WorldWideScience

Sample records for clinical knowledge gaps

  1. Knowledge Gaps

    DEFF Research Database (Denmark)

    Lyles, Marjorie; Pedersen, Torben; Petersen, Bent

    2003-01-01

    , assimilating, and utilizing knowledge - are crucial determinants ofknowledge gap elimination. In contrast, the two factors deemed essential in traditionalinternationalization process theory - elapsed time of operations and experientiallearning - are found to have no or limited effect.Key words......: Internationalization, knowledge gap, absorptive capacity, learning box....

  2. Expanding the use of empiricism in nursing: can we bridge the gap between knowledge and clinical practice?

    Science.gov (United States)

    Giuliano, Karen K

    2003-04-01

    The philosophy of Aristotle and its impact on the process of empirical scientific inquiry has been substantial. The influence of the clarity and orderliness of his thinking, when applied to the acquisition of knowledge in nursing, can not be overstated. Traditional empirical approaches have and will continue to have an important influence on the development of nursing knowledge through nursing research. However, as nursing is primarily a practice discipline, the transition from empirical and syllogistic reasoning is problematic. Other types of inquiry are essential in the application of nursing knowledge obtained by empirical scientific approaches and to understand how that knowledge can best be used in the care of patients. This paper reviews the strengths and limitations of syllogistic reasoning by applying it to a recently published study on temperature measurement in nursing. It then discusses possible ways that the empirical knowledge gained from that study and confirmed in its reasoning by logical analysis could be used in the daily care of critically ill patients. It concludes by highlighting the utility of broader approaches to knowledge development, including interpretative approaches and contemporary empiricism, as a way to bridge the gap between factual empirical knowledge and the practical application of that knowledge in everyday clinical nursing practice.

  3. Bridging the gap between clinical research and knowledge translation in pediatric emergency medicine.

    Science.gov (United States)

    Hartling, Lisa; Scott-Findlay, Shannon; Johnson, David; Osmond, Martin; Plint, Amy; Grimshaw, Jeremy; Klassen, Terry P

    2007-11-01

    In 2006, a multidisciplinary group of researchers from across Canada submitted a successful application to the Canadian Institutes for Health Research for a Canadian Institutes for Health Research Team in Pediatric Emergency Medicine. The conceptual foundation for the proposal was to bring together two areas deemed critical for optimizing health outcomes: clinical research and knowledge translation (KT). The framework for the proposed work is an iterative figure-eight model that provides logical steps for research and a seamless flow between the development and evaluation of therapeutic interventions (clinical research) and the implementation and uptake of those interventions that prove to be effective (KT). Under the team grant, we will conduct seven distinct projects relating to the two most common medical problems affecting children in the emergency department: respiratory illness and injury. The projects span the research continuum, with some projects targeting problems for which there is little evidence, while other projects involve problems with a strong evidence base but require further work in the KT realm. In this article, we describe the history of the research team, the research framework, the individual research projects, and the structure of the team, including coordination and administration. We also highlight some of the many advantages of bringing this research program together under the umbrella of a team grant, including opportunities for cross-fertilization of ideas, collaboration among multiple disciplines and centers, training of students and junior researchers, and advancing a methodological research agenda.

  4. The gap between available knowledge and its use in clinical psychiatry

    DEFF Research Database (Denmark)

    Munk-Jørgensen, Povl; Blanner Kristiansen, C; Uwawke, R;

    2015-01-01

    and clinical research experience among psychiatrists and staff in the wards. In particular, the involvement of medical students interested in clinical research activities seems to have a positive impact. CONCLUSION: Academia needs to be re-implemented into clinical psychiatry. Staff with research experience...

  5. The Gap in Knowledge of Clinical Practice Guidelines by Mental Health Residents in Buenos Aires (Argentina

    Directory of Open Access Journals (Sweden)

    Javier Fabrissin

    2014-05-01

    Full Text Available The aim of this pilot study was to evaluate if the residents of psychiatry and clinical psychology from the city of Buenos Aires knew any of the existing mental health Clinical Practice and Treatment Guidelines (CPTGs. We asked residents their opinion about CPTGs and, also, if they followed their recommendations in clinical practice. We asked 59 mental health residents (28 physicians and 29 psychologists with different years of clinical training to fill a questionnaire to know their opinion about CPTGs and also if they follow the CPTG recommendations in their clinical practice. We found that 79.31% of residents did not know any CPTG. Eighty percent of the residents who did know any CPTG have a positive opinion about CPTGs. Finally, the American Psychiatric Association Guidelines were the most known CPTGs. The authors emphasize the need for a clinical guidelines diffusion policy in Buenos Aires city and particularly as a clinical and training resource for mental health residents.

  6. Understanding the digital divide in the clinical setting: the technology knowledge gap experienced by US safety net patients during teleretinal screening.

    Science.gov (United States)

    George, Sheba; Moran, Erin; Fish, Allison; Ogunyemi, Lola

    2013-01-01

    Differential access to everyday technology and healthcare amongst safety net patients is associated with low technological and health literacies, respectively. These low rates of literacy produce a complex patient "knowledge gap" that influences the effectiveness of telehealth technologies. To understand this "knowledge gap", six focus groups (2 African-American and 4 Latino) were conducted with patients who received teleretinal screenings in U.S. urban safety-net settings. Findings indicate that patients' "knowledge gap" is primarily produced at three points: (1) when patients' preexisting personal barriers to care became exacerbated in the clinical setting; (2) through encounters with technology during screening; and (3) in doctor-patient follow-up. This "knowledge gap" can produce confusion and fear, potentially affecting patients' confidence in quality of care and limiting their disease management ability. In rethinking the digital divide to include the consequences of this knowledge gap faced by patients in the clinical setting, we suggest that patient education focus on both their disease and specific telehealth technologies deployed in care delivery.

  7. Closing the Knowledge Gap in Foreign Markets

    DEFF Research Database (Denmark)

    Lyles, Marjorie A.; Pedersen, Torben; Petersen, Bent

    The study explores how firms close their knowledge gaps in relation to business environments of foreign markets. Potential determinants are derived from traditional internationalization process theory as well as more recent literature on organizational learning processes, including the concept...... of absorptive capacity. Building on these two literature streams a conceptual model is developed and tested on a set of primary data of Danish firms and their foreign market operations. The empirical study suggests that factors considered essential in traditional internationalization process theory...

  8. Bridging the Gap in Knowledge Transfer between Academia and Practitioners

    Science.gov (United States)

    Gera, Rajat

    2012-01-01

    Purpose: The paper intends to identify the causes or gaps in transfer of managerial knowledge between academia and practitioners and to develop a framework that overcomes the gaps through knowledge management, information technology and human resource practices. The paper aims to suggest a strategic approach based on the knowledge transfer cycle.…

  9. Overcoming Knowledge Gaps in Postmerger Integration

    DEFF Research Database (Denmark)

    Alaranta, Maria Eliisa; Martela, Eero

    2012-01-01

    Over 50% of mergers and acquisitions (M&As) fail, mainly because of integration problems. In such integrations, much of the experiential (learning-by-doing) knowledge critical for running the business becomes redundant or is lost. However, we know virtually nothing about what type of mechanisms b...... of change, integrating information systems, leadership, joint collaboration, acquiring knowledge externally, and relocating personnel....

  10. Financial Knowledge and the Gender Gap

    Directory of Open Access Journals (Sweden)

    Ann Woodyard

    2012-06-01

    Full Text Available Financial knowledge has been identified as an issue of importance to individual financial wellness. The FINRA Financial Capability Study provides data that make it possible to assess financial knowledge, and to analyze it in the context of financial satisfaction and participation in financial behaviors that are generally considered positive. This paper looks at these relationships by gender and by age group, identifying key differences in outcomes and behaviors. The aim of this study was to identify areas and issues where policy makers can focus efforts, and where practitioners can develop education and therapy protocols to assist clients in financial development and restoration.

  11. Gaps in Alzheimer's Knowledge among College Students

    Science.gov (United States)

    Eshbaugh, Elaine M.

    2014-01-01

    Despite the prevalence of the disease, it appears that there may be a need for increased education for formal and family caregivers of those with Alzheimer's disease and related dementias. Today's college students will be asked to fill both of these roles in the future. This study examined the level of knowledge of Alzheimer's disease among…

  12. Knowledge gaps and research recommendations for essential tremor.

    Science.gov (United States)

    Hopfner, Franziska; Haubenberger, Dietrich; Galpern, Wendy R; Gwinn, Katrina; Van't Veer, Ashlee; White, Samantha; Bhatia, Kailash; Adler, Charles H; Eidelberg, David; Ondo, William; Stebbins, Glenn T; Tanner, Caroline M; Helmich, Rick C; Lenz, Fred A; Sillitoe, Roy V; Vaillancourt, David; Vitek, Jerrold L; Louis, Elan D; Shill, Holly A; Frosch, Matthew P; Foroud, Tatiana; Kuhlenbäumer, Gregor; Singleton, Andrew; Testa, Claudia M; Hallett, Mark; Elble, Rodger; Deuschl, Günther

    2016-12-01

    Essential tremor (ET) is a common cause of significant disability, but its etiologies and pathogenesis are poorly understood. Research has been hampered by the variable definition of ET and by non-standardized research approaches. The National Institute of Neurological Disorders and Stroke (USA) invited experts in ET and related fields to discuss current knowledge, controversies, and gaps in our understanding of ET and to develop recommendations for future research. Discussion focused on phenomenology and phenotypes, therapies and clinical trials, pathophysiology, pathology, and genetics. Across all areas, the need for collaborative and coordinated research on a multinational level was expressed. Standardized data collection using common data elements for genetic, clinical, neurophysiological, and pathological studies was recommended. Large cohorts of patients should be studied prospectively to collect bio-samples, characterize the natural history of the clinical syndrome including patient-oriented outcomes, investigate potential etiologies of various phenotypes, and identify pathophysiological mechanisms. In particular, cellular and system-level mechanisms of tremor oscillations should be elucidated because they may yield effective therapeutic targets and biomarkers. A neuropathology consortium was recommended to standardize postmortem analysis and further characterize neuropathological observations in the cerebellum and elsewhere. Furthermore, genome-wide association studies on large patient cohorts (>10,000 patients) may allow the identification of common genes contributing to risk, and whole exome or genome sequencing may enable the identification of genetic risk and causal mutations in cohorts and well-characterized families.

  13. Nutraceuticals for older people: facts, fictions and gaps in knowledge.

    Science.gov (United States)

    González-Sarrías, Antonio; Larrosa, Mar; García-Conesa, María Teresa; Tomás-Barberán, Francisco A; Espín, Juan Carlos

    2013-08-01

    In the last decades nutraceuticals have entered the health market as an easy and attractive means of preventing diseases. These products are of interest for an increasingly health-concerned society and may be especially relevant for preventing or delaying a number of age-related diseases, i.e. arthritis, cancer, metabolic and cardiovascular diseases, osteoporosis, cataracts, brain disorders, etc. Nutraceuticals are marketed in a variety of forms, composition and potential applications which have made their definition ambiguous and their use uncontrolled and poorly funded. Although epidemiological, animal and in vitro studies have given evidence of the potential benefits of some of these nutraceuticals or of their components, definitive proof of their effects in appropriate human clinical trials is still lacking in most cases, more critically among people above 65 years of age. We cover the well-established nutraceuticals (polyvitamins, omega-3 fatty acids, etc.) and will focus on many other 'novel' commercial nutraceuticals where the scientific evidence is more limited (food extracts, polyphenols, carotenoids, etc.). Solid scientific evidence has been reported only for a few nutraceuticals, which have some health claims approved by the European Food Safety Authority (EFSA). Further well-designed trials are needed to improve the current knowledge on the health benefits of nutraceuticals in the elderly. Overall, there are some facts, a lot of fiction and many gaps in the knowledge of nutraceutical benefits.

  14. Planetary Protection Knowledge Gaps for Human Extraterrestrial Missions: Workshop Report

    Science.gov (United States)

    Race, Margaret S. (Editor); Johnson, James E. (Editor); Spry, James A. (Editor); Siegel, Bette; Conley, Catharine A.

    2015-01-01

    This report on Planetary Protection Knowledge Gaps for Human Extraterrestrial Missions summarizes the presentations, deliberations and findings of a workshop at NASA Ames Research Center, March 24-26, 2015, which was attended by more than 100 participants representing a diverse mix of science, engineering, technology, and policy areas. The main objective of the three-day workshop was to identify specific knowledge gaps that need to be addressed to make incremental progress towards the development of NASA Procedural Requirements (NPRs) for Planetary Protection during human missions to Mars.

  15. The developmental origins of fairness: the knowledge-behavior gap.

    Science.gov (United States)

    Blake, Peter R; McAuliffe, Katherine; Warneken, Felix

    2014-11-01

    Recent research in developmental psychology shows that children understand several principles of fairness by 3 years of age, much earlier than previously believed. However, children's knowledge of fairness does not always align with their behavior, and immediate self-interest alone cannot explain this gap. In this forum paper, we consider two factors that influence the relation between fairness knowledge and behavior: relative advantage and how rewards are acquired.

  16. Gaps in knowledge and prospects for research of adjuvanted vaccines.

    Science.gov (United States)

    Seder, Robert; Reed, Steven G; O'Hagan, Derek; Malyala, Padma; D'Oro, Ugo; Laera, Donatello; Abrignani, Sergio; Cerundolo, Vincenzo; Steinman, Lawrence; Bertholet, Sylvie

    2015-06-08

    A panel of researchers working in different areas of adjuvanted vaccines deliberated over the topic, "Gaps in knowledge and prospects for research of adjuvanted vaccines" at, "Enhancing Vaccine Immunity and Value" conference held in July 2014. Several vaccine challenges and applications for new adjuvant technologies were discussed.

  17. Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease

    Science.gov (United States)

    Thompson, Megan R.; Stone, Ramona F.; Ochs, V. Dan; Litvan, Irene

    2013-01-01

    In order to determine primary health care providers' (PCPs) knowledge gaps on Parkinson's disease, data were collected before and after a one-hour continuing medical education (CME) lecture on early Parkinson's disease recognition and treatment from a sample of 104 PCPs participating at an annual meeting. The main outcome measure was the…

  18. Bridging Implementation, Knowledge, and Ambition Gaps to Eliminate Tuberculosis

    Centers for Disease Control (CDC) Podcasts

    2011-02-22

    In this podcast, Dr. Kenneth Castro, director of CDC's Division of Tuberculosis Eliminatio,discusses bridging implementation, knowledge, and ambition gaps to eliminate tuberculosis.  Created: 2/22/2011 by National Center for Emerging Zoonotic and Infectious Diseases (NCEZID).   Date Released: 3/2/2011.

  19. The Gap between Mapuche Knowledge and School Knowledge in the Mapuche Context

    Directory of Open Access Journals (Sweden)

    Segundo Quintriqueo Millán

    2012-05-01

    Full Text Available This article describes the gap between Mapuche and school knowledge in schools of the Ninth Region of Araucanía, Chile. To that end, we examine the implications of a monocultural curriculum for the education of Mapuche children and youth who present different systems of logic for native knowledge and academic knowledge. The methodology used is educational research, based on the multi-method approach. The results provide a knowledge base for understanding the gap between school knowledge and traditional Mapuche knowledge in intercultural educational contexts. The objective is to overcome epistemological issues in the teaching and learning of sciences, through contextualized pedagogical practices that will generate intercultural dialogue in the school-based educational process of Mapuche and non-Mapuche children and youth.

  20. Internet Use and the Political Knowledge Gap in Spain

    Directory of Open Access Journals (Sweden)

    Anduiza, Eva

    2012-04-01

    Full Text Available Media availability and fragmentation and the resulting possibilities of content selection have risen dramatically with the expansion of new digital media. Previous research has found that this may increase knowledge gaps among citizens with different resources and motivations. This article analyses how Internet use affects political knowledge gaps due to education and to political interest in Spain. As expected, frequent Internet users are more knowledgeable about politics than non-users. Furthermore, Internet use increases knowledge more for the highly educated than for citizens with lower levels of education. Thus, the political knowledge gap related to education seems to be growing with the introduction of new media. However, the knowledge gap between citizens with high and low levels of political interest is smaller for frequent Internet users than for non-users. These findings provide a complex picture and partially contradict the pessimistic theory about the impact of increasing media choice on political knowledge.

    La disponibilidad y fragmentación de medios de comunicación y las posibilidades de elegir contenidos han aumentado en gran medida a raíz de la expansión de los medios digitales. Éstos pueden, según investigaciones anteriores, incrementar las diferencias en los niveles de conocimiento entre ciudadanos con distintas características. En este artículo se analiza cómo el uso de Internet afecta a las diferencias en el conocimiento político según el nivel educativo y el interés por la política en España. Los usuarios frecuentes de Internet saben más sobre política que los no usuarios, como era de esperar. Además, el uso de Internet incrementa el conocimiento político de manera más intensa para los usuarios con niveles educativos más elevados. Por tanto, parece que las diferencias en los niveles de conocimiento pueden estar creciendo con la expansión de los medios digitales. Sin embargo, las diferencias

  1. Pharmacogenomic knowledge gaps and educational resource needs among physicians in selected specialties

    Directory of Open Access Journals (Sweden)

    Johansen Taber KA

    2014-07-01

    Full Text Available Katherine A Johansen Taber, Barry D Dickinson Department of Science and Biotechnology, American Medical Association, Chicago, IL, USA Background: The use of pharmacogenomic testing in the clinical setting has the potential to improve the safety and effectiveness of drug therapy, yet studies have revealed that physicians lack knowledge about the topic of pharmacogenomics, and are not prepared to implement it in the clinical setting. This study further explores the pharmacogenomic knowledge deficit and educational resource needs among physicians. Materials and methods: Surveys of primary care physicians, cardiologists, and psychiatrists were conducted. Results: Few physicians reported familiarity with the topic of pharmacogenomics, but more reported confidence in their knowledge about the influence of genetics on drug therapy. Only a small minority had undergone formal training in pharmacogenomics, and a majority reported being unsure what type of pharmacogenomic tests were appropriate to order for the clinical situation. Respondents indicated that an ideal pharmacogenomic educational resource should be electronic and include such components as how to interpret pharmacogenomic test results, recommendations for prescribing, population subgroups most likely to be affected, and contact information for laboratories offering pharmacogenomic testing. Conclusion: Physicians continue to demonstrate pharmacogenomic knowledge gaps, and are unsure about how to use pharmacogenomic testing in clinical practice. Educational resources that are clinically oriented and easily accessible are preferred by physicians, and may best support appropriate clinical implementation of pharmacogenomics. Keywords: pharmacogenomics, knowledge gap, drug response, educational resource

  2. Cancer and the environment: Filling knowledge gaps together

    Institute of Scientific and Technical Information of China (English)

    Linda S. BIRNBAUM

    2010-01-01

    @@ When considering disease etiology, we need to view the role of the environment along the continuum from health to disease for individuals because we know that there are complex interactions between genes, their molecular expression, and environmental factors over a person's lifetime. We clearly have huge gaps in our knowledge along this continuum, and these gaps are natural opportunities for research. There are many factors to consider as we assess the relationship between environmental exposures over a lifetime. One factor is persistence of chemicals that "live" beyond their initial intended use. Another factor is the fact that "inert ingredients" are not really inert. "Low dose" is also another consideration. We need to understand the biological effect of low dose exposure and we should clearly define what they mean by low dose research. For example, are we measuring the administered dose, or the internal/circulating dose?

  3. Mobilizing Knowledge: The Evidence Gap for Assistive Devices

    Directory of Open Access Journals (Sweden)

    Edward D. Lemaire

    2016-09-01

    Full Text Available Knowledge mobilization can be hindered in healthcare technology settings where the pace of change outpaces the ability to perform high-quality research methodologies that provide timely knowledge to enable informed prescription and technology application to the end user. Although well-controlled research with appropriate sample sizes is needed, this approach must be balanced with other evidence sources to address the knowledge immediacy requirements. Using carbon-fibre ankle–foot orthoses (i.e., lower-limb braces that improve stability, alignment, and foot-to-ground placement as a case study, various sources of assistive device evidence were explored for their contribution to the continuum of knowledge in this area. A basic level of knowledge exists, but the quality is insufficient to inform the physical rehabilitation community on selecting from the almost 70 different devices on the market and the expected clinical outcomes for a target population. A combination of enhanced single-participant reports should be considered as an important part of the knowledge continuum and essential for knowledge immediacy. This approach must also be expanded to national and multinational database initiatives that provide a better base from which to extract knowledge on assistive device performance and mobilize this knowledge to provide optimal care for people with physical disabilities.

  4. DCS: A Case Study of Identification of Knowledge and Disposition Gaps Using Principles of Continuous Risk Management

    Science.gov (United States)

    Norcross, Jason; Steinberg, Susan; Kundrot, Craig; Charles, John

    2011-01-01

    The Human Research Program (HRP) is formulated around the program architecture of Evidence-Risk-Gap-Task-Deliverable. Review of accumulated evidence forms the basis for identification of high priority risks to human health and performance in space exploration. Gaps in knowledge or disposition are identified for each risk, and a portfolio of research tasks is developed to fill them. Deliverables from the tasks inform the evidence base with the ultimate goal of defining the level of risk and reducing it to an acceptable level. A comprehensive framework for gap identification, focus, and metrics has been developed based on principles of continuous risk management and clinical care. Research towards knowledge gaps improves understanding of the likelihood, consequence or timeframe of the risk. Disposition gaps include development of standards or requirements for risk acceptance, development of countermeasures or technology to mitigate the risk, and yearly technology assessment related to watching developments related to the risk. Standard concepts from clinical care: prevention, diagnosis, treatment, monitoring, rehabilitation, and surveillance, can be used to focus gaps dealing with risk mitigation. The research plan for the new HRP Risk of Decompression Sickness (DCS) used the framework to identify one disposition gap related to establishment of a DCS standard for acceptable risk, two knowledge gaps related to DCS phenomenon and mission attributes, and three mitigation gaps focused on prediction, prevention, and new technology watch. These gaps were organized in this manner primarily based on target for closure and ease of organizing interim metrics so that gap status could be quantified. Additional considerations for the knowledge gaps were that one was highly design reference mission specific and the other gap was focused on DCS phenomenon.

  5. Current knowledge, gaps and challenges in the Southern European Seas

    Science.gov (United States)

    Papathanassiou, Evangelos

    2015-04-01

    New knowledge advances our current understanding on the selection and application of the appropriate tools for assessing the state of the marine environment in the Southern European Seas (SES). Diminishing the lack of knowledge is a prerequisite for sound policy decisions. Although gaps and knowledge are fewer today, the health of marine and coastal ecosystems in the SES is under pressure and shows, in places, some signs of deterioration and declining quality. Overall, there is a lack of data accessibility and long time series in the SES, while in many cases poorly constrained processes cannot really support knowledge-based policy making (e.g. ecosystem functioning, climate change, fisheries management, etc.). New knowledge has to be produced and excellence must be promoted to support sustainable economic growth. At the same time, existing and new capacities have to be upgraded and increased in order to support sustainable convergence between SES countries. There are several gaps that have been identified and processes that have been poorly understood in the SES, mainly from research projects that have been working at basin level. The main research priorities that have been identified from the SeasERA Project for both, the Mediterranean and the Black Sea include: the climate change and its impacts, the hydrological cycle, the ventilation and the inter-basin coupling, the marine biodiversity and the provision of goods and services, the marine protected areas, the deep sea ecosystems, the biological invasions, the marine pollution and the ocean and human health, the renewable energy, the maritime transport, the fisheries and aquaculture activities and the biotechnology and the exploitation of marine resources for industrial application. More important, however, is the fact that the economic, the social and the scientific and the environmental challenges must be collectively tackled. They should have prioritisation and clear objectives as well as data sharing for

  6. Procedural and Conceptual Knowledge: Exploring the Gap between Knowledge Type and Knowledge Quality

    Science.gov (United States)

    Star, Jon R.; Stylianides, Gabriel J.

    2013-01-01

    Following Star (2005, 2007), we continue to problematize the entangling of type and quality in the use of conceptual knowledge and procedural knowledge. Although those whose work is guided by types of knowledge and those whose work is guided by qualities of knowledge seem to be referring to the same phenomena, actually they are not. This lack of…

  7. A brief simulation intervention increasing basic science and clinical knowledge

    OpenAIRE

    Sheakley, Maria L.; Gilbert, Gregory E.; Leighton, Kim; Hall, Maureen; Callender, Diana; Pederson, David

    2016-01-01

    Background: The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application.Purpose: To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant d...

  8. Irreproducibility in Preclinical Biomedical Research: Perceptions, Uncertainties, and Knowledge Gaps.

    Science.gov (United States)

    Jarvis, Michael F; Williams, Michael

    2016-04-01

    Concerns regarding the reliability of biomedical research outcomes were precipitated by two independent reports from the pharmaceutical industry that documented a lack of reproducibility in preclinical research in the areas of oncology, endocrinology, and hematology. Given their potential impact on public health, these concerns have been extensively covered in the media. Assessing the magnitude and scope of irreproducibility is limited by the anecdotal nature of the initial reports and a lack of quantitative data on specific failures to reproduce published research. Nevertheless, remediation activities have focused on needed enhancements in transparency and consistency in the reporting of experimental methodologies and results. While such initiatives can effectively bridge knowledge gaps and facilitate best practices across established and emerging research disciplines and therapeutic areas, concerns remain on how these improve on the historical process of independent replication in validating research findings and their potential to inhibit scientific innovation.

  9. Understanding indigenous knowledge: Bridging the knowledge gap through a knowledge creation model for agricultural development

    OpenAIRE

    Edda T. Lwoga; Patrick Ngulube; Christine Stilwell

    2010-01-01

    This article addresses the management of agricultural indigenous knowledge (IK) in developing countries, with a specific focus on Tanzania. It provides background details on IK and its importance for agricultural development. It introduces various knowledge management (KM) concepts and discusses their application in managing IK in the developing world by placing Nonaka’s knowledge creation theory (Nonaka 1991; Nonaka & Takeuchi 1995; Nonaka, Toyama & Konno 2000) in the context of the ...

  10. Understanding indigenous knowledge: Bridging the knowledge gap through a knowledge creation model for agricultural development

    Directory of Open Access Journals (Sweden)

    Edda T. Lwoga

    2010-08-01

    Full Text Available This article addresses the management of agricultural indigenous knowledge (IK in developing countries, with a specific focus on Tanzania. It provides background details on IK and its importance for agricultural development. It introduces various knowledge management (KM concepts and discusses their application in managing IK in the developing world by placing Nonaka’s knowledge creation theory (Nonaka 1991; Nonaka & Takeuchi 1995; Nonaka, Toyama & Konno 2000 in the context of the local communities. Data from focus groups were used to triangulate with data from interviews in order to validate, confirm and corroborate quantitative results with qualitative findings. The study findings showed that knowledge creation theory can be used to manage IK in the local communities, however, adequate and appropriate resources need to be allocated for capturing and preserving IK before it disappears altogether. For sustainable agricultural development, the communities have to be placed within a knowledge-creating setting that continuously creates, distributes and shares knowledge within and beyond the communities’ boundaries and integrates it with new agricultural technologies, innovations and knowledge.

  11. ROSS Skills, Knowledge, and Abilities Training Evaluation. Gaps and Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Ala, Maureen [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gruidl, Jeremiah [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Buddemeier, Brooke [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2015-09-30

    This document describes the development of the ROSS SKAs, the cross-mapping of the SKAs to the available training, identifies gaps in the SKA and training, and provides recommendations to address those gaps.

  12. Experimental Evidence of the Knowledge Gap: Message Arousal, Motivation, and Time Delay

    Science.gov (United States)

    Grabe, Maria Elizabeth; Yegiyan, Narine; Kamhawi, Rasha

    2008-01-01

    This study experimentally tested the knowledge gap from an information processing perspective. Specifically, knowledge acquisition was investigated under conditions of medium and low news message arousal, with time delay. Results show the persistence of a knowledge gap, particularly for low arousing messages. In fact, at low levels of message…

  13. Human strongyloidiasis: identifying knowledge gaps, with emphasis on environmental control

    Directory of Open Access Journals (Sweden)

    Taylor MJ

    2014-08-01

    Full Text Available Michael J Taylor, Tara A Garrard, Francis J O'Donahoo, Kirstin E Ross Health and Environment, School of the Environment, Flinders University, Adelaide, SA, Australia Abstract: Strongyloides is a human parasitic nematode that is poorly understood outside a clinical context. This article identifies gaps within the literature, with particular emphasis on gaps that are hindering environmental control of Strongyloides. The prevalence and distribution of Strongyloides is unclear. An estimate of 100–370 million people infected worldwide has been proposed; however, inaccuracy of diagnosis, unreliability of prevalence mapping, and the fact that strongyloidiasis remains a neglected disease suggest that the higher figure of more than 300 million cases is likely to be a more accurate estimate. The complexity of Strongyloides life cycle means that laboratory cultures cannot be maintained outside of a host. This currently limits the range of laboratory-based research, which is vital to controlling Strongyloides through environmental alteration or treatment. Successful clinical treatment with antihelminthic drugs has meant that controlling Strongyloides through environmental control, rather than clinical intervention, has been largely overlooked. These control measures may encompass alteration of the soil environment through physical means, such as desiccation or removal of nutrients, or through chemical or biological agents. Repeated antihelminthic treatment of individuals with recurrent strongyloidiasis has not been observed to result in the selection of resistant strains; however, this has not been explicitly demonstrated, and relying on such assumptions in the long-term may prove to be shortsighted. It is ultimately naive to assume that continued administration of antihelminthics will be without any negative long-term effects. In Australia, strongyloidiasis primarily affects Indigenous communities, including communities from arid central Australia. This

  14. Knowledge gaps between nanotoxicological research and nanomaterial safety.

    Science.gov (United States)

    Hu, Xiangang; Li, Dandan; Gao, Yue; Mu, Li; Zhou, Qixing

    2016-09-01

    With the wide research and application of nanomaterials in various fields, the safety of nanomaterials attracts much attention. An increasing number of reports in the literature have shown the adverse effects of nanomaterials, representing the quick development of nanotoxicology. However, many studies in nanotoxicology have not reflected the real nanomaterial safety, and the knowledge gaps between nanotoxicological research and nanomaterial safety remain large. Considering the remarkable influence of biological or environmental matrices (e.g., biological corona) on nanotoxicity, the situation of performing nanotoxicological experiments should be relevant to the environment and humans. Given the possibility of long-term and low-concentration exposure of nanomaterials, the reversibility of and adaptation to nanotoxicity, and the transgenerational effects should not be ignored. Different from common pollutants, the specific analysis methodology for nanotoxicology need development and exploration furthermore. High-throughput assay integrating with omics was highlighted in the present review to globally investigate nanotoxicity. In addition, the biological responses beyond individual levels, special mechanisms and control of nanotoxicity deserve more attention. The progress of nanotoxicology has been reviewed by previous articles. This review focuses on the blind spots in nanotoxicological research and provides insight into what we should do in future work to support the healthy development of nanotechnology and the evaluation of real nanomaterial safety.

  15. Mammalian Metabolism of β-Carotene: Gaps in Knowledge

    Directory of Open Access Journals (Sweden)

    Varsha Shete

    2013-11-01

    Full Text Available β-carotene is the most abundant provitamin A carotenoid in human diet and tissues. It exerts a number of beneficial functions in mammals, including humans, owing to its ability to generate vitamin A as well as to emerging crucial signaling functions of its metabolites. Even though β-carotene is generally considered a safer form of vitamin A due to its highly regulated intestinal absorption, detrimental effects have also been ascribed to its intake, at least under specific circumstances. A better understanding of the metabolism of β-carotene is still needed to unequivocally discriminate the conditions under which it may exert beneficial or detrimental effects on human health and thus to enable the formulation of dietary recommendations adequate for different groups of individuals and populations worldwide. Here we provide a general overview of the metabolism of this vitamin A precursor in mammals with the aim of identifying the gaps in knowledge that call for immediate attention. We highlight the main questions that remain to be answered in regards to the cleavage, uptake, extracellular and intracellular transport of β-carotene as well as the interactions between the metabolism of β-carotene and that of other macronutrients such as lipids.

  16. Key Knowledge Gaps for Plasmodium vivax Control and Elimination

    Science.gov (United States)

    Bassat, Quique; Velarde, Mar; Mueller, Ivo; Lin, Jessica; Leslie, Toby; Wongsrichanalai, Chansuda; Baird, J. Kevin

    2016-01-01

    There is inadequate understanding of the biology, pathology, transmission, and control of Plasmodium vivax, the geographically most widespread cause of human malaria. During the last decades, study of this species was neglected, in part due to the erroneous belief that it is intrinsically benign. In addition, many technical challenges in culturing the parasite also hampered understanding its fundamental biology and molecular and cellular responses to chemotherapeutics. Research on vivax malaria needs to be substantially expanded over the next decade to accelerate its elimination and eradication. This article summarizes key knowledge gaps identified by researchers, national malaria control programs, and other stakeholders assembled by the World Health Organization to develop strategies for controlling and eliminating vivax malaria. The priorities presented in this article emerged in these technical discussions, and were adopted by expert consensus of the authors. All involved understood the priority placed upon pragmatism in this research agenda, that is, focus upon tools delivering better prevention, diagnosis, treatment, and surveillance of P. vivax. PMID:27430544

  17. Bridging the PSI Knowledge Gap: A Multi-Scale Approach

    Energy Technology Data Exchange (ETDEWEB)

    Wirth, Brian D [University of Tennessee, Knoxville

    2015-01-08

    Plasma-surface interactions (PSI) pose an immense scientific hurdle in magnetic confinement fusion and our present understanding of PSI in confinement environments is highly inadequate; indeed, a recent Fusion Energy Sciences Advisory Committee report found that 4 out of the 5 top five fusion knowledge gaps were related to PSI. The time is appropriate to develop a concentrated and synergistic science effort that would expand, exploit and integrate the wealth of laboratory ion-beam and plasma research, as well as exciting new computational tools, towards the goal of bridging the PSI knowledge gap. This effort would broadly advance plasma and material sciences, while providing critical knowledge towards progress in fusion PSI. This project involves the development of a Science Center focused on a new approach to PSI science; an approach that both exploits access to state-of-the-art PSI experiments and modeling, as well as confinement devices. The organizing principle is to develop synergistic experimental and modeling tools that treat the truly coupled multi-scale aspect of the PSI issues in confinement devices. This is motivated by the simple observation that while typical lab experiments and models allow independent manipulation of controlling variables, the confinement PSI environment is essentially self-determined with few outside controls. This means that processes that may be treated independently in laboratory experiments, because they involve vastly different physical and time scales, will now affect one another in the confinement environment. Also, lab experiments cannot simultaneously match all exposure conditions found in confinement devices typically forcing a linear extrapolation of lab results. At the same time programmatic limitations prevent confinement experiments alone from answering many key PSI questions. The resolution to this problem is to usefully exploit access to PSI science in lab devices, while retooling our thinking from a linear and de

  18. Biochar effects on soils: overview and knowledge gaps

    Science.gov (United States)

    Verheijen, F. G. A.; Jeffery, S.; Bastos, A. C.; van der Velde, M.

    2012-04-01

    One of the cornerstones of the sustainable biochar concept is to improve, or at least to not deteriorate, soil quality and functioning. The idea of global sustainable biochar systems, with biochar applied to global cropland and grassland soils, has highlighted limitations in: i) current scientific understanding of biochar interactions with soil components, ii) the capacity to assess ecosystem services provided by soils, and iii) the uncertainty in spatio-temporal representation of both (i) and (ii). Pyrolysis conditions and feedstock characteristics largely control the physico-chemical properties of the resulting biochar, which in turn determine the suitability for a given application. Soils are highly heterogeneous systems at a range of scales. Combinations of land use, soil management and changing climatic conditions further enhance this heterogeneity. While this leads to difficulties in identifying the underlying mechanisms behind reported effects in the scientific literature, it also provides an opportunity for 'critical matching' of biochar properties that are best suited to a particular site (depending on soil type, hydrology, climate, land use, soil contaminants, etc.). Biochar's relatively long mean residence times in soils (100s of years) make it a potential instrument for sequestering carbon (if done sustainably). However, that same long mean residence time sets biochar apart from conventional soil amendments (such as manures and other organic fertilizers) that are considered as transient in the soil (1-10s of years). The functional life time of biochar in soils essentially moves biochar from a soil management tool to a geo-engineering technique. One of the consequences is that desired ecosystem services that are provided by soils, have to be projected for the same time period. This presentation aims to discuss critical knowledge gaps in biochar-soil-ecosystem interactions against a background of ecosystem services.

  19. Mitigating the Mathematical Knowledge Gap between High School and First Year University Chemical Engineering Mathematics Course

    Science.gov (United States)

    Basitere, Moses; Ivala, Eunice

    2015-01-01

    This paper reports on a study carried out at a University of Technology, South Africa, aimed at identifying the existence of the mathematical knowledge gap and evaluating the intervention designed to bridge the knowledge gap amongst students studying first year mathematics at the Chemical Engineering Extended Curriculum Program (ECP). In this…

  20. The gap in scientific knowledge and role of science communication in South Korea.

    Science.gov (United States)

    Chang, Jeong-Heon; Kim, Sei-Hill; Kang, Myung-Hyun; Shim, Jae Chul; Ma, Dong Hoon

    2017-01-01

    Using data from a national survey of South Koreans, this study explores the role of science communication in enhancing three different forms of scientific knowledge ( factual, procedural, and subjective). We first assess learning effects, looking at the extent to which citizens learn science from different channels of communication (interpersonal discussions, traditional newspapers, television, online newspapers, and social media). We then look into the knowledge gap hypothesis, investigating how different communication channels can either widen or narrow the gap in knowledge between social classes. Television was found to function as a "knowledge leveler," narrowing the gap between highly and less educated South Koreans. The role of online newspapers in science learning is pronounced in our research. Reading newspapers online indicated a positive relationship to all three measures of knowledge. Contrary to the knowledge-leveling effect of television viewing, reading online newspapers was found to increase, rather than decrease, the gap in knowledge. Implications of our findings are discussed in detail.

  1. Filling Knowledge Gaps with Five Fuel Cycle Studies

    Energy Technology Data Exchange (ETDEWEB)

    Steven J. Piet; Jess Gehin; William Halsey; Temitope Taiwo

    2010-11-01

    During FY 2010, five studies were conducted of technology families’ applicability to various fuel cycle strategies to fill in knowledge gaps in option space and to better understand trends and patterns. Here, a “technology family” is considered to be defined by a type of reactor and by selection of which actinides provide fuel. This report summarizes the higher-level findings; the detailed analyses and results are documented in five individual reports, as follows: • Advanced once through with uranium fuel in fast reactors (SFR), • Advanced once through (uranium fuel) or single recycle (TRU fuel) in high temperature gas cooled reactors (HTGR), • Sustained recycle with Th/U-233 in light water reactors (LWRs), • Sustained recycle with Th/U-233 in molten salt reactors (MSR), and • Several fuel cycle missions with Fusion-Fission Hybrid (FFH). Each study examined how the designated technology family could serve one or more designated fuel cycle missions, filling in gaps in overall option space. Each study contains one or more illustrative cases that show how the technology family could be used to meet a fuel cycle mission, as well as broader information on the technology family such as other potential fuel cycle missions for which insufficient information was available to include with an illustrative case. None of the illustrative cases can be considered as a reference, baseline, or nominal set of parameters for judging performance; the assessments were designed to assess areas of option space and were not meant to be optimized. There is no implication that any of the cases or technology families are necessarily the best way to meet a given fuel cycle mission. The studies provide five examples of 1-year fuel cycle assessments of technology families. There is reasonable coverage in the five studies of the performance areas of waste management and uranium utilization. The coverage of economics, safety, and proliferation resistance and physical protection in

  2. Gaps and Progress in Our Knowledge of Learning Organizations

    Science.gov (United States)

    Tuggle, Francis D.

    2016-01-01

    Purpose: This study aims to review previously published issues of "The Learning Organization" ("TLO") to assess what progress has been made since the journal started in terms of what is known about learning organizations. The author also aims to identify important gaps in what is still to be discovered about organizations that…

  3. Clinical sensitivity: the inseparability of ethical perceptiveness and clinical knowledge.

    Science.gov (United States)

    Nortvedt, P

    2001-01-01

    This article argues that there is an important connection between ethical sensitivity and clinical competency in nursing. This is more than a defense for ethical attitudes and virtues in clinical practice, however. I will show in what way ethical sensitivity is important not only to moral judgment, but to professional clinical knowledge and judgment as well. Drawing on central insights from continental philosophy, Husserl, Heidegger, Levinas and Foucault, as well as classical virtue theory, the article elucidates the inseparability of ethical sensitivity and clinical knowledge in nursing. Ethical sensitivity has bearing upon clinical knowledge and awareness in two important ways. First, what we consider relevant clinical knowledge and therapeutic measures frequently encounter the realities of clinical conditions, realities which embody certain moral qualities and appeal to moral values. In clinical nursing, it is important to understand how this encounter between professional knowledge and moral values informs clinical action, making it morally as well as professionally proper. Second, sensitivity to vulnerability qualifies clinical knowledge in the way that it alerts clinical sensitivity altogether. Perception of morally salient features informs the nurse about significant changes in the patient's pathological condition. The ability to be touched morally by the patient's condition, his or her vulnerability or vitality and positive experience is epistemologically and prognostically significant.

