the challenges that confront MSMEs globally, especially in Nigeria, due to the lockdown occasioned by COVID-19. A descriptive research design (quantitative analysis) was adopted, while primary data were employed for the study. Purpose of the article: The population for the study was 587 MSMEs from the Ojo local government area of Lagos State, Nigeria, with a sample size of 234 derived using the Taro Yamane (1967) techniques. A total of 240 questionnaires were distributed, allowing room for errors, and 228 of them were returned usable for the study, constituting a 95% response rate for the study. Methods: Content validity was adopted. A reliability test was conducted using Cronbach’s Alpha, which returned a value of 0.869, indicating internal consistency of the research instrument. Descriptive statistics (means and simple percentages) were used to analyse the data, alongside regression and Pearson’s correlation coefficients. The findings revealed that a strategic alliance and partnership could positively affect MSMES survival post-COVID-19 in Nigeria, with a p-value of 0.000<0.05, and that its impact on the performance of MSMEs in the Nigerian economy post-Covid-19 was statistically significant and positive, with a correlation coefficient of 0.824 (82.4%) and a p-value of 0.000<0.05. Findings & Value added: The results and findings suggest that a strategic alliance and partnership is indeed a veritable tool for MSMEs’ survival post-COVID-19 in Nigeria.

AN INTEGRATED APPROACH BASED ON ARTIFICIAL INTELLIGENCE USING ANFIS AND ANN FOR MULTIPLE CRITERIA REAL ESTATE PRICE PREDICTION

A relatively high level of precision is required in real estate valuation for investment purposes. Such estimates of value which is carried out by real estate professionals are relied upon by the end-users of such financial information having paid a certain fee for consultation hence leaving little room for errors. However, valuation reports are often criticised for their inability to be replicated by two or more valuers. Hence, stirring to a keen interest within the academic cycle leading to the need for exploring avenues to improve the price prediction ability of the professional valuer. This study, therefore, focuses on overcoming these challenges by introducing an integrated approach that combines ANFIS with ANN termed ANFIS-AN, thereby having a reiteration in terms of ANN application to fortify price predictability. Using 255 property data alongside 12 variables, the ANFIS-AN model was adopted and its outcome was compared with that of ANN. Finally, the results were subjected to 3 different error testing models using the same training and learning benchmarks. The proposed model’s RMSE gave 1.413169, while that of ANN showed 9.942206. Similarly, using MAPE, ANN recorded 0.256438 while ANFIS-AN had 0.208324. Hence, ANFIS-AN’s performance is laudable, thus a better tool over ANN.

Operator Involvement Leads to Hydraulic Modeling Success

A firm deadline and a tight budget meant there was little room for error in a water district's improvement project. Thanks to the expertise and innovative thinking of a cross‐departmental team, the project results exceeded expectations.

Automated parasite faecal egg counts: Limiting the room for error

Automated parasite faecal egg counts: Limiting the room for error

When Wrong Is Right: Leaving Room for Error in Innovation Measurement

To date, measuring innovation has not been an exact science. As in many areas of organizational life, errors in measuring innovation are a recurring fact. Innovation researchers and practitioners alike have become increasingly interested in understanding the occurrence of organizational errors and how these errors affect innovation and its measurement. This empirical study aims to address this under-explored area by utilizing a qualitative in-depth case study at the innovation department of an organization with production sites and sales organizations worldwide. A total of 28 semi-structured interviews at several organizational levels were conducted, with innovation managers, project managers, senior managers, and staff. Based on the findings in this case study, three explanations are presented on how organizational errors occur when using innovation KPIs (key performance indicators). The first explanation can be connected to the increasing complexity of innovation and its intangible nature. Another explanation can be traced to the difference between innovation strategy and innovation KPIs. Lastly, room for organizational errors can be related to the multitude of individuals and organizational levels involved in innovation and its measurement. The implications for practitioners are that innovation KPIs are not precise metrics but should be seen as estimates with organizational errors. Whether or not these innovation KPIs can be used as tools to turn innovation into competitive advantages largely depends on whether wrong is right. Future research should focus on the metrics that are implemented and actually in use, as this future path would highlight the function and dysfunction that organizational errors in innovation KPIs can have.