  4. Cybernetics: A Possible Solution for the "Knowledge Gap" between "External" and "Internal" in Evaluation Processes

    Science.gov (United States)

    Levin-Rozalis, Miri

    2010-01-01

    This paper addresses the issue of the knowledge gap between evaluators and the entity being evaluated: the dilemma of the knowledge of professional evaluators vs. the in-depth knowledge of the evaluated subjects. In order to optimize evaluative outcomes, the author suggests an approach based on ideas borrowed from the science of cybernetics as a…

  5. The gap in your knowledge: gender on wheels.

    Science.gov (United States)

    Crisp, A H; Lincoln, H; Mintram, M K; Crutchfield, M; Bhat, A V

    Among a group of young car drivers the size of the gap perceived as necessary to allow them to drive their cars through was related to their degree of measured fatness. This relationship extended to measured height and shoulder breadth in women and self-perception of shoulder breadth in men. No relationship could be found with the premenstrual phase in women. These findings may have important social implications.

  6. Maximizing scientific knowledge from randomized clinical trials

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Atar, Dan; Pitt, Bertram

    2010-01-01

    Trialists have an ethical and financial responsibility to plan and conduct clinical trials in a manner that will maximize the scientific knowledge gained from the trial. However, the amount of scientific information generated by randomized clinical trials in cardiovascular medicine is highly...

  7. Measurement error of waist circumference: gaps in knowledge.

    NARCIS (Netherlands)

    Verweij, L.M.; Terwee, C.B.; Proper, K.I.; Hulshof, C.T.J.; Mechelen, W. van

    2013-01-01

    Objective: It is not clear whether measuring waist circumference in clinical practice is problematic because the measurement error is unclear, as well as what constitutes a clinically relevant change. The present study aimed to summarize what is known from state-of-the-art research. Design: To ident

  8. Measurement error of waist circumference: Gaps in knowledge

    NARCIS (Netherlands)

    Verweij, L.M.; Terwee, C.B.; Proper, K.I.; Hulshof, C.T.; Mechelen, W.V. van

    2013-01-01

    Objective It is not clear whether measuring waist circumference in clinical practice is problematic because the measurement error is unclear, as well as what constitutes a clinically relevant change. The present study aimed to summarize what is known from state-of-the-art research. Design To identif

  9. Gaps in Alzheimer's Knowledge among College Students

    Science.gov (United States)

    Eshbaugh, Elaine M.

    2014-01-01

    Despite the prevalence of the disease, it appears that there may be a need for increased education for formal and family caregivers of those with Alzheimer's disease and related dementias. Today's college students will be asked to fill both of these roles in the future. This study examined the level of knowledge of Alzheimer's…

  10. Maximizing scientific knowledge from randomized clinical trials

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Atar, Dan; Pitt, Bertram;

    2010-01-01

    Trialists have an ethical and financial responsibility to plan and conduct clinical trials in a manner that will maximize the scientific knowledge gained from the trial. However, the amount of scientific information generated by randomized clinical trials in cardiovascular medicine is highly...... variable. Generation of trial databases and/or biobanks originating in large randomized clinical trials has successfully increased the knowledge obtained from those trials. At the 10th Cardiovascular Trialist Workshop, possibilities and pitfalls in designing and accessing clinical trial databases were......, in particular with respect to collaboration with the trial sponsor and to analytic pitfalls. The advantages of creating screening databases in conjunction with a given clinical trial are described; and finally, the potential for posttrial database studies to become a platform for training young scientists...

  11. Knowledge gaps regarding APN roles: what hospital decision-makers tell us.

    Science.gov (United States)

    Carter, Nancy; Dobbins, Maureen; Ireland, Sandra; Hoxby, Heather; Peachey, Gladys; DiCenso, Alba

    2013-12-01

    The implementation of advanced practice nursing (APN) roles can yield improvements in patient and health system outcomes, and supportive leadership is integral in facilitating the implementation of such roles. The purpose of this study was to explore the awareness and understanding of APN roles among hospital decision-makers, and to learn about the information they require and the ways in which they prefer to receive that information. Fifteen administrators and leaders from two multi-site acute care organizations were interviewed. Their practical knowledge of APN roles was based on experience developing the roles or working with APNs in hospital programs. The most common sources of APN information were internal contacts (i.e., APNs) and documents from nursing organizations. Participants reported difficulty distinguishing between the roles of nurse practitioners (NPs) and clinical nurse specialists (CNSs), and identified knowledge regarding CNS roles as their greatest need. They required specific information regarding the "value-added" benefits offered by an APN role. Strategies to address the knowledge gaps of healthcare leaders are urgently needed in order to support the implementation of new APN roles and to sustain existing ones.

  12. Junior doctors' knowledge of applied clinical anatomy.

    Science.gov (United States)

    Gupta, Yuri; Morgan, Mia; Singh, Annika; Ellis, Harold

    2008-05-01

    This study examines the level of knowledge of applied clinical anatomy among junior doctors. A multiple-choice questionnaire was designed, which covered 15 areas of anatomical knowledge essential to clinical practice, for example, important surface landmarks and interpretation of radiographs. The questionnaire was completed by 128 individuals. They comprised anatomy demonstrators, preregistration house officers (PRHOs), senior house officers (SHOs) and specialist registrars (SpRs) across the range of medical and surgical specialities. Answers were scored and analyzed by group, allowing comparison not only between newly qualified PRHOs and more senior doctors, but also with anatomy demonstrators who had undergone more traditional anatomical training. The results reveal a wide variation of knowledge among junior doctors, with PRHOs scoring an average of 72.1%, SHOs 77.1%, SpRs 82.4%, and demonstrators 82.9%. This progression in knowledge up the clinical hierarchy may reflect clinical experience building upon the foundations laid in medical school, although with demonstrators topping the league table, it seems that intensive academic training is the most beneficial. With junior doctors' training in the UK currently in flux, these results highlight the need for training in clinical anatomy to hold an important place in the development of tomorrow's clinicians.

  13. Childhood TB Surveillance: Bridging the Knowledge Gap to Inform Policy

    Directory of Open Access Journals (Sweden)

    Andrew J. Brent

    2012-01-01

    Full Text Available Tuberculosis (TB is a leading cause of death globally. Natural history studies show that young children are at particularly high risk of progression to active TB and severe, disseminated disease following infection. Despite this, high-quality regional and global surveillance data on the burden of childhood TB are lacking. We discuss the unique aspects of TB in children that make diagnosis and therefore surveillance challenging; the limitations of available surveillance data; other data which provide insights into the true burden of childhood TB. Improved surveillance is among the key research priorities identified for childhood TB, but progress to date has been slow. Recent advances in TB diagnostics, and standardized clinical diagnostic guidelines and case definitions, all provide opportunities for new strategies to improve surveillance. Better-quality data on the burden and trends of childhood TB will inform and improve both public health policy and clinical practice.

  14. Bridging the knowledge gap between Big Data producers and consumers

    Science.gov (United States)

    Peng, G. S.; Worley, S. J.

    2015-12-01

    Most weather data is produced, disseminated and consumed by expert users in large national operational centers or laboratories. Data 'ages' off their systems in days or weeks. While archives exist, would-be users often lack the credentials necessary to obtain an account to access or search its contents. Moreover, operational centers and many national archives lack the mandate and the resources to serve non-expert users. The National Center for Atmospheric Research (NCAR) Research Data Archive (RDA), rda.ucar.edu, was created over 40 years ago to collect data for NCAR's internal Big Science projects such as the NCEP/NCAR Reanalysis Project. Over time, the data holdings have grown to 1.8+ Petabytes spanning 600+ datasets. The user base has also grown; in 2014, we served 1.1 Petabytes of data to over 11,000 unique users. The RDA works with national centers, such as NCEP, ECMWF and JMA to make their data available to worldwide audiences and mutually support data access at the production source. We have become not just an open-access data center, but also a data education center. Each dataset archived at the RDA is assigned to a data specialist (DS) who curates the data. If a user has a question not answered in the dataset information web pages prepared by the DS, they can call or email a skilled DS for further clarification. The RDA's diverse staff—with academic training in meteorology, oceanography, engineering (electrical, civil, ocean and database), mathematics, physics, chemistry and information science—means we likely have someone who "speaks your language." Erroneous data assumptions are the Achilles heel of Big Data. It doesn't matter how much data you crunch if the data is not what you think it is. Data discovery is another difficult Big Data problem; one can only solve problems with data if one can find the right data. Metadata, both machine and human-generated, underpin the RDA data search tools. The RDA has stepped in to fill the gap between data

  15. Allergic Rhinitis and Associated Comorbidities: Prevalence in Oman with Knowledge Gaps in Literature

    Directory of Open Access Journals (Sweden)

    Rashid Al-Abri

    2014-11-01

    Full Text Available Objectives: Allergic rhinitis (AR is a global health problem and its impact on health related quality of life for patients is substantial, and the economic impact often underestimated. The prevalence of allergic rhinitis in Oman is unknown. This study aimed to estimate the prevalence of AR and associated co-morbidities among adults in Oman. Its secondary objective was to identify knowledge gaps in the literature with the aim of directing future research. Methods: A prospective, cross-sectional study of patients who presented to the outpatient otolaryngology clinic at Sultan Qaboos University Hospital with nasal symptoms between June 2010 and June 2011 was conducted. Results: A total of 887 patients were seen with nasal complaints. Among them 127 patients were diagnosed with non-infective rhinitis, the mean age of presentation was 27 years. AR was noted in 48% of patients, and non-allergic rhinitis in 52%. The prevalence of AR was 7%, with females being more affected than males, and age ranging from 18 to 51 years. Prevalence of perennial AR was 84% compared to seasonal AR which was 16%. The most common perennial antigens were house dust mites (80% followed by cockroaches (67%. All patients diagnosed with seasonal AR were found to be sensitive to Russian thistle. The prevalence of chronic rhinosinusitis in patients with AR was 34%. Conclusion: The prevalence of AR in the adult population presenting with nasal symptoms was found to be 7%, with associated chronic rhinosinusitis present in a third of these patients. However, there appears to be substantial knowledge gaps regarding the association of other comorbidities, like otitis media, bronchitis and bronchial asthma, the long-term outcomes of medical management, and indication of surgical intervention in patients with AR. Future research in AR among Omani patients should aim to address these issues.

  16. Iron deficiency anemia--bridging the knowledge and practice gap.

    Science.gov (United States)

    Shander, Aryeh; Goodnough, Lawrence T; Javidroozi, Mazyar; Auerbach, Michael; Carson, Jeffrey; Ershler, William B; Ghiglione, Mary; Glaspy, John; Lew, Indu

    2014-07-01

    Despite its high prevalence, anemia often does not receive proper clinical attention, and detection, evaluation, and management of iron deficiency anemia and iron-restricted erythropoiesis can possibly be an unmet medical need. A multidisciplinary panel of clinicians with expertise in anemia management convened and reviewed recent published data on prevalence, etiology, and health implications of anemia as well as current therapeutic options and available guidelines on management of anemia across various patient populations and made recommendations on the detection, diagnostic approach, and management of anemia. The available evidence confirms that the prevalence of anemia is high across all populations, especially in hospitalized patients. Anemia is associated with worse clinical outcomes including longer length of hospital stay, diminished quality of life, and increased risk of morbidity and mortality, and it is a modifiable risk factor of allogeneic blood transfusion with its own inherent risks. Iron deficiency is usually present in anemic patients. An algorithm for detection and management of anemia was discussed, which incorporated iron study (with primary emphasis on transferrin saturation), serum creatinine and glomerular filtration rate, and vitamin B12 and folic acid measurements. Management strategies included iron therapy (oral or intravenous), erythropoiesis-stimulating agents, and referral as needed.

  17. The value of health information technology: filling the knowledge gap.

    Science.gov (United States)

    Rudin, Robert S; Jones, Spencer S; Shekelle, Paul; Hillestad, Richard J; Keeler, Emmett B

    2014-11-01

    Despite rapid growth in the rate of adoption of health information technology (HIT), and in the volume of evaluation studies, the existing knowledge base for the value of HIT is not advancing at a similar rate. Most evaluation articles are limited in that they use incomplete measures of value and fail to report the important contextual and implementation characteristics that would allow for an adequate understanding of how the study results were achieved. To address these deficiencies, we present a conceptual framework for measuring HIT value and we propose a checklist of characteristics that should be considered in HIT evaluation studies. The framework consists of 3 key principles: 1) value includes both costs and benefits; 2) value accrues over time; and 3) value depends on which stakeholder's perspective is used. Through examples, we show how these principles can be used to guide and improve HIT evaluation studies. The checklist includes a list of contextual and implementation characteristics that are important for interpretation of results. These improvements will make future studies more useful for policy makers and more relevant to the current needs of the healthcare system.

  18. Knowledge Management Practices and Enablers in Public Universities: A Gap Analysis

    Science.gov (United States)

    Ramachandran, Sharimllah Devi; Chong, Siong-Choy; Wong, Kuan-Yew

    2013-01-01

    Purpose: The purpose of this paper is to examine the gap between knowledge management (KM) practices and key strategic enablers in public universities. For this purpose, a 57-item survey on two dimensions--"use" and "importance"--was used as the instrument for this study. Design/methodology/approach: The questionnaire was administered to academics…

  19. Closing Gaps in Political Knowledge: Effects of a School Intervention via Communication in the Home.

    Science.gov (United States)

    McDevitt, Michael; Chaffee, Steven

    A model of family influence that reverses the traditional roles of parents and children is presented to explain the results of a school intervention that narrowed political communication and knowledge gaps between parents of high and low socioeconomic status (SES). Students' exposure to a civics curriculum stimulated adolescent news media use at…

  20. Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease

    Science.gov (United States)

    Thompson, Megan R.; Stone, Ramona F.; Ochs, V. Dan; Litvan, Irene

    2013-01-01

    In order to determine primary health care providers' (PCPs) knowledge gaps on Parkinson's disease, data were collected before and after a one-hour continuing medical education (CME) lecture on early Parkinson's disease recognition and treatment from a sample of 104 PCPs participating at an annual meeting. The main outcome measure…

  1. The biomedical disciplines and the structure of biomedical and clinical knowledge.

    Science.gov (United States)

    Nederbragt, H

    2000-11-01

    The relation between biomedical knowledge and clinical knowledge is discussed by comparing their respective structures. The knowledge of a disease as a biological phenomenon is constructed by the interaction of facts and theories from the main biomedical disciplines: epidemiology, diagnostics, clinical trial, therapy development and pathogenesis. Although these facts and theories are based on probabilities and extrapolations, the interaction provides a reliable and coherent structure, comparable to a Kuhnian paradigma. In the structure of clinical knowledge, i.e. knowledge of the patient with the disease, not only biomedical knowledge contributes to the structure but also economic and social relations, ethics and personal experience. However, the interaction between each of the participating "knowledges" in clinical knowledge is not based on mutual dependency and accumulation of different arguments from each, as in biomedical knowledge, but on competition and partial exclusion. Therefore, the structure of biomedical knowledge is different from that of clinical knowledge. This difference is used as the basis for a discussion in which the place of technology, evidence-based medicine and the gap between scientific and clinical knowledge are evaluated.

  2. Personalized medicine. Closing the gap between knowledge and clinical practice.

    Science.gov (United States)

    Anaya, Juan-Manuel; Duarte-Rey, Carolina; Sarmiento-Monroy, Juan C; Bardey, David; Castiblanco, John; Rojas-Villarraga, Adriana

    2016-08-01

    Personalized medicine encompasses a broad and evolving field informed by a patient distinctive information and biomarker profile. Although terminology is evolving and some semantic interpretations exist (e.g., personalized, individualized, precision), in a broad sense personalized medicine can be coined as: "To practice medicine as it once used to be in the past using the current biotechnological tools." A humanized approach to personalized medicine would offer the possibility of exploiting systems biology and its concept of P5 medicine, where predictive factors for developing a disease should be examined within populations in order to establish preventive measures on at-risk individuals, for whom healthcare should be personalized and participatory. Herein, the process of personalized medicine is presented together with the options that can be offered in health care systems with limited resources for diseases like rheumatoid arthritis and type 1 diabetes.

  3. A brief simulation intervention increasing basic science and clinical knowledge

    Directory of Open Access Journals (Sweden)

    Maria L. Sheakley

    2016-04-01

    Full Text Available Background: The United States Medical Licensing Examination (USMLE is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. Purpose: To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. Methods: This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (n l=515 and the intervention group received lecture plus a simulation exercise (nl+s=1,066. Assessment included summative exam questions (n=4 that were scored as pass/fail (≥75%. USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. Results: Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003. Discussion: Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum.

  4. A brief simulation intervention increasing basic science and clinical knowledge

    Science.gov (United States)

    Sheakley, Maria L.; Gilbert, Gregory E.; Leighton, Kim; Hall, Maureen; Callender, Diana; Pederson, David

    2016-01-01

    Background The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. Purpose To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. Methods This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (nl=515) and the intervention group received lecture plus a simulation exercise (nl+s=1,066). Assessment included summative exam questions (n=4) that were scored as pass/fail (≥75%). USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. Results Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003). Discussion Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum. PMID:27060102

  5. Collective Construction of Knowledge in Clinical Biochemistry

    Directory of Open Access Journals (Sweden)

    S.B. Barreto

    2010-05-01

    Full Text Available The collective construction of knowledge occurs by the convergence of ideas and semantic. This paper was made for a graduation discipline, in 2009-2, with 240students who were separated into 4 groups: morning period (M1,M2 and night period (N1,N2. This study aims the collective construction of a abstract-manual of clinical biochemistry tests, due the difficulty in comprehension of certain concepts by the students; it intends to help them in the process of knowledge acquirement. The constructivist approach was adopted and the matters of the discipline were available in a “Student Group e-mail account”, a functional communication tool. The instructions were reachable on the web. M1,M2 and N1 made one part of the study at the first period. N2 did not conclude the study at the same time period of the other groups; therefore they received a new responsibility: they were supposed to conclude and correct the manual and its application which included 90 different kinds of labor exams. A textbook has been defined containing illustrative pictures of blood collection and biosecurity. Three banners were exposed inside the hall of the institution. Collective work is important for the effective arrangement in health area. In the process of teaching/learning, the teacher must proceed on practices and methodologies aiming the development of the student competences and skills which represent its professional identity.

  6. KNOWLEDGE GAPS AMONG SCHOOL STAFF AND THE ROLE OF HIGH QUALITY ECOLOGICAL ASSESSMENTS IN SCHOOLS.

    Science.gov (United States)

    Bowen, Natasha K; Powers, Joelle D

    2005-11-01

    OBJECTIVE: The purpose of the current study was to examine the practice validity of a new ecological assessment instrument for 3(rd) through 5(th) graders in terms of whether it provided school staff with new knowledge about students. METHOD: Pre-assessment knowledge of school staff was compared to data obtained from 21 children and their parents on 29 measures. Data were collected using the Elementary School Success Profile (ESSP). School staff pre-assessment knowledge was compared to obtained data across seven domains of children's lives (neighborhood, school, family, peers, parent educational involvement, well-being, and home behavior), data sources (child and parent), and grade level of students. RESULTS: Pre-assessment knowledge was not highly correlated with obtained data; pre-assessment expectations matched obtained data only about 41% of the time; and knowledge varied by domain, source, and grade level. CONCLUSIONS: Ecological assessments can address gaps in school staff's knowledge of targetable factors that influence the success of students.

  7. Stakeholder Meeting: Integrated Knowledge Translation Approach to Address the Caregiver Support Gap.

    Science.gov (United States)

    Holroyd-Leduc, Jayna M; McMillan, Jacqueline; Jette, Nathalie; Brémault-Phillips, Suzette C; Duggleby, Wendy; Hanson, Heather M; Parmar, Jasneet

    2017-03-01

    Family caregivers are an integral and increasingly overburdened part of the health care system. There is a gap between what research evidence shows is beneficial to caregivers and what is actually provided. Using an integrated knowledge translation approach, a stakeholder meeting was held among researchers, family caregivers, caregiver associations, clinicians, health care administrators, and policy makers. The objectives of the meeting were to review current research evidence and conduct multi-stakeholder dialogue on the potential gaps, facilitators, and barriers to the provision of caregiver supports. A two-day meeting was attended by 123 individuals. Three target populations of family caregivers were identified for discussion: caregivers of seniors with dementia, caregivers in end-of-life care, and caregivers of frail seniors with complex health needs. The results of this meeting can and are being used to inform the development of implementation research endeavours and policies targeted at providing evidence-informed caregiver supports.

  8. Standards for scalable clinical decision support: need, current and emerging standards, gaps, and proposal for progress.

    Science.gov (United States)

    Kawamoto, Kensaku; Del Fiol, Guilherme; Lobach, David F; Jenders, Robert A

    2010-01-01

    Despite their potential to significantly improve health care, advanced clinical decision support (CDS) capabilities are not widely available in the clinical setting. An important reason for this limited availability of CDS capabilities is the application-specific and institution-specific nature of most current CDS implementations. Thus, a critical need for enabling CDS capabilities on a much larger scale is the development and adoption of standards that enable current and emerging CDS resources to be more effectively leveraged across multiple applications and care settings. Standards required for such effective scaling of CDS include (i) standard terminologies and information models to represent and communicate about health care data; (ii) standard approaches to representing clinical knowledge in both human-readable and machine-executable formats; and (iii) standard approaches for leveraging these knowledge resources to provide CDS capabilities across various applications and care settings. A number of standards do exist or are under development to meet these needs. However, many gaps and challenges remain, including the excessive complexity of many standards; the limited availability of easily accessible knowledge resources implemented using standard approaches; and the lack of tooling and other practical resources to enable the efficient adoption of existing standards. Thus, the future development and widespread adoption of current CDS standards will depend critically on the availability of tooling, knowledge bases, and other resources that make the adoption of CDS standards not only the right approach to take, but the cost-effective path to follow given the alternative of using a traditional, ad hoc approach to implementing CDS.

  9. [Evidence-Based Knowledge Translation: From Scientific Evidence to Clinical Nursing Practice].

    Science.gov (United States)

    Chen, Kee-Hsin; Kao, Ching-Chiu; Chen, Chiehfeng

    2016-12-01

    In 1992, Gordon Guyatt coined the term "evidence-based medicine", which has since attracted worldwide attention. In 2007, the Institute of Medicine's Roundtable on Evidence-Based Medicine set the goal that 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information and would reflect the best available evidence by 2020. However, the chasm between knowing and doing remains palpable. In 2000, the Canadian Institute of Health Research applied the term "knowledge translation" to describe the bridge that is necessary to cross the gap between research knowledge and clinical practice. The present paper outlines the conceptual framework, barriers, and promotion strategies for evidence-based knowledge translation and shares clinical experience related to overcoming the seven layers of leakage (aware, accepted, applicable, able, acted on, agreed, and adhered to). We hope that this paper can enhance the public well-being and strengthen the future health care system.

  10. Zika virus infection, transmission, associated neurological disorders and birth abnormalities: A review of progress in research, priorities and knowledge gaps

    Directory of Open Access Journals (Sweden)

    Yitades Gebre

    2016-10-01

    Full Text Available On February 1, 2016, the World Health Organization declared that the cluster of microcephaly cases and other neurological disorders constitute public health emergency of international concern. Furthermore, few studies demonstrated that there was an increased evidence of causal relationship of Zika virus (ZIKAV infection and microcephaly, birth abnormalities and neurological disorders such as Guillain–Barré syndrome. ZIKAV transmission occurs mainly by the bite of infected mosquitos (Aedes species, but there are also reports that infections could occur via the placenta, breast milk, saliva, blood transfusion and sex. This article reviews the global efforts, progress in scientific research to understand the pathogenesis of ZIKAV infection & disease, clinical presentations, congenital transmission and autoimmune neurological disorders. The paper further explores the knowledge gaps, future priority research agenda for strategic response including vector control and prevention. We conducted a systematic literature review to synthesise available evidence on ZIKAV infection and its vector and host interaction from electronic databases.

  11. Crucial knowledge gaps in current understanding of climate change impacts on coral reef fishes

    KAUST Repository

    Wilson, S. K.

    2010-02-26

    Expert opinion was canvassed to identify crucial knowledge gaps in current understanding of climate change impacts on coral reef fishes. Scientists that had published three or more papers on the effects of climate and environmental factors on reef fishes were invited to submit five questions that, if addressed, would improve our understanding of climate change effects on coral reef fishes. Thirty-three scientists provided 155 questions, and 32 scientists scored these questions in terms of: (i) identifying a knowledge gap, (ii) achievability, (iii) applicability to a broad spectrum of species and reef habitats, and (iv) priority. Forty-two per cent of the questions related to habitat associations and community dynamics of fish, reflecting the established effects and immediate concern relating to climate-induced coral loss and habitat degradation. However, there were also questions on fish demographics, physiology, behaviour and management, all of which could be potentially affected by climate change. Irrespective of their individual expertise and background, scientists scored questions from different topics similarly, suggesting limited bias and recognition of a need for greater interdisciplinary and collaborative research. Presented here are the 53 highest-scoring unique questions. These questions should act as a guide for future research, providing a basis for better assessment and management of climate change impacts on coral reefs and associated fish communities.

  12. Towards a Consensus View on Understanding Nanomaterials Hazards and Managing Exposure: Knowledge Gaps and Recommendations

    Directory of Open Access Journals (Sweden)

    Maria Dusinska

    2013-03-01

    Full Text Available The aim of this article is to present an overview of salient issues of exposure, characterisation and hazard assessment of nanomaterials as they emerged from the consensus-building of experts undertaken within the four year European Commission coordination project NanoImpactNet. The approach adopted is to consolidate and condense the findings and problem-identification in such a way as to identify knowledge-gaps and generate a set of interim recommendations of use to industry, regulators, research bodies and funders. The categories of recommendation arising from the consensual view address: significant gaps in vital factual knowledge of exposure, characterisation and hazards; the development, dissemination and standardisation of appropriate laboratory protocols; address a wide range of technical issues in establishing an adequate risk assessment platform; the more efficient and coordinated gathering of basic data; greater inter-organisational cooperation; regulatory harmonization; the wider use of the life-cycle approaches; and the wider involvement of all stakeholders in the discussion and solution-finding efforts for nanosafety.

  13. Crucial knowledge gaps in current understanding of climate change impacts on coral reef fishes.

    Science.gov (United States)

    Wilson, S K; Adjeroud, M; Bellwood, D R; Berumen, M L; Booth, D; Bozec, Y-Marie; Chabanet, P; Cheal, A; Cinner, J; Depczynski, M; Feary, D A; Gagliano, M; Graham, N A J; Halford, A R; Halpern, B S; Harborne, A R; Hoey, A S; Holbrook, S J; Jones, G P; Kulbiki, M; Letourneur, Y; De Loma, T L; McClanahan, T; McCormick, M I; Meekan, M G; Mumby, P J; Munday, P L; Ohman, M C; Pratchett, M S; Riegl, B; Sano, M; Schmitt, R J; Syms, C

    2010-03-15

    Expert opinion was canvassed to identify crucial knowledge gaps in current understanding of climate change impacts on coral reef fishes. Scientists that had published three or more papers on the effects of climate and environmental factors on reef fishes were invited to submit five questions that, if addressed, would improve our understanding of climate change effects on coral reef fishes. Thirty-three scientists provided 155 questions, and 32 scientists scored these questions in terms of: (i) identifying a knowledge gap, (ii) achievability, (iii) applicability to a broad spectrum of species and reef habitats, and (iv) priority. Forty-two per cent of the questions related to habitat associations and community dynamics of fish, reflecting the established effects and immediate concern relating to climate-induced coral loss and habitat degradation. However, there were also questions on fish demographics, physiology, behaviour and management, all of which could be potentially affected by climate change. Irrespective of their individual expertise and background, scientists scored questions from different topics similarly, suggesting limited bias and recognition of a need for greater interdisciplinary and collaborative research. Presented here are the 53 highest-scoring unique questions. These questions should act as a guide for future research, providing a basis for better assessment and management of climate change impacts on coral reefs and associated fish communities.

  14. Teachers' instructional goals for science practice: Identifying knowledge gaps using cultural-historical activity theory (CHAT)

    Science.gov (United States)

    Farrar, Cynthia Hamen

    In AP Biology, the course goal, with respect to scientific acts and reasoning, has recently shifted toward a reform goal of science practice, where the goal is for students to have a scientific perspective that views science as a practice of a community rather than a body of knowledge. Given this recent shift, this study is interested in the gaps that may exist between an individual teacher's instructional goal and the goals of the AP Biology course. A Cultural-Historical Activity Theory (CHAT) methodology and perspective is used to analyze four teachers' knowledge, practice, and learning. Teachers have content knowledge for teaching, a form of knowledge that is unique for teaching called specialized content knowledge. This specialized content knowledge (SCK) defines their instructional goals, the student outcomes they ultimately aim to achieve with their students. The study employs a cultural-historical continuum of scientific acts and reasoning, which represents the development of the AP Biology goal over time, to study gaps in their instructional goal. The study also analyzes the contradictions within their teaching practice and how teachers address those contradictions to shift their instructional practice and learn. The findings suggest that teachers have different interpretations of the AP Biology goals of science practice, placing their instructional goal at different points along the continuum. Based on the location of their instructional goal, different micro-communities of teachers exist along the continuum, comprised of teachers with a shared goal, language, and culture of their AP Biology teaching. The in-depth study of one teacher's AP Biology teaching, using a CHAT perspective, provides a means for studying the mechanisms that connect SCK to classroom actions and ultimately to instructional practice. CHAT also reveals the nature and importance of contradictions or cognitive dissonance in teacher learning and the types of support teachers need to

  15. Analyzing the "CareGap": assessing gaps in adherence to clinical guidelines in adult soft tissue sarcoma.

    Science.gov (United States)

    Waks, Zeev; Goldbraich, Esther; Farkash, Ariel; Torresani, Michele; Bertulli, Rossella; Restifo, Nicola; Locatelli, Paolo; Casali, Paolo; Carmeli, Boaz

    2013-01-01

    Clinical decision support systems (CDSSs) are gaining popularity as tools that assist physicians in optimizing medical care. These systems typically comply with evidence-based medicine and are designed with input from domain experts. Nonetheless, deviations from CDSS recommendations are abundant across a broad spectrum of disorders, raising the question as to why this phenomenon exists. Here, we analyze this gap in adherence to a clinical guidelines-based CDSS by examining the physician treatment decisions for 1329 adult soft tissue sarcoma patients in northern Italy using patient-specific parameters. Dubbing this analysis "CareGap", we find that deviations correlate strongly with certain disease features such as local versus metastatic clinical presentation. We also notice that deviations from the guideline-based CDSS suggestions occur more frequently for patients with shorter survival time. Such observations can direct physicians' attention to distinct patient cohorts that are prone to higher deviation levels from clinical practice guidelines. This illustrates the value of CareGap analysis in assessing quality of care for subsets of patients within a larger pathology.

  16. Minding the Gap: The Barriers and Facilitators of Getting Evidence into Policy When Using a Knowledge-Brokering Approach

    Science.gov (United States)

    Reid, Garth; Connolly, John; Halliday, Wendy; Love, Anne-Marie; Higgins, Michael; MacGregor, Anita

    2017-01-01

    Transferring knowledge into action is challenging. Ward et al. (2009a) developed a framework for bridging this gap. This article describes what helps and hinders getting knowledge into action when using this approach in the field of mental health. Four areas of Scotland were selected which had used resources to inform local planning and…

  17. Dissemination 2.0: closing the gap between knowledge and practice with new media and marketing.

    Science.gov (United States)

    Bernhardt, Jay M; Mays, Darren; Kreuter, Matthew W

    2011-01-01

    Despite substantial investments in public health and clinical research at the national level, and significant advancements in these areas of science, few evidence-based programs and services are rapidly implemented in health care or public health practice as a result of failures of dissemination. A significant gap in current processes to disseminate and implement effective programs relates to the lack of systems and infrastructure to facilitate distribution of scientific research products to potential end users, including clinicians and other practitioners. In this article, the authors assert that Web 2.0 technologies can be leveraged to enhance dissemination efforts and increase the implementation of evidence-based programs and services in everyday practice. The authors describe the research-to-practice delivery process and highlight gaps in the supply chain necessary to translate research findings into evidence-based practice. The authors critically evaluate the 4 most prominent strategies currently used to promote dissemination and implementation of research evidence in practice, and they detail how each can be improved by leveraging Web 2.0 technologies to enhance dissemination of research evidence. Last, the authors provide examples and suggestions for capitalizing on Web 2.0 technologies to enhance dissemination efforts and ensure that evidence-based research products reach intended end users and are implemented in clinical practice.

  18. Research gaps identified during systematic reviews of clinical trials: glass-ionomer cements

    OpenAIRE

    Mickenautsch Steffen

    2012-01-01

    Abstract Background To report the results of an audit concerning research gaps in clinical trials that were accepted for appraisal in authored and published systematic reviews regarding the application of glass-ionomer cements (GIC) in dental practice Methods Information concerning research gaps in trial precision was extracted, following a framework that included classification of the research gap reasons: ‘imprecision of information (results)’, ‘biased information’, ‘inconsistency or unknow...

  19. A Meta-Analysis of Seaweed Impacts on Seagrasses: Generalities and Knowledge Gaps

    DEFF Research Database (Denmark)

    Thomsen, M. S.; Wernberg, T.; Engelen, A. H.

    2012-01-01

    are replaced with unstable sediments, turbid waters, hypoxia, and poor habitat conditions for fishes and invertebrates. Understanding the situations under which seaweeds impact seagrasses on local patch scales can help proactive management and prevent losses at greater scales. Here, we provide a quantitative......Seagrasses are important habitat-formers and ecosystem engineers that are under threat from bloom-forming seaweeds. These seaweeds have been suggested to outcompete the seagrasses, particularly when facilitated by eutrophication, causing regime shifts where green meadows and clear waters...... identified major knowledge gaps that need to be addressed before general predictive models on seaweed-seagrass interactions can be build, in order to effectively protect seagrass habitats from detrimental competition from seaweeds....

  20. Bridging the Otolaryngology Peer Review Knowledge Gap: A Call for a Residency Development Program.

    Science.gov (United States)

    Schmalbach, Cecelia E

    2016-07-01

    Current otolaryngology literature and future scientific direction rely heavily on a rigorous peer review process. Just as manuscripts warrant thoughtful review with constructive feedback to the authors, the same can be said for critiques written by novice peer reviewers. Formal scientific peer review training programs are lacking. Recognizing this knowledge gap, Otolaryngology-Head and Neck Surgery is excited to offer its new Resident Reviewer Development Program. All otolaryngology residents who are postgraduate year 2 and above and in excellent academic standing are eligible to participate in this mentored program, during which they will conduct 6 manuscript reviews under the direction of a seasoned reviewer in his or her subspecialty area of interest. By completing reviews alongside a mentor, participants gain the required skills to master the peer review process-a first step that often leads to journal editorial board and associate editor invitations.

  1. Summary of knowledge gaps related to quality and efficacy of current influenza vaccines.

    Science.gov (United States)

    Pfleiderer, Michael; Trouvin, Jean-Hugues; Brasseur, Daniel; Gränstrom, Marta; Shivji, Ragini; Mura, Manuela; Cavaleri, Marco

    2014-07-31

    Influenza viruses are a public health threat, as they are pathogenic, highly transmissible and prone to genetic changes. For decades vaccination strategies have been based on trivalent inactivated vaccines, which are regulated by specific guidelines. The progress in scientific knowledge and the lessons learned from the A(H1N1)2009 pandemic have highlighted further the need to improve current guidelines, including the immunogenicity criteria set by the CHMP in 1997, and to promote the discussion on the shortcomings encountered, e.g. the evaluation of vaccine efficacy in the paediatric and elderly populations, the measurement of the naivety of a population, the impact of prior immunity on subsequent vaccinations, and the technical issues with the serological assays for detection of immunity and immunogenicity. The authors attempted to summarise and tackle key gaps in the existing evidence concerning quality and efficacy of influenza vaccines, aiming at favouring a common understanding and a coordinated approach across stakeholders.

  2. Bridging implementation, knowledge, and ambition gaps to eliminate tuberculosis in the United States and globally.

    Science.gov (United States)

    Castro, Kenneth G; LoBue, Philip

    2011-03-01

    We reflect on remarkable accomplishments in global tuberculosis (TB) control and identify persistent obstacles to the successful elimination of TB from the United States and globally. One hundred and twenty nine years after Koch's discovery of the etiologic agent of TB, this health scourge continues to account for 9.4 million cases and 1.7 million deaths annually worldwide. Implementation of the Directly Observed Treatment Short-course strategy from 1995 through 2009 has saved 6 million lives. TB control is increasingly being achieved in countries with high-income economies, yet TB continues to plague persons living in countries with low-income and lower-middle-income economies. To accelerate progress against the global effects of disease caused by TB and achieve its elimination, we must bridge 3 key gaps in implementation, knowledge, and ambition.

  3. Engineered Nanomaterials: Knowledge Gaps in Fate, Exposure, Toxicity, and Future Directions

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2014-01-01

    Full Text Available The aim of this study is to identify current knowledge gaps in fate, exposure, and toxicity of engineered nanomaterials (ENMs, highlight research gaps, and suggest future research directions. Humans and other living organisms are exposed to ENMs during production or use of products containing them. To assess the hazards of ENMs, it is important to assess their physiochemical properties and try to relate them to any observed hazard. However, the full determination of these relationships is currently limited by the lack of empirical data. Moreover, most toxicity studies do not use realistic environmental exposure conditions for determining dose-response parameters, affecting the accurate estimation of health risks associated with the exposure to ENMs. Regulatory aspects of nanotechnology are still developing and are currently the subject of much debate. Synthesis of available studies suggests a number of open questions. These include (i developing a combination of different analytical methods for determining ENM concentration, size, shape, surface properties, and morphology in different environmental media, (ii conducting toxicity studies using environmentally relevant exposure conditions and obtaining data relevant to developing quantitative nanostructure-toxicity relationships (QNTR, and (iii developing guidelines for regulating exposure of ENMs in the environment.

  4. Bioinvasion in a Brazilian bay: filling gaps in the knowledge of southwestern Atlantic biota.

    Directory of Open Access Journals (Sweden)

    Barbara L Ignacio

    Full Text Available BACKGROUND: Biological invasions are a major cause of global species change. Nevertheless, knowledge about the distribution and ecology of introduced species is regionally biased, and many gaps in knowledge exist for most developing countries. METHODOLOGY/PRINCIPAL FINDINGS: To study the zoobenthos on the hard substratum of the Ilha Grande Bay, a survey was conducted on both natural and artificial substrata at three depths and seven sites. The species recorded were classified as native, cryptogenic or introduced. Multivariate analyses were conducted to assess the prevalence of introduced species in these communities and to compare the distribution of species on natural and artificial substrata of this bay to identify possible discrepancies in habitat use. Of the 61 species, 25 were cryptogenic, 10 were introduced and 26 were native. Similar numbers of introduced species were found on both natural and artificial substrata, though the community composition was significantly different between them. We also compared the species composition of the Ilha Grande Bay survey to other inventories taken around the world. The highest similarities were found between the Ilha Grande Bay inventory and the Atlantic coastal region (Tampa Bay, USA and the Gulf of Mexico, American Samoa and Pearl Harbor (USA inventories. CONCLUSIONS/SIGNIFICANCE: This study presents the first published comprehensive list of hard substratum sessile marine invertebrate species in a Brazilian bay. The high percentage of cryptogenic species reveals gaps in both zoological records and information on introduced species for the Brazilian coast. The introduced species successfully colonized different sites in the Ilha Grande Bay, including both natural and artificial substrata. In addition, we find that artificial structures may not be good surrogates for natural rocky shores and may represent an ecological threat. Comparisons with other inventories suggest a history of broad

  5. Human papillomavirus and cancer prevention: gaps in knowledge and prospects for research, policy, and advocacy.

    Science.gov (United States)

    Franco, Eduardo L; de Sanjosé, Silvia; Broker, Thomas R; Stanley, Margaret A; Chevarie-Davis, Myriam; Isidean, Sandra D; Schiffman, Mark

    2012-11-20

    The recognition that human papillomavirus (HPV) infection is the central, necessary cause of cervical cancer paved the way to new fronts of prevention via improved screening methods and HPV vaccination. Much has been learned in all fronts, from the molecular basis of our understanding of how HPV causes disease to the health economics of preventive strategies at the individual and population levels. Progress in other areas of cancer control has yet to show the same multi- and trans-disciplinary gains seen in research on HPV-associated malignancies, which is one of the unequivocal success stories in disease prevention. Yet, as an embarrassment of riches, much more research is needed to fill the gaps in knowledge that remain before we are able to reap the benefits from the knowledge translation from all fronts. Public health research on setting-specific implementation of HPV-based preventive strategies and more concerted advocacy to counter barriers facing the adoption of these strategies are likely to yield major dividends in reducing the burden of HPV-associated diseases. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.

  6. Assisted knowledge discovery for the maintenance of clinical guidelines.

    Directory of Open Access Journals (Sweden)

    Emilie Pasche

    Full Text Available BACKGROUND: Improving antibiotic prescribing practices is an important public-health priority given the widespread antimicrobial resistance. Establishing clinical practice guidelines is crucial to this effort, but their development is a complex task and their quality is directly related to the methodology and source of knowledge used. OBJECTIVE: We present the design and the evaluation of a tool (KART that aims to facilitate the creation and maintenance of clinical practice guidelines based on information retrieval techniques. METHODS: KART consists of three main modules 1 a literature-based medical knowledge extraction module, which is built upon a specialized question-answering engine; 2 a module to normalize clinical recommendations based on automatic text categorizers; and 3 a module to manage clinical knowledge, which formalizes and stores clinical recommendations for further use. The evaluation of the usability and utility of KART followed the methodology of the cognitive walkthrough. RESULTS: KART was designed and implemented as a standalone web application. The quantitative evaluation of the medical knowledge extraction module showed that 53% of the clinical recommendations generated by KART are consistent with existing clinical guidelines. The user-based evaluation confirmed this result by showing that KART was able to find a relevant antibiotic for half of the clinical scenarios tested. The automatic normalization of the recommendation produced mixed results among end-users. CONCLUSIONS: We have developed an innovative approach for the process of clinical guidelines development and maintenance in a context where available knowledge is increasing at a rate that cannot be sustained by humans. In contrast to existing knowledge authoring tools, KART not only provides assistance to normalize, formalize and store clinical recommendations, but also aims to facilitate knowledge building.