Facilis descensus averno: WTO dispute settlement and trade-wars - is the WTO heading where it should?

Trading is arguably the most important element of our modern society, and its importance in the globalized world is second to none. International commerce nowadays involves more complex supply chains, more sophisticated financial operations and more economic agents. However, states do remain influential factors in that ecosystem, and together they create the framework of international trade. That framework is closely supervised and controlled by none other, than the World Trade Organization. Although, the creation of the WTO did not guarantee, that there would be no tensions between trading nations. Trade wars cause no surprise for an economist or lawyer assessing international trade. But did the most appropriate organization handle these trade wars right? In this article we will succinctly analyse the current framework, and will try to answer whether the Dispute Settlement Mechanism (hereinafter “DSM”) is compatible with all the cases. There is no room for error: if there are certain cases where the DSM only aggravates the problem, then these cases have to be identified and have to be handled with special attention. We are familiar with the disruptive effects of a trade war; hence we are challenged to do our utmost to prevent them – and to rethink what, according to John H. Jackson, has to be a rule-based system.

Proposing new system for handling business data systems with more functionality and usability

This paper focuses on creating a Water Refiling Station Management System (WRSMS) for selected water refilling stations in Havana, Cuba as most of them still operate by means of pen and paper, a tedious as well as time-consuming process when it comes to recording, manipulating, editing, and retrieving data, which leaves room for errors. The WRSMS is capable of storing, processing, and monitoring sales, customer, employee, inventory and attendance data, which it can be used to create financial statement reports. Furthermore, expressive investigation technique is used in this paper to assess current system of selected water stations and the WRSMS in terms of functionality and usability. It also helped to determine the noteworthy alteration among current system and WRSMS assessment. The researcher used purposive sampling technique and an industry-validated instrument to assess functionality and usability of employees from selected water stations in the area and was able to get the participation of 15 different water-refilling stations and 30 employees. Some statistical tools are used for this research paper to have sufficient evidence to conclude that the majority of employees “agree” that their current system is functional and usable. However, once presented with the WRSMS, most employees “strongly agree” that the system is more useful to handle business data. The used t-test strengthens the point that the noteworthy alteration exists among ratings of the present system in addition to WRSMS when it comes to functionality and usability.

Qualification of Electroslag Welds made from HPS 485W (70W) and 345W (50W) Steels

Electroslag welding (ESW) is a highly efficient welding process for completing single-pass complete joint penetration welds that offers production gains over conventional welding processes. This gain in productivity requires very high heat inputs, often to the detriment of the base metal's heat-affected zone (HAZ) impact energy. U.S. bridge-welding codes recognize the ESW Narrow Gap (termed ESW-NG) process developed in the early 1980s to remedy the substandard weld and HAZ impact energies found in bridges across the United States fabricated with the original ESW process used roughly from 1967 to 1977. ESW-NG process is limited to certain base metals; particularly, ESW-NG with quenched and tempered (Q&T), and thermo-mechanically controlled processed steels are prohibited because they are not part of the ESW-NG process development. This study was specifically performed to evaluate whether the existing ESW-NG process could be qualified for use with grade HPS 485W (70W) Q&T bridge steel and hybrid weldments between grade HPS 485W (70W) Q&T and conventionally processed grade 345W (50W) bridge steels. None of the weldments met fracture critical impact requirements. The weldment of just Q&T steel and the hybrid weldment met nonfracture critical requirements. However, the weldment of just Q&T had tension and impact resistance results right on the margin, leaving little room for error.