  7. Systematic reviews, systematic error and the acquisition of clinical knowledge

    Directory of Open Access Journals (Sweden)

    Mickenautsch Steffen

    2010-06-01

    Full Text Available Abstract Background Since its inception, evidence-based medicine and its application through systematic reviews, has been widely accepted. However, it has also been strongly criticised and resisted by some academic groups and clinicians. One of the main criticisms of evidence-based medicine is that it appears to claim to have unique access to absolute scientific truth and thus devalues and replaces other types of knowledge sources. Discussion The various types of clinical knowledge sources are categorised on the basis of Kant's categories of knowledge acquisition, as being either 'analytic' or 'synthetic'. It is shown that these categories do not act in opposition but rather, depend upon each other. The unity of analysis and synthesis in knowledge acquisition is demonstrated during the process of systematic reviewing of clinical trials. Systematic reviews constitute comprehensive synthesis of clinical knowledge but depend upon plausible, analytical hypothesis development for the trials reviewed. The dangers of systematic error regarding the internal validity of acquired knowledge are highlighted on the basis of empirical evidence. It has been shown that the systematic review process reduces systematic error, thus ensuring high internal validity. It is argued that this process does not exclude other types of knowledge sources. Instead, amongst these other types it functions as an integrated element during the acquisition of clinical knowledge. Conclusions The acquisition of clinical knowledge is based on interaction between analysis and synthesis. Systematic reviews provide the highest form of synthetic knowledge acquisition in terms of achieving internal validity of results. In that capacity it informs the analytic knowledge of the clinician but does not replace it.

  8. Telesurgery: remote knowledge translation in clinical surgery.

    Science.gov (United States)

    Anvari, Mehran

    2007-08-01

    Dissemination of new surgical knowledge, skills, and techniques across the wide spectrum of practicing surgeons in the community is often difficult and slow. This is even more problematic in countries such as Canada, where geographic distances separate a large portion of community surgeons from the large teaching centers. As an example, the penetration of advanced minimally invasive techniques in Canada has been severely hampered by the inability to provide adequate training opportunities and support for community surgeons, many of whom live in remote regions of the country. In an attempt to overcome the barriers that exist, the Centre for Minimal Access Surgery (CMAS) at McMaster University has been using broadband Internet and telecommunication systems to provide distance training and mentoring to community surgeons living in remote northern communities of Canada. This article describes our experience with telementoring and robot-assisted remote telepresence surgery and assisting, between a teaching hospital in Hamilton and two community hospitals in northern Ontario and Quebec.

  9. Evolution in clinical knowledge management strategy at Intermountain Healthcare.

    Science.gov (United States)

    Hulse, Nathan C; Galland, Joel; Borsato, Emerson P

    2012-01-01

    In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs.

  10. A MSFD complementary approach for the assessment of pressures, knowledge and data gaps in Southern European Seas: The PERSEUS experience

    DEFF Research Database (Denmark)

    Crise, A.; Kaberi, H.; Ruiz, José Luis Martinez;

    2015-01-01

    PERSEUS project aims to identify the most relevant pressures exerted on the ecosystems of the Southern European Seas (SES), highlighting knowledge and data gaps that endanger the achievement of SES Good Environmental Status (GES) as mandated by the Marine Strategy Framework Directive (MSFD......). A complementary approach has been adopted, by a meta-analysis of existing literature on pressure/impact/knowledge gaps summarized in tables related to the MSFD descriptors, discriminating open waters from coastal areas. A comparative assessment of the Initial Assessments (IAs) for five SES countries has been also...

  11. [Schizophrenic disorders: current etiologic and clinical knowledge].

    Science.gov (United States)

    Olié, Jean-Pierre; Krebs, Marie-Odile; Lôo, Henri

    2005-05-01

    Brain anomalies associated with schizophrenic disorders may be of a cognitive, neurophysiological or neurological nature [the latter being relatively minor and nonspecific]. Brain imaging has revealed early anomalies such as cortical-subcortical atrophy and abnormal gyration. These anomalies can also be present in relatives free of schizophrenic symptoms. This raises the question of what determines the transition from vulnerability to clinical onset. There is now evidence that schizophrenic disorders are true brain diseases. This is based on neuropathological studies, brain imaging and clinical findings such as "soft" neurological signs (pyramidal and extrapyramidal symptoms, coordination difficulties, etc.). Cognitive dysfunctions such as attention and memory disorders and abnormal verbal fluency have also been described. Oculomotor pursuit and auditive evoked potentials have identified specific neurophysiological disorders such as N300 and P50 wave modifications. Schizophrenic disorders can also be associated with neuronal abnormalities, notably affecting factors involved in synaptic transmission and plasticity. For example, BDNF protein deficit is linked to certain late-onset forms of schizophrenia. Genetic studies are no longer focusing on a possible disease genotype but rather on phenotypic characteristics determined by simpler genotypes (P50 wave modulation, COMT and BDNF genes). The ultimate objective is to identify high-risk subjects, in order to shorten the treatment delay and thereby improve long-term outcome. The benefit of primary prophylaxis remains to be determined, however.

  12. Factors impacting on nurses' transference of theoretical knowledge of holistic care into clinical practice.

    Science.gov (United States)

    Henderson, Saras

    2002-12-01

    Since nurse education moved to universities, a reoccurring concern of health consumers, health administrators, and some practising nurses is that nurses are not able to transfer the theoretical knowledge of holistic care into practice. Much has been written about this concern usually under the heading of the theory-practice gap. A common reason that has been highlighted as the cause of this gap is that the theoretical knowledge that nurses learn in academia is predicated on concepts such as humanism and holistic caring. In contrast, the bureaucratic organisation where nurses provide care tends to be based on management concepts where cost containment and outcome measures are more acceptable. Hence nurses' learned values of holistic caring are pitted against the reality of the practice setting. So what is this practice reality? This paper attempts to provide an insider view of why the theoretical knowledge of holistic care may be difficult to enact in the clinical setting. In-depth taped interviews with nurses and participant observation were conducted in acute care hospitals in Western Australia. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings indicated that utilitarian nursing and role models had impacted on the transference of theoretical knowledge of holistic care into practice. The paper outlines some measures that nurses themselves can undertake to ensure the narrowing of the theory-practice gap in this area.

  13. Environmental Impact on DNA Methylation in the Germline: State of the Art and Gaps of Knowledge

    Directory of Open Access Journals (Sweden)

    Francesca Pacchierotti

    2015-01-01

    Full Text Available The epigenome consists of chemical changes in DNA and chromatin that without modifying the DNA sequence modulate gene expression and cellular phenotype. The epigenome is highly plastic and reacts to changing external conditions with modifications that can be inherited to daughter cells and across generations. Whereas this innate plasticity allows for adaptation to a changing environment, it also implies the potential of epigenetic derailment leading to so-called epimutations. DNA methylation is the most studied epigenetic mark. DNA methylation changes have been associated with cancer, infertility, cardiovascular, respiratory, metabolic, immunologic, and neurodegenerative pathologies. Experiments in rodents demonstrate that exposure to a variety of chemical stressors, occurring during the prenatal or the adult life, may induce DNA methylation changes in germ cells, which may be transmitted across generations with phenotypic consequences. An increasing number of human biomonitoring studies show environmentally related DNA methylation changes mainly in blood leukocytes, whereas very few data have been so far collected on possible epigenetic changes induced in the germline, even by the analysis of easily accessible sperm. In this paper, we review the state of the art on factors impinging on DNA methylation in the germline, highlight gaps of knowledge, and propose priorities for future studies.

  14. A review of concentrated flow erosion processes on rangelands: Fundamental understanding and knowledge gaps

    Directory of Open Access Journals (Sweden)

    Sayjro K. Nouwakpo

    2016-06-01

    Full Text Available Concentrated flow erosion processes are distinguished from splash and sheetflow processes in their enhanced ability to mobilize and transport large amounts of soil, water and dissolved elements. On rangelands, soil, nutrients and water are scarce and only narrow margins of resource losses are tolerable before crossing the sustainability threshold. In these ecosystems, concentrated flow processes are perceived as indicators of degradation and often warrant the implementation of mitigation strategies. Nevertheless, this negative perception of concentrated flow processes may conflict with the need to improve understanding of the role of these transport vessels in redistributing water, soil and nutrients along the rangeland hillslope. Vegetation influences the development and erosion of concentrated flowpaths and has been the primary factor used to control and mitigate erosion on rangelands. At the ecohydrologic level, vegetation and concentrated flow pathways are engaged in a feedback relationship, the understanding of which might help improve rangeland management and restoration strategies. In this paper, we review published literature on experimental and conceptual research pertaining to concentrated flow processes on rangelands to: (1 present the fundamental science underpinning concentrated flow erosion modeling in these landscapes, (2 discuss the influence of vegetation on these erosion processes, (3 evaluate the contribution of concentrated flow erosion to overall sediment budget and (4 identify knowledge gaps.

  15. Programming the brain: Common outcomes and gaps in knowledge from animal studies of IUGR.

    Science.gov (United States)

    Hunter, Damien S; Hazel, Susan J; Kind, Karen L; Owens, Julie A; Pitcher, Julia B; Gatford, Kathryn L

    2016-10-01

    IUGR in humans is associated with impaired pre- and postnatal neurodevelopment, and subsequent postnatal cognition, resulting in lower IQ, poorer memory, visuomotor and executive function skills, as well as behavioural and attentional problems. Experimental models of IUGR are needed to allow direct testing of causality and interventions, and have benefits in reducing both confounding by comorbidities such as prematurity, and variation due to environment and genetics. This review describes and discusses experimental models of IUGR in which neurodevelopmental and cognitive outcomes of IUGR have been reported. We consider the timing of neurodevelopment relative to birth and to the period of restriction, as well as the effects of each experimental perturbation on the fetal environment and development, before discussing neurodevelopmental and cognitive outcomes for progeny as fetuses, neonates and into adolescent and adult life. Experimental IUGR induces broadly similar outcomes to human IUGR, with altered brain morphology, in particular grey matter loss and discordant trajectory of white matter development, and poorer cognition and memory reported in various studies. Nevertheless, there remain gaps in knowledge of neurodevelopment in experimental models. We end the review with recommendations for the design of future studies to further investigate the mechanisms underlying adverse neurodevelopmental consequences of IUGR, and to evaluate interventions that may subsequently improve outcomes of IUGR in humans.

  16. Monitoring of persistent organic pollutants in the polar regions: knowledge gaps & gluts through evidence mapping.

    Science.gov (United States)

    Mangano, Maria Cristina; Sarà, Gianluca; Corsolini, Simonetta

    2017-04-01

    Persistent organic pollutants (POPs) are widespread compounds that accumulating in polar regions canalise through trophic webs. Although several dozens of studies have been carried out in the last decades, the information is generally scattered across a large number of literature sources. This does not allow an efficient synthesis and constraints our understanding on how address future monitoring plans and environmental conservation strategies on the Polar Regions with respect to POPs. Thus, here, we present the outcome of a systematic map (SM) to scope, screen and chart evidences from literature dealing with POPs in Polar regions. The SMs strive to produce rigorous guidelines and have recently been proposed as useful and effective tools to summarise growing bodies of research that seek to reduce bias and increase reliability, particularly in the case of high priority and controversial topics. Our SM was based on 125 polar studies, focussing on the most studied target species among those listed in the International Union for Conservation of Nature's Red List (IUCN Red List). To facilitate analysis of evidence, the studies were classified into Accumulation Monitoring (accounting for POP monitoring through sub-organismal, functional and population levels) and Food Web Monitoring approaches (accounting for contaminants monitoring through food webs). Our SM allowed us to assess and visualise, a set of both knowledge gaps and gluts and lastly a list was provided to address future research on POPs in Polar Regions.

  17. Gaps in scientific knowledge about the carcinogenic potential of asphalt/bitumen fumes.

    Science.gov (United States)

    Schulte, Paul A

    2007-01-01

    Despite a relatively large body of published research, the potential carcinogenicity of asphalt/bitumen fumes is still a vexing question. Various uncertainties and gaps in scientific knowledge need to be addressed. These include uncertainties in chemistry, animal studies, and human studies. The chemistry of asphalt/bitumen fumes is complex and varies according to the source of the crude oil and the application parameters. The epidemiological studies, while showing weak evidence of lung cancer, are inconsistent and many confounding factors have not been addressed. Studies of animal exposure are also inconsistent regarding laboratory and field-generated fumes. There is a need for further human studies that address potential confounding factors such as smoking, diet, coal tar, and diesel exposures. Animal inhalation studies need to be conducted with asphalt/bitumen fumes that are chemically representative of roofing and paving fumes. Underlying all of this is the need for continued characterization of fumes so their use in animal and field studies can be properly assessed. Nonetheless, uncertainties such as these should not preclude appropriate public health actions to protect workers in the even that asphalt fumes are found to be a carcinogenic hazard.

  18. Avoiding a knowledge gap in a multiethnic statewide social marketing campaign: is cultural tailoring sufficient?

    Science.gov (United States)

    Buchthal, O Vanessa; Doff, Amy L; Hsu, Laura A; Silbanuz, Alice; Heinrich, Katie M; Maddock, Jay E

    2011-03-01

    In 2007, the State of Hawaii, Healthy Hawaii Initiative conducted a statewide social-marketing campaign promoting increased physical activity and nutrition. The campaign included substantial formative research to develop messages tailored for Hawaii's multiethnic Asian and Pacific Islander populations. The authors conducted a statewide random digital dialing telephone survey to assess the campaign's comparative reach among individuals with different ethnicities and different levels of education and income. This analysis suggests that the intervention was successful in reaching its target ethnic audiences. However, a knowledge gap related to the campaign appeared among individuals with incomes less than 130% of the poverty level and those with less than a high school education. These results varied significantly by message and the communication channel used. Recall of supermarket-based messages was significantly higher among individuals below 130% of the poverty level and those between 18 and 35 years of age, 2 groups that showed consistently lower recall of messages in other channels. Results suggest that cultural tailoring for ethnic audiences, although important, is insufficient for reaching low-income populations, and that broad-based social marketing campaigns should consider addressing socioeconomic status-related channel preferences in formative research and campaign design.

  19. Expanding Knowledge Gaps: The Function of Fictions in Teaching Materials after the 2011 Swedish High School Reform

    Science.gov (United States)

    Graeske, Caroline

    2016-01-01

    The aim in the study is to analyze how work with fiction is organized in six textbooks for senior high school in Sweden after the school reform 2011. Research into Swedish teaching materials has been neglected in recent years and there is a knowledge gap about how the work with fictions is affected by the reform in 2011. In the study quantitative…

  20. The "Chugakuryoko" and Hogan's Heroes: The Experience Gap between U.S. and Japanese Students' Knowledge of World War II

    Science.gov (United States)

    Olwell, Russ

    2011-01-01

    Based on his own teaching experiences and findings, the author discusses the experience gap between U.S. and Japanese students' knowledge of World War II. He compares and contrasts how the subject of World War II is taught in the United States versus Japan. While it takes teacher effort to enrich the history experiences of U.S. students, the…

  1. A Framework for a Clinical Reasoning Knowledge Warehouse

    DEFF Research Database (Denmark)

    Vilstrup Pedersen, Klaus; Boye, Niels

    2004-01-01

    In many areas of the medical domain, the decision process i.e. reasoning, involving health care professionals is distributed, cooperative and complex. This paper presents a framework for a Clinical Reasoning Knowledge Warehouse that combines theories and models from Artificial Intelligence, Knowl...... level, reasoning participants can express their argument based opinions about a patient case, thereby enhancing the knowledge about the state of and plans for the patient. An opinion language that supports expressing a possible imprecise/uncertain opinion based on imprecise......In many areas of the medical domain, the decision process i.e. reasoning, involving health care professionals is distributed, cooperative and complex. This paper presents a framework for a Clinical Reasoning Knowledge Warehouse that combines theories and models from Artificial Intelligence......, Knowledge Management Systems and Business Intelligence to make context based, patient case specific analysis and knowledge management. The knowledge base integrates three sources of information that supports clinical reasoning: general information, guidelines and health records. New generalized knowledge...

  2. 76 FR 72957 - 4th Annual Trauma Spectrum Conference: Bridging the Gap Between Research and Clinical Practice of...

    Science.gov (United States)

    2011-11-28

    ... HUMAN SERVICES National Institutes of Health 4th Annual Trauma Spectrum Conference: Bridging the Gap... Annual Trauma Spectrum Conference: Bridging the Gap Between Research and Clinical Practice of... conference information, visit the Trauma Spectrum Conference Web site at...

  3. [Knowledge management system for laboratory work and clinical decision support].

    Science.gov (United States)

    Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko

    2011-05-01

    This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support.

  4. Whole dairy matrix or single nutrients in assessment of health effects: current evidence and knowledge gaps.

    Science.gov (United States)

    Thorning, Tanja Kongerslev; Bertram, Hanne Christine; Bonjour, Jean-Philippe; de Groot, Lisette; Dupont, Didier; Feeney, Emma; Ipsen, Richard; Lecerf, Jean Michel; Mackie, Alan; McKinley, Michelle C; Michalski, Marie-Caroline; Rémond, Didier; Risérus, Ulf; Soedamah-Muthu, Sabita S; Tholstrup, Tine; Weaver, Connie; Astrup, Arne; Givens, Ian

    2017-04-12

    Foods consist of a large number of different nutrients that are contained in a complex structure. The nature of the food structure and the nutrients therein (i.e., the food matrix) will determine the nutrient digestion and absorption, thereby altering the overall nutritional properties of the food. Thus, the food matrix may exhibit a different relation with health indicators compared to single nutrients studied in isolation. The evidence for a dairy matrix effect was presented and discussed by an expert panel at a closed workshop, and the following consensus was reached: 1) Current evidence does not support a positive association between intake of dairy products and risk of cardiovascular disease (i.e., stroke and coronary heart disease) and type 2 diabetes. In contrast, fermented dairy products, such as cheese and yogurt, generally show inverse associations. 2) Intervention studies have indicated that the metabolic effects of whole dairy may be different than those of single dairy constituents when considering the effects on body weight, cardiometabolic disease risk, and bone health. 3) Different dairy products seem to be distinctly linked to health effects and disease risk markers. 4) Different dairy structures and common processing methods may enhance interactions between nutrients in the dairy matrix, which may modify the metabolic effects of dairy consumption. 5) In conclusion, the nutritional values of dairy products should not be considered equivalent to their nutrient contents but, rather, be considered on the basis of the biofunctionality of the nutrients within dairy food structures. 6) Further research on the health effects of whole dairy foods is warranted alongside the more traditional approach of studying the health effects of single nutrients. Future diet assessments and recommendations should carefully consider the evidence of the effects of whole foods alongside the evidence of the effects of individual nutrients. Current knowledge gaps and

  5. Lens glutathione homeostasis: Discrepancies and gaps in knowledge standing in the way of novel therapeutic approaches.

    Science.gov (United States)

    Fan, Xingjun; Monnier, Vincent M; Whitson, Jeremy

    2016-06-29

    Cataract is the major cause of blindness worldwide. The WHO has estimated around 20 million people have bilateral blindness from cataract, and that number is expected to reach 50 million in 2050. The cataract surgery is currently the main treatment approach, though often associated with complications, such as Posterior Capsule Opacification (PCO)-also known as secondary cataract. The lens is an avascular ocular structure equipped with an unusually high level of glutathione (GSH), which plays a vital role in maintaining lens transparency by regulating lenticular redox state. The lens epithelium and outer cortex are thought to be responsible for providing the majority of lens GSH via GSH de novo synthesis, assisted by a continuous supply of constituent amino acids from the aqueous humor, as well as extracellular GSH recycling from the gamma-glutamyl cycle. However, when de novo synthesis is impaired, in the presence of low GSH levels, as in the aging human lens, compensatory mechanisms exist, suggesting that the lens is able to uptake GSH from the surrounding ocular tissues. However, these uptake mechanisms, and the GSH source and its origin, are largely unknown. The lens nucleus does not have the ability to synthesize its own GSH and fully relies on transport from the outer cortex by yet unknown mechanisms. Understanding how aging reduces GSH levels, particularly in the lens nucleus, how it is associated with age-related nuclear cataract (ARNC), and how the lens compensates for GSH loss via external uptake should be a major research priority. The intent of this review, which is dedicated to the memory of David C. Beebe, is to summarize our current understanding of lens GSH homeostasis and highlight discrepancies and gaps in knowledge that stand in the way of pharmacologically minimizing the impact of declining GSH content in the prevention of age-related cataract.

  6. Radiotelemetry and wildlife: Highlighting a gap in the knowledge on radiofrequency radiation effects.

    Science.gov (United States)

    Balmori, Alfonso

    2016-02-01

    Radio transmitters and associated devices may induce negative effects that can bias the results of ongoing research. The main documented effects of radio transmitters on animals include reduced survival, decreased productivity, changes in behaviour and movement patterns and a biased sex ratio. The only factors that have claimed responsibility for these possible damages are the weight of the radio transmitter and associated devices, and the attachment type. The electromagnetic radiation produced by radio transmitters has not been considered so far in research. There have been no studies evaluating the effects of non-ionising electromagnetic radiation (radiofrequency signals) necessary for tracking, although the problems found were significantly associated with the length of time that animals had been carrying their radio transmitters. Similar problems as those in radiotracked animals have been found in numerous studies with animals exposed to radiofrequency radiation for a sufficient amount of time. Laboratory scientists investigating the orientation of animals know they have to shield the place where experiments are performed to prevent interference from man-made radiation, as anthropogenic signals may distort the results. It is paradoxical that, at the same time, field scientists investigating the movements and other aspects of animal biology are providing animals with radio transmitters that emit the same type of radiation, since this may affect the results concerning their orientation and movement. This paper identifies gaps in the knowledge that should be investigated in-depth. The possibility that the radiofrequency radiation from radiotracking devices is responsible for the findings should be considered. Considering this factor may allow researchers to best understand the long-term effects found.

  7. A short review of fecal indicator bacteria in tropical aquatic ecosystems: knowledge gaps and future directions

    Directory of Open Access Journals (Sweden)

    Emma Jane Rochelle-Newall

    2015-04-01

    Full Text Available Given the high numbers of deaths and the debilitating nature of diseases caused by the use of unclean water it is imperative that we have an understanding of the factors that control the dispersion of water borne pathogens and their respective indicators. This is all the more important in developing countries where significant proportions of the population often have little or no access to clean drinking water supplies. Moreover, and notwithstanding the importance of these bacteria in terms of public health, at present little work exists on the persistence, transfer and proliferation of these pathogens and their respective indicator organisms e.g. fecal indicator bacteria (FIB such as Escherichia coli and fecal coliforms in humid tropical systems, such as are found in South East Asia or in the tropical regions of Africa. Both FIB and the waterborne pathogens they are supposed to indicate are particularly susceptible to shifts in water flow and quality and the predicted increases in rainfall and floods due to climate change will only exacerbate the problems of contamination. This will be furthermore compounded by the increasing urbanization and agricultural intensification that developing regions are experiencing. Therefore, recognizing and understanding the link between human activities, natural process and microbial functioning and their ultimate impacts on human health are prerequisites for reducing the risks to the exposed populations. Most of the existing work in tropical systems has been based on the application of temperate indicator organisms, models and mechanisms regardless of their applicability or appropriateness for tropical environments. Here we present a short review on the factors that control FIB dynamics in temperate systems and discuss their applicability to tropical environments. We then highlight some of the knowledge gaps in order to stimulate future research in this field in the tropics.

  8. Forests, savannas and grasslands: bridging the knowledge gap between ecology and Dynamic Global Vegetation Models

    Directory of Open Access Journals (Sweden)

    M. Baudena

    2014-06-01

    Full Text Available The forest, savanna, and grassland biomes, and the transitions between them, are expected to undergo major changes in the future, due to global climate change. Dynamic Global Vegetation Models (DGVMs are very useful to understand vegetation dynamics under present climate, and to predict its changes under future conditions. However, several DGVMs display high uncertainty in predicting vegetation in tropical areas. Here we perform a comparative analysis of three different DGVMs (JSBACH, LPJ-GUESS-SPITFIRE and aDGVM with regard to their representation of the ecological mechanisms and feedbacks that determine the forest, savanna and grassland biomes, in an attempt to bridge the knowledge gap between ecology and global modelling. Model outcomes, obtained including different mechanisms, are compared to observed tree cover along a mean annual precipitation gradient in Africa. Through these comparisons, and by drawing on the large number of recent studies that have delivered new insights into the ecology of tropical ecosystems in general, and of savannas in particular, we identify two main mechanisms that need an improved representation in the DGVMs. The first mechanism includes water limitation to tree growth, and tree-grass competition for water, which are key factors in determining savanna presence in arid and semi-arid areas. The second is a grass-fire feedback, which maintains both forest and savanna occurrences in mesic areas. Grasses constitute the majority of the fuel load, and at the same time benefit from the openness of the landscape after fires, since they recover faster than trees. Additionally, these two mechanisms are better represented when the models also include tree life stages (adults and seedlings, and distinguish between fire-prone and shade-tolerant savanna trees, and fire-resistant and shade-intolerant forest trees. Including these basic elements could improve the predictive ability of the DGVMs, not only under current climate

  9. A short review of fecal indicator bacteria in tropical aquatic ecosystems: knowledge gaps and future directions.

    Science.gov (United States)

    Rochelle-Newall, Emma; Nguyen, Thi Mai Huong; Le, Thi Phuong Quynh; Sengtaheuanghoung, Oloth; Ribolzi, Olivier

    2015-01-01

    Given the high numbers of deaths and the debilitating nature of diseases caused by the use of unclean water it is imperative that we have an understanding of the factors that control the dispersion of water borne pathogens and their respective indicators. This is all the more important in developing countries where significant proportions of the population often have little or no access to clean drinking water supplies. Moreover, and notwithstanding the importance of these bacteria in terms of public health, at present little work exists on the persistence, transfer and proliferation of these pathogens and their respective indicator organisms, e.g., fecal indicator bacteria (FIB) such as Escherichia coli and fecal coliforms in humid tropical systems, such as are found in South East Asia or in the tropical regions of Africa. Both FIB and the waterborne pathogens they are supposed to indicate are particularly susceptible to shifts in water flow and quality and the predicted increases in rainfall and floods due to climate change will only exacerbate the problems of contamination. This will be furthermore compounded by the increasing urbanization and agricultural intensification that developing regions are experiencing. Therefore, recognizing and understanding the link between human activities, natural process and microbial functioning and their ultimate impacts on human health are prerequisites for reducing the risks to the exposed populations. Most of the existing work in tropical systems has been based on the application of temperate indicator organisms, models and mechanisms regardless of their applicability or appropriateness for tropical environments. Here, we present a short review on the factors that control FIB dynamics in temperate systems and discuss their applicability to tropical environments. We then highlight some of the knowledge gaps in order to stimulate future research in this field in the tropics.

  10. Radiotelemetry and wildlife: Highlighting a gap in the knowledge on radiofrequency radiation effects

    Energy Technology Data Exchange (ETDEWEB)

    Balmori, Alfonso, E-mail: balmaral@jcyl.es

    2016-02-01

    Radio transmitters and associated devices may induce negative effects that can bias the results of ongoing research. The main documented effects of radio transmitters on animals include reduced survival, decreased productivity, changes in behaviour and movement patterns and a biased sex ratio. The only factors that have claimed responsibility for these possible damages are the weight of the radio transmitter and associated devices, and the attachment type. The electromagnetic radiation produced by radio transmitters has not been considered so far in research. There have been no studies evaluating the effects of non-ionising electromagnetic radiation (radiofrequency signals) necessary for tracking, although the problems found were significantly associated with the length of time that animals had been carrying their radio transmitters. Similar problems as those in radiotracked animals have been found in numerous studies with animals exposed to radiofrequency radiation for a sufficient amount of time. Laboratory scientists investigating the orientation of animals know they have to shield the place where experiments are performed to prevent interference from man-made radiation, as anthropogenic signals may distort the results. It is paradoxical that, at the same time, field scientists investigating the movements and other aspects of animal biology are providing animals with radio transmitters that emit the same type of radiation, since this may affect the results concerning their orientation and movement. This paper identifies gaps in the knowledge that should be investigated in-depth. The possibility that the radiofrequency radiation from radiotracking devices is responsible for the findings should be considered. Considering this factor may allow researchers to best understand the long-term effects found. - Highlights: • Radiotracking may induce negative effects that can bias the results. • Effects have been documented on survival, reproduction and behaviour.

  11. Cost assessment of natural hazards in Europe - state-of-the-art, knowledge gaps and recommendations

    Science.gov (United States)

    Meyer, V.; Becker, N.; Markantonis, V.; Schwarze, R.; van den Bergh, J. C. J. M.; Bouwer, L. M.; Bubeck, P.; Ciavola, P.; Thieken, A. H.; Genovese, E.; Green, C.; Hallegatte, S.; Kreibich, H.; Lequeux, Q.; Viavattenne, C.; Logar, I.; Papyrakis, E.; Pfurtscheller, C.; Poussin, J.; Przyluski, V.

    2012-04-01

    Effective and efficient reduction of natural hazard risks requires a thorough understanding of the costs of natural hazards in order to develop sustainable risk management strategies. The current methods that assess the costs of different natural hazards employ a diversity of terminologies and approaches for different hazards and impacted sectors. This makes it difficult to arrive at robust, comprehensive and comparable cost figures. The CONHAZ (Costs of Natural Hazards) project aimed to compile and synthesise current knowledge on cost assessment methods in order to strengthen the role of cost assessments in the development of integrated natural hazard management and adaptation planning. In order to achieve this, CONHAZ has adopted a comprehensive approach, considering natural hazards ranging from droughts, floods and coastal hazards to Alpine hazards, as well as different impacted sectors and cost types. Its specific objectives have been 1) to compile the state-of-the-art methods for cost assessment; 2) to analyse and assess these methods in terms of technical aspects, as well as terminology, data quality and availability, and research gaps; and 3) to synthesise resulting knowledge into recommendations and to identify further research needs. This presentation summarises the main results of CONHAZ. CONHAZ differentiates between direct tangible damages, losses due to business interruption, indirect damages, intangible effects, and costs of risk mitigation. It is shown that the main focus of cost assessment methods and their application in practice is on direct costs, while existing methods for assessing intangible and indirect effects are rather rarely applied and methods for assessing indirect effects often cannot be used on the scale of interest (e.g. the regional scale). Furthermore, methods often focus on single sectors and/or hazards, and only very few are able to reflect several sectors or multiple hazards. Process understanding and its use in cost assessment

  12. Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.

    Science.gov (United States)

    Kalogeropoulos, Dimitris A; Carson, Ewart R; Collinson, Paul O

    2003-09-01

    Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

  13. Clinical Decision Support Knowledge Management: Strategies for Success.

    Science.gov (United States)

    Khalifa, Mohamed; Alswailem, Osama

    2015-01-01

    Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital.

  14. [Relevance of nutrition knowledge on clinical practice: medical opinion survey].

    Science.gov (United States)

    Alvares, Luísa; Moreira, Isabel; Oliveira, António

    2007-01-01

    Although previous studies show that physicians generally agree that nutrition knowledge is important for their daily clinical practice, several other studies report their poor knowledge of the subject. One of the strongest reasons given for this is the non-incorporation of Nutrition as a compulsory subject for the medical sciences degree. Dietary counselling and assessment of the patients' nutritional status don't seem to be systematic. The aim of this study is to asses how relevant physicians consider Nutrition to be in the successful running of a good practice. The study was undertaken at the general hospital of Vila Real/Peso da Régua (CHVR/PR) by distribution of a self- administered questionnaire to 153 of the physicians of the clinical body. Mean values were compared with the Student's t test and proportions with the Chi-square test. Of the 153 physicians, 108 replies were received (70,6%). Of these 108 replies, 53,3% consider nutrition knowledge important although 29,6% state their knowledge is poor. More than half say that Clinical Nutrition should be a compulsory subject of the Medical Sciences syllabus, and 99,1% deem it important to assess the patient's nutritional status. About 95% stated they provided written or verbal nutritional guidance, and most of the physicians had already sought the assistance of a nutritionist. This study shows that the clinical body of the CHVR/PR is aware of the importance nutrition knowledge has in their daily practice. It must be noted, though, that although almost one third of the physicians rate their nutrition knowledge poor, most of them provide nutritional guidance to their patients.

  15. Bridging the Gap between Reinforcement Learning and Knowledge Representation: A Logical Off- and On-Policy Framework

    CERN Document Server

    Saad, Emad

    2010-01-01

    Knowledge Representation is important issue in reinforcement learning. In this paper, we bridge the gap between reinforcement learning and knowledge representation, by providing a rich knowledge representation framework, based on normal logic programs with answer set semantics, that is capable of solving model-free reinforcement learning problems for more complex do-mains and exploits the domain-specific knowledge. We prove the correctness of our approach. We show that the complexity of finding an offline and online policy for a model-free reinforcement learning problem in our approach is NP-complete. Moreover, we show that any model-free reinforcement learning problem in MDP environment can be encoded as a SAT problem. The importance of that is model-free reinforcement

  16. Child anxiety in mental health care: Closing the gaps between research and clinical practice

    NARCIS (Netherlands)

    Jongerden, L.

    2015-01-01

    In this dissertation about child anxiety in mental health care, three gaps between research and everyday clinical practice were addressed. Despite the high prevalence of anxiety disorders in children, only a minority is referred to mental health care. It was found that more severe impairment in the

  17. Conceptual Model-based Systems Biology: mapping knowledge and discovering gaps in the mRNA transcription cycle.

    Directory of Open Access Journals (Sweden)

    Judith Somekh

    2012-12-01

    Full Text Available We propose a Conceptual Model-based Systems Biology framework for qualitative modeling, executing, and eliciting knowledge gaps in molecular biology systems. The framework is an adaptation of Object-Process Methodology (OPM, a graphical and textual executable modeling language. OPM enables concurrent representation of the system's structure-the objects that comprise the system, and behavior-how processes transform objects over time. Applying a top-down approach of recursively zooming into processes, we model a case in point-the mRNA transcription cycle. Starting with this high level cell function, we model increasingly detailed processes along with participating objects. Our modeling approach is capable of modeling molecular processes such as complex formation, localization and trafficking, molecular binding, enzymatic stimulation, and environmental intervention. At the lowest level, similar to the Gene Ontology, all biological processes boil down to three basic molecular functions: catalysis, binding/dissociation, and transporting. During modeling and execution of the mRNA transcription model, we discovered knowledge gaps, which we present and classify into various types. We also show how model execution enhances a coherent model construction. Identification and pinpointing knowledge gaps is an important feature of the framework, as it suggests where research should focus and whether conjectures about uncertain mechanisms fit into the already verified model.

  18. Conceptual Model-based Systems Biology: mapping knowledge and discovering gaps in the mRNA transcription cycle.

    Science.gov (United States)

    Somekh, Judith; Choder, Mordechai; Dori, Dov

    2012-12-20

    We propose a Conceptual Model-based Systems Biology framework for qualitative modeling, executing, and eliciting knowledge gaps in molecular biology systems. The framework is an adaptation of Object-Process Methodology (OPM), a graphical and textual executable modeling language. OPM enables concurrent representation of the system's structure-the objects that comprise the system, and behavior-how processes transform objects over time. Applying a top-down approach of recursively zooming into processes, we model a case in point-the mRNA transcription cycle. Starting with this high level cell function, we model increasingly detailed processes along with participating objects. Our modeling approach is capable of modeling molecular processes such as complex formation, localization and trafficking, molecular binding, enzymatic stimulation, and environmental intervention. At the lowest level, similar to the Gene Ontology, all biological processes boil down to three basic molecular functions: catalysis, binding/dissociation, and transporting. During modeling and execution of the mRNA transcription model, we discovered knowledge gaps, which we present and classify into various types. We also show how model execution enhances a coherent model construction. Identification and pinpointing knowledge gaps is an important feature of the framework, as it suggests where research should focus and whether conjectures about uncertain mechanisms fit into the already verified model.

  19. How Do Nursing Students Perceive the Needs of Older Clients? Addressing a Knowledge Gap

    Directory of Open Access Journals (Sweden)

    Sandra P. Hirst

    2016-01-01

    Full Text Available Background. Many nurse educators understand that students need to embrace the challenges and rewards of working with older clients. Yet, they might wonder how they can help students to develop and what is the specialized knowledge necessary to care for older clients. Question. How do students perceive the nursing needs of older adults? Method. A qualitative descriptive study was undertaken. Data collection occurred through semistructured interviews (9 students and one focus group (8 students using a photoelicitation technique. The researchers used a descriptive approach to analyze the data. Findings. Six themes emerged from the data: ask the older client!; physiology rules; personal, not professional; who can validate?; hierarchy of needs; and help us learn. Conclusion. Participants relied upon previous patterns of learning, primarily experiential, and on the views of health care colleagues in clinical practice to make decisions about the health needs of older clients. Participants clearly recognized the need to and significance of understanding the health care requirements of older clients. Findings have implications for how the care of older clients is introduced into nursing education programs.

  20. Pharmaco- and toxicokinetics of selected exogenous and endogenous estrogens: a review of the data and identification of knowledge gaps.

    Science.gov (United States)

    Mattison, Donald R; Karyakina, Nataliya; Goodman, Michael; LaKind, Judy S

    2014-09-01

    Chemicals with estrogenic activity are derived from many different natural and synthetic processes and products, including endogenous production (e.g., estradiol, conjugated estrogens), drugs (e.g., ethinyl estradiol, conjugated estrogens), plants used as foods (phytoestrogens such as genistein, daidzein, S-equol), and man-made chemicals (xenoestrogens such as bisphenol A). Human exposure to low doses of endogenous estrogens, estrogenic drugs, phytoestrogens, and xenoestrogens has the potential to improve health or disrupt normal endocrine activity, as well as impact the diverse systems with which estrogens interact, including the cardiovascular system, and lipid and carbohydrate metabolism. Mechanisms of action and diversity of adverse and non-adverse effects following human exposure to low doses of estrogen active chemicals (EACs, defined as chemicals which interact with an estrogen receptor [ER]) are poorly understood. This review summarizes our current understanding of the pharmacological action with a focus on pharmacokinetics (PK) and toxicokinetics (TK) of several representative EACs in both physiological and pathological processes. The goal of this review is to assess the current state-of-the-science on: (i) the potential for EACs to interfere with endocrine activity, (ii) factors which contribute to endocrine-related clinical outcomes, and (iii) existing knowledge gaps. While classical PK approaches (compartmental or non-compartmental) can be used to characterize absorption, distribution, metabolism, and elimination of EACs, many of the detailed pharmacological characteristics necessary to understand benefit-risk balance have not yet been clarified. Pharmacological complexities mirror the complexity of determining whether and under what conditions exposure to estrogens in drugs, foods or to xenoestrogenic chemicals are beneficial or harmful to human health.

  1. Bridging knowledge translation gap in health in developing countries: visibility, impact and publishing standards in journals from the Eastern Mediterranean

    Directory of Open Access Journals (Sweden)

    Utrobičić Ana

    2012-05-01

    Full Text Available Abstract Background Local and regional scientific journals are important factors in bridging gaps in health knowledge translation in low-and middle-income countries. We assessed indexing, citations and publishing standards of journals from the Eastern Mediterranean region. Methods For journals from 22 countries in the collection of the Index Medicus for the Eastern Mediterranean Region (IMEMR, we analyzed indexing in bibliographical databases and citations during 2006–2009 to published items in 2006 in Web of Science (WoS and SCOPUS. Adherence to editorial and publishing standards was assessed using a special checklist. Results Out of 419 journals in IMEMR, 19 were indexed in MEDLINE, 23 in WoS and 46 in SCOPUS. Their impact factors ranged from 0.016 to 1.417. For a subset of 175 journals with available tables of contents from 2006, articles published in 2006 from 93 journals received 2068 citations in SCOPUS (23.5% self-citations and articles in 86 journals received 1579 citations in WoS (24.3% self-citations during 2006–2009. Citations to articles came mostly from outside of the Eastern Mediterranean region (76.8% in WoS and 75.4% in SCOPUS. Articles receiving highest number of citations presented topics specific for the region. Many journals did not follow editorial and publishing standards, such addressing requirements about the patient’s privacy rights (68.0% out of 244 analyzed, policy on managing conflicts of interest (66.4%, and ethical conduct in clinical and animal research (66.4%. Conclusion Journals from the Eastern Mediterranean are visible in and have impact on global scientific community. Coordinated effort of all stakeholders in journal publishing, including researchers, journal editors and owners, policy makers and citation databases, is needed to further promote local journals as windows to the research in the developing world and the doors for valuable regional research to the global scientific community.

  2. Pre-clinical patient contacts and the application of biomedical and clinical knowledge

    NARCIS (Netherlands)

    Diemers, Agnes D.; van de Wiel, Margje W. J.; Scherpbier, Albert J. J. A.; Heineman, Erik; Dolmans, Diana H. J. M.

    2011-01-01

    Context Real-patient contacts in problem-based undergraduate medical education are promoted as a good way to introduce biomedical and (in)formal clinical knowledge early in the curriculum and thereby to foster the development of coherent and integrated knowledge networks. There are concerns, however

  3. Knowledge of diabetes among type 2 diabetes patients attending a primary health care clinic in Sri Lanka.

    Science.gov (United States)

    Perera, D P; De Silva, R E E; Perera, W L S P

    2013-07-01

    Patients' knowledge about their illness is considered important in controlling diabetes and preventing complications. A descriptive, cross-sectional study was conducted among patients attending the diabetes clinic of a primary care level hospital in Moratuwa, Sri Lanka. During a 1-month period in 2009 all consenting patients diagnosed with type 2 diabetes who had been attending the clinic for more than 3 months were included in the study. Using an interviewer administered, structured questionnaire 150 patients (135 females, 15 males) answered 25 questions about diabetes knowledge (scored x4 to give score range 0-100). A majority of patients (70.0%) had a good score (> 65) on the knowledge test but critical gaps in knowledge were revealed, especially regarding knowledge about symptoms of poor control and importance of regular follow-up. Although patients with longer duration of diabetes had higher mean knowledge scores, they also had higher fasting blood glucose levels. Education programmes are needed to address critical gaps in patients' knowledge.

  4. Acquiring, encoding, and re-using clinical knowledge in PRODIGY

    Directory of Open Access Journals (Sweden)

    Richard Hall

    2002-11-01

    Full Text Available The development, implementation and maintenance of computer-executable clinical guidelines encompass a series of complex processes. As they are often performed by more than one organisation, this introduces further complexity. Within the PRODIGY project we attempt to control as many aspects of the process as possible, in order to increase the likelihood of achieving success. To illustrate the complexity of the process and many of the inherent problems and solutions, this paper describes the evolution of the PRODIGY knowledge base, describing the steps from acquiring knowledge, through encoding, to the execution of guidelines, and 'closing the loop' by discussing an approach to knowledge re-use. We will also consider some of the wider implications of our work and propose directions for future research and development activities.

  5. The Communication Skills of Accountants: What We Know and the Gaps in Our Knowledge

    Science.gov (United States)

    Siriwardane, Harshini P.; Durden, Chris H.

    2014-01-01

    This paper critically reviews 19 studies published between 1972 and 2012 that investigated the written and/or oral communication skills of practicing accountants. The core aim of the review was to identify skills considered important and highlight gaps regarding what is known about existing and desired communication skills in the accounting…

  6. Optimizing clinical environments for knowledge translation: strategies for nursing leaders.

    Science.gov (United States)

    Scott, Shannon D; VandenBeld, Brenda; Cummings, Greta G

    2011-10-01

    Using findings from our recent study that found that a context of uncertainty in the work environment hindered nurses' research utilization, we suggest strategies for nurse managers and leaders to optimize clinical environments and support efforts to put research into clinical practice (knowledge translation). Two important sources of uncertainty were the complexity of teamwork and inconsistency in management and leadership styles. To reduce the uncertainty arising from teamwork, we propose (a) clarifying nurses' scopes of practice, (b) increasing knowledge sharing through supporting journal clubs and enhanced computer access and (c) creating safe venues for multidisciplinary dialogue. To reduce uncertainty arising from variations in management and leadership, we propose (a) developing policies that enhance the consistency of leadership and clarify the strategic direction of the management team, (b) clearly communicating those policies to nurses and (c) providing explicit rationales for treatment changes. Small, incremental steps can be taken to realize substantive changes in clinical environments in order to optimize nursing work environments for knowledge translation.

  7. Examine the Gaps between Current and Ideal State of Knowledge Management in the Department of Physical Education

    Directory of Open Access Journals (Sweden)

    Kaveh Hasani

    2013-02-01

    Full Text Available In today's competitive world, knowledge has become the strategic resource in many organizations. Nonaka believes that in today's volatile situation, the only viable source of sustainable competitive advantage is knowledge. Thus, the knowledge management has become a major task for organizations that are looking to take advantage of this valuable asset. In this case the goal of this study is to examine the gaps between current and ideal state of knowledge management in the Department of Physical Education in Iran. Research's method was descriptive-menstruation. Study sample consisted of all employees of the Department of Physical Education of Kurdistan that were 320 members and it was selected by using Morgan table that were 175 members. The reliability of the questionnaire was measured and verified based on Cronbach's Alpha for the knowledge management dimension equals 0/89. Also a questionnaire to be standardized and be normalized in internal research, ensure validity of test. Used statistical methods in current study is use SPSS software and descriptive statistics to describe sex, age, education level and staff's job precedence variables and Kolmogorov – Smirnov test (K-S to verify data to be normal and to verify or reject hypothesis, Paired t-test is been used. Research results showed, there are meaningful differences among knowledge management Dimensions, including Technology infrastructure, organizational culture and organizational structure from the perspective of the Kurdistan's physical education staff in current situation with the ideal situation.

  8. Bridging the Nagoya Compliance Gap: The Fundamental Role of Customary Law in Protection of Indigenous Peoples’ Resource and Knowledge Rights

    Directory of Open Access Journals (Sweden)

    Brendan M. Tobin

    2013-09-01

    Full Text Available The Nagoya Protocol requires states to ensure that access to and use of genetic resources and traditional knowledge of Indigenous peoples and local communities is subject to their prior informed consent (PIC. It also requires states to take into consideration their customary laws. However, it lacks effective compliance mechanisms, a gap exposed in draft European legislation that sidesteps the Nagoya Protocol’s obligations regarding PIC and customary law, leaving traditional knowledge largely unprotected. This article examines the status of customary law under international, regional and national law, and the challenges and opportunities for securing recognition of its role in the protection of traditional knowledge. The article contends that all commercial and development activities with the potential to impact on Nagoya Protocol rights will in the future need to ensure compliance with relevant customary law. It finds state reluctance to adopt measures to ensure consideration of customary law shortsighted and likely to lead to increased litigation. It concludes that customary law has a key role to play in closing the Nagoya compliance gap but to do so it will need to be supported by enforcement mechanisms such as disclosure of origin regimes in intellectual property law.

  9. Hyperspectral remote sensing of vegetation and agricultural crops: knowledge gain and knowledge gap after 40 years of research

    Science.gov (United States)

    Thenkabail, Prasad S.; Lyon, John G.; Huete, Alfredo; Edited by Thenkabail, Prasad S.; Lyon, John G.; Huete, Alfredo

    2011-01-01

    The focus of this chapter was to summarize the advances made over last 40+ years, as reported in various chapters of this book, in understanding, modeling, and mapping terrestrial vegetation using hyperspectral remote sensing (or imaging spectroscopy) using sensors that are ground-based, truck-mounted, airborne, and spaceborne. As we have seen in various chapters of this book and synthesized in this chapter, the advances made include: (a) significantly improved characterization and modeling of a wide array of biophysical and biochemical properties of vegetation, (b) ability to discriminate plant species and vegetation types with high degree of accuracies (c) reducing uncertainties in determining net primary productivity or carbon assessments from terrestrial vegetation, (d) improved crop productivity and water productivity models, (b), (e) ability to access stress resulting from causes such as management practices, pests and disease, water deficit or excess; , and (f) establishing more sensitive wavebands and indices to detect plant water\\moisture content. The advent of spaceborne hyperspectral sensors (e.g., NASA’s Hyperion, ESA’s PROBA, and upcoming NASA’s HyspIRI) and numerous methods and techniques espoused in this book to overcome Hughes phenomenon or data redundancy when handling large volumes of hyperspectral data have generated tremendous interest in advancing our hyperspectral applications knowledge base over larger spatial extent such as region, nation, continent, and globe.

  10. [Clinical practice guidelines and knowledge management in healthcare].

    Science.gov (United States)

    Ollenschläger, Günter

    2013-10-01

    Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers.

  11. "Big Data": Big Knowledge Gaps in the Field of Internet Science

    Directory of Open Access Journals (Sweden)

    Ulf-Dietrich Reips

    2012-01-01

    Full Text Available Research on so-called ‘Big Data’ has received a considerable momentum and is expected to grow in the future. One very interesting stream of research on Big Data analyzes online networks. Many online networks are known to have some typical macro-characteristics, such as ‘small world’ properties. Much less is known about underlying micro-processes leading to these properties. The models used by Big Data researchers usually are inspired by mathematical ease of exposition. We propose to follow in addition a different strategy that leads to knowledge about micro-processes that match with actual online behavior. This knowledge can then be used for the selection of mathematically-tractable models of online network formation and evolution. Insight from social and behavioral research is needed for pursuing this strategy of knowledge generation about micro-processes. Accordingly, our proposal points to a unique role that social scientists could play in Big Data research. ...

  12. Exploring the gap between hand washing knowledge and practices in Bangladesh: a cross-sectional comparative study

    Directory of Open Access Journals (Sweden)

    Rabbi Sifat E

    2013-01-01

    Full Text Available Abstract Background Hand washing is considered as one of the most effective hygiene promotion activities for public health in developing countries. This study compared hand washing knowledge and practices in BRAC’s water; sanitation and hygiene (WASH programme areas over time. Methods This study is a cross-sectional comparative study between baseline (2006, midline (2009 and end-line (2011 surveys in 50 sub-districts from the first phase of the programme. Thirty thousand households from 50 sub-districts were selected in two steps: i 30 villages were selected from each sub-district by cluster sampling, and ii 20 households were chosen systematically from each village. The matched households were considered (26,404 in each survey for analysis. Data were collected from households through face-to-face interview using a pre-tested questionnaire. Respondents were the adult female members of the same households, who had knowledge of day-to-day household activities related to water, sanitation and hygiene. Results A gap between perception and practice of proper hand washing practices with soap was identified in the study areas. Hand washing practice with soap before eating was much lower than after defecation. In baseline data, 8% reported to wash their hands with soap which significantly increased to 22% in end line. Hand washing knowledge and practices before cooking food, before serving food and while handling babies is considerably limited than other critical times. A multivariate analysis shows that socio-economic factors including education of household head and respondent, water availability and access to media have strong positive association with hand washing with soap. Conclusion Gap between knowledge and practice still persists in hand washing practices. Long term and extensive initiatives can aware people about the effectiveness of hand washing.

  13. Integrating research into clinical internship training bridging the science/practice gap in pediatric psychology.

    Science.gov (United States)

    McQuaid, Elizabeth L; Spirito, Anthony

    2012-03-01

    Existing literature highlights a critical gap between science and practice in clinical psychology. The internship year is a "capstone experience"; training in methods of scientific evaluation should be integrated with the development of advanced clinical competencies. We provide a rationale for continued exposure to research during the clinical internship year, including, (a) critical examination and integration of the literature regarding evidence-based treatment and assessment, (b) participation in faculty-based and independent research, and (c) orientation to the science and strategy of grantsmanship. Participation in research provides exposure to new empirical models and can foster the development of applied research questions. Orientation to grantsmanship can yield an initial sense of the "business of science." Internship provides an important opportunity to examine the challenges to integrating the clinical evidence base into professional practice; for that reason, providing research exposure on internship is an important strategy in training the next generation of pediatric psychologists.

  14. Data standards in clinical research: gaps, overlaps, challenges and future directions.

    Science.gov (United States)

    Richesson, Rachel L; Krischer, Jeffrey

    2007-01-01

    Current efforts to define and implement health data standards are driven by issues related to the quality, cost and continuity of care, patient safety concerns, and desires to speed clinical research findings to the bedside. The President's goal for national adoption of electronic medical records in the next decade, coupled with the current emphasis on translational research, underscore the urgent need for data standards in clinical research. This paper reviews the motivations and requirements for standardized clinical research data, and the current state of standards development and adoption--including gaps and overlaps--in relevant areas. Unresolved issues and informatics challenges related to the adoption of clinical research data and terminology standards are mentioned, as are the collaborations and activities the authors perceive as most likely to address them.

  15. Nausea: current knowledge of mechanisms, measurement and clinical impact.

    Science.gov (United States)

    Kenward, Hannah; Pelligand, Ludovic; Savary-Bataille, Karine; Elliott, Jonathan

    2015-01-01

    Nausea is a subjective sensation, which often acts as a signal that emesis is imminent. It is a widespread problem that occurs as a clinical sign of disease or as an adverse effect of a drug therapy or surgical procedure. The mechanisms of nausea are complex and the neural pathways are currently poorly understood. This review summarises the current knowledge of nausea mechanisms, the available animal models for nausea research and the anti-nausea properties of commercially available anti-emetic drugs. The review also presents subjective assessment and scoring of nausea. A better understanding of the underlying mechanisms of nausea might reveal potential clinically useful biomarkers for objective measurement of nausea in species of veterinary interest.

  16. Zika virus infection, transmission, associated neurological disorders and birth abnormalities:A review of progress in research, priorities and knowledge gaps

    Institute of Scientific and Technical Information of China (English)

    Yitades Gebre; Nikkiah Forbes; Teshome Gebre

    2016-01-01

    On February 1, 2016, the World Health Organization declared that the cluster of microcephaly cases and other neurological disorders constitute public health emergency of international concern. Furthermore, few studies demonstrated that there was an increased evidence of causal relationship of Zika virus (ZIKAV) infection and micro-cephaly, birth abnormalities and neurological disorders such as Guillain–Barr ´e syndrome. ZIKAV transmission occurs mainly by the bite of infected mosquitos (Aedes species), but there are also reports that infections could occur via the placenta, breast milk, saliva, blood transfusion and sex. This article reviews the global efforts, progress in scientific research to understand the pathogenesis of ZIKAV infection & disease, clinical pre-sentations, congenital transmission and autoimmune neurological disorders. The paper further explores the knowledge gaps, future priority research agenda for strategic response including vector control and prevention. We conducted a systematic literature review to synthesise available evidence on ZIKAV infection and its vector and host interaction from electronic databases.

  17. Electronic Continuous Professional Development (E-CPD) for Teachers: Bridging the Gap between Knowledge and Application

    Science.gov (United States)

    Razak, Rafiza Abdul; Yusop, Farah Dina; Halili, Siti Hajar; Chukumaran, Sri Raman

    2015-01-01

    The continuing professional development (CPD) is a concerted effort to ensure the educational service officers equip themselves with professional knowledge, skill, values and practices of teachers through in-service training programs organized based on competency development, lifelong learning and career path. Nonetheless, educators do not only…

  18. Knowledge translation of the HELPinKIDS clinical practice guideline for managing childhood vaccination pain: usability and knowledge uptake of educational materials directed to new parents

    Directory of Open Access Journals (Sweden)

    Taddio Anna

    2013-02-01

    Full Text Available Abstract Background Although numerous evidence-based and feasible interventions are available to treat pain from childhood vaccine injections, evidence indicates that children are not benefitting from this knowledge. Unrelieved vaccination pain puts children at risk for significant long-term harms including the development of needle fears and subsequent health care avoidance behaviours. Parents report that while they want to mitigate vaccination pain in their children, they lack knowledge about how to do so. An evidence-based clinical practice guideline for managing vaccination pain was recently developed in order to address this knowledge-to-care gap. Educational tools (pamphlet and video for parents were included to facilitate knowledge transfer at the point of care. The objectives of this study were to evaluate usability and effectiveness in terms of knowledge acquisition from the pamphlet and video in parents of newly born infants. Methods Mixed methods design. Following heuristic usability evaluation of the pamphlet and video, parents of newborn infants reviewed revised versions of both tools and participated in individual and group interviews and individual knowledge testing. The knowledge test comprised of 10 true/false questions about the effectiveness of various pain management interventions, and was administered at three time points: at baseline, after review of the pamphlet, and after review of the video. Results Three overarching themes were identified from the interviews regarding usability of these educational tools: receptivity to learning, accessibility to information, and validity of information. Parents’ performance on the knowledge test improved (p≤0.001 from the baseline phase to after review of the pamphlet, and again from the pamphlet review phase to after review of the video. Conclusions Using a robust testing process, we demonstrated usability and conceptual knowledge acquisition from a parent-directed educational

  19. The clinical translation gap in child health exercise research: a call for disruptive innovation.

    Science.gov (United States)

    Ashish, Naveen; Bamman, Marcas M; Cerny, Frank J; Cooper, Dan M; D'Hemecourt, Pierre; Eisenmann, Joey C; Ericson, Dawn; Fahey, John; Falk, Bareket; Gabriel, Davera; Kahn, Michael G; Kemper, Han C G; Leu, Szu-Yun; Liem, Robert I; McMurray, Robert; Nixon, Patricia A; Olin, J Tod; Pianosi, Paolo T; Purucker, Mary; Radom-Aizik, Shlomit; Taylor, Amy

    2015-02-01

    In children, levels of play, physical activity, and fitness are key indicators of health and disease and closely tied to optimal growth and development. Cardiopulmonary exercise testing (CPET) provides clinicians with biomarkers of disease and effectiveness of therapy, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response that is hidden when the child is at rest. Yet the growth of clinical trials utilizing CPET in pediatrics remains stunted despite the current emphasis on preventative medicine and the growing recognition that therapies used in children should be clinically tested in children. There exists a translational gap between basic discovery and clinical application in this essential component of child health. To address this gap, the NIH provided funding through the Clinical and Translational Science Award (CTSA) program to convene a panel of experts. This report summarizes our major findings and outlines next steps necessary to enhance child health exercise medicine translational research. We present specific plans to bolster data interoperability, improve child health CPET reference values, stimulate formal training in exercise medicine for child health care professionals, and outline innovative approaches through which exercise medicine can become more accessible and advance therapeutics across the broad spectrum of child health.

  20. Knowledge gaps about smoking cessation in hospitalized patients and their doctors.

    OpenAIRE

    Raupach, Tobias; Merker, Jacqueline; Hasenfuß, Gerd; Andreas, Stefan; Pipe, Andrew

    2011-01-01

    BACKGROUND: Hospitalization is an opportune time for smoking cessation support; cessation interventions delivered by hospital physicians are effective. While general practitioners' and outpatients' knowledge and attitudes towards smoking cessation have been studied in great detail, in-patient cessation programmes have received less attention. DESIGN: Questionnaire-based survey of a convenience sample of hospital physicians and in-patients at Göttingen University Hospital, Germany. M...

  1. Bridging a Gap Between Knowledge and Experience: Civilian Views of Military Service

    OpenAIRE

    Hayek, Philip

    2014-01-01

    Assume that knowledge can never exceed experience. In the case of studying the military and veterans’ issues, then, how much can a civilian understand, or how much credibility might a civilian have to leverage when making claims about ideology, motives, or identity concerning veterans? Are the experiences of veterans insulated from the public in a way that deflects any possible judgment from outsiders, from civilians? Consider the value judgments concerning the military that reveal a certain ...

  2. Disinfection of stethoscopes: Gap between knowledge and practice in an Indian tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Anshu Jain

    2013-01-01

    Full Text Available Context: Stethoscopes are used primarily to assess the health of patients and are one of the most commonly used medical devices. Thus, are the prominent tools for the spread of health-care associated infections (HAIs. Aims: The study was conducted to assess the knowledge and awareness about handling of the stethoscope and cleaning practices followed among the healthcare workers (HCWs. Materials and Methods: A total of 80 participants were included during a 4-month study period at a tertiary care hospital in Ujjain. A semi-structured questionnaire was distributed to HCWs and the surface of the diaphragm of their stethoscopes were swabbed for bacteriological analysis using standard techniques. Results: Out of total 80 stethoscopes, 69 (86% were found to be contaminated with at least one type of microorganism. Pseudomonas aeruginosa was the most predominant bacterial species found on 58 stethoscopes, followed by Bacillus subtilis (n = 21 and Staphylococcus spp. (n = 16. Out of total 10 S. aureus isolated, 3 were methicillin-resistant S. aureus ( MRSA. Majority (97% of the HCWs had good knowledge about the topic, but only 22 (27% reported to apply it in the practice. Conclusions: Our study confirmed that majority of the stethoscopes were contaminated with microorganisms. Besides having knowledge about the importance of cleaning the stethoscopes, lower percentage of HCWs reported to follow it in practice. Thus, the authors recommend regularization of reminders such as circulars, motivating posters for the HCWs to clean the diaphragm of the stethoscopes.

  3. Closing the Gap between Research Evidence and Clinical Practice: Jordanian Nurses' Perceived Barriers to Research Utilisation

    Science.gov (United States)

    Al Khalaileh, Murad; Al Qadire, Mohammad; Musa, Ahmad S.; Al-Khawaldeh, Omar A.; Al Qudah, Hani; Alhabahbeh, Atalla

    2016-01-01

    Background: The nursing profession is a combination of theory and practical skill, and nurses are required to generate and develop knowledge through implementing research into clinical practice. Considerable number of barriers could hind implementing research findings into practice. Barriers to research utilisation are not identified in the…

  4. Team Learning to Narrow the Gap between Healthcare Knowledge and Practice

    Science.gov (United States)

    Anand, Tejwansh S.

    2014-01-01

    This study explored team-based learning in teams of healthcare professionals working on making meaning of evidence-based clinical guidelines in their field to apply them within their practice setting. The research based team learning models posited by Kasl, Marsick, and Dechant (1997) and Edmondson, Dillon, and Roloff (2007) were used as the…

  5. Ageing research on vertebrates shows knowledge gaps and opportunities for species conservation and management

    DEFF Research Database (Denmark)

    Conde, Dalia Amor

    is constant when species reach maturity. The implications of these assumptions have strong consequences not only in the development of evolutionary theories of ageing and population ecology but also in species conservation. By modeling mortality of different species of vertebrates we show that different...... models are needed to explore the diversity of mortality trajectories in animals. However, our state of demographic knowledge even for vertebrates is by far deficient to incorporate the effects on age. Exploring 13 available datasets on vertebrate life histories traits, our results show surprising figures...

  6. Review of the effects of protection in marine protected areas: current knowledge and gaps

    Directory of Open Access Journals (Sweden)

    Ojeda–Martínez, C.

    2011-06-01

    Full Text Available The effectiveness of marine protected areas (MPAs and the conservation of marine environments must be based on reliable information on the quality of the marine environment that can be obtained in a reasonable timeframe. We reviewed studies that evaluated all aspects related to the effectiveness of MPAs in order to describe how the studies were conducted and to detect fields in which research is lacking. Existing parameters used to evaluate the effectiveness of MPAs are summarised. Two-hundred and twenty-two publications were reviewed. We identified the most commonly used study subjects and methodological approaches. Most of the studies concentrated on biological parameters. Peer reviewed studies were based on control vs. impact design. BACI and mBACI designs were used in very few studies. Through this review, we have identified gaps in the objectives assigned to MPAs and the way in which they have been evaluated. We suggest some guidelines aimedat improving the assessment of the effects of protection in MPAs.

  7. Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era.

    Science.gov (United States)

    Kendall, Tamil; Langer, Ana

    2015-06-05

    Effective interventions to promote maternal health and address obstetric complications exist, however 800 women die every day during pregnancy and childbirth from largely preventable causes and more than 90% of these deaths occur in low and middle income countries (LMIC). In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health. The vision of maternal health articulated was comprehensive and priorities for knowledge generation encompassed improving the availability, accessibility, acceptability, and quality of institutional labor and delivery services and other effective interventions, such as contraception and safe abortion services. Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time. Researchers also emphasized the development of tools to measure quality of care and promote ongoing quality improvement at the facility, district, and national level. Knowledge generation to improve distribution and retention of healthcare workers, facilitate task shifting, develop and evaluate training models to improve "hands-on" skills and promote evidence-based practice, and increase managerial capacity at different levels of the health system were also prioritized. Interviewees noted that attitudes, behavior, and power relationships between health professionals and within institutions must be transformed to achieve coverage of high-quality maternal health services in LMIC. The increasing burden of non-communicable diseases, urbanization, and the persistence of social and economic inequality were identified as emerging challenges that require knowledge generation to improve health system responses and evaluate

  8. Gaps in the Public's Knowledge About Chronic Pain: Representative Sample of Hispanic Residents From 5 States.

    Science.gov (United States)

    Turner, Barbara J; Liang, Yuanyuan; Rodriguez, Natalia; Valerio, Melissa A; Rochat, Andrea; Potter, Jennifer S; Winkler, Paula

    2017-01-12

    Educating the general public about chronic pain and its care is a national health priority. We evaluated knowledge, attitudes, and beliefs (KAB) of a 5-state, population-based sample of Hispanic individuals aged 35 to 75 years without chronic pain, representing more than 8.8 million persons. A Web-based survey assessed KAB using an adapted version of the Survey of Pain Attitudes-Brief and self-reported knowledge about chronic pain (nothing, a little, a lot). In unweighted analyses of participants (N = 349), the mean age was 52.0 (±10.6) years, 54% were women, 53% preferred Spanish, and 39% did not graduate from high school. More participants reported knowing nothing about chronic pain (24%) than a lot (12%). In weighted logistic models with knowing nothing as the reference, knowing a lot was associated with greater KAB for chronic pain-related emotions, functioning, and cure (all P chronic pain care, these data underscore the need for effective public educational campaigns about chronic pain.

  9. Canine vector-borne diseases in India: a review of the literature and identification of existing knowledge gaps

    Directory of Open Access Journals (Sweden)

    Coleman Glen T

    2010-04-01

    Full Text Available Abstract Despite the combination of favourable climate for parasites and vectors, and large populations of stray dogs, information concerning the epidemiology, diagnosis and management of canine vector-borne diseases in India is limited. However, with the country's expanding economy and adaptation to western culture, higher expectations and demands are being placed on veterinary surgeons for improved knowledge of diseases and control. This review aims to provide an overview of the current state of knowledge of these diseases in India and identify existing knowledge gaps in the literature which need to be addressed. The available literature on this subject, although limited, suggests that a number of canine vector-borne diseases such as filariasis, babesiosis and ehrlichiosis are endemic throughout India, as diagnosed mostly by morphological methods. Detailed investigations of the epidemiology and zoonotic potential of these pathogens has been neglected. Further study is essential to develop a better understanding of the diversity of canine vector-borne diseases in India, and their significance for veterinary and public health.

  10. Tranexamic Acid and Trauma: Current Status and Knowledge Gaps with Recommended Research Priorities

    Science.gov (United States)

    2013-01-01

    Trauma 65:300Y308, 2008. 16. Ekeh AP, Dominguez KM, Markert RJ, McCarthy MC: Incidence and risk factors for deep venous thrombosis after moderate and...the impact of tranexamic acid and other risk factors . Can J Anaesth 59:6Y13, 2012. 22. Koster A, Börgermann J, Zittermann A, Lueth JU, Gillis...mortality were observed. As is common for retrospective database analyses, there were some confounding factors , including a change in clinical practice

  11. The distributional ecology of the maned sloth: environmental influences on its distribution and gaps in knowledge.

    Directory of Open Access Journals (Sweden)

    Danielle de Oliveira Moreira

    Full Text Available The maned sloth Bradypus torquatus (Pilosa, Bradypodidae is endemic to a small area in the Atlantic Forest of coastal Brazil. It has been listed as a threatened species because of its restricted geographic range, habitat loss and fragmentation, and declining populations. The major objectives of this study were to estimate its potential geographic distribution, the climatic conditions across its distributional range, and to identify suitable areas and potential species strongholds. We developed a model of habitat suitability for the maned sloth using two methods, Maxent and Mahalanobis Distance, based on 42 occurrence points. We evaluated environmental variable importance and the predictive ability of the generated distribution models. Our results suggest that the species distribution could be strongly influenced by environmental factors, mainly temperature seasonality. The modeled distribution of the maned sloth included known areas of occurrence in the Atlantic Forest (Sergipe, Bahia, Espírito Santo, and Rio de Janeiro, but did not match the observed distributional gaps in northern Rio de Janeiro, northern Espírito Santo or southern Bahia. Rather, the model showed that these areas are climatically suitable for the maned sloth, and thus suggests that factors other than climate might be responsible for the absence of species. Suitable areas for maned sloth were located mainly in the mountainous region of central Rio de Janeiro throughout Espírito Santo and to the coastal region of southern Bahia. We indicate 17 stronghold areas and recommended survey areas for the maned sloth. In addition, we highlight specific areas for conservation, including the current network protected areas. Our results can be applied for novel surveys and discovery of unknown populations, and help the selection of priority areas for management and conservation planning, especially of rare and relatively cryptic species directed associated with forested habitats.

  12. The distributional ecology of the maned sloth: environmental influences on its distribution and gaps in knowledge.

    Science.gov (United States)

    Moreira, Danielle de Oliveira; Leite, Gustavo Rocha; Ferreira de Siqueira, Marinez; Coutinho, Bruno Rocha; Zanon, Mariana Santos; Mendes, Sérgio Lucena

    2014-01-01

    The maned sloth Bradypus torquatus (Pilosa, Bradypodidae) is endemic to a small area in the Atlantic Forest of coastal Brazil. It has been listed as a threatened species because of its restricted geographic range, habitat loss and fragmentation, and declining populations. The major objectives of this study were to estimate its potential geographic distribution, the climatic conditions across its distributional range, and to identify suitable areas and potential species strongholds. We developed a model of habitat suitability for the maned sloth using two methods, Maxent and Mahalanobis Distance, based on 42 occurrence points. We evaluated environmental variable importance and the predictive ability of the generated distribution models. Our results suggest that the species distribution could be strongly influenced by environmental factors, mainly temperature seasonality. The modeled distribution of the maned sloth included known areas of occurrence in the Atlantic Forest (Sergipe, Bahia, Espírito Santo, and Rio de Janeiro), but did not match the observed distributional gaps in northern Rio de Janeiro, northern Espírito Santo or southern Bahia. Rather, the model showed that these areas are climatically suitable for the maned sloth, and thus suggests that factors other than climate might be responsible for the absence of species. Suitable areas for maned sloth were located mainly in the mountainous region of central Rio de Janeiro throughout Espírito Santo and to the coastal region of southern Bahia. We indicate 17 stronghold areas and recommended survey areas for the maned sloth. In addition, we highlight specific areas for conservation, including the current network protected areas. Our results can be applied for novel surveys and discovery of unknown populations, and help the selection of priority areas for management and conservation planning, especially of rare and relatively cryptic species directed associated with forested habitats.

  13. Key success factors for clinical knowledge management systems: Comparing physician and hospital manager viewpoints.

    Science.gov (United States)

    Chang, Sho-Fang; Hsieh, Ping-Jung; Chen, Hui-Fang

    2015-01-01

    The study explores the perceptions of physicians and hospital managers regarding the key success factors (KSFs) of a clinical knowledge management system (CKMS). It aims to eliminate the perception gap and gain more insights for a successful CKMS.A survey was conducted in four medical centers in Taiwan. A total of 340 questionnaires, including 15 for hospital managers and 70 for physicians in each hospital, were administered. The effective response rates are 78.3% and 56.1% respectively. Partial least square (PLS) were used to analyze the data.The results identified six KSFs of CKMS including system software and hardware, knowledge quality, system quality, organizational factors, user satisfaction, and policy factors. User satisfaction and policy factors have direct effects on perceived CKMS performance. Knowledge quality is regarded as an antecedent to user satisfaction, while system quality is the antecedent to both user satisfaction and policy factors. System software and hardware was supported only by managers, and organizational factors were supported only by physicians.Among the factors, this study highlighted the policy factor. Besides, the study provides hospital managers additional insights into physician requirements for organizational support. Third, more physician participation and involvement are recommended when introducing and developing a CKMS.

  14. Marine biodiversity in the Atlantic and Pacific coasts of South America: knowledge and gaps.

    Directory of Open Access Journals (Sweden)

    Patricia Miloslavich

    Full Text Available The marine areas of South America (SA include almost 30,000 km of coastline and encompass three different oceanic domains--the Caribbean, the Pacific, and the Atlantic--ranging in latitude from 12∘N to 55∘S. The 10 countries that border these coasts have different research capabilities and taxonomic traditions that affect taxonomic knowledge. This paper analyzes the status of knowledge of marine biodiversity in five subregions along the Atlantic and Pacific coasts of South America (SA: the Tropical East Pacific, the Humboldt Current,the Patagonian Shelf, the Brazilian Shelves, and the Tropical West Atlantic, and it provides a review of ecosystem threats and regional marine conservation strategies. South American marine biodiversity is least well known in the tropical subregions (with the exception of Costa Rica and Panama. Differences in total biodiversity were observed between the Atlantic and Pacific oceans at the same latitude. In the north of the continent, the Tropical East Pacific is richer in species than the Tropical West Atlantic, however, when standardized by coastal length, there is very little difference among them. In the south, the Humboldt Current system is much richer than the Patagonian Shelf. An analysis of endemism shows that 75% of the species are reported within only one of the SA regions, while about 22% of the species of SA are not reported elsewhere in the world. National and regional initiatives focusing on new exploration, especially to unknown areas and ecosystems, as well as collaboration among countries are fundamental to achieving the goal of completing inventories of species diversity and distribution.These inventories will allow accurate interpretation of the biogeography of its two oceanic coasts and latitudinal trends,and will also provide relevant information for science based policies.

  15. Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society.

    Science.gov (United States)

    Rich, Michael W; Chyun, Deborah A; Skolnick, Adam H; Alexander, Karen P; Forman, Daniel E; Kitzman, Dalane W; Maurer, Mathew S; McClurken, James B; Resnick, Barbara M; Shen, Win K; Tirschwell, David L

    2016-05-24

    The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The

  16. Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society.

    Science.gov (United States)

    Rich, Michael W; Chyun, Deborah A; Skolnick, Adam H; Alexander, Karen P; Forman, Daniel E; Kitzman, Dalane W; Maurer, Mathew S; McClurken, James B; Resnick, Barbara M; Shen, Win K; Tirschwell, David L

    2016-05-24

    The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The

  17. Determinants of healthy eating in Aboriginal peoples in Canada: the current state of knowledge and research gaps.

    Science.gov (United States)

    Willows, Noreen D

    2005-01-01

    Aboriginal peoples are the original inhabitants of Canada. These many diverse peoples have distinct languages, cultures, religious beliefs and political systems. The current dietary practices of Aboriginal peoples pose significant health risks. Interventions to improve the nutritional status of Aboriginal peoples must reflect the realities of how people make food choices and therefore should be informed by an understanding of contemporary patterns of food procurement, preparation and distribution. Most of the literature documenting the health of Aboriginal peoples is primarily epidemiologic, and there is limited discussion of the determinants that contribute to health status. The majority of studies examining dietary intake in Aboriginal communities do not aim to study the determinants of food intake per se even though many describe differences in food intake across sex, age groups, seasons and sometimes communities, and may describe factors that could have an effect on food consumption (e.g., employment status, level of education, household size, presence of a hunter/trapper/fisher, occupation, main source of income). For these reasons, there are many gaps in knowledge pertaining to the determinants of healthy eating in Aboriginal peoples that must be filled. Given the diversity of Aboriginal peoples, research to address the gaps should take place at both the national level and at a more local level. Research would be important for each of Inuit, Métis and First Nations.

  18. [Hypothyroidism during pregnancy risks the child's neurocognitive development. New guidelines and remaining knowledge gaps].

    Science.gov (United States)

    Skalkidou, Alkistis; Bixo, Marie; Sköldebrand Sparre, Ann-Charlotte; Strandell, Annika; Lindén Hirschberg, Angelica; Filipsson Nyström, Helena

    2016-02-05

    Thyroid abnormalities are common during pregnancy and can affect pregnancy outcome. In 2012, the working group for endocrinology was assigned by SFOG to develop evidence based guidelines for their management. There is high quality evidence that untreated clinical hypothyroidism increases the risk of pregnancy and fetal complications. Subclinical hypothyroidism is associated with pregnancy complications. The presence of TPO-antibodies is linked to miscarriage and premature birth. It is uncertain whether subclinical hypothyroidism/maternal TPO-antibodies adversely affect the child's neurocognitive development. Reference intervals for TSH among pregnant women in Sweden need to be established.

  19. The central Vienna Basin Transfer Fault - lack of knowledge or seismic gap?

    Science.gov (United States)

    Hintersberger, E.; Decker, K.

    2012-12-01

    main fault, indicating at least three larger late Quaternary earthquakes. These results, together with the fact that additional en echelon arranged faults as part of the flower structure are still not investigated, indicate that the seismic potential of the Vienna Basin might be much higher than the distribution of the historical seismicity suggests, and that the seismic gap at the central basin might not be a long-lasting feature.

  20. Human resource management in post-conflict health systems: review of research and knowledge gaps.

    Science.gov (United States)

    Roome, Edward; Raven, Joanna; Martineau, Tim

    2014-01-01

    distribution, and workforce performance. However, this should apply a longer-term focus throughout the different post-conflict phases, while paying attention to key cross-cutting themes such as leadership and governance, gender equity, and task shifting. The research gaps identified should enable future studies to examine how HRM could be used to meet both short and long term objectives for rebuilding health workforces and thereby contribute to achieving more equitable and sustainable health systems outcomes after conflict.

  1. Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge

    Directory of Open Access Journals (Sweden)

    Katie L. Losenno

    2012-01-01

    Full Text Available The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of bicuspid aortic valve disease with associated ascending aortic aneurysms.

  2. Using an eye tracker during medication administration to identify gaps in nursing students' contextual knowledge: an observational study.

    Science.gov (United States)

    Amster, Brian; Marquard, Jenna; Henneman, Elizabeth; Fisher, Donald

    2015-01-01

    In this clinical simulation study using an eye-tracking device, 40% of senior nursing students administered a contraindicated medication to a patient. Our findings suggest that the participants who did not identify the error did not know that amoxicillin is a type of penicillin. Eye-tracking devices may be valuable for determining whether nursing students are making rule- or knowledge-based errors, a distinction not easily captured via observations and interviews.

  3. Prevalence of HBV Infection and Knowledge of Hepatitis B Among Patients Attending Primary Care Clinics in Poland.

    Science.gov (United States)

    Ganczak, Maria; Dmytrzyk-Daniłów, Gabriela; Korzeń, Marcin; Drozd-Dąbrowska, Marzena; Szych, Zbigniew

    2016-06-01

    It is well known that community awareness of hepatitis B (HB) can lead to vaccination and testing. The study objectives were to assess the prevalence of HBV infection and knowledge of HB among adult patients attending randomly selected primary care clinics. A cross-sectional sero-survey was conducted in March 2013 in the Zgorzelec region, Poland, with the use of an investigator-developed questionnaire containing 22 questions regarding HB knowledge. Serum samples were assayed for anti-HBc total and anti-HBs with enzyme immunoassay. The prevalence of anti-HBc total among 410 participants (median age 56 years) was 10.3 % (95 % CI 7.6-13.8 %), nobody was aware of an infection. The main sources of HB knowledge were the media and medical staff. The mean knowledge score was 14.8 ± 4.9; 76.7 % of the respondents had scores >50 %. Particular gaps were detected relating to knowledge of unprotected sexual intercourse and MTCT; 45.6 % patients were not aware of the potential asymptomatic course of HBV infection, 41.2 % about chronic HB treatment. A patient's low educational level was negatively associated with a high knowledge level; the willingness for further education on HB and HBV vaccination in the past were independently associated with good knowledge. In conclusion, the HBV infection remains a public health threat in Poland, since the prevalence of infection markers in asymptomatic adult patients was high. Knowledge gaps call for awareness campaigns which may increase testing and diagnosis, audiences representing lower education level should be targeted first. Knowledge on HB might serve as an effective tool in decision making regarding vaccination.

  4. Overland flow in plot- to hillslope-scale hydrology: what are the major knowledge gaps?

    Science.gov (United States)

    Dunkerley, David

    2016-04-01

    Though overland flow has been studied systematically for more than 70 years, knowledge has been built in a piecemeal fashion, through studies exploring only particular aspects of overland flow. Holistic investigations have been notably lacking. An overview of the literature suggests that the occurrence of overland flow on hillslopes is frequently characterised by very large spatio-temporal variability, reflecting the many factors that influence overland flow behaviour. These include rainfall intensity, duration, event profile, and other properties; antecedent soil moisture and soil hydraulic properties; the influence of vegetation canopies, ground litter, and associated throughfall, stemflow, and percolates; microtopography and soil surface roughness; soil erodibility; runon and interactive infiltration; raindrop impact; and surface detention and afterflow. Overland flow may be patchy and discontinuous over the groundsurface. The integration all of these influences, with support from suitable distributed data collected during rainfall, remains an unrealised need. Progress has been slowed by a lack of suitable field data collection apparatus, especially for the recording of flow depths and speeds in overland flows that are commonly < 1-3 mm deep. There is also a need to develop a view of overland flow that accords with existing field observations showing that in many cases overland flow does not result from soil infiltrability being exceeded. In this context, a new descriptive term for transitory forms of overland flow arising from other mechanisms is suggested - facilitated overland flow.

  5. Isolated papillary muscle hypertrophy: A gap in our knowledge of hypertrophic cardiomyopathy?

    Science.gov (United States)

    Ferreira, Catarina; Delgado, Carlos; Vázquez, María; Trinidad, Carmen; Vilar, Manuel

    2014-06-01

    Increased thickness of left ventricular walls is the predominant characteristic and one of the diagnostic criteria of hypertrophic cardiomyopathy (HCM). This case illustrates an uncommon but important finding of isolated hypertrophy of the papillary muscles (PMs), observed in a young woman in whom an abnormal electrocardiogram was initially detected. During the investigation isolated PM hypertrophy was identified. The structural characteristics of the PMs have received scant attention in this setting and there is little information in the literature on this entity, whose real prevalence and clinical significance remain to be determined. The available information relates solitary PM hypertrophy with an early form or a different pattern of HCM. In this case PM hypertrophy was only detected due to the finding of an abnormal electrocardiogram, which prompted further diagnostic tests and a search for possible etiologies.