IoT Based System to Measure Vehicle and Driver Parameters

Accountable for performing important maintenance checks and changes in a high-stakes, high-pressure environment, today’s pit crew teamsare termed to be of equal importance as the driver. Assisting the driver at key moments throughout the race, which could be as many as 500 rounds around the circuit, the average pit stop happens over the course of a swift 12-seconds. There’s no room for error as the pit crew’s precision, timing and decision making is crucial to the safety and resulting performance or the driver and the team as an overall. In a race where every microsecond counts, a wrong decision or a mistake by the crew members for a pit stop will certainly change the result of the race. The crew (and the team) makes the decisions based on vehicle and driver parameters such as individual tire pressure, Fuel level, Driver heartbeat/pulse and also the driver’s body temperature. For this project, Team Xelerate plans to implement an on-board system on a moving vehicle that will read, measure and calculate all the required vehicle parameters using sensors. Parameters such as Engine/Shaft RPM, Velocity, Instantaneous Acceleration/Deceleration and many more shall be fed to a Display module which would be mounted on the steering for better access. Also, by incorporating IOT, all necessary parameters (Vehicle and Driver) would be sent to a secure remote server which would be accessible to all crew members in the pit.

Scaphoid Nonunion Volar Plating with Pure Nonvascularized Cancellous Autograft.

Surgical treatment of scaphoid nonunion has evolved over the years to include a variety of procedures and techniques involving a number of vascularized and nonvascularized bone grafting options and fixation strategies. Volar plating of scaphoid nonunions with use of pure cancellous nonvascularized autograft is a safe and effective treatment method with good functional outcomes and union rates1. Volar plating of the scaphoid nonunion is performed via a volar approach, with debridement and reduction of the nonunion site. A nonvascularized pure cancellous bone autograft is then harvested and impacted from the distal aspect of the ipsilateral radius or the olecranon. Finally, a low-profile volar locking plate is applied for fixation2. There is no consensus regarding the optimal treatment of scaphoid nonunion. Headless compression screws are currently popular, and advances have been made over time to include various nonvascularized and vascularized corticocancellous grafts. The advent of plate fixation of the scaphoid has enabled the surgical treatment of nonunion to better replicate scaphoid morphology, allowing for improved biomechanical stability and optimizing the biologic milieu for healing. Headless compression screws, although a reasonable option for most acute scaphoid fractures, may not be the most appropriate application for nonunions. Compression, in itself, is not required for the surgical treatment of scaphoid nonunion, and can even prove detrimental by forcing the reduction into a malunion. The stability of headless compression screws must rely on a structural graft to resist the compression and create friction. The more structural the graft, however, the less biologically active it tends to be. Further, the simple placement of a metallic screw within the fracture site is counter to orthopaedic principles because it dramatically lowers the surface area available for union. Volar locking plates address the shortcoming of headless compression screws by (1) directly buttressing the deforming forces superior to headless screws3-6; (2) utilizing the most accessible, biologically active nonvascularized bone graft, which is pure cancellous graft; (3) allowing for maximal surface area contact for union; and (4) preserving the intraosseous vascular network within the scaphoid and its vascular supply at its dorsal ridge. Volar scaphoid plating with cancellous bone grafting is a reliable technique with excellent union rates and favorable functional outcomes. A review of 34 patients with scaphoid nonunions with segmental defects treated with volar plates and pure cancellous autograft demonstrated 100% union as verified by computed tomography scans postoperatively1. Average Disabilities of the Arm, Shoulder and Hand scores and grip strengths improved by final follow-up. Another series of 13 scaphoid nonunions with osteonecrosis treated with volar plating and pure cancellous autograft showed 100% union and good patient-reported and functional outcomes, despite smokers, proximal poles, and previous failed surgical procedures in the cohort2. These favorable results are consistent with earlier reports of the modern plating systems; however, concerns for hardware-related complications have been elucidated over the years, including symptomatic hardware impingement7. This risk can be mitigated by proper surgical technique and plate placement. Clear visualization of the entire volar surface of the scaphoid is crucial. Take care not to reflect too much capsule, so as to cause ulnar translation of the carpus.Thorough debridement of nonviable bone is paramount. Using a 2.0 or 3.0-mm low-speed burr with continuous irrigation can be helpful. We have had successful unions even in cases in which the remaining proximal pole was just a cortical shell and essentially a hollow vessel for graft.Err on the side of verticalization of the scaphoid, overextending and supinating the distal pole. Overstuffing the nonunion site with cancellous autograft aids in reduction and maximizes the osteoinductive and osteoconductive properties of the graft.Impaction of the graft is crucial, and the surgeon should harvest more autograft than one might initially anticipate.Secure the plate to the proximal portion of the scaphoid first. There is less room for error on the proximal portion where plate positioning is more critical.Do not cross the scaphoid "line in the sand"; to do so will result in plate impingement on the radius. Proper placement of the plate is just distal to the point at which the convex surface of the proximal pole transitions to become the concave surface of the scaphoid waist, as viewed from a volar approach.Plate modification for proximal pole fractures and nonunions: removal of the most proximal hole in the plate allows for improved fixation despite the plate itself remaining behind the scaphoid "line in the sand." In these cases, the locking screws must be directed so that they buttress the subchondral bone of each pole, especially the proximal pole.