  6. Bridging the HL7 template - 13606 archetype gap with detailed clinical models.

    Science.gov (United States)

    Goossen, William T F; Goossen-Baremans, Anneke

    2010-01-01

    The idea of two level modeling has been taken up in healthcare information systems development. There is ongoing debate which approach should be taken. From the premise that there is a lack of clinician's time available, and the need for semantic interoperability, harmonization efforts are important. The question this paper addresses is whether Detailed Clinical Models (DCM) can bridge the gap between existing approaches. As methodology, a bottom up approach in multilevel comparison of existing content and modeling is used. Results indicate that it is feasible to compare and reuse DCM with clinical content from one approach to the other, when specific limitations are taken into account and precise analysis of each data-item is carried out. In particular the HL7 templates, the ISO/CEN 13606 and OpenEHR archetypes reveal more commonalties than differences. The linkage of DCM to terminologies suggests that data-items can be linked to concepts present in multiple terminologies. This work concludes that it is feasible to model a multitude of precise items of clinical information in the format of DCM and that transformations between different approaches are possible without loss of meaning. However, a set of single or combined clinical items and assessment scales have been tested. Larger groupings of clinical information might bring up more challenges.

  7. Health Care Providers’ Knowledge and Practice Gap towards Joint Zoonotic Disease Surveillance System: Challenges and Opportunities, Gomma District, Southwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Desta Hiko Gemeda

    2016-01-01

    Full Text Available Background. Health care providers play a crucial role for realization of joint zoonotic diseases surveillance by human and animal health sectors, yet there is limited evidence. Hence, this study aimed to determine knowledge and practice gap of health care providers towards the approach for Rabies and Anthrax in Southwest Ethiopia. Methods. A cross-sectional survey was conducted from December 16, 2014, to January 14, 2015. Eligible health care providers were considered for the study. Data were entered in to Epi-data version 3.1 and analyzed using SPSS version 20. Results. A total of 323 (92.02% health care providers participated in the study. Three hundred sixteen (97.8% of participants reported that both human and animal health sectors can work together for zoonotic diseases while 96.9% of them replied that both sectors can jointly conduct surveillance. One hundred seventeen (36.2% of them reported that their respective sectors had conducted joint surveillance for zoonotic diseases. Their involvement was, however, limited to joint outbreak response. Conclusion. There is good opportunity in health care providers’ knowledge even though the practice was unacceptably low and did not address all surveillance components. Therefore, formal joint surveillance structure should be in place for optimal implementation of surveillance.

  8. Health Care Providers' Knowledge and Practice Gap towards Joint Zoonotic Disease Surveillance System: Challenges and Opportunities, Gomma District, Southwest Ethiopia.

    Science.gov (United States)

    Gemeda, Desta Hiko; Sime, Abiot Girma; Hajito, Kifle Woldemichael; Gelalacha, Benti Deresa; Tafese, Wubit; Gebrehiwot, Tsegaye Tewelde

    2016-01-01

    Background. Health care providers play a crucial role for realization of joint zoonotic diseases surveillance by human and animal health sectors, yet there is limited evidence. Hence, this study aimed to determine knowledge and practice gap of health care providers towards the approach for Rabies and Anthrax in Southwest Ethiopia. Methods. A cross-sectional survey was conducted from December 16, 2014, to January 14, 2015. Eligible health care providers were considered for the study. Data were entered in to Epi-data version 3.1 and analyzed using SPSS version 20. Results. A total of 323 (92.02%) health care providers participated in the study. Three hundred sixteen (97.8%) of participants reported that both human and animal health sectors can work together for zoonotic diseases while 96.9% of them replied that both sectors can jointly conduct surveillance. One hundred seventeen (36.2%) of them reported that their respective sectors had conducted joint surveillance for zoonotic diseases. Their involvement was, however, limited to joint outbreak response. Conclusion. There is good opportunity in health care providers' knowledge even though the practice was unacceptably low and did not address all surveillance components. Therefore, formal joint surveillance structure should be in place for optimal implementation of surveillance.

  9. EcAMSat and BioSentinel: Autonomous Bio Nanosatellites Addressing Strategic Knowledge Gaps for Manned Spaceflight Beyond LEO

    Science.gov (United States)

    Padgen, Michael R.

    2017-01-01

    Manned missions beyond low Earth orbit (LEO) require that several strategic knowledge gaps about the effects of space travel on the human body be addressed. NASA Ames Research Center has been the leader in developing autonomous bio nanosatellites, including past successful missions for GeneSat, PharmaSat, and O/OREOS, that tackled some of these issues. These nanosatellites provide in situ measurements, which deliver insight into the dynamic changes in cell behavior in microgravity. In this talk, two upcoming bio nanosatellites developed at Ames, the E. coli Antimicrobial Satellite (EcAMSat) and BioSentinel, will be discussed. Both satellites contain microfluidic systems that precisely deliver nutrients to the microorganisms stored within wells of fluidic cards. Each well, in turn, has its own 3-color LED and detector system which is used to monitor changes in metabolic activity with alamarBlue, a redox indicator, and the optical density of the cells. EcAMSat investigates the effects of microgravity on bacterial resistance to antimicrobial drugs, vital knowledge for understanding how to maintain the health of astronauts in long-term and beyond LEO spaceflight. The behavior of wild type and mutant uropathic E. coli will be compared in microgravity and with ground data to help understand the molecular mechanisms behind antibiotic resistance and how these phenotypes might change in space. BioSentinel seeks to directly measure the effects of space radiation on budding yeast S. cerevisiae, particularly double strand breaks (DSB). While hitching a ride on the SLS EM-1 mission (Orion's first unmanned mission to the moon) in 2018, BioSentinel will be kicked off and enter into a heliocentric orbit, becoming the first study of the effects of radiation on living organisms outside LEO since the Apollo program. The yeast are stored in eighteen independent 16-well microfluidic cards, which will be individually activated over the 12 month mission duration. In addition to the wild

  10. Knowledge gaps in scientific literature on maternal mortality: a systematic review.

    Science.gov (United States)

    Gil-González, Diana; Carrasco-Portiño, Mercedes; Ruiz, Maria Teresa

    2006-11-01

    Issues related to maternal mortality have generated a lot of empirical and theoretical information. However, despite the amount of work published on the topic, maternal mortality continues to occur at high rates and solutions to the problem are still not clear. Scientific research on maternal mortality is focused mainly on clinical factors. However, this approach may not be the most useful if we are to understand the problem of maternal mortality as a whole and appreciate the importance of economical, political and social macrostructural factors. In this paper, we report the number of scientific studies published between 2000 and 2004 about the main causes of maternal death, as identified by WHO, and compare the proportion of papers on each cause with the corresponding burden of each cause. Secondly, we systematically review the characteristics and quality of the papers on the macrostructural determinants of maternal mortality. In view of their burden, obstructed labour, unsafe abortion and haemorrhage are proportionally underrepresented in the scientific literature. In our review, most studies analysed were cross-sectional, and were carried out by developed countries without the participation of researchers in the developing countries where maternal mortality was studied. The main macrostructural factors mentioned were socioeconomic variables. Overall, there is a lack of published information about the cultural and political determinants of maternal mortality. We believe that a high-quality scientific approach must be taken in studies of maternal mortality in order to obtain robust comparative data and that study design should be improved to allow causality between macrostructural determinants and maternal mortality to be shown.

  11. The Role of Biomedical Knowledge in Diagnosis of Difficult Clinical Cases

    Science.gov (United States)

    Woods, Nicole N.; Brooks, Lee R.; Norman, Geoffrey R.

    2007-01-01

    Although biomedical knowledge is believed to be of little value in diagnosis of routine clinical cases, studies of clinical reasoning have found that physicians revert to use of basic biomedical knowledge when faced with challenging clinical problems. The current paper presents two experiments that empirically examine the role of biomedical…

  12. Evidence and knowledge gaps on the disease burden in sexual and gender minorities: a review of systematic reviews.

    Science.gov (United States)

    Blondeel, Karel; Say, Lale; Chou, Doris; Toskin, Igor; Khosla, Rajat; Scolaro, Elisa; Temmerman, Marleen

    2016-01-22

    Sexual and gender minorities (SGM) include individuals with a wide range of sexual orientations, physical characteristics, and gender identities and expressions. Data suggest that people in this group face a significant and poorly understood set of additional health risks and bear a higher burden of some diseases compared to the general population. A large amount of data is available on HIV/AIDS, but far less on other health problems. In this review we aimed to synthesize the knowledge on the burden of communicable and non-communicable diseases, mental health conditions and violence experienced by SGM, based on available systematic reviews. We conducted a global review of systematic reviews, including searching the Cochrane and the Campbell Collaboration libraries, as well as PubMed, using a range of search terms describing the populations of interest, without time or language restrictions. Google Scholar was also scanned for unpublished literature, and references of all selected reviews were checked to identify further relevant articles. We found 30 systematic reviews, all originally written in English. Nine reviews provided data on HIV, 12 on other sexually transmitted infections (STIs), 4 on cancer, 4 on violence and 3 on mental health and substance use. A quantitative meta-analysis was not possible. The findings are presented in a narrative format. Our review primarily showed that there is a high burden of disease for certain subpopulations of SGM in HIV, STIs, STI-related cancers and mental health conditions, and that they also face high rates of violence. Secondly, our review revealed many knowledge gaps. Those gaps partly stem from a lack of original research, but there is an equally urgent need to conduct systematic and literature reviews to assess what we already know on the disease burden in SGM. Additional reviews are needed on the non-biological factors that could contribute to the higher disease burden. In addition, to provide universal access to

  13. The Gap between Tobacco Treatment Guidelines, Health Service Organization, and Clinical Practice in Comprehensive Cancer Centres

    Directory of Open Access Journals (Sweden)

    R. Mazza

    2011-01-01

    Full Text Available Smoking cessation is necessary to reach a higher quality of life, and, for a cancer patient, it represents an important step in improving the outcome of both prognosis and therapy. Being a cancer patient addicted to nicotine may be a critical situation. We conducted a survey to monitor how many comprehensive cancer centres in Italy have an outpatient smoker clinic and which kinds of resources are available. We also inquired about inpatient services offering psychological and pharmacological support for smoking cessation, reduction, or care of acute nicotine withdrawal symptoms. What we have witnessed is a significant gap between guidelines and services. Oncologists and cancer nurses are overscheduled, with insufficient time to engage in discussion on a problem that they do not consider directly related to cancer treatment. Furthermore, smoking habits and limited training in tobacco dependence and treatment act as an important barrier and lead to the undervaluation of smokers' needs.

  14. Bridging the gap between basic science and clinical practice: a role for community clinicians

    Directory of Open Access Journals (Sweden)

    Cho Michelle

    2011-04-01

    Full Text Available Abstract Background Translating the extraordinary scientific and technological advances occurring in medical research laboratories into care for patients in communities throughout the country has been a major challenge. One contributing factor has been the relative absence of community practitioners from the US biomedical research enterprise. Identifying and addressing the barriers that prevent their participation in research should help bridge the gap between basic research and practice to improve quality of care for all Americans. Methods We interviewed over 200 clinicians and other healthcare stakeholders from 2004 through 2005 to develop a conceptual framework and set of strategies for engaging a stable cadre of community clinicians in a clinical research program. Results Lack of engagement of community practitioners, lack of necessary infrastructure, and the current misalignment of financial incentives and research participation emerged as the three primary barriers to community clinician research participation. Although every effort was made to learn key motivators for engagement in clinical research from interviewees, we did not observe their behavior and self-report by clinicians does not always track with their behavior. Conclusions A paradigm shift involving acknowledgement of the value of clinicians in the context of community research, establishment of a stable infrastructure to support a cohort of clinicians across time and research studies, and realignment of incentives to encourage participation in clinical research is required.

  15. Microplastics in freshwater and terrestrial environments: Evaluating the current understanding to identify the knowledge gaps and future research priorities.

    Science.gov (United States)

    Horton, Alice A; Walton, Alexander; Spurgeon, David J; Lahive, Elma; Svendsen, Claus

    2017-05-15

    Plastic debris is an environmentally persistent and complex contaminant of increasing concern. Understanding the sources, abundance and composition of microplastics present in the environment is a huge challenge due to the fact that hundreds of millions of tonnes of plastic material is manufactured for societal use annually, some of which is released to the environment. The majority of microplastics research to date has focussed on the marine environment. Although freshwater and terrestrial environments are recognised as origins and transport pathways of plastics to the oceans, there is still a comparative lack of knowledge about these environmental compartments. It is highly likely that microplastics will accumulate within continental environments, especially in areas of high anthropogenic influence such as agricultural or urban areas. This review critically evaluates the current literature on the presence, behaviour and fate of microplastics in freshwater and terrestrial environments and, where appropriate, also draws on relevant studies from other fields including nanotechnology, agriculture and waste management. Furthermore, we evaluate the relevant biological and chemical information from the substantial body of marine microplastic literature, determining the applicability and comparability of this data to freshwater and terrestrial systems. With the evidence presented, the authors have set out the current state of the knowledge, and identified the key gaps. These include the volume and composition of microplastics entering the environment, behaviour and fate of microplastics under a variety of environmental conditions and how characteristics of microplastics influence their toxicity. Given the technical challenges surrounding microplastics research, it is especially important that future studies develop standardised techniques to allow for comparability of data. The identification of these research needs will help inform the design of future studies, to

  16. TOLKIN--Tree of Life Knowledge and Information Network: filling a gap for collaborative research in biological systematics.

    Directory of Open Access Journals (Sweden)

    Reed S Beaman

    Full Text Available The development of biological informatics infrastructure capable of supporting growing data management and analysis environments is an increasing need within the systematics biology community. Although significant progress has been made in recent years on developing new algorithms and tools for analyzing and visualizing large phylogenetic data and trees, implementation of these resources is often carried out by bioinformatics experts, using one-off scripts. Therefore, a gap exists in providing data management support for a large set of non-technical users. The TOLKIN project (Tree of Life Knowledge and Information Network addresses this need by supporting capabilities to manage, integrate, and provide public access to molecular, morphological, and biocollections data and research outcomes through a collaborative, web application. This data management framework allows aggregation and import of sequences, underlying documentation about their source, including vouchers, tissues, and DNA extraction. It combines features of LIMS and workflow environments by supporting management at the level of individual observations, sequences, and specimens, as well as assembly and versioning of data sets used in phylogenetic inference. As a web application, the system provides multi-user support that obviates current practices of sharing data sets as files or spreadsheets via email.

  17. Trauma hemostasis and oxygenation research position paper on remote damage control resuscitation: definitions, current practice, and knowledge gaps.

    Science.gov (United States)

    Jenkins, Donald H; Rappold, Joseph F; Badloe, John F; Berséus, Olle; Blackbourne, Lorne; Brohi, Karim H; Butler, Frank K; Cap, Andrew P; Cohen, Mitchell Jay; Davenport, Ross; DePasquale, Marc; Doughty, Heidi; Glassberg, Elon; Hervig, Tor; Hooper, Timothy J; Kozar, Rosemary; Maegele, Marc; Moore, Ernest E; Murdock, Alan; Ness, Paul M; Pati, Shibani; Rasmussen, Todd; Sailliol, Anne; Schreiber, Martin A; Sunde, Geir Arne; van de Watering, Leo M G; Ward, Kevin R; Weiskopf, Richard B; White, Nathan J; Strandenes, Geir; Spinella, Philip C

    2014-05-01

    The Trauma Hemostasis and Oxygenation Research Network held its third annual Remote Damage Control Resuscitation Symposium in June 2013 in Bergen, Norway. The Trauma Hemostasis and Oxygenation Research Network is a multidisciplinary group of investigators with a common interest in improving outcomes and safety in patients with severe traumatic injury. The network's mission is to reduce the risk of morbidity and mortality from traumatic hemorrhagic shock, in the prehospital phase of resuscitation through research, education, and training. The concept of remote damage control resuscitation is in its infancy, and there is a significant amount of work that needs to be done to improve outcomes for patients with life-threatening bleeding secondary to injury. The prehospital phase of resuscitation is critical in these patients. If shock and coagulopathy can be rapidly identified and minimized before hospital admission, this will very likely reduce morbidity and mortality. This position statement begins to standardize the terms used, provides an acceptable range of therapeutic options, and identifies the major knowledge gaps in the field.

  18. Intervention strategies to reduce the risk of zoonotic infection with avian influenza viruses: scientific basis, challenges and knowledge gaps.

    Science.gov (United States)

    Sims, Leslie D

    2013-09-01

    A range of measures has been recommended and used for the control and prevention of avian influenza. These measures are based on the assessment of local epidemiological situations, field observations and other scientific information. Other non-technical factors are (or in some cases should be) taken into account when developing and recommending control measures. The precise effects under field conditions of most individual interventions applied to control and prevent avian influenza have not been established or subjected to critical review, often because a number of measures are applied simultaneously without controls. In most cases, the combination of measures used results in control or elimination of the virus although there are some countries where this has not been the case. In others, especially those with low poultry density, it is not clear whether the link between the adoption of a set of measures and the subsequent control of the disease is causative. This article discusses the various measures recommended, with particular emphasis on stamping out and vaccination, examines how these measures assist in preventing zoonotic infections with avian influenza viruses and explores gaps in knowledge regarding their effectiveness.

  19. Addressing the Knowledge Gaps in Agroecology and Identifying Guiding Principles for Transforming Conventional Agri-Food Systems

    Directory of Open Access Journals (Sweden)

    Angelina Sanderson Bellamy

    2017-02-01

    Full Text Available Today’s society faces many challenges when it comes to food production: producing food sustainably, producing enough of it, distributing food, consuming enough calories, consuming too many calories, consuming culturally-appropriate foods, and reducing the amount of food wasted. The distribution of power within the current mainstream agri-food system is dominated by multinational agri-businesses that control the flow of goods and wealth through the system. This hegemony has implemented a regime whose structures reinforce its control. A growing response to the current agri-food regime is the rise of agroecology, in both developed and developing country contexts. This is not a new phenomenon, but it has evolved over time from its Latin American origins. However, agroecology is not a monolithic block and represents many different perceptions of what it means to advance agroecology and ways in which it can help today’s society tackle the crisis of the agri-food system. This paper addresses these sometimes discordant view points, as well as the gaps in our knowledge regarding agroecology in an effort to lay out some guiding principles for how we can move forward in transforming the current agri-food system to achieve sustainability and a more equitable distribution of power and resources.

  20. Bridging the Gap between Scientific and Indigenous knowledge to Better Understand Social Impacts of Changing Rainfall Regimes

    Science.gov (United States)

    Lynch, A. H.; Joachim, L.; Zhu, X.; Hammer, C.; Harris, M.; Griggs, D.

    2011-12-01

    The Murray-Darling Basin incorporates Australia's three longest rivers and is important for an agricultural industry worth more than $9 billion per annum, a rich biodiversity of habitat and species, and the very life of its traditional owners. The complex and sometimes enigmatic relationships between modes of variability and Australian regional rainfall distribution means that reliable projections of future water availability remain highly uncertain. Persistent drought, with associated heat stress and high fire danger, and episodic flooding rains present further challenges. Indeed, recent extremes likely herald a tipping point for the communities and ecosystems that rely on the river system. The Barmah-Millewa region in the Murray-Darling Basin is the heart of Yorta Yorta Traditional Tribal Lands. The Yorta Yorta continue to assert their inherent rights to country and have shown through oral, documentary and material evidence, that their social, spiritual, economic and cultural links with country have never been broken. Current water policy and practice, highly contested community consultation processes, cross-border governance issues and a changing social landscape create in this region a microcosm for understanding the complex demands of economic, environmental and cultural security along the Murray-Darling Basin as the climate changes. New approaches to bridging the gap between scientific and Indigenous epistemologies have emerged in recent years, including for example ecosystem-based adaptation (Vignola et al. 2009) and the analysis of cultural water flows (Weir 2010). The potential for innovation using these approaches has informed a study that investigates how the deep knowledge of country of the Yorta Yorta people can be combined with state of the art climate science to develop a better understanding of the competing demands on water resources in the Barmah-Millewa region now and in the future. An important dimension of this collaborative work with the Yorta

  1. Phenotypic variability in gap junction syndromic skin disorders: experience from KID and Clouston syndromes' clinical diagnostics.

    Science.gov (United States)

    Kutkowska-Kaźmierczak, Anna; Niepokój, Katarzyna; Wertheim-Tysarowska, Katarzyna; Giza, Aleksandra; Mordasewicz-Goliszewska, Maria; Bal, Jerzy; Obersztyn, Ewa

    2015-08-01

    Connexins belong to the family of gap junction proteins which enable direct cell-to-cell communication by forming channels in adjacent cells. Mutations in connexin genes cause a variety of human diseases and, in a few cases, result in skin disorders. There are significant differences in the clinical picture of two rare autosomal dominant syndromes: keratitis-ichthyosis-deafness (KID) syndrome and hidrotic ectodermal dysplasia (Clouston syndrome), which are caused by GJB2 and GJB6 mutations, respectively. This is despite the fact that, in both cases, malfunctioning of the same family proteins and some overlapping clinical features (nail dystrophy, hair loss, and palmoplantar keratoderma) is observed. KID syndrome is characterized by progressive vascularizing keratitis, ichthyosiform erythrokeratoderma, and neurosensory hearing loss, whereas Clouston syndrome is characterized by nail dystrophy, hypotrichosis, and palmoplantar keratoderma. The present paper presents a Polish patient with sporadic KID syndrome caused by the mutation of p.Asp50Asn in GJB2. The patient encountered difficulties in obtaining a correct diagnosis. The other case presented is that of a family with Clouston syndrome (caused by p.Gly11Arg mutation in GJB6), who are the first reported patients of Polish origin suffering from this disorder. Phenotype diversity among patients with the same genotypes reported to date is also summarized. The conclusion is that proper diagnosis of these syndromes is still challenging and should always be followed by molecular verification.

  2. Medical Teachers Conceptualize a Distinctive Form of Clinical Knowledge

    Science.gov (United States)

    Barrett, J.; Yates, L.; McColl, G.

    2015-01-01

    For over four decades, there have been efforts to specify the types of knowledge that medical students need, how that knowledge is acquired and how its constituent parts are related. It is one of the areas of continuing concern underlying medical education reform. Despite their importance to medical students' learning and development, the…

  3. Stroke prevention in atrial fibrillation in older adults: existing knowledge gaps and areas for innovation: a summary of an American Federation for Aging research seminar.

    Science.gov (United States)

    Lubitz, Steven A; Bauer, Kenneth A; Benjamin, Emelia J; Besdine, Richard W; Forman, Daniel E; Gurol, Mahmut E; Reddy, Vivek Y; Singer, Daniel E

    2013-10-01

    Atrial fibrillation (AF) is a common and morbid cardiac arrhythmia that increases in prevalence with advancing age. The risk of ischemic stroke, a primary and disabling hazard of AF, also increases with advancing age. The aging of the population is anticipated to contribute to a rising burden of AF-related morbidity and economic costs, given the close association between the arrhythmia and aging. Recent biological, diagnostic, and therapeutic developments raise hope that AF-related stroke can be largely prevented, yet despite advances in stroke prevention for individuals with AF, numerous scientific and clinical knowledge gaps remain, particularly as these developments are applied to older adults. Given the public health importance of AF-related stroke in elderly adults, a group of clinician-investigators convened on April 5, 2012, to identify promising areas for investigation that may ultimately reduce stroke-related morbidity. This article summarizes the meeting discussion and emphasizes innovative topic areas that may ultimately facilitate the application of novel preventive, diagnostic, and therapeutic insights into the management of older adults with AF. The opinions of those that participated in the meeting limit this report, which may not represent all of the questions that other experts in this field might raise.

  4. Gap between evidence and physicians' knowledge and practice regarding hypertension and its drug treatment: a survey in a Chinese city

    Institute of Scientific and Technical Information of China (English)

    WANG Wei-zhong; TANG Jin-ling; HU Yong-hua; AN Jian-gang; WANG Yan-ling; REN Zhong-he; ZHANG Hong; Sian Griffiths

    2011-01-01

    Background Evidence-based medicine has come into its second decade. How prepared clinicians are in practicing it in particular in developing countries remains unclear. Thus we conducted this survey of physicians in urban hospitals in China to determine the size of the gap between research evidence and physicians' knowledge and practice regarding antihypertensive drugs for primary prevention of cardiovascular diseases in China.Methods A cross sectional survey by a face-to-face interview was conducted in 20 tertiary general hospitals in China in 2005. A total of 444 physicians (mostly cardiologists) in internal medicine who had treated at least one hypertensive patient in the past 12 months were invited for the interview on their perception of the cardiovascular risk of hypertension,the magnitude of the benefit of antihypertensive drugs, knowledge on the overall risk approach, first-line drugs used, the risk above which drug treatment is recommended, and knowledge on evidence-based medicine.Results A total of 444 of the 468 eligible physicians were successfully interviewed with a response rate of 94.9%. They estimated that a hypertensive man with an actual 5-year cardiovascular risk of 8.4% would have a 5-year cardiovascular risk of 40% (95% CI: 38% to 42%) if not treated, and have an absolute risk reduction and relative risk reduction from drug treatment by 20% (95% CI. 18% to 22%) and 39% (95% CI: 37% to 42%) respectively, as compared to 3.3% and 33%respectively shown in research evidence. On average, the physicians would recommend drug treatment at a number needed to treat (NNT) of 368 or smaller, as compared to the actual NNT of 50 for drug treatment in an average hypertensive Chinese. Fifty-five percent (95% CI: 50% to 59%) of them had never intently used the national hypertension guidelines. The majority still prescribed drugs primarily based on blood pressure alone by ignoring other risk factors or the overall risk and 78% (95 % C/. 76% to 83%) used new

  5. Introduction to the special issue on advances in clinical and health-care knowledge management.

    Science.gov (United States)

    Bali, Rajeev K; Feng, David Dagan; Burstein, Frada; Dwivedi, Ashish N

    2005-06-01

    Clinical and health-care knowledge management (KM) as a discipline has attracted increasing worldwide attention in recent years. The approach encompasses a plethora of interrelated themes including aspects of clinical informatics, clinical governance, artificial intelligence, privacy and security, data mining, genomic mining, information management, and organizational behavior. This paper introduces key manuscripts which detail health-care and clinical KM cases and applications.

  6. A Synthesis Of Knowledge About Caregiver Decision Making Finds Gaps In Support For Those Who Care For Aging Loved Ones.

    Science.gov (United States)

    Garvelink, Mirjam M; Ngangue, Patrice A G; Adekpedjou, Rheda; Diouf, Ndeye T; Goh, Larissa; Blair, Louisa; Légaré, France

    2016-04-01

    We conducted a mixed-methods knowledge synthesis to assess the effectiveness of interventions to improve caregivers' involvement in decision making with seniors, and to describe caregivers' experiences of decision making in the absence of interventions. We analyzed forty-nine qualitative, fourteen quantitative, and three mixed-methods studies. The qualitative studies indicated that caregivers had unmet needs for information, discussions of values and needs, and decision support, which led to negative sentiments after decision making. Our results indicate that there have been insufficient quantitative evaluations of interventions to involve caregivers in decision making with seniors and that the evaluations that do exist found few clinically significant effects. Elements of usual care that received positive evaluations were the availability of a decision coach and a supportive decision-making environment. Additional rigorously evaluated interventions are needed to help caregivers be more involved in decision making with seniors.

  7. From Idea to Product--Translating Knowledge between the Lab and the Clinic

    Science.gov (United States)

    Ali, Ayfer Habib

    2012-01-01

    This dissertation is composed of three essays looking at innovation at Academic Medical Centers. It tries to empirically explore the problem of translating knowledge from the laboratory bench to the clinic and from the clinic to the bench. Chapter 1, co-authored with Iain Cockburn, establishes the importance of in-house complementary knowledge in…

  8. Neonicotinoid Insecticides and Their Impacts on Bees: A Systematic Review of Research Approaches and Identification of Knowledge Gaps.

    Directory of Open Access Journals (Sweden)

    Ola Lundin

    Full Text Available It has been suggested that the widespread use of neonicotinoid insecticides threatens bees, but research on this topic has been surrounded by controversy. In order to synthesize which research approaches have been used to examine the effect of neonicotinoids on bees and to identify knowledge gaps, we systematically reviewed research on this subject that was available on the Web of Science and PubMed in June 2015. Most of the 216 primary research studies were conducted in Europe or North America (82%, involved the neonicotinoid imidacloprid (78%, and concerned the western honey bee Apis mellifera (75%. Thus, little seems to be known about neonicotinoids and bees in areas outside Europe and North America. Furthermore, because there is considerable variation in ecological traits among bee taxa, studies on honey bees are not likely to fully predict impacts of neonicotinoids on other species. Studies on crops were dominated by seed-treated maize, oilseed rape (canola and sunflower, whereas less is known about potential side effects on bees from the use of other application methods on insect pollinated fruit and vegetable crops, or on lawns and ornamental plants. Laboratory approaches were most common, and we suggest that their capability to infer real-world consequences are improved when combined with information from field studies about realistic exposures to neonicotinoids. Studies using field approaches often examined only bee exposure to neonicotinoids and more field studies are needed that measure impacts of exposure. Most studies measured effects on individual bees. We suggest that effects on the individual bee should be linked to both mechanisms at the sub-individual level and also to the consequences for the colony and wider bee populations. As bees are increasingly facing multiple interacting pressures future research needs to clarify the role of neonicotinoids in relative to other drivers of bee declines.

  9. Representing clinical communication knowledge through database management system integration.

    Science.gov (United States)

    Khairat, Saif; Craven, Catherine; Gong, Yang

    2012-01-01

    Clinical communication failures are considered the leading cause of medical errors [1]. The complexity of the clinical culture and the significant variance in training and education levels form a challenge to enhancing communication within the clinical team. In order to improve communication, a comprehensive understanding of the overall communication process in health care is required. In an attempt to further understand clinical communication, we conducted a thorough methodology literature review to identify strengths and limitations of previous approaches [2]. Our research proposes a new data collection method to study the clinical communication activities among Intensive Care Unit (ICU) clinical teams with a primary focus on the attending physician. In this paper, we present the first ICU communication instrument, and, we introduce the use of database management system to aid in discovering patterns and associations within our ICU communications data repository.

  10. [Knowledge discovery in database and its application in clinical diagnosis].

    Science.gov (United States)

    Lui, Hui; Qiu, Tianshuang

    2004-08-01

    Nowadays the tremendous amount of data has far exceeded our human ability for comprehension, and this has been particularly true for the medical database. However, traditional statistical techniques are no longer adequate for analyzing this vast collection of data. Knowledge discovery in database and data mining play an important role in analyzing data and uncovering important data patterns. This paper briefly presents the concepts of knowledge discovery in database and data mining, then describes the rough set theory, and gives some examples based on rough set.

  11. Respiratory clinical guidelines inform ward-based nurses' clinical skills and knowledge required for evidence-based care.

    Science.gov (United States)

    Johnson, Alisha M; Smith, Sheree M S

    2016-09-01

    Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

  12. Microplastics in freshwater systems: a review of the emerging threats, identification of knowledge gaps and prioritisation of research needs.

    Science.gov (United States)

    Eerkes-Medrano, Dafne; Thompson, Richard C; Aldridge, David C

    2015-05-15

    Plastic contamination is an increasing environmental problem in marine systems where it has spread globally to even the most remote habitats. Plastic pieces in smaller size scales, microplastics (particles microplastic presence and interactions are equally as far reaching as are being observed in marine systems. Microplastics are being detected in freshwaters of Europe, North America, and Asia, and the first organismal studies are finding that freshwater fauna across a range of feeding guilds ingest microplastics. Drawing from the marine literature and these initial freshwater studies, we review the issue of microplastics in freshwater systems to summarise current understanding, identify knowledge gaps and suggest future research priorities. Evidence suggests that freshwater systems may share similarities to marine systems in the types of forces that transport microplastics (e.g. surface currents); the prevalence of microplastics (e.g. numerically abundant and ubiquitous); the approaches used for detection, identification and quantification (e.g. density separation, filtration, sieving and infrared spectroscopy); and the potential impacts (e.g. physical damage to organisms that ingest them, chemical transfer of toxicants). Differences between freshwater and marine systems include the closer proximity to point sources in freshwaters, the typically smaller sizes of freshwater systems, and spatial and temporal differences in the mixing/transport of particles by physical forces. These differences between marine and freshwater systems may lead to differences in the type of microplastics present. For example, rivers may show a predictable pattern in microplastic characteristics (size, shape, relative abundance) based on waste sources (e.g. household vs. industrial) adjacent to the river, and distance downstream from a point source. Given that the study of microplastics in freshwaters has only arisen in the last few years, we are still limited in our understanding of 1

  13. Review of carbon flux estimates and other greenhouse gas emissions from oil palm cultivation on Tropical peatlands - Identifying the gaps in Knowledge

    OpenAIRE

    Verwer, C.C.; Meer, van der, D; Nabuurs, G.J.

    2008-01-01

    This report provides an independent review that clarifies current confusion on carbon dioxide emissions resulting from oil palm cultivation on tropical peatlands in Malaysia, that was brought about by two recent publications. It describes the processes of carbon flow in forests, degraded forests and oil palm plantations on peat and depicts uncertainties in existing datasets. The report identifies the gaps of knowledge and offers recommendations for further research to be commissioned by the J...

  14. Knowledge Creation in Clinical Product Development Management Research

    DEFF Research Database (Denmark)

    Karlsson, Christer; Sköld, Martin

    2012-01-01

    This paper explores the clinical approach to management research and positions it in relation to other similar approaches. It achieves this by pointing out the most important historical milestones in the development of such approaches. The literature on the approach is mapped, including...... that on the most adjacent approaches, in order to characterize and position the different approaches. Field or application data are used to identify how the approach has been used and developed in publications in major journals in the field. After the introduction, which presents the brief characteristics...... of the approaches, the paper discusses the research issues to which clinical research is relevant and how the research framework should be designed, then practical issues relating to how to approach the study objects, the design of the research instruments, and the conducting of the field research. Finally...

  15. There are big gaps in our knowledge, and thus approach, to zoo animal welfare: a case for evidence-based zoo animal management.

    Science.gov (United States)

    Melfi, V A

    2009-11-01

    There are gaps in knowledge that hinder our ability within zoos to provide good animal welfare. This does not mean that zoos cannot or do not provide good welfare, only that currently this goal is hindered. Three reasons for these gaps are identified as: (1) there is an emphasis on the identification and monitoring of indicators that represent poor welfare and it is assumed that an absence of poor welfare equates to good welfare. This assumption is overly simplistic and potentially erroneous; (2) our understanding of how housing and husbandry (H&H) affects animals is limited to a small set of variables determined mostly by our anthropogenic sensitivities. Thus, we place more value on captive environmental variables like space and companionship, ignoring other factors that may have a greater impact on welfare, like climate; (3) finally, whether intentional or not, our knowledge and efforts to improve zoo animal welfare are biased to very few taxa. Most attention has been focused on mammals, notably primates, large cats, bears, and elephants, to the exclusion of the other numerous species about which very little is known. Unfortunately, the extent to which these gaps limit our ability to provide zoo animals with good welfare is exacerbated by our over reliance on using myth and tradition to determine zoo animal management. I suggest that we can fill these gaps in our knowledge and improve our ability to provide zoo animals with good welfare through the adoption of an evidence-based zoo animal management framework. This approach uses evidence gathered from different sources as a basis for making any management decisions, as good quality evidence increases the likelihood that these decisions result in good zoo animal welfare.

  16. Sexuality in early childhood: pediatric nurses' attitudes, knowledge, and clinical practice.

    Science.gov (United States)

    Popovich, D M

    2000-01-01

    This exploratory study assessed pediatric nurses' attitudes, knowledge, and patient care practices related to the sexuality of hospitalized preschool and early school-age children. Sexuality was defined as the sum of the physical, emotional, and psychologic attributes that are expressed in gender identity and behavior. For this study, a questionnaire containing 24 attitude, 20 knowledge, and 29 nursing practice Likert-scale items was used to survey 45 pediatric nurses in a southeastern tertiary care teaching hospital. Results indicated that, in general, the nurses surveyed had positive attitudes, sound knowledge, and appropriate practice with regard to the sexuality-related needs of their patients. However, there appeared to be some attitudinal biases and knowledge gaps that could adversely affect nursing practice. These findings were used to alter the content in pediatric nursing education at the study institution.

  17. Negotiating clinical knowledge: a field study of psychiatric nurses' everyday communication

    DEFF Research Database (Denmark)

    Buus, Niels

    2008-01-01

    Nursing practices at psychiatric hospitals have changed significantly over the last decades. In this paper, everyday nursing practices were interpreted in light of these institutional changes. The objective was to examine how mental health nurses' production of clinical knowledge was influenced...... was highly dependent on the individual nurses' practical ability to participate in the game. Furthermore, the nurses colluded in their mutual communication to enable the collective display and sense of knowing that protected them against explicit signs of uncertainty about the clinic. The game of clinical...... by the particular social relations on hospital wards. Empirical data stemming from an extended fieldwork at two Danish psychiatric hospital wards were interpreted using interactionistic theory and the metaphor: 'the game of clinical knowledge'. The results indicated that the nurses' production of clinical knowledge...

  18. Back Translating: An Integrated Approach to Focus Learners' Attention on Their L2 Knowledge Gaps

    Science.gov (United States)

    Zhang, Yun; Gao, Cun

    2014-01-01

    Integration of the four language skills can be enhanced by focusing on back translating--translating an English text into the students' first language and then back into English. This article describes a three-step process for using back translation in reading classes as a way to help students identify gaps in their English competence.

  19. The clinical effects of closure of the hernia gap after laparoscopic ventral hernia repair:

    DEFF Research Database (Denmark)

    Christoffersen, Mette W; Westen, Mikkel; Assadzadeh, Sami;

    2014-01-01

    outcomes are patient-rated cosmesis and hernia-specific quality of life. METHODS: A randomised, controlled, double-blinded study is planned. Based on power calculation, we will include 40 patients in each arm. Patients undergoing elective laparoscopic umbilical, epigastric or umbilical trocar-site hernia......INTRODUCTION: Closure of the hernia gap in laparoscopic ventral hernia repair before mesh reinforcement has gained increasing acceptance among surgeons despite creating a tension-based repair. Beneficial effects of this technique have been reported sporadically, but no evidence is available from...... randomised controlled trials. The primary purpose of this paper is to compare early post-operative activity-related pain in patients undergoing laparoscopic ventral hernia repair with closure of the gap with patients undergoing standard laparoscopic ventral hernia repair (non-closure of the gap). Secondary...

  20. Dogmatism and the "Knowledge Gap" among Users of the Mass Media of Communication: A Study in Brasilia, Brasil.

    Science.gov (United States)

    Simmons, Robert E.; Garda, Eduardo Carlos

    A study was conducted to discover whether (1) use of each of the print and broadcast media could be correlated with subjects' knowledge level, and (2) whether controlling for dogmatism would increase the proportion of media users, with higher levels of knowledge among those less dogmatic, and decrease the proportion among the more dogmatic.…

  1. Maximizing the Nutritional Value of Produce Post-Harvest: Consumer Knowledge Gaps, Interests, and Opinions Regarding Nutrition Education Strategies

    Science.gov (United States)

    Remley, Dan; Goard, Linnette Mizer; Taylor, Christopher A.; Ralston, Robin A.

    2015-01-01

    Although many consumers perceive locally produced, fresh fruits and vegetables to be healthier, they might not have the knowledge and skills to retain optimal nutritional quality following harvest or purchase. We surveyed Ohio farmers market consumers' and managers' knowledge and interests related to maximizing nutritional value of produce.…

  2. Clinical Acceptability of the Internal Gap of CAD/CAM PD-AG Crowns Using Intraoral Digital Impressions.

    Science.gov (United States)

    Kim, Tae-Gyung; Kim, Sungtae; Choi, Hyunmin; Lee, Jae-Hoon; Kim, Jae-Hong; Moon, Hong-Seok

    2016-01-01

    The purpose of this study was to compare the internal gap between CAD/CAM palladium-silver crowns and cast gold crowns generated from intraoral digital versus conventional impressions and to determine the clinical acceptability. Nickel-chrome master dies were made from the prepared resin tooth with the conventional impression method (n = 40). For ICC (Intraoral, CAD/CAM) group, 10 intraoral digital impressions were made, and 10 CAD/CAM crowns of a PD-AG (palladium-silver) machinable alloy were generated. For IC (Intraoral, Cast) group, 10 gold crowns were cast from ten intraoral digital impressions. For CCC (Conventional, CAD/CAM) group, 10 CAD/CAM PD-AG crowns were made using the conventional impression method. For CC (Conventional, Cast) group, 10 gold crowns were fabricated from 10 conventional impressions. One hundred magnifications of the internal gaps of each crown were measured at 50 points with an optical microscope and these values were statistically analyzed using a two-way analysis of variance (α = 0.05). The internal gap of the intraoral digital impression group was significantly larger than in the conventional impression group (P CAD/CAM group and the cast group (P > 0.05). Within the limitations of this in vitro study, crowns from intraoral digital impressions showed larger internal gap values than crowns from conventional impressions.

  3. Clinical Acceptability of the Internal Gap of CAD/CAM PD-AG Crowns Using Intraoral Digital Impressions

    Directory of Open Access Journals (Sweden)

    Tae-Gyung Kim

    2016-01-01

    Full Text Available The purpose of this study was to compare the internal gap between CAD/CAM palladium-silver crowns and cast gold crowns generated from intraoral digital versus conventional impressions and to determine the clinical acceptability. Nickel-chrome master dies were made from the prepared resin tooth with the conventional impression method (n=40. For ICC (Intraoral, CAD/CAM group, 10 intraoral digital impressions were made, and 10 CAD/CAM crowns of a PD-AG (palladium-silver machinable alloy were generated. For IC (Intraoral, Cast group, 10 gold crowns were cast from ten intraoral digital impressions. For CCC (Conventional, CAD/CAM group, 10 CAD/CAM PD-AG crowns were made using the conventional impression method. For CC (Conventional, Cast group, 10 gold crowns were fabricated from 10 conventional impressions. One hundred magnifications of the internal gaps of each crown were measured at 50 points with an optical microscope and these values were statistically analyzed using a two-way analysis of variance (α=0.05. The internal gap of the intraoral digital impression group was significantly larger than in the conventional impression group (P0.05. Within the limitations of this in vitro study, crowns from intraoral digital impressions showed larger internal gap values than crowns from conventional impressions.

  4. Clinical instructors' knowledge and perceptions about nursing care of older people: a pilot study.

    Science.gov (United States)

    Baumbusch, Jennifer; Dahlke, Sherry; Phinney, Alison

    2014-08-01

    With an aging population, the majority of nurses will spend their careers working with older people. Currently, there is scant research about clinical instructors' knowledge and perceptions about nursing care of older people despite their instrumental role in preparing nurses for practice. The purpose of this study was to explore clinical instructors' knowledge and perceptions about nursing care of older people. A mixed methods approach was used. Fifteen clinical instructors and 15 nurse educators employed on specialized units for older people completed questionnaires. Independent t-tests were administered. Five of the clinical instructors also participated in semi-structured interviews, which were analyzed using thematic analysis. Findings indicated that clinical instructors had significantly lower scores on knowledge and perceptions about nursing care of older people than practice-based nurse educators. Further, clinical instructors found it difficult to integrate specialized knowledge about nursing care of older people along with other aspects of their teaching. They also reported that it was challenging to support learning about best practices for older people within the current clinical context, which was complex and fast-paced. This study reinforces the need for professional development opportunities for clinical instructors to support their instrumental role in preparing students for practice with older people.

  5. Improving Adjunct Nursing Instructors' Knowledge of Student Assessment in Clinical Courses

    Science.gov (United States)

    Johnson, Kelly Vowell

    2014-01-01

    Utilization of adjunct nursing instructors to teach clinical courses is a common occurrence in nursing programs. Adjunct clinical instructors are often expert clinicians, but they have limited experience in teaching and lack the expertise needed to be successful in the educator role, such as knowledge of student assessment. Faculty development…

  6. Addressing the Common Pathway Underlying Hypertension and Diabetes in People Who Are Obese by Maximizing Health: The Ultimate Knowledge Translation Gap

    Directory of Open Access Journals (Sweden)

    Elizabeth Dean

    2011-01-01

    Full Text Available In accordance with the WHO definition of health, this article examines the alarming discord between the epidemiology of hypertension, type 2 diabetes mellitus (T2DM, and obesity and the low profile of noninvasive (nondrug compared with invasive (drug interventions with respect to their prevention, reversal and management. Herein lies the ultimate knowledge translation gap and challenge in 21st century health care. Although lifestyle modification has long appeared in guidelines for medically managing these conditions, this evidence-based strategy is seldom implemented as rigorously as drug prescription. Biomedicine focuses largely on reducing signs and symptoms; the effects of the problem rather than the problem. This article highlights the evidence-based rationale supporting prioritizing the underlying causes and contributing factors for hypertension and T2DM, and, in turn, obesity. We argue that a primary focus on maximizing health could eliminate all three conditions, at best, or, at worst, minimize their severity, complications, and medication needs. To enable such knowledge translation and maximizing health outcome, the health care community needs to practice as an integrated team, and address barriers to effecting maximal health in all patients. Addressing the ultimate knowledge translation gap, by aligning the health care paradigm to 21st century needs, would constitute a major advance.

  7. Using a Clinical Knowledge Base to Assess Comorbidity Interrelatedness Among Patients with Multiple Chronic Conditions

    Science.gov (United States)

    Zulman, Donna M.; Martins, Susana B.; Liu, Yan; Tu, Samson W.; Hoffman, Brian B.; Asch, Steven M.; Goldstein, Mary K.

    2015-01-01

    Decision support tools increasingly integrate clinical knowledge such as medication indications and contraindications with electronic health record (EHR) data to support clinical care and patient safety. The availability of this encoded information and patient data provides an opportunity to develop measures of clinical decision complexity that may be of value for quality improvement and research efforts. We investigated the feasibility of using encoded clinical knowledge and EHR data to develop a measure of comorbidity interrelatedness (the degree to which patients’ co-occurring conditions interact to generate clinical complexity). Using a common clinical scenario—decisions about blood pressure medications in patients with hypertension—we quantified comorbidity interrelatedness by calculating the number of indications and contraindications to blood pressure medications that are generated by patients’ comorbidities (e.g., diabetes, gout, depression). We examined properties of comorbidity interrelatedness using data from a decision support system for hypertension in the Veterans Affairs Health Care System. PMID:26958279

  8. Familiarity knowledge in student nurses' clinical studies: exemplified by student nurses in palliative care.

    Science.gov (United States)

    Haugan, Grethe; Hanssen, Ingrid

    2012-01-01

    In this article based on a literary study, the form of knowledge named familiarity knowledge is examined. Although rooted in the philosophical tradition of Wittgenstein and Polanyi, the development of familiarity knowledge is tied in with clinical practice and particular patients and contexts while paying attention to the framework factors influencing the setting as a whole as well as with theoretical knowledge relevant to the situation at hand. Palliative care makes a backdrop for some of the discussion. Familiarity knowledge can never be context free and attends to that which is unique in every nurse-patient relationship. Both assertive and familiarity knowledge are needed to care for dying patients in a competent, sensitive, and truly caring manner. Mentors need to help students synthesize assertive knowledge and familiarity knowledge during their clinical studies to enrich both kinds of knowledge and deepen their understanding. Student nurses expertly mentored and tutored while caring for dying patients living at home become, for instance, less apprehensive about facing dying patients than students not so mentored. Nurses need to understand the complexity of nursing care to be able to see the uniqueness of the situation and approach the individual patient on the bases of experience and insight.

  9. Developing knowledge resources to support precision medicine: principles from the Clinical Pharmacogenetics Implementation Consortium (CPIC).

    Science.gov (United States)

    Hoffman, James M; Dunnenberger, Henry M; Kevin Hicks, J; Caudle, Kelly E; Whirl Carrillo, Michelle; Freimuth, Robert R; Williams, Marc S; Klein, Teri E; Peterson, Josh F

    2016-07-01

    To move beyond a select few genes/drugs, the successful adoption of pharmacogenomics into routine clinical care requires a curated and machine-readable database of pharmacogenomic knowledge suitable for use in an electronic health record (EHR) with clinical decision support (CDS). Recognizing that EHR vendors do not yet provide a standard set of CDS functions for pharmacogenetics, the Clinical Pharmacogenetics Implementation Consortium (CPIC) Informatics Working Group is developing and systematically incorporating a set of EHR-agnostic implementation resources into all CPIC guidelines. These resources illustrate how to integrate pharmacogenomic test results in clinical information systems with CDS to facilitate the use of patient genomic data at the point of care. Based on our collective experience creating existing CPIC resources and implementing pharmacogenomics at our practice sites, we outline principles to define the key features of future knowledge bases and discuss the importance of these knowledge resources for pharmacogenomics and ultimately precision medicine.

  10. [Medical practice and clinical research: keys to generate knowledge and improve care].

    Science.gov (United States)

    Martínez Castuera-Gómez, Carla; Talavera, Juan O

    2013-01-01

    The increased quality in medical care may be immediately accomplished if clinical research is integrated into daily clinical practice. In the generation of medical knowledge are four steps: an unanswered question awakened from clinical practice, the critical analysis of specialized literature, the development of a research protocol, and, finally, the publication of outcomes. Decision making and continuous training are becoming part of an effective strategy of medical attention improvement.

  11. Constructing Clinical Decision Support Systems for Adverse Drug Event Prevention: A Knowledge-based Approach.

    Science.gov (United States)

    Koutkias, Vassilis; Kilintzis, Vassilis; Stalidis, George; Lazou, Katerina; Collyda, Chrysa; Chazard, Emmanuel; McNair, Peter; Beuscart, Regis; Maglaveras, Nicos

    2010-11-13

    A knowledge-based approach is proposed that is employed for the construction of a framework suitable for the management and effective use of knowledge on Adverse Drug Event (ADE) prevention. The framework has as its core part a Knowledge Base (KB) comprised of rule-based knowledge sources, that is accompanied by the necessary inference and query mechanisms to provide healthcare professionals and patients with decision support services in clinical practice, in terms of alerts and recommendations on preventable ADEs. The relevant Knowledge Based System (KBS) is developed in the context of the EU-funded research project PSIP (Patient Safety through Intelligent Procedures in Medication). In the current paper, we present the foundations of the framework, its knowledge model and KB structure, as well as recent progress as regards the population of the KB, the implementation of the KBS, and results on the KBS verification in decision support operation.

  12. Extensive gaps and biases in our knowledge of a well-known fauna: Implications for integrating biological traits into macroecology

    KAUST Repository

    Tyler, Elizabeth

    2011-12-09

    Aim Ecologists seeking to describe patterns at ever larger scales require compilations of data on the global abundance and distribution of species. Comparable compilations of biological data are needed to elucidate the mechanisms behind these patterns, but have received far less attention. We assess the availability of biological data across an entire assemblage: the well-documented demersal marine fauna of the United Kingdom. We also test whether data availability for a species depends on its taxonomic group, maximum body size, the number of times it has been recorded in a global biogeographic database, or its commercial and conservation importance. Location Seas of the United Kingdom. Methods We defined a demersal marine fauna of 973 species from 15 phyla and 40 classes using five extensive surveys around the British Isles. We then quantified the availability of data on eight key biological traits (termed biological knowledge) for each species from online databases. Relationships between biological knowledge and our predictors were tested with generalized linear models. Results Full data on eight fundamental biological traits exist for only 9% (n= 88) of the UK demersal marine fauna, and 20% of species completely lack data. Clear trends in our knowledge exist: fish (median biological knowledge score = six traits) are much better known than invertebrates (one trait). Biological knowledge increases with biogeographic knowledge and (to a lesser extent) with body size, and is greater in species that are commercially exploited or of conservation concern. Main conclusions Our analysis reveals deep ignorance of the basic biology of a well-studied fauna, highlighting the need for far greater efforts to compile biological trait data. Clear biases in our knowledge, relating to how well sampled or \\'important\\' species are suggests that caution is required in extrapolating small subsets of biologically well-known species to ecosystem-level studies. © 2011 Blackwell

  13. PSYCHIATRIC CLINICAL PLACEMENT UPON NURSING STUDENTS PERCEIVED KNOWLEDGE IN CARING FOR MENTALLY ILL

    Directory of Open Access Journals (Sweden)

    Herry Prasetyo

    2012-08-01

    Full Text Available Background: The implementation of a psychiatric clinical placement has been an integral component in Indonesia Nursing Academies. Purpose: The research was to investigate how nursing students’ perceived knowledge in caring for mentally ill patients as a result of their psychiatric clinical placement. Method: A descriptive survey design commonly called non-experimental design was used in this research. Students, who had completed two weeks in a psychiatric clinical placement as a component of mental health nursing subject, were invited to participate. Then, a questionnaire was distributed to nursing students (N=40, giving an overall responses rate of 85 %. Result: The finding revealed that as a result of clinical placement, the majority of nursing students had better perceived knowledge regarding the concept of mental health and mental illness, nursing care plan, medication and providing education towards patient and people in community about mental health. Conclusion: The findings provide evidence for the benefits of such a clinical placement in relation to students’ perceived knowledge in caring for psychiatric patients. Key words: Clinical placement, nursing students, knowledge, mentally ill

  14. Executive summary of NIH workshop on the Use and Biology of Energy Drinks: Current Knowledge and Critical Gaps.

    Science.gov (United States)

    Sorkin, Barbara C; Camp, Kathryn M; Haggans, Carol J; Deuster, Patricia A; Haverkos, Lynne; Maruvada, Padma; Witt, Ellen; Coates, Paul M

    2014-10-01

    Sales of energy drinks in the United States reached $12.5 billion in 2012. Emergency department visits related to consumption of these products have increased sharply, and while these numbers remain small relative to product sales, they raise important questions regarding biological and behavioral effects. Although some common ingredients of energy drinks have been extensively studied (e.g., caffeine, B vitamins, sugars, inositol), data on other ingredients (e.g., taurine) are limited. Summarized here are data presented elsewhere in this issue on the prevalence and patterns of caffeine-containing energy drink use, the effects of these products on alertness, fatigue, cognitive functions, sleep, mood, homeostasis, as well as on exercise physiology and metabolism, and the biological mechanisms mediating the observed effects. There are substantial data on the effects of some energy drink ingredients, such as caffeine and sugars, on many of these outcomes; however, even for these ingredients many controversies and gaps remain, and data on other ingredients in caffeine-containing energy drinks, and on ingredient interactions, are sparse. This summary concludes with a discussion of critical gaps in the data and potential next steps.

  15. Clinical and basic science teachers' opinions about the required depth of biomedical knowledge for medical students.

    Science.gov (United States)

    Koens, Franciska; Custers, Eugène J F M; ten Cate, Olle T J

    2006-05-01

    The aim of the present study was to investigate whether basic scientists and physicians agree on the required depth of biomedical knowledge of medical students at graduation. A selection of basic science and clinical teachers rated the relevance of biomedical topics for students at graduation, illustrated by 80 example items. The items were derived from ten organ systems and designed at four levels: clinical, organ, cellular and molecular. Respondents were asked to identify for each item to what extent recently graduated medical students should have knowledge about it. In addition, they were asked to indicate whether the content of the item should be included in the medical curriculum. Analysis showed that basic scientists and physicians do not diverge at the clinical level. At the organ, cellular and molecular levels however, basic scientists judge that medical students should have more active knowledge. As expected, basic scientists also indicate that more deep level content should be included. Explanations for this phenomenon will be discussed.

  16. Newly graduated nurses use of knowledge sources in clinical decison-making - a qualitative study

    DEFF Research Database (Denmark)

    Voldbjerg, Siri

    within evidence-based practice to a limited extent. The thesis is based on a synthesis of findings from two studies. The aim of the first study was to explore which knowledge sources newly graduated nurses use in clinical decision making as reported within international qualitative research. The purpose...... into a clinical setting influences the use of knowledge sources among newly graduated nurses. In study 1, meta-ethnography as described by Noblit and Hare was applied as method of synthesis of international qualitative research. Based on iterative literature search in the databases CINAHL, PubMed, SCOPUS...... of clinical decisions, based on transparent, articulate and reflective use of knowledge sources. Furthermore, it is implied that nurses are able to retrieve, asses, implement and evaluate research evidence. To meet these requirements, nursing educations around the world have organised curricula to educate...

  17. Integrative Technologies and Knowledge Gatekeepers: Bridging the Gap between Epistemic Communities in the Case of Stem Cell Science

    Science.gov (United States)

    Wink, Rudiger

    2008-01-01

    The article analyses the role of gatekeepers between regional and disciplinary innovation systems in stem cell research as a case of integrative technologies. Which kind of gatekeepers is needed and which function can be fulfilled, differs along the knowledge value chain. Empirical results are used to explain the rationality of stem cell policies…

  18. 大数据时代下的知沟理论探析%The theory of knowledge gap in the age of big data

    Institute of Scientific and Technical Information of China (English)

    孙丽娅

    2014-01-01

    人类社会自诞生至今,经历了农业社会、工业社会、信息社会以及现在的数字时代。数字时代就是电子信息时代的代名词,它的特点就是大量信息的爆炸式发展与变化,就是我们现在做说的“大数据”。大数据时代所承载的海量信息能否为所有的地球村的村民带来福利,是否会降低“知沟”理论的假设结果,以及如何应对大数据带来的挑战,此文将探讨这一问题。%Since the human society birth until now, has experienced agricultural society, industrial society, information society and now in the digital age. The digital age is the synonym of electronic information age, the characteristic is the explosive development and change of the extensive information, data that we do now"knowledge gap". The age of big data information benefits the villagers, will reduce the results of"knowledge gap"theory, and how to deal with the challenges of big data, this paper will discuss this problem.

  19. Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

    Science.gov (United States)

    Friesen, Lynn Roosa; Walker, Mary P; Kisling, Rebecca E; Liu, Ying; Williams, Karen B

    2014-09-01

    This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ≥6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient.

  20. 知识缺口视角下的建设项目知识风险管理%Knowledge Risk Identification of Construction Projects From the Perspective of Knowledge Gap

    Institute of Scientific and Technical Information of China (English)

    张连营; 李轶宁; 谷李忠

    2015-01-01

    为改善建设项目知识风险难以识别、缺乏管理的现状,从理论层面明确界定知识风险的实质;基于知识缺口视角建立建设项目知识风险识别的模型,输入案例质性数据对模型进行演示和验证,运用质性方法分析得出知识风险的来源和风险类型;针对案例提出知识风险管理的策略。结果表明,模型能够充分挖掘建设项目质性数据的价值,有针对性地识别知识风险,开拓了建设项目知识风险管理的知识缺口新视角,为项目知识风险管理的理论研究和实践提供了新思路。%In order to improve the knowledge risk identification status in construction projects,this study firstly clearly defined the essence of risk knowledge from the theoretical level. Secondly,from the perspective of knowledge gap,project knowledge risk identification model were established. Based on that,qualitative data of a case was inputted to demonstrate and validate the model. Qualitative analysis was applied to the model to work out the risk source and risk types. Finally,some risk management strategies were proposed for the case. The results show that the model can fully glean value of the qualitative data and identify specific knowledge risk. The model developed the new knowledge gap perspective for the knowledge risk identification of construction projects and provided ideas for the research and practice of project knowledge risk management.

  1. A More Transparent System for Clinical Trials Data in Europe – Mind the Gaps!

    DEFF Research Database (Denmark)

    Minssen, Timo

    2014-01-01

    on medicinal products for human use” repealing Directive 2001/20/EC. As described in a press-release, the new law: “aims to remedy the shortcomings of the existing Clinical Trials Directive by setting up a uniform framework for the authorization of clinical trials by all the member states concerned...... with a given single assessment outcome. Simplified reporting procedures, and the possibility for the Commission to do checks, are among the law’s key innovations.” Moreover, and very importantly, the Regulation seeks to improve transparency by requiring pharmaceutical companies and academic researchers...... to publish the results of all their European clinical trials in a publicly-accessible EU database. In contrast to earlier stipulations which only obliged sponsors to publish the end-results of their clinical trials, the new law requires full clinical study reports to be published after a decision...

  2. A Collaborative Project to Bridging the Gap between Basic and Clinical Teachers: The Opinion of Medical Students

    Directory of Open Access Journals (Sweden)

    Mariano Sentí

    2015-01-01

    Full Text Available The organization of medical curricula with a clear distinction between basic and clinical subjects makes it difficult for teachers to collaborate and teach students in an integrated way. We designed a new subject, Integrated Medicine, to overcome such limitations. Here, we describe the evaluation of the first three years of running the experience, as well as the opinion of the first group of students in their sixth year. Three cohorts of first-year medical students (n=158 and eight teachers, as well as a group of students of sixth year (n=41, participated in the experiment. Students worked following the problem-based learning approach. Their satisfaction, their subjective improvement of content knowledge in basic and clinical fields, and their belief about the accomplishment of educational objectives were evaluated. The results showed a high level of satisfaction, increased content knowledge, and improvement in solving problems, searching for relevant information, team working, and oral and written communication skills. Students of sixth year agreed that the subject helped them to better understand the clinical manifestations of disease, the diagnosis process, and therapeutic approaches. In conclusion, experiences such as Integrated Medicine may enhance the integration of knowledge by the joint work of basic and clinical teachers.

  3. Towards an integrated environmental risk assessment of multiple stressors on bees: review of research projects in Europe, knowledge gaps and recommendations

    Directory of Open Access Journals (Sweden)

    European Food Safety Authority

    2014-03-01

    Full Text Available This report reviews recent work on bee health carried out by EFSA, Member States (MSs and the European Commission (EC. It identifies data and knowledge gaps and provides research recommendations that may facilitate the transition towards an integrated environmental risk assessment of multiple stressors on bees. The report was produced by the EFSA Bee Task Force (TF, involved representatives from six different Scientific Units, and was coordinated by the Scientific Committee and Emerging Risks Unit (SCER. The TF consulted experts from MSs and the Bee Interservice Group of the EC. Additional scientific exchanges with experts were promoted by SCER through the organisation of a scientific colloquium on bee health in May 2013. The review identified a total of 220 research projects on bee health at EU level (EFSA, 19; MSs, 181; EC, 20, and 33 additional projects from other international organisations dealing with general aspects, non-research-focused, of bee issues. A quantitative assessment of the retrieved projects revealed that research projects on multiple stressors on bees and projects on bees other than honeybees were missing, especially with regard to monitoring and testing. EFSA projects were predominantly in the area of risk assessments of pesticides on bees. Research projects on in-hive treatments and bee exposure to chemicals funded at the EC level were scarce, as were those focusing on protection goals, bee diversity and pollination services at the MS level. The qualitative assessment of the retrieved projects revealed knowledge gaps at each step of the risk assessment, which led to several recommendations for future scientific work at EFSA and research to be undertaken in the framework of Horizon 2020. Additional recommendations are given for research coordination, planning and knowledge sharing with MSs and the EC. At EFSA level, further communication, internal collaborations and training on bee health are suggested.

  4. Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

    Science.gov (United States)

    Dell’Osso, Bernardo; Albert, Umberto; Atti, Anna Rita; Carmassi, Claudia; Carrà, Giuseppe; Cosci, Fiammetta; Del Vecchio, Valeria; Di Nicola, Marco; Ferrari, Silvia; Goracci, Arianna; Iasevoli, Felice; Luciano, Mario; Martinotti, Giovanni; Nanni, Maria Giulia; Nivoli, Alessandra; Pinna, Federica; Poloni, Nicola; Pompili, Maurizio; Sampogna, Gaia; Tarricone, Ilaria; Tosato, Sarah; Volpe, Umberto; Fiorillo, Andrea

    2015-01-01

    More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review. PMID:26257524

  5. [Induced abortion--clinical problems, regulatory gaps, chaos. How much longer?].

    Science.gov (United States)

    Andreeva, A; Marinov, B; Tzankova, M

    2014-01-01

    Induced abortion is becoming more and more frequent in the contemporary clinical practice. Usually these are pregnant women with diagnosed foetal malformations. Most of them reach a final diagnose in the late second trimester and hence need a pregnancy termination at this gestational age. They are treated in accordance with The Artificial Pregnancy Termination Regulations and put on N 142 clinical-care pathway. The presentation describes the patients' journey form the diagnose through the induced abortion and to the discharge. Analyses the regulations, the multiple inaccuracies and striking omissions with regards to the procedure. Stimulates a discussion on the clinical problems and offers reasonable and realistic solutions.

  6. WAYS TO EVALUATE THE QUANTITY AND QUALITY OF KNOWLEDGE IN THE STUDY OF CLINICAL MEDICI

    Directory of Open Access Journals (Sweden)

    F. F. Tetenev

    2014-01-01

    Full Text Available Analysis of the current literature showed that in publications, in our opinion, there is no master: a scientific analysis of the reasons behind the decline in the quality of knowledge of the doctor, as well as the scientific basis of modern pedagogical technologies introduced in the process of training future doctors to address this problem. Objective and subjective factors are having a negative effect on the quality of the doctor's knowledge. The generally accepted methods of assessing the quality of knowledge – testing and rating system – have their limitations. Testing reflects the level of knowledge about the thinking style of the originator of test tasks. Ranking system for assessing knowledge increasingly characterized by diligence in studying medicine. It is proposed to upgrade the quality of medical knowledge in the teaching of the theory of integration of diagnostics. Amount of knowledge to evaluate the content of educational narrative history of the disease. The quality of the knowledge to assess the content of professional clinical picture comment in the history of the disease.

  7. Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

    Directory of Open Access Journals (Sweden)

    Dell’Osso B

    2015-07-01

    Full Text Available Bernardo Dell’Osso,1,2,* Umberto Albert,3,* Anna Rita Atti,4 Claudia Carmassi,5 Giuseppe Carrà,6 Fiammetta Cosci,7 Valeria Del Vecchio,8 Marco Di Nicola,9 Silvia Ferrari,10 Arianna Goracci,11 Felice Iasevoli,12 Mario Luciano,8 Giovanni Martinotti,13 Maria Giulia Nanni,14 Alessandra Nivoli,15,16 Federica Pinna,17 Nicola Poloni,18 Maurizio Pompili,19 Gaia Sampogna,8 Ilaria Tarricone,20 Sarah Tosato,21 Umberto Volpe,8 Andrea Fiorillo8 1Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 2Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA; 3Rita Levi Montalcini Department of Neuroscience, University of Turin, Torino, 4Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, 5Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 6Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; 7Department of Health Sciences, University of Florence, Florence, 8Department of Psychiatry, University of Naples SUN, Naples, 9Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, 10Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, 11Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, 12Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, 13Department of Neuroscience, Imaging, and Clinical Science, University G.d Annunzio, Chieti-Pescara, 14Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, 15Psychiatric Institute, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy; 16Bipolar Disorder Unit, CIBERSAM, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain; 17Department of

  8. Investigating nurses' knowledge, attitudes, and skills patterns towards clinical management system: results of a cluster analysis.

    Science.gov (United States)

    Chan, M F

    2006-09-01

    To determine whether definable subtypes exist within a cohort of Hong Kong nurses as related to the clinical management system use in their clinical practices based on their knowledge, attitudes, skills, and background factors. Data were collected using a structured questionnaire. The sample of 242 registered nurses was recruited from three hospitals in Hong Kong. The study employs personal and demographic variables, knowledge, attitudes, and skills scale. A cluster analysis yielded two clusters. Each cluster represents a different profile of Hong Kong nurses on the clinical management system use in their clinical practices. The first group (Cluster 1) was labeled 'lower attitudes, less skilful and average knowledge' group, and represented 55.4% of the total respondents. The second group (Cluster 2) was labeled as 'positive attitudes, good knowledge but less skilful'. They comprised almost 44.6% of this nursing sample. Cluster 2 had more older nurses, the majority were educated to the baccalaureate or above level, with more than 10 years working experience, and they held a more senior ranking then Cluster 1. A clear profile of Hong Kong nurses may benefit healthcare professionals in making appropriate education or assistance to prompt the use of the clinical management system by nurses an officially recognized profession. The findings were useful in determining nurse-users' specific needs and their preferences for modification of the clinical management system. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' knowledge, attitudes, and skills toward such system.

  9. Measuring knowledge and clinical reasoning skills in a problem-based curriculum

    NARCIS (Netherlands)

    H.P.A. Boshuizen (Henny); C. van der Vleuten; H.G. Schmidt (Henk); M. Machiels-Bongaerts

    1997-01-01

    textabstractThe purpose of this study was to investigate the validity of the Progress Test that was specially designed for measuring the growth of knowledge and clinical reasoning skills in a problem-based medical curriculum. Scores and subscores of students from the different categories of the Prog

  10. First-Year Residents' Caring, Medical Knowledge, and Clinical Judgment in Relation to Laboratory Utilization.

    Science.gov (United States)

    Yarnold, Paul R.; And Others

    1994-01-01

    A study of 36 first-year Northwestern University (Illinois) medical residents found that students' medical knowledge was a predictor of increased laboratory test use, that clinical judgment was a predictor of decreased laboratory use, and that level of caring was statistically unrelated to amount of laboratory use. (Author/MSE)

  11. Forms of Knowledge Incorporated in Clinical Decision-making among Newly-Graduated Nurses: A Metasynthesis

    DEFF Research Database (Denmark)

    Voldbjerg, Siri; Elgaard Sørensen, Erik; Grønkjær, Mette;

    2013-01-01

    the knowledge that informs clinical decision-making among newly-graduated nurses. Qualitative studies were retrieved from CINAHL, PubMed, SCOPE, ERIC and GOOGLE-Scholar and subsequently selected by pre-defined inclusion criteria and critically appraised using CASP. Metaphors identified in the analytical process...

  12. A legal framework to enable sharing of Clinical Decision Support knowledge and services across institutional boundaries.

    Science.gov (United States)

    Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

    2011-01-01

    The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight.

  13. Towards symbiosis in knowledge representation and natural language processing for structuring clinical practice guidelines.

    Science.gov (United States)

    Weng, Chunhua; Payne, Philip R O; Velez, Mark; Johnson, Stephen B; Bakken, Suzanne

    2014-01-01

    The successful adoption by clinicians of evidence-based clinical practice guidelines (CPGs) contained in clinical information systems requires efficient translation of free-text guidelines into computable formats. Natural language processing (NLP) has the potential to improve the efficiency of such translation. However, it is laborious to develop NLP to structure free-text CPGs using existing formal knowledge representations (KR). In response to this challenge, this vision paper discusses the value and feasibility of supporting symbiosis in text-based knowledge acquisition (KA) and KR. We compare two ontologies: (1) an ontology manually created by domain experts for CPG eligibility criteria and (2) an upper-level ontology derived from a semantic pattern-based approach for automatic KA from CPG eligibility criteria text. Then we discuss the strengths and limitations of interweaving KA and NLP for KR purposes and important considerations for achieving the symbiosis of KR and NLP for structuring CPGs to achieve evidence-based clinical practice.

  14. Newly graduated nurses' use of knowledge sources in clinical decision-making

    DEFF Research Database (Denmark)

    Voldbjerg, Siri Lygum; Grønkjaer, Mette; Wiechula, Rick;

    2016-01-01

    could be used. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Although there is a complexity and variety to knowledge sources used there is an imbalance with the experienced nurse playing a key role, functioning both as predominant source and a role-model as to which sources are valued and used......AIMS AND OBJECTIVES: To explore which knowledge sources newly graduated nurses' use in clinical decision-making and why and how they are used. BACKGROUND: In spite of an increased educational focus on skills and competencies within evidence based practice newly graduated nurses' ability to use...... approaches to strengthen the knowledgebase used in clinical decision-making. DESIGN AND METHODS: Ethnographic study using participant-observation and individual semi-structured interviews of nine Danish newly graduated nurses in medical and surgical hospital settings. RESULTS: Newly graduates use...

  15. Knowledge Gaps in Rodent Pancreas Biology: Taking Human Pluripotent Stem Cell-Derived Pancreatic Beta Cells into Our Own Hands.

    Science.gov (United States)

    Santosa, Munirah Mohamad; Low, Blaise Su Jun; Pek, Nicole Min Qian; Teo, Adrian Kee Keong

    2015-01-01

    In the field of stem cell biology and diabetes, we and others seek to derive mature and functional human pancreatic β cells for disease modeling and cell replacement therapy. Traditionally, knowledge gathered from rodents is extended to human pancreas developmental biology research involving human pluripotent stem cells (hPSCs). While much has been learnt from rodent pancreas biology in the early steps toward Pdx1(+) pancreatic progenitors, much less is known about the transition toward Ngn3(+) pancreatic endocrine progenitors. Essentially, the later steps of pancreatic β cell development and maturation remain elusive to date. As a result, the most recent advances in the stem cell and diabetes field have relied upon combinatorial testing of numerous growth factors and chemical compounds in an arbitrary trial-and-error fashion to derive mature and functional human pancreatic β cells from hPSCs. Although this hit-or-miss approach appears to have made some headway in maturing human pancreatic β cells in vitro, its underlying biology is vaguely understood. Therefore, in this mini-review, we discuss some of these late-stage signaling pathways that are involved in human pancreatic β cell differentiation and highlight our current understanding of their relevance in rodent pancreas biology. Our efforts here unravel several novel signaling pathways that can be further studied to shed light on unexplored aspects of rodent pancreas biology. New investigations into these signaling pathways are expected to advance our knowledge in human pancreas developmental biology and to aid in the translation of stem cell biology in the context of diabetes treatments.

  16. Population-based study of epilepsy in Cambodia associated factors, measures of impact, stigma, quality of life, knowledge-attitude-practice, and treatment gap.

    Directory of Open Access Journals (Sweden)

    Devender Bhalla

    Full Text Available PURPOSE: Identify epilepsy-associated factors and calculate measures of impact, stigma, quality of life (QOL, knowledge-attitude-practice (KAP and treatment gap in Prey Veng, Cambodia. METHODS: This first Cambodian population-based case-control study had 96 epileptologist-confirmed epilepsy cases and 192 randomly selected matched healthy controls. Standard questionnaires, which have been used in similar settings, were used for collecting data on various parameters. Univariate and multivariate regression was done to determine odds ratios. Jacoby stigma, 31-item QOL, KAP etc were determined and so were the factors associated with them using STATA software. Treatment gap was measured using direct method. KEY FINDINGS: Multivariate analyses yielded family history of epilepsy, difficult or long delivery, other problems beside seizures (mainly mental retardation, hyperthermia, and eventful pregnancy of the subject's mother as factors associated with epilepsy. There was high frequency of seizure precipitants esp. those related to sleep. Population attributable risk (% was: family history (15.0, eventful pregnancy of subject's mother (14.5, long/difficult birth (6.5, and other problem beside seizures (20.0. Mean stigma (1.9±1.1, on a scale of 3 was mainly related to treatment efficacy. Mean QOL (5.0±1.4 on a scale of 10 was mainly related to treatment regularity. Cause or risk factor could be determined in 56% of cases. Treatment gap was 65.8%. SIGNIFICANCE: Factors in pre- and perinatal period were found to be most crucial for epilepsy risk in Cambodia which inturn provides major prevention opportunities. A global action plan for treatment, stigma reduction and improvement of QOL should be set-up in this country.

  17. Bridging the gap between clinical failure and laboratory fracture strength tests using a fractographic approach

    NARCIS (Netherlands)

    Aboushelib, M.N.; Feilzer, A.J.; Kleverlaan, C.J.

    2009-01-01

    Objective: The aim of this study was to analyze and to compare the fracture type and the stress at failure of clinically fractured zirconia-based all ceramic restorations with that of morphologically similar replicas tested in a laboratory setup. Methods: Replicas of the same shape and dimensions we

  18. The continuing challenge of providing drug information services to diminish the knowledge--practice gap in medical practice.

    Science.gov (United States)

    Alván, Gunnar; Andersson, Marine L; Asplund, Annika B; Böttiger, Ylva; Elwin, Carl-Eric; Gustafsson, Lars L; Öhman, Birgitta; Törnqvist, Elisabeth

    2013-05-01

    Information must be collected, evaluated and utilized to support every qualified activity. Medicine, with a written scientific tradition stretching back more than 2,000 years, is no exception. Here, we discuss a number of important items associated with the establishment of a drug information centre run by clinical pharmacologists and information pharmacists, serving a broad demand, mainly among clinical specialists. The working methods include a professional literature search, critical evaluation of the material, writing a structured answer, quality control, feedback to the inquirer and storage in a database which is publicly available. One can foresee even more complex systems wherein a number of active and specialized databases communicate to provide relevant advice and support at the point of care, supplying information on drug recommendations, reimbursement, environmental aspects, antimicrobial resistance, pharmacogenetics and adverse effects, and linked to a list of prescribed drugs for the individual patient. This will be possible in both rich and poor countries through the application of modern and developing information technology. However, research on the best and safest methods of such decision support systems will be needed to ensure that they really do improve the quality of drug prescribing and use.

  19. Integration of preclinical and clinical knowledge to predict intravenous PK in human: bilastine case study.

    Science.gov (United States)

    Vozmediano, Valvanera; Ortega, Ignacio; Lukas, John C; Gonzalo, Ana; Rodriguez, Monica; Lucero, Maria Luisa

    2014-03-01

    Modern pharmacometrics can integrate and leverage all prior proprietary and public knowledge. Such methods can be used to scale across species or comparators, perform clinical trial simulation across alternative designs, confirm hypothesis and potentially reduce development burden, time and costs. Crucial yet typically lacking in integration is the pre-clinical stage. Prediction of PK in man, using in vitro and in vivo studies in different animal species, is increasingly well theorized but could still find wider application in drug development. The aim of the present work was to explore methods for bridging pharmacokinetic knowledge from animal species (i.v. and p.o.) and man (p.o.) into i.v. in man using the antihistamine drug bilastine as example. A model, predictive of i.v. PK in man, was developed on data from two pre-clinical species (rat and dog) and p.o. in man bilastine trials performed earlier. In the knowledge application stage, two different approaches were used to predict human plasma concentration after i.v. of bilastine: allometry (several scaling methods) and a semi-physiological method. Both approaches led to successful predictions of key i.v. PK parameters of bilastine in man. The predictive i.v. PK model was validated using later data from a clinical study of i.v. bilastine. Introduction of such knowledge in development permits proper leveraging of all emergent knowledge as well as quantification-based exploration of PK scenario, e.g. in special populations (pediatrics, renal insufficiency, comedication). In addition, the methods permit reduction or elimination and certainly optimization of learning trials, particularly those concerning alternative off-label administration routes.

  20. Assessing the Comorbidity Gap between Clinical Studies and Prevalence in Elderly Patient Populations

    OpenAIRE

    He, Zhe; Charness, Neil; Bian, Jiang; Hogan, William R

    2016-01-01

    Well-designed and well-conducted clinical studies represent gold standard approaches for generating medical evidence. However, elderly populations are systematically underrepresented in studies across major chronic medical conditions, which has hampered the generalizability (external validity) of studies to the real-world patient population. It is the norm that intervention studies often require a homogeneous cohort to test their hypotheses; therefore older adults with co-medications and como...

  1. The Medical Use of Wheatgrass: Review of the Gap Between Basic and Clinical Applications.

    Science.gov (United States)

    Bar-Sela, Gil; Cohen, Miri; Ben-Arye, Eran; Epelbaum, Ron

    2015-01-01

    A wide range of health benefits have been attributed to wheatgrass, the young grass of the common wheat plant Triticum aestivum. Its components include chlorophyll, flavonoids, and vitamins C and E. Forms of wheatgrass include fresh juice, frozen juice, tablets, and powders, with compositions varying according to their production processes, as well as to the growing conditions of the wheatgrass. Laboratory in vitro studies, mostly using the fermented wheat germ extract, have demonstrated anti-cancer potential and have identified apoptosis as a possible mechanism. In animal experiments, wheatgrass demonstrated benefits in cancer prevention and as an adjunct to cancer treatment, as well as benefits to immunological activity and oxidative stress. Clinical trials show that wheatgrass may induce synergistic benefits to chemotherapy and may attenuate chemotherapy-related side effects, as well as benefit rheumatoid arthritis, ulcerative colitis, hematological diseases, diabetes, obesity, and oxidative stress. However, all the trials were small and a number of methodological problems arose. No adverse events of wheatgrass have been reported, although some forms pose problems of tolerability. The popularity of wheatgrass continues to grow. Nevertheless, the advantages seen in the clinical trials need to be proved in larger studies before clinical recommendations for the public can be given.

  2. Integrating complex business processes for knowledge-driven clinical decision support systems.

    Science.gov (United States)

    Kamaleswaran, Rishikesan; McGregor, Carolyn

    2012-01-01

    This paper presents in detail the component of the Complex Business Process for Stream Processing framework that is responsible for integrating complex business processes to enable knowledge-driven Clinical Decision Support System (CDSS) recommendations. CDSSs aid the clinician in supporting the care of patients by providing accurate data analysis and evidence-based recommendations. However, the incorporation of a dynamic knowledge-management system that supports the definition and enactment of complex business processes and real-time data streams has not been researched. In this paper we discuss the process web service as an innovative method of providing contextual information to a real-time data stream processing CDSS.

  3. The Contextual Gap between Theoretical Knowledge and Practical Knowledge for Novice Teachers%新手教师理论性知识与实践性知识之间的教学情景间隙

    Institute of Scientific and Technical Information of China (English)

    陈俊伟; 吴月珍

    2014-01-01

    TWith professional teaching training , most novice teachers still fail to cope with the teaching problems in the reality of classroom .This paper analyzes four types of teacher knowledge for further understanding on this issue ,and accordingly dividing them into two major kinds of knowledge:theoretical knowledge and practical knowledge .By comparing the knowledge features in the five progressive stages of teachers`expertise development ,it is pointed out that there might be a contextual gap among them .Therefore, the development of effective learning channels in combination with different contexts is an import measure of the integration of theoretical and practical knowledge .Based on SECI model generated for enterprise knowledge management and proposed by Nonaka and Ta -deuch,the IAIR model of knowledge transfer by novice teacher is tentatively put forward ,i.e.Interaction,Applica-tion,Integration and Reflection ,for the enlightenments of novice teachers`development .%新手教师面对课堂教学问题时往往束手无策,对教学情景无所适从。针对此问题,文章将陈述性知识、概念性知识、程序性知识和策略性知识归纳为理论性知识与实践性知识两大类。通过比较教师五个阶段专业发展的知识特征,揭示四种知识之间存在的“情景间隙”。因此,结合情境开辟有效的学习途径成为整合理论知识与实践知识的重要举措。基于Nonaka和Tadeuchi提出的企业知识管理创造的“SECI”模型,文章提出了新手教师知识转化的“IAIR”模式,即互动、运用、融合和反思,为新手教师的专业发展提供参考。

  4. The gap between knowledge on HIV/AIDS and sexual behavior: a study of teenagers in Vespasiano, Minas Gerais State, Brazil.