Case—GreatDeal and NewChicken Merger: Designing an Omni-Channel Supply Chain

On Monday morning, Alice Smith, vice president of supply chain (VP-SC) for GreatDeal, sat at her desk wondering how she and Rosie Dartmouth, the supply chain executive for NewChicken, are going to navigate the merger between their two companies. The merger was finalized last Friday, and NewChicken is now absorbed into GreatDeal. This week, Alice and Rosie, along with their team of experts, have to start the long and arduous process of reconfiguring their now combined supply chains to ensure the most profitable path for the company. Alice and Rosie are expected to give a presentation to the new chief executive officer, Michelle Shalhoub. The expectations from the merger are high, and there is no room for error. Furthermore, Ms. Shalhoub is known for asking for multiple competitive proposals so that she has the option to choose the best one. Depending on which proposal Ms. Shalhoub accepts, Alice may stay in her position as a VP or she may lose her title and office to Rosie. Hence, the stakes are high for Alice at a personal level too. As Alice took another sip of her coffee, she contemplated the changes and challenges ahead. She collected all of her notes on the merger, data sources, related news stories, and business magazines and then pulled up her sleeves to get started.

A case for improving frail patient outcomes in multiple myeloma with phenotype‐driven personalized medicine

AbstractThe treatment of older persons with cancer is fraught by a delicate balance of targeting the disease while avoiding treatment‐related complications. “Personalized,” or “precision” medicine approaches can ease this problem through more efficacious and less toxic treatments. Multiple myeloma epitomizes the struggle to balance treatment options and their complications, for it is an incurable disease afflicting a predominantly aged population, and treatment is administered on a continuous schedule with little or no breaks. Over the last two decades, advances in drug development have improved outcomes for younger, fit patients, but older, frail patients have not realized the same benefit. This could be related to the benefits of three drug combinations, when frail patients can often tolerate only two drugs at a time. In myeloma, personalized approaches have lagged behind some other malignancies due to its genetic complexity and a paucity of abnormalities with associated targeted therapies. In contrast, the disease is managed with an array of drugs that target phenotypic characteristics common in malignant plasma cells. To address the unmet need for personalized medicine in myeloma, we developed a functional approach by profiling the sensitivity of patients’ myeloma to clinically available drugs. Through this, we observed that receiving at least two effective drugs portended better outcomes, leaving those patients who can only tolerate two drug regimens without room for error. We now describe a frail patient's case and their drug sensitivity profile to illustrate how personalized treatment could have led to an improved disease course. Personalized treatment could provide the greatest survival improvements to older adults with cancers, such as multiple myeloma, through avoiding undertreatment, limiting attrition through subsequent lines of therapy, reducing exposure to ineffective drugs and streamlining the management of relapses. Exploring these avenues is imperative to closing the gap of cancer‐related mortality in older and frail persons.