    Science.gov (United States)

    Moura, Luciana Ramos de; Lamounier, Joyce Romano; Guimarães, Patrícia Regina; Duarte, Júlia Mesquita; Beling, Maria Tereza Cordeiro; Pinto, Jorge Andrade; Goulart, Eugênio Marcos de Andrade; Grillo, Cristiane de Freitas Cunha

    2013-05-01

    The aim of this study was to investigate gaps between knowledge on HIV/AIDS and sexual behavior among teenagers. The study used a cross-sectional design with a representative random sample of 1,158 teenagers (14 to 19 years of age) enrolled in nine public secondary schools and who answered validated questionnaires. Data analysis included descriptive statistics and tests of hypotheses (chi-square, Mann-Whitney and Kruskal-Wallis, Kendall, and Fisher's exact test). The vast majority of the teenagers (98.7%) expressed doubt on at least one question. Condom use during first sexual intercourse was significantly associated with condom use in sexual relations in the previous six months. There was no statistical association between knowledge on HIV/AIDS and frequency of condom use or number of sexual partners. Health actions are needed that link schools to health services, in addition to not only elaborating appropriate information but also valorizing teenagers' individuality in the development of proposals.

  5. Recognition and mirroring. Constraints and knowledge gaps in energy conservation in the greenhouse sector; Herkennen en Spiegelen. Barrieres en kennishiaten bij energiebesparing in de glastuinbouw

    Energy Technology Data Exchange (ETDEWEB)

    Bremmer, J.; Ravensbergen, P.; Kempkes, F.; Dueck, T.; Verstegen, J.

    2007-07-01

    Results of an in-depth study into barriers and knowledge gaps experienced by greenhouse growers saving energy are discussed. In the course of years, growers have found a balance between inputs and production. Merely saving energy endangers this balance. A new balance can only be found if all inputs are adjusted simultaneously. The grower lacks the necessary cultivation knowledge to search independently for a new balance without running huge risks, and is limited in his possibilities by the investment cycle. [Dutch] In dit rapport wordt verslag gedaan van een dieptestudie naar barrieres en kennishiaten die glastuinders ervaren bij hun streven naar het besparen van energie. Glastuinders hebben in de loop der jaren een 'persoonlijk optimum' van produceren ontwikkeld dat een (kwetsbaar) evenwicht is tussen de inzet van productiemiddelen en de opbrengst. Besparing op alleen energie brengt dit evenwicht in gevaar. Een nieuw evenwicht kan pas gevonden worden wanneer de inzet van alle productiemiddelen simultaan wordt aangepast. De teler ontbeert de noodzakelijke teeltkundige kennis om zonder grote risico's te lopen zelfstandig op zoek te gaan naar het nieuwe evenwicht, en wordt in zijn mogelijkheden begrensd door de investeringscyclus.

  6. Transition to clinical training : influence of pre-clinical knowledge and skills, and consequences for clinical performance

    NARCIS (Netherlands)

    van Hell, Elisabeth A.; Kuks, Jan B. M.; Schonrock-Adema, Johanna; van Lohuizen, Mirjam T.; Cohen-Schotanus, Janke

    2008-01-01

    CONTEXT Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students' progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transi

  7. Development, validation and clinical assessment of a short questionnaire to assess disease-related knowledge in inflammatory bowel disease patients.

    LENUS (Irish Health Repository)

    Keegan, Denise

    2013-02-01

    Only two inflammatory bowel disease (IBD) knowledge scales are available, both primarily aimed at evaluating the effectiveness of clinical education programs. The aim of this study was to develop and validate a short knowledge questionnaire for clinical and academic research purposes.

  8. GAP Analysis Program (GAP)

    Data.gov (United States)

    Kansas Data Access and Support Center — The Kansas GAP Analysis Land Cover database depicts 43 land cover classes for the state of Kansas. The database was generated using a two-stage hybrid classification...

  9. Bridging the financial gap through providing contract services: a model for publicly funded clinical biobanks.

    Science.gov (United States)

    Kozlakidis, Zisis; Mant, Christine; Cason, John

    2012-08-01

    Biobanks offer translational researchers a novel method of obtaining clinical research materials, patient data, and relevant ethical and legal permissions. However, such tissue collections are expensive to establish and maintain. Current opinion is that such initiatives can only survive with core funding from Government or major funding bodies. Given the present climate of financial austerity, funding agencies may be tempted to invest in fast-return research projects rather than in maintaining tissue collections, whose benefits will only become apparent in much longer timescales. Thus, securing additional funding for biobanks could provide a valuable boost enabling an extension of core services. Here we suggest that using biobank expertise to offer contract services to clinicians and industry may be an alternative approach to obtaining such extra funding.

  10. A vertically integrated geriatric curriculum improves medical student knowledge and clinical skills.

    Science.gov (United States)

    Supiano, Mark A; Fitzgerald, James T; Hall, Karen E; Halter, Jeffrey B

    2007-10-01

    The objective of this study was to determine the effect of a vertically integrated curriculum intervention on the geriatric knowledge and performance in clinical skills of third-year medical students. This observational cohort study conducted at the University of Michigan Medical School evaluates the performance of 622 third-year medical students from the graduating class years of 2004 through 2007. An integrated curriculum intervention was developed and implemented for the class of 2006. Its elements included identification and tracking of geriatric learning outcomes in an individualized Web-based student portfolio, integration of geriatric content into preclinical courses, development of a geriatric functional assessment standardized patient instructor, and an experience in a geriatrics clinic during the ambulatory component of the third-year internal medicine clerkship. Medical student performance was assessed on a geriatric knowledge test and during a geriatric functional assessment station administered during an Observed Structured Clinical Examination (OSCE) at the beginning of the fourth year. Student performance on the geriatric functional assessment OSCE station progressively improved from pre-intervention performance (mean performance+/-standard deviation 43+/-15% class of 2005, 62 + 15% class of 2006, 78+/-10% class of 2007; analysis of variance, P<.001). Similarly, student performance on the geriatric knowledge test was significantly better for the classes of 2006 and 2007 than for the class of 2005 (model F ratio=4.72; P<.001). In conclusion, an integrated approach to incorporating new educational geriatric objectives into the medical school curriculum leads to significant improvements in medical student knowledge and in important clinical skills in the functional assessment of older patients.

  11. Extraction of the human cerebral ventricular system from MRI: inclusion of anatomical knowledge and clinical perspective

    Science.gov (United States)

    Aziz, Aamer; Hu, Qingmao; Nowinski, Wieslaw L.

    2004-04-01

    The human cerebral ventricular system is a complex structure that is essential for the well being and changes in which reflect disease. It is clinically imperative that the ventricular system be studied in details. For this reason computer assisted algorithms are essential to be developed. We have developed a novel (patent pending) and robust anatomical knowledge-driven algorithm for automatic extraction of the cerebral ventricular system from MRI. The algorithm is not only unique in its image processing aspect but also incorporates knowledge of neuroanatomy, radiological properties, and variability of the ventricular system. The ventricular system is divided into six 3D regions based on the anatomy and its variability. Within each ventricular region a 2D region of interest (ROI) is defined and is then further subdivided into sub-regions. Various strict conditions that detect and prevent leakage into the extra-ventricular space are specified for each sub-region based on anatomical knowledge. Each ROI is processed to calculate its local statistics, local intensity ranges of cerebrospinal fluid and grey and white matters, set a seed point within the ROI, grow region directionally in 3D, check anti-leakage conditions and correct growing if leakage occurs and connects all unconnected regions grown by relaxing growing conditions. The algorithm was tested qualitatively and quantitatively on normal and pathological MRI cases and worked well. In this paper we discuss in more detail inclusion of anatomical knowledge in the algorithm and usefulness of our approach from clinical perspective.

  12. Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.

    Science.gov (United States)

    Licskai, Christopher; Sands, Todd; Ong, Michael; Paolatto, Lisa; Nicoletti, Ivan

    2012-10-01

    Quality problem International guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets. Initial assessment Regional pilot data demonstrated a knowledge-to-practice gap. Choice of solutions We engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework. Implementation Knowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient. Evaluation Six guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ± 24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ± 7) months. Lessons learned A knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1.

  13. Relational Network for Knowledge Discovery through Heterogeneous Biomedical and Clinical Features.

    Science.gov (United States)

    Chen, Huaidong; Chen, Wei; Liu, Chenglin; Zhang, Le; Su, Jing; Zhou, Xiaobo

    2016-07-18

    Biomedical big data, as a whole, covers numerous features, while each dataset specifically delineates part of them. "Full feature spectrum" knowledge discovery across heterogeneous data sources remains a major challenge. We developed a method called bootstrapping for unified feature association measurement (BUFAM) for pairwise association analysis, and relational dependency network (RDN) modeling for global module detection on features across breast cancer cohorts. Discovered knowledge was cross-validated using data from Wake Forest Baptist Medical Center's electronic medical records and annotated with BioCarta signaling signatures. The clinical potential of the discovered modules was exhibited by stratifying patients for drug responses. A series of discovered associations provided new insights into breast cancer, such as the effects of patient's cultural background on preferences for surgical procedure. We also discovered two groups of highly associated features, the HER2 and the ER modules, each of which described how phenotypes were associated with molecular signatures, diagnostic features, and clinical decisions. The discovered "ER module", which was dominated by cancer immunity, was used as an example for patient stratification and prediction of drug responses to tamoxifen and chemotherapy. BUFAM-derived RDN modeling demonstrated unique ability to discover clinically meaningful and actionable knowledge across highly heterogeneous biomedical big data sets.

  14. Relational Network for Knowledge Discovery through Heterogeneous Biomedical and Clinical Features

    Science.gov (United States)

    Chen, Huaidong; Chen, Wei; Liu, Chenglin; Zhang, Le; Su, Jing; Zhou, Xiaobo

    2016-07-01

    Biomedical big data, as a whole, covers numerous features, while each dataset specifically delineates part of them. “Full feature spectrum” knowledge discovery across heterogeneous data sources remains a major challenge. We developed a method called bootstrapping for unified feature association measurement (BUFAM) for pairwise association analysis, and relational dependency network (RDN) modeling for global module detection on features across breast cancer cohorts. Discovered knowledge was cross-validated using data from Wake Forest Baptist Medical Center’s electronic medical records and annotated with BioCarta signaling signatures. The clinical potential of the discovered modules was exhibited by stratifying patients for drug responses. A series of discovered associations provided new insights into breast cancer, such as the effects of patient’s cultural background on preferences for surgical procedure. We also discovered two groups of highly associated features, the HER2 and the ER modules, each of which described how phenotypes were associated with molecular signatures, diagnostic features, and clinical decisions. The discovered “ER module”, which was dominated by cancer immunity, was used as an example for patient stratification and prediction of drug responses to tamoxifen and chemotherapy. BUFAM-derived RDN modeling demonstrated unique ability to discover clinically meaningful and actionable knowledge across highly heterogeneous biomedical big data sets.

  15. Mathematical knowledge and drug dosage calculation: Necessary clinical skills for the nurse

    Directory of Open Access Journals (Sweden)

    Athanasakis Efstratios

    2013-01-01

    Full Text Available When nurses perform their tasks, they manage situations where maths knowledge is required. Such a situation is the calculation of medication dosage. Aim: The literature review of papers relevant with the mathematical knowledge and drug calculation skills of nurses and nursing students. Material-Method: A search of published research and review articles from January 1989 until March 2012, has been conducted in Pubmed database. The search terms used were: nurses, mathematics skills, numeracy skills and medication dosology calculation skills. Results: Literature review showed that many studies focus in the mathematical knowledge and drug dosage calculation competency of nursing students. Results from these studies revealed that nursing students had poor mathematical knowledge and drug dosage calculation skills. In contrast with students, professional nurses are more likely to have sufficient skills in drug calculations. Apart from the papers analyzing calculation skills' assessment, several studies examined educational interventions in the context of calculation skills enhancement. Accuracy and proficiency in the dosage calculation of medications is a preventive factor of errors made at medication preparation and administration. Conclusion: Mathematical knowledge and drug dosage calculation abilities are interrelated concepts and essential clinical skills for the nurse. The fact that nursing students do not have adequate skills for calculating medications' dosage, might be an issue that schools of nursing education should focus in. Further research of the drug dosage calculation skills is considered essential.

  16. A cluster analysis to investigating nurses' knowledge, attitudes, and skills regarding the clinical management system.

    Science.gov (United States)

    Chan, M F

    2007-01-01

    Nurses' knowledge, attitudes, and skills regarding the Clinical Management System are explored by identifying profiles of nurses working in Hong Kong. A total of 282 nurses from four hospitals completed a self-reported questionnaire during the period from December 2004 to May 2005. Two-step cluster analysis yielded two clusters. The first cluster (n = 159, 56.4%) was labeled "negative attitudes, less skillful, and average knowledge" group. The second cluster (n = 123, 43.6%) was labeled "positive attitudes, good knowledge, but less skillful." There was a positive correlation in cluster 1 for nurses' knowledge and attitudes (rs = 0.28) and in cluster 2 for nurses' skills and attitudes (rs = 0.25) toward computerization. The study showed that senior and more highly educated nurses generally held more positive attitudes to computerization, whereas the attitudes among younger and less well educated nurses generally were more negative. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' computer knowledge and skills and improve their attitudes toward computerization.

  17. Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

    Directory of Open Access Journals (Sweden)

    Ash Joan S

    2012-02-01

    Full Text Available Abstract Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS development and implementation and for knowledge management (KM processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1 workflow; 2 knowledge management; 3 data as a foundation for CDS; 4 user computer interaction; 5 measurement and metrics; 6 governance; 7 translation for collaboration; 8 the meaning of CDS; 9 roles of special, essential people; and 10 communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.

  18. Nosocomial infections: knowledge and source of information among clinical health care students in Ghana

    Directory of Open Access Journals (Sweden)

    Bello AI

    2011-08-01

    Full Text Available Ajediran I Bello1, Eunice N Asiedu1, Babatunde OA Adegoke2, Jonathan NA Quartey1, Kwadwo O Appiah-Kubi1, Bertha Owusu-Ansah11Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana; 2Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, NigeriaBackground: This study determined and compared the knowledge of nosocomial infections among clinical health care students at the College of Health Sciences, University of Ghana.Methods: Two hundred undergraduate health care students from four academic programs participated in the study. The study sample was drawn from each academic program by a simple random sampling technique using the class directory from each course. The Infection Control Standardized Questionnaire (ICSQ was used to assess the knowledge of students about three main domains, ie, hand hygiene, nosocomial infections, and standard precautions. A maximum score of 50 was obtainable, and respondents with scores ≥70% were classified as having a satisfactory knowledge. The response on each item was coded numerically to generate data for statistical analysis. Comparison of knowledge on the domains among categories of students was assessed using the Kruskal–Wallis test, while associations between courses of study and knowledge about nosocomial infections were determined using the Chi-square test. All statistical tests had a significant level of 5% (P < 0.05Results: Overall mean percentage score of the participants on ICSQ was 65.4 ± 2.58, with medical, physiotherapy, radiography, and nursing students recording mean percentage scores of 70.58 ± 0.62, 65.02 ± 2.00, 64.74 ± 1.19, and 61.31 ± 2.35, respectively. The main source of information about the prevention of nosocomial infections as cited by participants was their routine formal training in class. There was no significant association (P > 0.05 between course of study and knowledge of

  19. Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement.

    Science.gov (United States)

    Thornton, Tim

    2006-03-17

    The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. The paper focuses on research evidence, drawing first on the work of Kuhn to suggest that tacit knowledge contributes, as a matter of fact, to puzzle solving within what he calls normal science. A stronger argument that it must play a role in research is first motivated by looking to Collins' first hand account of replication in applied physics and then broader considerations of replication in justifying knowledge claims in scientific research. Finally, consideration of an argument from Wittgenstein shows that whatever explicit guidelines can be drawn up to guide judgement the specification of what counts as correctly following them has to remain implicit.Overall, the paper sets out arguments for the claim that even though explicit guidelines and codifications can play a practical role in informing clinical practice, they rest on a body of tacit or implicit skill that is in principle ineliminable. It forms the bedrock of good judgement and unites the integration of research, expertise and values.

  20. Genetic counselors' (GC) knowledge, awareness, understanding of clinical next-generation sequencing (NGS) genomic testing.

    Science.gov (United States)

    Boland, P M; Ruth, K; Matro, J M; Rainey, K L; Fang, C Y; Wong, Y N; Daly, M B; Hall, M J

    2015-12-01

    Genomic tests are increasingly complex, less expensive, and more widely available with the advent of next-generation sequencing (NGS). We assessed knowledge and perceptions among genetic counselors pertaining to NGS genomic testing via an online survey. Associations between selected characteristics and perceptions were examined. Recent education on NGS testing was common, but practical experience limited. Perceived understanding of clinical NGS was modest, specifically concerning tumor testing. Greater perceived understanding of clinical NGS testing correlated with more time spent in cancer-related counseling, exposure to NGS testing, and NGS-focused education. Substantial disagreement about the role of counseling for tumor-based testing was seen. Finally, a majority of counselors agreed with the need for more education about clinical NGS testing, supporting this approach to optimizing implementation.

  1. Knowledge of causes, clinical features and diagnosis of common zoonoses among medical practitioners in Tanzania

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    Mfinanga Godfrey S

    2008-12-01

    Full Text Available Abstract Background Many factors have been mentioned as contributing to under-diagnosis and under-reporting of zoonotic diseases particularly in the sub-Sahara African region. These include poor disease surveillance coverage, poor diagnostic capacity, the geographical distribution of those most affected and lack of clear strategies to address the plight of zoonotic diseases. The current study investigates the knowledge of medical practitioners of zoonotic diseases as a potential contributing factor to their under-diagnosis and hence under-reporting. Methods The study was designed as a cross-sectional survey. Semi-structured open-ended questionnaire was administered to medical practitioners to establish the knowledge of anthrax, rabies, brucellosis, trypanosomiasis, echinococcosis and bovine tuberculosis in selected health facilities within urban and rural settings in Tanzania between April and May 2005. Frequency data were analyzed using likelihood ratio chi-square in Minitab version 14 to compare practitioners' knowledge of transmission, clinical features and diagnosis of the zoonoses in the two settings. For each analysis, likelihood ratio chi-square p-value of less than 0.05 was considered to be significant. Fisher's exact test was used where expected results were less than five. Results Medical practitioners in rural health facilities had poor knowledge of transmission of sleeping sickness and clinical features of anthrax and rabies in humans compared to their urban counterparts. In both areas the practitioners had poor knowledge of how echinococcosis is transmitted to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans. Conclusion Knowledge of medical practitioners of zoonotic diseases could be a contributing factor to their under-diagnosis and under-reporting in Tanzania. Refresher courses on zoonotic diseases should be conducted particularly to practitioners in rural areas. More emphasis

  2. Antibiotic prescribing and resistance: knowledge level of medical students of clinical years of University Sultan Zainal Abidin, Malaysia

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    Haque M

    2016-03-01

    Full Text Available Mainul Haque, Nor Iza A Rahman, Zainal Zulkifli, Salwani Ismail Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia Abstract: The innovation of penicillin by Dr Alexander Fleming in 1928 and its use in clinical practice saved many lives, especially during the Second World War. Tuberculosis still carries a significant public health threat and has re-emerged over the past two decades, even in modern countries where tuberculosis was thought to be eliminated. The World Health Organization defines antimicrobial resistance as the resistance of a microorganism to an antimicrobial drug that was initially effective for treatment of infections caused by the microbe. Therefore, the findings of the current study will provide data to enable the design of a new educational program to better equip our students in confronting antimicrobial resistance. This study was a cross-sectional, questionnaire-based survey, which was undertaken in the Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia. The study participants were students of the Bachelor of Medicine and Bachelor of Surgery program (MBBS of Year III, IV, and V. A total of 142 out of 164 (86% medical students returned the questionnaire. Specifically, the year-wise breakdown of responses was 29% (41, 39% (55, and 32% (45 for Year III, IV, and V, respectively. Among the study respondents, 28% (40 were male, and the remaining 72% (102 were female. In all, 67% of the participants felt more confident in “making an accurate diagnosis of infection/sepsis.” The majority (88% of the study participants stated that they would like more training on antibiotic selection. This research has found that there is a gap between theoretical input and clinical practice; the students are demanding more educational intervention to face the threat of antimicrobial resistance. Keywords: antibiotic, prescribing, resistance, medical students, knowledge

  3. PARTAKE survey of public knowledge and perceptions of clinical research in India.

    Directory of Open Access Journals (Sweden)

    Tal Burt

    Full Text Available BACKGROUND: A public that is an informed partner in clinical research is important for ethical, methodological, and operational reasons. There are indications that the public is unaware or misinformed, and not sufficiently engaged in clinical research but studies on the topic are lacking. PARTAKE - Public Awareness of Research for Therapeutic Advancements through Knowledge and Empowerment is a program aimed at increasing public awareness and partnership in clinical research. The PARTAKE Survey is a component of the program. OBJECTIVE: To study public knowledge and perceptions of clinical research. METHODS: A 40-item questionnaire combining multiple-choice and open-ended questions was administered to 175 English- or Hindi-speaking individuals in 8 public locations representing various socioeconomic strata in New Delhi, India. RESULTS: Interviewees were 18-84 old (mean: 39.6, SD ± 16.6, 23.6% female, 68.6% employed, 7.3% illiterate, 26.3% had heard of research, 2.9% had participated and 58.9% expressed willingness to participate in clinical research. The following perceptions were reported (% true/% false/% not aware: 'research benefits society' (94.1%/3.5%/2.3%, 'the government protects against unethical clinical research' (56.7%/26.3%/16.9%, 'research hospitals provide better care' (67.2%/8.7%/23.9%, 'confidentiality is adequately protected' (54.1%/12.3%/33.5%, 'participation in research is voluntary' (85.3%/5.8%/8.7%; 'participants treated like 'guinea pigs'' (20.7%/53.2%/26.0%, and 'compensation for participation is adequate' (24.7%/12.9%/62.3%. CONCLUSIONS: Results suggest the Indian public is aware of some key features of clinical research (e.g., purpose, value, voluntary nature of participation, and supports clinical research in general but is unaware of other key features (e.g., compensation, confidentiality, protection of human participants and exhibits some distrust in the conduct and reporting of clinical trials. Larger, cross

  4. Vector-borne diseases of small companion animals in Namibia: Literature review, knowledge gaps and opportunity for a One Health approach

    Directory of Open Access Journals (Sweden)

    Bruce H. Noden

    2015-03-01

    Full Text Available Namibia has a rich history in veterinary health but little is known about the vector-borne diseases that affect companion dogs and cats. The aim of this review is to summarise the existing published and available unpublished literature, put it into a wider geographical context, and explore some significant knowledge gaps. To date, only two filarial pathogens (Dirofilaria repens and Acanthocheilonema dracunculoides and three tick-borne pathogens (Babesia canis vogeli, Hepatozoon canis and Ehrlichia canis have been reported. Most studies have focused solely on dogs and cats in the urban Windhoek and surrounding areas, with almost nothing reported in rural farming areas, in either the populous northern regions or the low-income urban areas where animal owners have limited access to veterinary services. With the development of several biomedical training programmes in the country, there is now an excellent opportunity to address zoonotic vector-borne diseases through a One Health approach so as to assess the risks to small companion animals as well as diseases of public health importance.

  5. A review of quantitative structure-property relationships for the fate of ionizable organic chemicals in water matrices and identification of knowledge gaps.

    Science.gov (United States)

    Nolte, Tom M; Ragas, Ad M J

    2017-03-22

    Many organic chemicals are ionizable by nature. After use and release into the environment, various fate processes determine their concentrations, and hence exposure to aquatic organisms. In the absence of suitable data, such fate processes can be estimated using Quantitative Structure-Property Relationships (QSPRs). In this review we compiled available QSPRs from the open literature and assessed their applicability towards ionizable organic chemicals. Using quantitative and qualitative criteria we selected the 'best' QSPRs for sorption, (a)biotic degradation, and bioconcentration. The results indicate that many suitable QSPRs exist, but some critical knowledge gaps remain. Specifically, future focus should be directed towards the development of QSPR models for biodegradation in wastewater and sediment systems, direct photolysis and reaction with singlet oxygen, as well as additional reactive intermediates. Adequate QSPRs for bioconcentration in fish exist, but more accurate assessments can be achieved using pharmacologically based toxicokinetic (PBTK) models. No adequate QSPRs exist for bioconcentration in non-fish species. Due to the high variability of chemical and biological species as well as environmental conditions in QSPR datasets, accurate predictions for specific systems and inter-dataset conversions are problematic, for which standardization is needed. For all QSPR endpoints, additional data requirements involve supplementing the current chemical space covered and accurately characterizing the test systems used.

  6. NHLBI state of the science symposium in therapeutic apheresis: Knowledge gaps and research opportunities in the area of hematology-oncology.

    Science.gov (United States)

    Karafin, Matthew S; Sachais, Bruce S; Connelly-Smith, Laura; Field, Joshua J; Linenberger, Michael L; Padmanabhan, Anand

    2016-02-01

    The National Heart Lung and Blood Institute (NHLBI) hosted a two-day state of the science symposium on therapeutic apheresis in Bethesda, MD on November 28th-29th, 2012. The purpose of the symposium was multifaceted, and included the following aims: (a) To discuss this state of research and key scientific questions in apheresis medicine; (b) To identify gaps in knowledge for relevant cardiovascular diseases, hematological and oncological diseases, infectious diseases and sepsis, renal diseases, and neurological diseases where there may be strong therapeutic rationale for the application of apheresis treatments; (c) To explore ways of coordinating therapeutic apheresis with other medical disciplines and treatment modalities; (d) To identify and prioritize the most important research questions to be answered in apheresis medicine; and (e) To offer NHLBI suggestions on how a structured research approach can be applied to the therapeutic apheresis research agenda in future years. The following document summarizes three such key proposals presented at the meeting for evaluating apheresis therapy for the treatment of pain in sickle cell disease, heparin induced thrombocytopenia, and leukostasis from acute myeloid leukemia. The challenges and limitations regarding apheresis therapy for each disease are discussed, and avenues for future investigation for each disease are outlined.

  7. The application of fDOM sensors in freshwater systems: Limitations, knowledge gaps and recommendations for future enhancement and novel development

    Science.gov (United States)

    Downing, B. D.; Bergamaschi, B. A.; Pellerin, B. A.; Saraceno, J.; Kraus, T. E.

    2010-12-01

    Commercially-available, field deployable sensors designed to measure colored or chromophoric dissolved organic matter fluorescence (fDOM; ex370/em460 nm) in-situ are of considerable interest to researchers owing to their potential to serve as a proxy for continuous DOC concentrations in many freshwater environments. The major challenge with these sensors stems from non-linearity effects between measured fDOM and DOC concentration over the range of DOC encountered as well as interferences from organic and inorganic particles and temperature effects. A series of laboratory based evaluations were designed to compare inherent sensor optical geometries as well as reveal non-linearity effects due to (1) high fDOM concentrations (inner filter effects), (2), particle interference, and (3) temperature effects. In addition to evaluating the correlation between DOC concentration and fDOM, we considered sensor dynamic range and gain settings as well as data output protocol (e.g. analog or digital). Previous studies have illustrated the role of particle interference, which results in underestimates of fDOM greater than 50% at turbidities observed in many rivers and streams. Here, we present the results from the array of laboratory evaluations and discuss the practical limitations, propose correction methods and highlight knowledge gaps.

  8. Developing clinical knowledge through a narrative-based method of interpretation.

    Science.gov (United States)

    Ekman, Inger; Skott, Carola

    2005-09-01

    The results of research using a narrative analysis provide new clinical knowledge, but the methods used are unknown to many readers. In this paper we present an example of how an analysis may be performed in practice. The purpose of the interpretation of this specific story was to develop clinical knowledge of how it is to live with chronic heart failure from a daily life perspective. The steps in the interpretation process, within the framework of Paul Ricoeur's Interpretation theory, were: (1) general or naïve reading, (2) distancing, (3) examination of discourse, (4) conjectures and questions, and (5) reflection over the whole. The demonstrated interpretation of the interview resulted in a theme called: "Struggling to comprehend medical information". This systematic way of working with narratives makes implicit assumptions about the relationship between meaning and language explicit. These themes can be used in everyday practice as clinical tools. Because of the interpretative nature of human understanding the experienced health professional will be capable of integrating evidence-based research findings and individual illness experience.

  9. Knowledge and Perception about Clinical Research Shapes Behavior: Face to Face Survey in Korean General Public.

    Science.gov (United States)

    Choi, Yun Jung; Beck, Sung-Ho; Kang, Woon Yong; Yoo, Soyoung; Kim, Seong-Yoon; Lee, Ji Sung; Burt, Tal; Kim, Tae Won

    2016-05-01

    Considering general public as potential patients, identifying factors that hinder public participation poses great importance, especially in a research environment where demands for clinical trial participants outpace the supply. Hence, the aim of this study was to evaluate knowledge and perception about clinical research in general public. A total of 400 Seoul residents with no previous experience of clinical trial participation were selected, as representative of population in Seoul in terms of age and sex. To minimize selection bias, every fifth passer-by was invited to interview, and if in a cluster, person on the very right side was asked. To ensure the uniform use of survey, written instructions have been added to the questionnaire. Followed by pilot test in 40 subjects, the survey was administered face-to-face in December 2014. To investigate how perception shapes behavior, we compared perception scores in those who expressed willingness to participate and those who did not. Remarkably higher percentage of responders stated that they have heard of clinical research, and knew someone who participated (both, P responders expressed willingness to participate was 39.3%, a significantly lower rate than the result of the India (58.9% vs. 39.3%, P < 0.001). Treatment benefit was the single most influential reason for participation, followed by financial gain. Concern about safety was the main reason for refusal, succeeded by fear and lack of trust. Public awareness and educational programs addressing these negative perceptions and lack of knowledge will be effective in enhancing public engaged in clinical research.

  10. Clinical tolerance in large field radiotherapy--the knowledge gained over the last ten years.

    Science.gov (United States)

    Gocheva, Lilia B

    2010-01-01

    Malignant disorders are still far from being successfully managed in spite of the apparent progress achieved by surgical treatment, high energy radiotherapy (RT) and chemotherapy (CHT). They keep being the second most frequent cause of lethal outcomes both in Bulgaria and in most countries of the world. One of the promising approaches to increasing the efficaciousness of treatment is development and use of methods that are in full accord with the modern requirements of a complex therapy. Over the last fifty years, large field radiation techniques, applied as systemic therapy in oncology, have been investigated and established. These techniques show the transition in oncology to using actively various variants of large field radiotherapy (LFR), the "heavy artillery" of oncoradiologic practice, as an alternative or adjunct therapy to chemotherapy (CHT). In the present paper we review the current knowledge in the field and present the clinical experience accumulated over the last ten years with respect to clinical tolerance in the major large-field radiotherapy techniques--total body irradiation, half body irradiation, whole abdominal irradiation, total and partial lymphoid irradiation. Described in detail are the contemporary knowledge about clinical and hematologic tolerance in total body irradiation as part of the myelo- and nonmyeloablative conditioning regimens as well as in half body irradiation as a systemic therapy in oncology. We also present the amassed experience in clinical tolerance in partial body irradiation in the form of whole abdominal and total or partial lymphoid irradiation. Another point worth noting based again on the experience gained over the last ten years is that for LFR we need to develop a radiotherapy technique that is designed carefully to achieve an optimal therapeutic effect that should include the disease control, good clinical tolerance and reduction of post-radiotherapy sequelae.

  11. Designing m-learning for junior registrars--activation of a theoretical model of clinical knowledge.

    Science.gov (United States)

    Kanstrup, Anne Marie; Boye, Niels; Nøhr, Christian

    2007-01-01

    The MINI-project aims at supporting junior registrars in the learning process of how to utilize their theoretical knowledge from Medical School in everyday clinical reasoning and practice. Due to the nature of the work--concurrent moving, learning and producing--we designed an m-learning application. This paper introduces the possibilities and challenges for design of the m-learning application based on a) analytical findings on learning and mobility as derived from the design case--an emergency medical ward b) theoretical perspectives on medical knowledge, and c) presentation of the design of an m-learning application. The design process was based on user-driven innovation and the paper discusses considerations on how to combine user-drive and generic models.

  12. Ultrasound to stimulate early bone formation in a distraction gap : a double blind randomised clinical pilot trial in the edentulous mandible

    NARCIS (Netherlands)

    Schortinghuis, J; Bronckers, ALLJ; Stegenga, B; Raghoebar, GM; de Bont, LGM

    2005-01-01

    Objective: In a double blind randomised clinical pilot trial, it was investigated whether tow intensity pulsed ultrasound therapy stimulates early bone formation in a distraction gap created in a severely resorbed mandible. Design: Eight patients underwent a mandibular vertical distraction over an a

  13. Polonium-210 and other radionuclides in terrestrial, freshwater and brackish environments Results from the NKS project GAPRAD (Filling knowledge gaps in radiation protection methodologies for non-human biota)

    Energy Technology Data Exchange (ETDEWEB)

    Gjelsvik, R.; Brown, J.; Holm, E.; Roos, P.; Saxen, R.; Outola, I.

    2012-01-15

    The background and rationale to filling knowledge gaps in radiation protection methodologies for biota are presented. Concentrations of Po-210 and Pb-210 are reported for biota sampled in Dovrefjell, Norway and selected lake and brackish ecosystems in Finland. Furthermore, details in relation to Po-210 uptake and biokinetics in humans based on experimental studies are recounted. (Author)

  14. Combining knowledge- and data-driven methods for de-identification of clinical narratives.

    Science.gov (United States)

    Dehghan, Azad; Kovacevic, Aleksandar; Karystianis, George; Keane, John A; Nenadic, Goran

    2015-12-01

    A recent promise to access unstructured clinical data from electronic health records on large-scale has revitalized the interest in automated de-identification of clinical notes, which includes the identification of mentions of Protected Health Information (PHI). We describe the methods developed and evaluated as part of the i2b2/UTHealth 2014 challenge to identify PHI defined by 25 entity types in longitudinal clinical narratives. Our approach combines knowledge-driven (dictionaries and rules) and data-driven (machine learning) methods with a large range of features to address de-identification of specific named entities. In addition, we have devised a two-pass recognition approach that creates a patient-specific run-time dictionary from the PHI entities identified in the first step with high confidence, which is then used in the second pass to identify mentions that lack specific clues. The proposed method achieved the overall micro F1-measures of 91% on strict and 95% on token-level evaluation on the test dataset (514 narratives). Whilst most PHI entities can be reliably identified, particularly challenging were mentions of Organizations and Professions. Still, the overall results suggest that automated text mining methods can be used to reliably process clinical notes to identify personal information and thus providing a crucial step in large-scale de-identification of unstructured data for further clinical and epidemiological studies.

  15. Pilot Study of Blood Pressure in Girls With Turner Syndrome: An Awareness Gap, Clinical Associations, and New Hypotheses.

    Science.gov (United States)

    Los, Evan; Quezada, Emilio; Chen, Zunqiu; Lapidus, Jodi; Silberbach, Michael

    2016-07-01

    Cardiovascular disease is the major factor that reduces lifespan in Turner syndrome. High blood pressure (BP) is common in Turner syndrome and is the most easily treatable cardiovascular risk factor. We studied the prevalence of elevated screening systemic BP, awareness of the problem, and its clinical associations in a large group of girls attending the annual meeting of the Turner Syndrome Society of the United States. Among 168 girls aged 2 to 17 years, 42% had elevated screening BP (systolic and diastolic), yet only 8% reported a previous diagnosis of hypertension. History of aortic coarctation repair (17%) was positively associated with elevated systolic BP (52% versus 32%; PTurner syndrome phenotype/genotype probably includes an intrinsic risk for hypertension. Obesity and repaired aortic coarctation increase this risk further. There seems to be a BP awareness gap in girls with Turner syndrome. Because girls living with Turner syndrome are a sensitized population for hypertension, further study may provide clues to genetic factors leading to a better understanding of essential hypertension in the general population.

  16. EXACKTE2: Exploiting the clinical consultation as a knowledge transfer and exchange environment: a study protocol

    Directory of Open Access Journals (Sweden)

    Ouimet Mathieu

    2009-03-01

    Full Text Available Abstract Background While the evidence suggests that the way physicians provide information to patients is crucial in helping patients decide upon a course of action, the field of knowledge translation and exchange (KTE is silent about how the physician and the patient influence each other during clinical interactions and decision-making. Consequently, based on a novel relationship-centered model, EXACKTE2 (EXploiting the clinicAl Consultation as a Knowledge Transfer and Exchange Environment, this study proposes to assess how patients and physicians influence each other in consultations. Methods We will employ a cross-sectional study design involving 300 pairs of patients and family physicians from two primary care practice-based research networks. The consultation between patient and physician will be audio-taped and transcribed. Following the consultation, patients and physicians will complete a set of questionnaires based on the EXACKTE2 model. All questionnaires will be similar for patients and physicians. These questionnaires will assess the key concepts of our proposed model based on the essential elements of shared decision-making (SDM: definition and explanation of problem; presentation of options; discussion of pros and cons; clarification of patient values and preferences; discussion of patient ability and self-efficacy; presentation of doctor knowledge and recommendation; and checking and clarifying understanding. Patients will be contacted by phone two weeks later and asked to complete questionnaires on decisional regret and quality of life. The analysis will be conducted to compare the key concepts in the EXACKTE2 model between patients and physicians. It will also allow the assessment of how patients and physicians influence each other in consultations. Discussion Our proposed model, EXACKTE2, is aimed at advancing the science of KTE based on a relationship process when decision-making has to take place. It fosters a new KTE

  17. [Possibilities for the improvement of the quality of knowledge and their evaluation in the course of studying clinical medicine].

    Science.gov (United States)

    Tetenev, F F; Bodrova, T N; Ageeva, T S; Karzilov, A I; Kalinina, O V

    2014-01-01

    The authors consider objective and subjective factors exerting negative influence on the quality of knowledge of physicians. The generally accepted methods for its evaluation (testing and rating-systems) have limitations. Testing reflects the level of knowledge with respect to the mode of thinking of its designer while rating mostly characterizes diligence of the trainee. It is proposed to improve the quality of knowledge by teaching the theory of diagnostics and to evaluate the amount of knowledge from the contents of the descriptive part of the medical history. The quality of knowledge can be assessed based on the contents of professional comments on the clinical picture described in the model case history.

  18. Identifying best practices for clinical decision support and knowledge management in the field.

    Science.gov (United States)

    Ash, Joan S; Sittig, Dean F; Dykstra, Richard; Wright, Adam; McMullen, Carmit; Richardson, Joshua; Middleton, Blackford

    2010-01-01

    To investigate best practices for implementing and managing clinical decision support (CDS) in community hospitals and ambulatory settings, we carried out a series of ethnographic studies to gather information from nine diverse organizations. Using the Rapid Assessment Process methodology, we conducted surveys, interviews, and observations over a period of two years in eight different geographic regions of the U.S.A. We first utilized a template organizing method for an expedited analysis of the data, followed by a deeper and more time consuming interpretive approach. We identified five major categories of best practices that require careful consideration while carrying out the planning, implementation, and knowledge management processes related to CDS. As more health care organizations implement clinical systems such as computerized provider order entry with CDS, descriptions of lessons learned by CDS pioneers can provide valuable guidance so that CDS can have optimal impact on health care quality.

  19. [Historical evolution of some clinical and epidemiological knowledge of coccidioidomycosis in the Americas].

    Science.gov (United States)

    Negroni, R

    2008-01-01

    Coccidioidomycosis is a systemic endemic mycosis caused by two dimorphic fungi of the Coccidioides genus: Coccidioides immitis and Coccidioides posadasii. This fungal infection is only endemic in the American Continent. The majority of the epidemiological, pathogenic, clinical, mycological and therapeutical findings were obtained in the U.S.A. Coccidioidomycosis was discovered in Argentina, at the end of the XIXth century by Alejandro Posadas. In the last two decades, a new endemic zone was found in the northeast of Brazil. Several countries of the region such as Mexico, Guatemala, Honduras, Venezuela and Argentina have performed epidemiological studies which allowed a better knowledge of the endemic areas and of the clinical characteristics of this mycosis.

  20. Studying children's religious knowledge: contributions of ethnography and the clinical-critical method.

    Science.gov (United States)

    García Palacios, Mariana; Castorina, José Antonio

    2014-12-01

    We analyze different methodological and conceptual contributions of anthropology and psychogenetic theory to the research of children's religious knowledge. We argue that for the study of children's points of view it is possible to build an approach that links aspects studied by both disciplinary fields. With this aim, we revise some of their basic theoretical assumptions and recent reviews as well as their methodological proposals. Then we review the core characteristics of ethnography and the clinical-critical method-proposed by Piaget's psychogenetic theory-with the goal of stressing their potentialities as well as their limitations in research. We argue that within an ethnographic approach, we must establish certain restrictions on the clinical-critical method following basic premises of social anthropology. This approach lets us demonstrate the importance of understanding children's constructions by placing them within social relations that children produce and update in everyday interactions.

  1. Toxicity of seven priority hazardous and noxious substances (HNSs) to marine organisms: Current status, knowledge gaps and recommendations for future research

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    Rocha, A. Cristina S., E-mail: cristinasrocha@gmail.com; Reis-Henriques, Maria Armanda; Galhano, Victor; Ferreira, Marta, E-mail: marta.ferreira@usp.ac.fj; Guimarães, Laura

    2016-01-15

    Shipping industry and seaborne trade have rapidly increased over the last fifty years, mainly due to the continuous increasing demand for chemicals and fuels. Consequently, despite current regulations, the occurrence of accidental spills poses an important risk. Hazardous and noxious substances (HNSs) have been raising major concern among environmental managers and scientific community for their heterogeneity, hazardous potential towards aquatic organisms and associated social-economic impacts. A literature review on ecotoxicological hazards to aquatic organisms was conducted for seven HNSs: acrylonitrile, n-butyl acrylate, cyclohexylbenzene, hexane, isononanol, trichloroethylene and xylene. Information on the mechanisms of action of the selected HNS was also reviewed. The main purpose was to identify: i) knowledge gaps in need of being addressed in future research; and ii) a set of possible biomarkers suitable for ecotoxicological assessment and monitoring in both estuarine and marine systems. Main gaps found concern the scarcity of information available on ecotoxicological effects of HNS towards marine species and their poorly understood mode of action in wildlife. Differences were found between the sensitivity of freshwater and seawater organisms, so endpoints produced in the former may not be straightforwardly employed in evaluations for the marine environment. The relationship between sub-individual effects and higher level detrimental alterations (e.g. behavioural, morphological, reproductive effects and mortality) are not fully understood. In this context, a set of biomarkers associated to neurotoxicity, detoxification and anti-oxidant defences is suggested as potential indicators of toxic exposure/effects of HNS in marine organisms. Overall, to support the development of contingency plans and the establishment of environmental safety thresholds, it will be necessary to undertake targeted research on HNS ecotoxicity in the marine environment. Research should

  2. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions

    Science.gov (United States)

    Légaré, France; Robitaille, Hubert; Gane, Claire; Hébert, Jessica; Labrecque, Michel; Rousseau, François

    2016-01-01

    Background Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. Objective We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. Methods We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. Results We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. Conclusions More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations. PMID:26938633

  3. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions.

    Directory of Open Access Journals (Sweden)

    France Légaré

    Full Text Available Knowledge translation (KT interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties.We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing.We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153 published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC and Consumers and Communication.We retrieved 2473 unique trials of which we retained only 28 (1%. Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1 and educational outreach (n = 1. Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15, communication of DNA-based disease risk estimates (n = 7, personalized risk communication (n = 3 and mobile phone messaging (n = 1. Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective.More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations.

  4. Building ICT capabilities for clinical work in a sustainable healthcare system: approaches to bridging the higher education learning and teaching gap.

    Science.gov (United States)

    Gray, Kathleen; Sim, Jenny

    2007-01-01

    There is a recognised gap in information and communications technology (ICT) learning and teaching in higher education for entry-level healthcare professionals. This paper proposes a research model for understanding the dimensions of this gap. We describe methodological approaches to understanding present practices, identifying levers for change and learning by doing. We discuss issues faced in getting started and sustaining momentum on the research that is an essential prerequisite to effectively build the ICT capacity required by the clinical workforce in a sustainable healthcare system.

  5. Differences in trial knowledge and motives for participation among cancer patients in phase 3 clinical trials.

    Science.gov (United States)

    Godskesen, T M; Kihlbom, U; Nordin, K; Silén, M; Nygren, P

    2016-05-01

    While participants in clinical oncology trials are essential for the advancement of cancer therapies, factors decisive for patient participation have been described but need further investigation, particularly in the case of phase 3 studies. The aim of this study was to investigate differences in trial knowledge and motives for participation in phase 3 clinical cancer trials in relation to gender, age, education levels and former trial experience. The results of a questionnaire returned from 88 of 96 patients (92%) were analysed using the Mann-Whitney U-test. There were small, barely relevant differences in trial knowledge among patients when stratified by gender, age or education. Participants with former trial experience were less aware about the right to withdraw. Male participants and those aged ≥65 years were significantly more motivated by a feeling of duty, or by the opinions of close ones. Men seem more motivated than women by external factors. With the awareness that elderly and single male participants might be a vulnerable group and participants with former trial experience are less likely to be sufficiently informed, the information consent process should focus more on these patients. We conclude that the informed consent process seems to work well, with good results within most subgroups.

  6. The Immunology of Neuromyelitis Optica-Current Knowledge, Clinical Implications, Controversies and Future Perspectives.

    Science.gov (United States)

    Jasiak-Zatonska, Michalina; Kalinowska-Lyszczarz, Alicja; Michalak, Slawomir; Kozubski, Wojciech

    2016-03-02

    Neuromyelitis optica (NMO) is an autoimmune, demyelinating disorder of the central nervous system (CNS) with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS), it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs) changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd) and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%-25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs) and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs). This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients.

  7. The Immunology of Neuromyelitis Optica—Current Knowledge, Clinical Implications, Controversies and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Michalina Jasiak-Zatonska

    2016-03-01

    Full Text Available Neuromyelitis optica (NMO is an autoimmune, demyelinating disorder of the central nervous system (CNS with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS, it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%–25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs. This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients.

  8. Nutritional knowledge of medical students studying in clinical courses of Shahid Sadoughi University of Medical Sciences in 2012

    OpenAIRE

    H Mozaffari-Khosravi; Vaziri, N; A. Mohammadimanesh; Z. Naderi; H. Daneshbodi

    2013-01-01

    Introduction: Nutrition is one of the important components of health promotion and disease prevention. However, nutrition literacy of medical students is unclear. This study aims to determine nutritional knowledge of medical students studying in clinical course of Shahid Sadoughi University of Medical Sciences in 2012. Methods: In this cross-sectional study, 114 medical students in clinical course of Shahid Sadoughi hospital were randomly selected. Nutritional knowledge questionnaire was comp...

  9. 知识缺口视域下科研团队成员选择研究%Research on the Selection of Research Team Members Based on Knowledge Gap

    Institute of Scientific and Technical Information of China (English)

    李纲; 刘先红

    2015-01-01

    将科研团队视为一个元网络,以成员、知识、目标为元素,建立元矩阵。以元矩阵为框架,分析了科研团队的成员选择路径。科研团队目标对知识存在需求关系,会形成知识缺口。在对目标和知识进行分解的基础上,提出了一种科研团队的知识缺口识别方法,该方法不仅量化了知识缺口,而且为科研团队的成员发现和评价提供了依据。以知识学习难度和时间紧缺程度为维度,分析了科研团队知识缺口的弥补策略和成员短缺的形成机理。科研团队的现有成员以知识缺口为依据,在各自局域网中发现符合要求的科研人员,从而形成候选成员集合。以候选成员集合为基础,提出了一种寻找入选成员的算法。%A research team can be viewed as a meta‐network ,whose elements include members ,knowledge ,and objec‐tives .A meta‐matrix of a research team can be created using theses elements in order to analyzing the path of selection of its members .The objectives of a research team demand knowledge ,while its members supply knowledge .This interaction between these elements results to a knowledge gap .A method of identifying the knowledge gap of a research team is pro‐posed based on the decomposition to knowledge and objectives .This method not only quantizes the knowledge gap ,but al‐so provides information for finding and evaluating the new members of a research team .It is proposed that how to remedy the knowledge gap and how a research team is formed according to the ability and time of a research team .The candidates can be found by members of a research team according to the knowledge gap .An algorithm that how to choose members form candidates is proposed .The results of our research are helpful to set up and manage research teams .

  10. Evolution of the clinical and epidemiological knowledge about Chagas disease 90 years after its discovery

    Directory of Open Access Journals (Sweden)

    Prata Aluízio

    1999-01-01

    Full Text Available Three different periods may be considered in the evolution of knowledge about the clinical and epidemiological aspects of Chagas disease since its discovery: (a early period concerning the studies carried out by Carlos Chagas in Lassance with the collaboration of other investigators of the Manguinhos School. At that time the disease was described and the parasite, transmitters and reservoirs were studied. The coexistence of endemic goiter in the same region generated some confusion about the clinical forms of the disease; (b second period involving uncertainty and the description of isolated cases, which lasted until the 1940 decade. Many acute cases were described during this period and the disease was recognized in many Latin American countries. Particularly important were the studies of the Argentine Mission of Regional Pathology Studies, which culminated with the description of the Romaña sign in the 1930 decade, facilitating the diagnosis of the early phase of the disease. However, the chronic phase, which was the most important, continued to be difficult to recognize; (c period of consolidation of knowledge and recognition of the importance of Chagas disease. Studies conducted by Laranja, Dias and Nóbrega in Bambuí updated the description of Chagas heart disease made by Carlos Chagas and Eurico Villela. From then on, the disease was more easily recognized, especially with the emphasis on the use of a serologic diagnosis; (d period of enlargement of knowledges on the disease. The studies on denervation conducted in Ribeirão Preto by Fritz Köberle starting in the 1950 decade led to a better understanding of the relations between Chagas disease and megaesophagus and other visceral megas detected in endemic areas.

  11. Nature-based solutions to climate change mitigation and adaptation in urban areas: perspectives on indicators, knowledge gaps, barriers, and opportunities for action

    Directory of Open Access Journals (Sweden)

    Nadja Kabisch

    2016-06-01

    Full Text Available Nature-based solutions promoting green and blue urban areas have significant potential to decrease the vulnerability and enhance the resilience of cities in light of climatic change. They can thereby help to mitigate climate change-induced impacts and serve as proactive adaptation options for municipalities. We explore the various contexts in which nature-based solutions are relevant for climate mitigation and adaptation in urban areas, identify indicators for assessing the effectiveness of nature-based solutions and related knowledge gaps. In addition, we explore existing barriers and potential opportunities for increasing the scale and effectiveness of nature-based solution implementation. The results were derived from an inter- and transdisciplinary workshop with experts from research, municipalities, policy, and society. As an outcome of the workshop discussions and building on existing evidence, we highlight three main needs for future science and policy agendas when dealing with nature-based solutions: (i produce stronger evidence on nature-based solutions for climate change adaptation and mitigation and raise awareness by increasing implementation; (ii adapt for governance challenges in implementing nature-based solutions by using reflexive approaches, which implies bringing together new networks of society, nature-based solution ambassadors, and practitioners; (iii consider socio-environmental justice and social cohesion when implementing nature-based solutions by using integrated governance approaches that take into account an integrative and transdisciplinary participation of diverse actors. Taking these needs into account, nature-based solutions can serve as climate mitigation and adaptation tools that produce additional cobenefits for societal well-being, thereby serving as strong investment options for sustainable urban planning.

  12. GAP between knowledge and skills for the implementation of the ACCM/PALS septic shock guidelines in India: Is the bridge too far?

    Directory of Open Access Journals (Sweden)

    Santhanam Indumathy

    2009-01-01

    Full Text Available Objective: To determine whether physicians were aware of and had the skills to implement the American College of Critical Care Medicine/Pediatric Advanced Life Support Course septic shock protocol. Design: A cross-sectional questionnaire survey. Setting: Four academic institutions in Chennai, Manipal, Mangalore, and Trivandrum - cities representing the three southern states of Tamil Nadu, Karnataka, and Kerala, respectively, between February and April 2006. Interventions: Pre and post lecture questions. They were evaluated using 11 questions testing knowledge and 10 questions testing their comfort level in performing interventions related to the initial resuscitation in septic shock. Measurement and Main Result: The ACCM/PALS sepsis guidelines were taught during the PALS course conducted in the four academic institutions. A total of 118 delegates participated, of whom 114 (97% were pediatricians and four (3% were anaesthetists. The overall mean number of correct responses for the 11 questions testing knowledge before and after the lecture was 2.1 and 4.07, respectively P=0.001(paired t test. Although, 42% of the respondents (n=50 were aware of the ACCM guidelines, 88% (n=104 did not adhere to it in their practice. A total of 86% (n=101 and 66% (n=78 did not feel comfortable titrating inotropes or intubating in the ED; 78% (n=92 and 67% (n=78, respectively felt that central venous access (CVA and arterial pressure (AP monitoring were unimportant in the management of fluid refractory shock. Of the physicians, 20% (n=24 had never intubated a patient, 78% (n=92 had not introduced a central venous catheter, and 76% (n=90 had never introduced an intra-arterial catheter. Conclusions: In view of the lack of skills and suboptimal knowledge, the ACCM/PALS sepsis guidelines may be inappropriate in its current format in the Indian setting. More emphasis needs to be placed on educating community pediatricians with a simpler clinical protocol, which has the

  13. Beyond bridging the know-do gap: a qualitative study of systemic interaction to foster knowledge exchange in the public health sector in The Netherlands

    NARCIS (Netherlands)

    Driessen Mareeuw, van den F.; Vaandrager, L.; Klerkx, L.W.A.; Naaldenberg, J.; Koelen, M.

    2015-01-01

    Background: Despite considerable attention currently being given to facilitating the use of research results in public health practice, several concerns remain, resulting in the so-called know-do gap. This article aims to identify the key tensions causing the know-do gap from a broad perspective by

  14. Beyond bridging the know-do gap: a qualitative study of systemic interaction to foster knowledge exchange in the public health sector in The Netherlands

    NARCIS (Netherlands)

    Driessen Mareeuw, F.A. van den; Vaandrager, L.; Klerkx, L.; Naaldenberg, J.; Koelen, M.

    2015-01-01

    BACKGROUND: Despite considerable attention currently being given to facilitating the use of research results in public health practice, several concerns remain, resulting in the so-called know-do gap. This article aims to identify the key tensions causing the know-do gap from a broad perspective by

  15. Cervical Cancer Screening Knowledge and Behavior among Women Attending an Urban HIV Clinic in Western Kenya.

    Science.gov (United States)

    Rosser, Joelle I; Njoroge, Betty; Huchko, Megan J

    2015-09-01

    Cervical cancer is a highly preventable disease that disproportionately affects women in developing countries and women with HIV. As integrated HIV and cervical cancer screening programs in Sub-Saharan Africa mature, we have an opportunity to measure the impact of outreach and education efforts and identify areas for future improvement. We conducted a cross-sectional survey of 106 women enrolled in care at an integrated HIV clinic in the Nyanza Province of Kenya 5 years after the start of a cervical cancer screening program. Female clinic attendees who met clinic criteria for cervical cancer screening were asked to complete an oral questionnaire assessing their cervical cancer knowledge, attitudes, and screening history. Ninety-nine percent of women had heard of screening, 70 % felt at risk, and 84 % had been screened. Increased duration of HIV diagnosis was associated with feeling at risk and with a screening history. Nearly half (48 %) of women said they would not get screened if they had to pay for it.

  16. Knowledge and critical thinking skills increase clinical reasoning ability in urogenital disorders: a Universitas Sriwijaya Medical Faculty experience

    Directory of Open Access Journals (Sweden)

    Irfannuddin Irfannuddin

    2009-03-01

    Full Text Available Aim Clinical reasoning is one of the essential competencies for medical practitioners, so that it must be exercised by medical students. Studies on quantitative evidence of factors influencing clinical reasoning abilicy of students are limited. The aim of this study was to determine the influence of knowledge and other factors on the clinical reasoning abiliry ofthe students, which can serve as reference to establish methods for learning ctinical reasoning.Methods This is a cross-sectional study on fourth semester students enrolled in the Competency-based Curriculum of the Medical Faculty, University of Sriwijaya. Data on clinical reasoning abilily and risk factors during urogenital blockwere collected inApril 2008, when the students have just completed the btock. Clinical reasoning abiliry was tested using the Script Concordance test and the risk factors were evaluated based on formative tests, block summative assessments, and student characteristics. Data were analyzed by Cox regression.Results The prevalence of low clinical reasoning ability of the 132 students was 38.6%. The group with low basic knowledge was found to have 63% risk ol low clinical reasoning abiliry when compared to those with high basic knowledge (adjusted RR = 1.63; 95% conidence intewal (Ct: 1.10 -2.42. When compared to students with high critical thinking skitls, those with lory critical thinking skills had 2.3 time to be low clinical reasoning abitity (adjusted RR : 2.30; 95% CI: 1.55 - 3.41.Conclusion Students with low critical thinking skills or with inadequate knowledge had a higher risk of low clinical reasoning ability. (Med J Indones 2009; 18: 53-9Keywords: clinical reasoning, basic knowledge, critical thinking, competency-based curriculum

  17. Human immunodeficiency virus and viral hepatitis among high-risk groups: Understanding the knowledge gap in the Middle East and North Africa Region

    Science.gov (United States)

    Melhem, Nada M; Rahhal, Nour; Charide, Rana; Kreidieh, Khalil; El-Khatib, Rolla

    2015-01-01

    AIM: To identify gaps in the existing knowledge on single, dual and triple infections of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in the Middle East and North Africa (MENA) region among men who have sex with men (MSMs), female sex workers (FSWs), injecting drug users (IDUs) and prisoners. METHODS: We performed an extensive literature search on articles published on the topic in the 25 countries of the MENA region. PubMed database was used as the main search engine. Case reports, case series, qualitative studies, editorials, commentaries, authors’ replies and animal studies were excluded. Original articles and reviews dealing with the prevalence of HIV, HBV and HCV and their co-infection were included. Data on population type, sample size, age and markers of infections were extracted from the relevant studies. RESULTS: HIV, HBV and HCV are blood-borne viruses with similar modes of transmission. The categories of people at high risk of acquiring HIV-1, HBV and HCV commonly include: MSMs, FSW and IDUs. It is well established that HIV-positive individuals co-infected with HBV or HCV suffer from liver pathology associated with morbidity and mortality. Moreover, HIV-infected individuals do not respond well to treatment for HBV or HCV and hence are at increased risk of hepatic toxicity. Consequently, co-infection of HIV-positive individuals with HBV and/or HCV is a global health problem of significant magnitude. Our review reveals the paucity of epidemiological data for key populations in many countries of the region. Limited number of studies exists in the MENA region on the status of HIV, HBV and HCV and their co-infections among prisoners, MSMs and FSWs. Evidence support the continued increase of the HIV epidemic among MSMs. In addition to the lack of studies on MSMs and FSWs in the MENA region, our review highlights the lack of data on the practices, characteristics, or the status of HIV infection and viral hepatitis

  18. The Developmental Brain Disorders Database (DBDB): a curated neurogenetics knowledge base with clinical and research applications.

    Science.gov (United States)

    Mirzaa, Ghayda M; Millen, Kathleen J; Barkovich, A James; Dobyns, William B; Paciorkowski, Alex R

    2014-06-01

    The number of single genes associated with neurodevelopmental disorders has increased dramatically over the past decade. The identification of causative genes for these disorders is important to clinical outcome as it allows for accurate assessment of prognosis, genetic counseling, delineation of natural history, inclusion in clinical trials, and in some cases determines therapy. Clinicians face the challenge of correctly identifying neurodevelopmental phenotypes, recognizing syndromes, and prioritizing the best candidate genes for testing. However, there is no central repository of definitions for many phenotypes, leading to errors of diagnosis. Additionally, there is no system of levels of evidence linking genes to phenotypes, making it difficult for clinicians to know which genes are most strongly associated with a given condition. We have developed the Developmental Brain Disorders Database (DBDB: https://www.dbdb.urmc.rochester.edu/home), a publicly available, online-curated repository of genes, phenotypes, and syndromes associated with neurodevelopmental disorders. DBDB contains the first referenced ontology of developmental brain phenotypes, and uses a novel system of levels of evidence for gene-phenotype associations. It is intended to assist clinicians in arriving at the correct diagnosis, select the most appropriate genetic test for that phenotype, and improve the care of patients with developmental brain disorders. For researchers interested in the discovery of novel genes for developmental brain disorders, DBDB provides a well-curated source of important genes against which research sequencing results can be compared. Finally, DBDB allows novel observations about the landscape of the neurogenetics knowledge base.

  19. A versatile knowledge-based clinical imaging annotation system for breast cancer screening

    Science.gov (United States)

    Gemo, Monica; Gouze, Annabelle; Debande, Benoît; Grivegnée, André; Mazy, Gilbert; Macq, Benoît

    2007-03-01

    Medical information is evolving towards more complex multimedia data representation, as new imaging modalities are made available by sophisticated devices. Features such as segmented lesions can now be extracted through analysis techniques and need to be integrated into clinical patient data. The management of structured information extracted from multimedia has been addressed in knowledge based annotation systems providing methods to attach interpretative semantics to multimedia content. Building on these methods, we develop a new clinical imaging annotation system for computer aided breast cancer screening. The proposed system aims at more consistent, efficient and standardised data mark-up of digital and digitalised radiology images. The objective is to provide detailed characterisation of abnormalities as an aid in the diagnostic task through integrated annotation management. The system combines imaging analysis results and radiologist diagnostic information about suspicious findings by mapping well-established visual and low-level descriptors into pathology specific profiles. The versatile characterisation allows differentiating annotation descriptors for different types of findings. Our approach of semi-automatic integrated annotations supports increased quality assurance in screening practice. This is achieved through detailed and objective patient imaging information while providing user-friendly means for their manipulation that is oriented to relieving the radiologist's workload.

  20. Changing HIV clinical knowledge and skill in context: the impact of longitudinal training in the Southeast United States.

    Science.gov (United States)

    Culyba, Rebecca J; McGee, Blake Tyler; Weyer, Dianne

    2011-01-01

    In the Southeast United States, HIV care is provided in a context of disproportionate HIV prevalence and barriers to care, including rural locales, higher proportions of African American and uninsured patients, and inadequate health care workforce and infrastructure. The authors describe a regional on-site longitudinal training program developed to target multidisciplinary teams providing HIV primary care at clinical sites in the region. The effect of this training program was evaluated using pre- and 3-month post-program knowledge and skills tests, a post-training evaluation questionnaire, and a post-program focus group. The authors found desired effects, with increases in knowledge and skills and improved capacity of providers to meet patient care needs across all clinical sites despite variations in terms of HIV-infected patient loads. However, the lack of enabling factors present in clinic environments may attenuate the application of new knowledge and skills, underscoring the relevance of teamwork training in HIV care settings.

  1. Learning in context: identifying gaps in research on the transfer of medical communication skills to the clinical workplace.

    NARCIS (Netherlands)

    Eertwegh, V. van den; Dulmen, S. van; Dalen, J. van; Scherpbier, A.J.J.A.; Vleuten, C.P.M. van der

    2013-01-01

    Objective: In order to reduce the inconsistencies of findings and the apparent low transfer of communication skills from training to medical practice, this narrative review identifies some main gaps in research on medical communication skills training and presents insights from theories on learning

  2. Learning in context: identifying gaps in research on the transfer of medical communication skills to the clinical workplace

    NARCIS (Netherlands)

    Eertwegh, V. van den; Dulmen, S. van; Dalen, J. Van; Scherpbier, A.J.J.A.; Vleuten, C.P.M. van der

    2013-01-01

    OBJECTIVE: In order to reduce the inconsistencies of findings and the apparent low transfer of communication skills from training to medical practice, this narrative review identifies some main gaps in research on medical communication skills training and presents insights from theories on learning

  3. Discovering treatment pattern in Traditional Chinese Medicine clinical cases by exploiting supervised topic model and domain knowledge.

    Science.gov (United States)

    Yao, Liang; Zhang, Yin; Wei, Baogang; Wang, Wei; Zhang, Yuejiao; Ren, Xiaolin; Bian, Yali

    2015-12-01

    In Traditional Chinese Medicine (TCM), the prescription is the crystallization of clinical experience of doctors, which is the main way to cure diseases in China for thousands of years. Clinical cases, on the other hand, describe how doctors diagnose and prescribe. In this paper, we propose a framework which mines treatment patterns in TCM clinical cases by exploiting supervised topic model and TCM domain knowledge. The framework can reflect principle rules in TCM and improve function prediction of a new prescription. We evaluate our method on 3090 real world TCM clinical cases. The experiment validates the effectiveness of our method.

  4. Oral health knowledge among pre-clinical students of International Branch of Shiraz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    2015-01-01

    Full Text Available   Background and Aims: Oral health is an important issue in public health with a great impact on individuals’ general health status. A good access to oral healthcare services and a good knowledge of it play a key role in the oral disease prevention. A better health attitude and practice require a better knowledge. The aims of this study was to evaluate the oral health knowledge among the International students branch (Kish of Shiraz University of Medical Sciences in 2011-12.   Materials and Methods: 159 pre-clinical students in medicine (54 students, dentistry (69 students and pharmacy (36 students participated in this research. A standard questionnaire was used as the main tool of research to evaluate the attitude and knowledge of students about the oral health. Data were analyzed using Chi-square test.   Results: According to the results, dental students had the best level of knowledge and pharmacy students had a better knowledge level compared to the medical students. The results also showed a significant relationship between students’ oral health knowledge and their field and duration of study and the place of their secondary school (P0.05.   Conclusion: The results showed that the students at the International Branch of Shiraz University of Medical Sciences had a relatively good knowledge of oral health. Students’ knowledge level can be improved by providing students with educational materials, organized workshops and seminars.

  5. A Study of the Competency of Third Year Medical Students to Interpret Biochemically Based Clinical Scenarios Using Knowledge and Skills Gained in Year 1 and 2

    Science.gov (United States)

    Gowda, Veena Bhaskar S.; Nagaiah, Bhaskar Hebbani; Sengodan, Bharathi

    2016-01-01

    Medical students build clinical knowledge on the grounds of previously obtained basic knowledge. The study aimed to evaluate the competency of third year medical students to interpret biochemically based clinical scenarios using knowledge and skills gained during year 1 and 2 of undergraduate medical training. Study was conducted on year 3 MBBS…

  6. The importance of knowledge, skills, and attitude attributes for veterinarians in clinical and non-clinical fields of practice: a survey of licensed veterinarians in Quebec, Canada.

    Science.gov (United States)

    Doucet, Michèle Y; Vrins, André

    2009-01-01

    To improve content validity and the pertinence of outcome assessment tools used for the undergraduate Doctor of Veterinary Medicine program at the University of Montreal's Faculté de médecine vétérinaire, a survey of members of the Quebec veterinary association was conducted. This survey aimed to determine the importance of a list of 71 attributes-categorized as knowledge, general skills, specific skills, and attitudes-for clinical and non-clinical types of professional activities. The results indicated that all basic knowledge components, general skills, and attitudes were equally important for all types of veterinary professional activities, while the importance of specific skills was significantly different for clinical practice and non-clinical fields. It was therefore proposed that outcomes assessment surveys of stakeholders, such as alumni and employers, be analyzed separately for each type of career option.

  7. The knowledge and attitudes towards complementary and alternative medicine among patients admitted dermatology outpatient clinic

    Directory of Open Access Journals (Sweden)

    Kürşat Göker

    2015-12-01

    Full Text Available Background and Design: This study aimed to evaluate the knowledge and general approach towards complementary and alternative medicine (CAM among patients admitted to our outpatient clinic. Materials and Methods: This descriptive cross-sectional survey was carried out between May 2012-2013. A questionnaire comprising 25 questions was prepared and filled by using face to face interview technique in our outpatient clinic. Results: A total of 1.021 patients were included. Six hundred nineteen (60.6% were male and 402 (39.4% were female. 30.5% of the participants reported CAM and 21.8% reported dermatological purpose. Women in the 30-39 age group and patients, who were college graduate and having high income levels, were using CAM more frequently. The most common conditions for CAM use were pigmentation disorders, hair diseases and inflammatory dermatoses. The most commonly used methods were herbal products, prayer and megavitamins. 61.1% of patients using CAM reported positive effects while 5.5% had side effects. Patients were using CAM because it was often recommended. 71.3% of patients reported not knowing the side effects, 59.5% of patients stated that they would inform their doctors about CAM usage, 1/3 of the patients wanted reimbursement of CAM by the Social Security Institution and would recommend CAM they used to others, 85% of patients reported that they would prefer medical treatments firstly. 12.9% of patients using CAM had a family history of CAM use. Conclusion: We found that the rate of CAM therapies was increased in the female patients, in those with high levels of income and education and who had a family history of CAM use. We observed that our participants commonly preferred herbal products. They usually used CAM on the recommendation of a friend. They did not have enough information about the side effects. The majority of participants preferred medical treatments.

  8. Using the Knowledge to Action Process Model to Incite Clinical Change

    Science.gov (United States)

    Petzold, Anita; Korner-Bitensky, Nicol; Menon, Anita

    2010-01-01

    Introduction: Knowledge translation (KT) has only recently emerged in the field of rehabilitation with attention on creating effective KT interventions to increase clinicians' knowledge and use of evidence-based practice (EBP). The uptake of EBP is a complex process that can be facilitated by the use of the Knowledge to Action Process model. This…

  9. Considering Human Capital Theory in Assessment and Training: Mapping the Gap between Current Skills and the Needs of a Knowledge-Based Economy in Northeast Iowa

    Science.gov (United States)

    Mihm-Herold, Wendy

    2010-01-01

    In light of the current economic downturn, thousands of Iowans are unemployed and this is the ideal time to build the skills of the workforce to compete in the knowledge-based economy so businesses and entrepreneurs can compete in a global economy. A tool for assessing the skills and knowledge of dislocated workers and students as well as…

  10. Ontology-supported processing of clinical text using medical knowledge integration for multi-label classification of diagnosis coding

    CERN Document Server

    Waraporn, Phanu; Clayton, Gareth

    2010-01-01

    This paper discusses the knowledge integration of clinical information extracted from distributed medical ontology in order to ameliorate a machine learning-based multi-label coding assignment system. The proposed approach is implemented using a decision tree based cascade hierarchical technique on the university hospital data for patients with Coronary Heart Disease (CHD). The preliminary results obtained show a satisfactory finding.

  11. Development and Analysis of an Instrument to Assess Student Understanding of GOB Chemistry Knowledge Relevant to Clinical Nursing Practice

    Science.gov (United States)

    Brown, Corina E.; Hyslop, Richard M.; Barbera, Jack

    2015-01-01

    The General, Organic, and Biological Chemistry Knowledge Assessment (GOB-CKA) is a multiple-choice instrument designed to assess students' understanding of the chemistry topics deemed important to clinical nursing practice. This manuscript describes the development process of the individual items along with a psychometric evaluation of the…

  12. Promoting Clinical Knowledge, Skills, and Empathy via a Creative Self-Suicide Assignment: Rationale, Purpose, and Student Responses

    Science.gov (United States)

    Cook, Katrina; Juhnke, Gerald A.; Peters, Scott W.; Marbach, Christina R.; Day, Sally; Choucroun, Pierre; Baker, Ria E.

    2007-01-01

    Suicide is a leading cause of American deaths. Given suicide's overall frequency and negative effects, specialized suicide training is warranted. This article describes a creative self-suicide assignment designed to enhance doctoral students' suicide assessment and intervention knowledge and clinical skills, and promote greater counselor empathy…

  13. The Adaptation Gap Report - a Preliminary Assessment

    DEFF Research Database (Denmark)

    Alverson, Keith; Olhoff, Anne; Noble, Ian;

    This first Adaptation Gap report provides an equally sobering assessment of the gap between adaptation needs and reality, based on preliminary thinking on how baselines, future goals or targets, and gaps between them might be defined for climate change adaptation. The report focuses on gaps in de...... in developing countries in three important areas: finance, technology and knowledge....

  14. Representation and integration of sociological knowledge using knowledge graphs

    NARCIS (Netherlands)

    Popping, R; Strijker, [No Value

    1997-01-01

    The representation and integration of sociological knowledge using knowledge graphs, a specific kind of semantic network, is discussed. Knowledge it systematically searched this reveals. inconsistencies, reducing superfluous research and knowledge, and showing gaps in a theory. This representation i

  15. The music therapy clinical intern: performance skills, academic knowledge, personal qualities, and interpersonal skills necessary for a student seeking clinical training.

    Science.gov (United States)

    Brookins, L M

    1984-01-01

    The music therapy curriculum consists of two distinct parts: the academic phase and the internship. The music therapy student must apply for a clinical internship during the last year of the academic phase, and the student is expected to evolve from student to professional music therapist during the internship phase. The present study sought to determine the skills, knowledge, and qualities clinical training directors considered most important for a prospective intern to possess. The sample population of the survey consisted of 25 clinical training directors from the Great Lakes Region. Results of the survey indicated that piano skills, knowledge of psychology, emotional maturity, and the ability to express needs and feelings were considered most important for the prospective intern to possess.

  16. Knowledge Toward Cancer Pain and the Use of Opioid Analgesics Among Medical Students in their Integrated Clinical Clerkship

    Directory of Open Access Journals (Sweden)

    Maria Fidelis C. Manalo

    2008-01-01

    Full Text Available Introduction: Among the focal issues of barriers to pain management include the physicians’ lack of knowledge about cancer pain and negative attitudes towards opioids. Many physicians and educators attribute this, at least in part, to limited exposure to pain and palliative care education during medical school.Aim: The researcher investigated the medical students’ knowledge about cancer pain and the use of opioid analgesics.Methods: The subjects were a sample of 50 students of the University of the Philippines College of Medicine in their integrated clinical clerkship year. Descriptive statistics (frequencies, means, standard deviation, rating scales were used to determine mean knowledge score and level of confidence with opioid use. The study also identified specific areas where students exhibited good or poor knowledge of opioids.Results: Approximately sixty-nine (69% of the study respondents mentioned that pain management was given to them during their Anesthesiology lectures while a few recalled that they had these lectures during their Family Medicine rotation in Supportive, Palliative and Hospice Care. More than a third (35% of the respondents admitted to not being confident with morphine use at present. The top three reasons cited as limitations in choice of opioids for cancer pain include fear of addiction, lack of adequate knowledge and experience and fear of side effects and complications. Out of a maximum of 13 correct answers, the mean knowledge score of the medical students was 6.6 ± 2.9. Less than 16% of the respondents had adequate knowledge on cancer pain and opioid use.Conclusions: The results show that basic knowledge of the role of opioids in cancer pain management among medical students in their integrated clinical clerkship year at the University of the Philippines is poor. The findings imply a need to look into making revisions in the medical curriculum to include a training program that will enable all students to

  17. Study of Clinical Decision Support Knowledge Base%临床决策支持知识库研究

    Institute of Scientific and Technical Information of China (English)

    徐金耀

    2011-01-01

    Objective To explore clinical decision support knowledge base model that is suitable to practical use by utilizing knowledge management idea and method, which is used to enhance hospital core competency. Methods Collecting domestic and foreign medical informatics related information, to study and analyze the framework of clinical decision support knowledge base with artificial intelligence. Results The key to implement hospital knowledge management is to establish machine-learning and dynamic clinical decision support knowledge base, which is not only connected with HIS to collect traditional medical knowledge , but also needs establishing standard medical knowledge collecting engine and tacit medical knowledge translation model; in addition, intelligentized tools are embedded in the knowledge base, which make it hold machine learning function and intelligentized clinical decision support capacity with dynamic and updated medical knowledge. Conclusion The process to establish hospital knowledge base, in fact, is to create hospital value.The development of intelligentized clinical decision support knowledge base is not only related to medical knowledge collection and processing,but also dealt with medical knowledge expression, artificial intelligence technique embedding and application of rules, terms and classifications, which needs further study.%目的 运用知识管理的理念和方法,探讨切合实际应用的临床决策支持知识库概念模型,使医院能够通过知识管理提升其核心竞争力.方法收集国内外相关资料,系统化研究及分析具有人工智能的临床决策支持知识库的框架.结果实施医院知识管理的关键就是必须建立一个动态的,并具有自我学习能力的临床决策支持知识库,该知识库不仅需要通过医院信息系统收集传统的医学知识,而且需要建立用于临床指南等的标准医学知识收集的引擎和隐性知识转化模型,并嵌入智能化工具,通过

  18. Pharmacy Education Reaction to Presentations on Bridging the Gap Between the Basic Sciences and Clinical Practice: Teaching, Research, and Service.

    Science.gov (United States)

    Doluisio, James T.

    1980-01-01

    Issues in the conflict between clinical practice and basic research in pharmacy are reviewed: professional associations' role, curriculum needs and traditions, internal strains and diversity in the profession, computer use, scholarly work of faculty, using the medical profession as a model, and misperceptions of what clinical and basic sciences…

  19. Improvement of knowledge, attitude and perception of healthcare workers about ADR, a pre- and post-clinical pharmacists' interventional study

    Science.gov (United States)

    Mohebbi, Niayesh; Hendoiee, Narjes; Keshtkar, Abbas-Ali; Dashti-Khavidaki, Simin

    2012-01-01

    Purpose Healthcare workers have a main role in detection, assessment and spontaneous reporting of adverse drug reactions (ADRs), and improvement of their related knowledge, attitude and perception is essential. The goal of this study was evaluation of clinical pharmacists' interventions in improvement of knowledge, attitude and perception of healthcare workers about ADRs in a teaching referral hospital, Tehran, Iran. Method Changes in knowledge, attitude and perception of healthcare workers of Imam teaching hospital about ADRs were evaluated before and after clinical pharmacists' interventions including workshops, meetings and presentations. Results From the 100 participated subjects, 82 of them completed the study. 51% of the health workers have been aware of the Iranian Pharmacovigilance Center at the ministry of health before intervention and after that all the participants knew this centre. About awareness and detection of ADRs in patients, 69 (84.1%) healthcare workers recognised at least one, and following interventions, it was improved to 73 (89%). Only seven (8.5%) subjects have reported ADRs in before intervention phase that were increased significantly to 18 (22%) after intervention. Conclusion Clinical pharmacists' interventions were successful in improvement of healthcare workers' knowledge, attitude and perception about ADRs and spontaneous reporting in our hospital. PMID:22246555

  20. The Adaptation Finance Gap Report

    DEFF Research Database (Denmark)

    UNEP’s Adaptation Gap Report series focuses on Finance, Technology and Knowledge gaps in climate change adaptation. It compliments the Emissions Gap Report series, and explores the implications of failing to close the emissions gap. The report builds on a 2014 assessment by the United Nations...... Environment Programme (UNEP), which laid out the concept of ‘adaptation gaps’ and outlined three such gaps: technology, finance and knowledge. The 2016 Adaptation Gap Report assesses the difference between the financial costs of adapting to climate change in developing countries and the amount of money...... actually available to meet these costs – a difference known as the “adaptation finance gap”. Like the 2014 report, the 2016 report focuses on developing countries, where adaptation capacity is often the lowest and needs the highest, and concentrates on the period up to 2050. The report identifies trends...

  1. Components of the Belief Gap

    Directory of Open Access Journals (Sweden)

    Cecilie Gaziano

    2014-01-01

    Full Text Available Knowledge gap research focuses on education as an indicator of socioeconomic status (SES. Belief gap research centers on ideology as potentially more powerful than education in comparing sociopolitical groups with scientifically established knowledge and groups with opposing beliefs accepted on faith. This study examined the relationship between education and ideology to understand belief gaps better. The study used 2008 American National Election Study (ANES data to compare conservatives, moderates, and liberals by education on religiosity, child rearing values, opinionation, need for cognition, orientation toward politics, and mass media access and use. Although liberals tended to be more educated than conservatives overall, better-educated conservatives had the highest household incomes and were a much larger group. No known knowledge gap studies have reported results on one group characterized by high education and an opposing group distinguished by a different indicator of SES. Reformulations of the belief gap hypothesis are offered.

  2. Nutritional knowledge of medical students studying in clinical courses of Shahid Sadoughi University of Medical Sciences in 2012

    Directory of Open Access Journals (Sweden)

    H. Mozaffari-Khosravi

    2013-09-01

    Full Text Available Introduction: Nutrition is one of the important components of health promotion and disease prevention. However, nutrition literacy of medical students is unclear. This study aims to determine nutritional knowledge of medical students studying in clinical course of Shahid Sadoughi University of Medical Sciences in 2012. Methods: In this cross-sectional study, 114 medical students in clinical course of Shahid Sadoughi hospital were randomly selected. Nutritional knowledge questionnaire was completed. Each correct answer had one score and wrong answers had no score. Results: Of 114 students, 69 students (60.5% were female and 45 students (39.5% were male with the mean age of 24.1±1.5 year. The mean score of students in basic nutrition, nutrition in the life cycle and diet therapy was 4.6±2.2, 6.2±3.2 and 6.2±3.8, respectively. There was significant association between the score of nutrition course and nutritional knowledge score in all of the fields. Conclusion: The average of scores was low. Improving the nutrition courses, especially clinical aspects, during clinical education and presence of nutritionist in treatment teams will be helpful.

  3. Bridging the gap between basic science and clinical practice: The role of organizations in addressing clinician barriers

    Directory of Open Access Journals (Sweden)

    Taylor Stephanie

    2011-04-01

    Full Text Available Abstract Background New National Institutes of Health policies call for expansion of practice-based research to improve the clinical research enterprise and facilitate dissemination of evidence-based medicine. Objective This paper describes organizational strategies that influence clinicians' decisions to participate in clinical research. Design We reviewed the literature and interviewed over 200 clinicians and stakeholders. Results The most common barriers to community clinician participation in clinical research relate to beliefs that clinical research is too burdensome and has little benefit for the participating clinician or patient. We identified a number of approaches healthcare organizations can use to encourage clinicians to participate in research, including an outreach campaign to promote the benefits of clinical research; selection of study topics of interest to clinicians; establishment and enforcement of a set of research principles valuing the clinician and patient; development of a transparent schedule of reimbursement for research tasks; provision of technological and technical assistance to practices as needed; and promotion of a sense of community among clinicians involved in practice-based research. Conclusions Many types of existing healthcare organizations could provide the technical and intellectual assistance community clinicians need to participate in clinical research. Multiple approaches are possible.

  4. How Can a Clinical Research Approach Contribute to Knowledge-Building for the Teaching Profession?

    Science.gov (United States)

    Bulterman-Bos, Jacquelien

    2017-01-01

    This article explains what clinical research is and why it is necessary. The term "clinical" refers to an academic way of solving practical problems. Clinical research starts from a view of science that not only acknowledges the value of rational analysis and empirical research, but also acknowledges the need for human skills and…

  5. Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727

    Directory of Open Access Journals (Sweden)

    Law Mary

    2006-07-01

    Full Text Available Abstract Background A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning related to health outcome measures. Method/Design Physical and occupational therapists (n = 144 will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1 Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS, and 2 Online Problem-Based course (e-PBL. SHIPS will consist of face-to-face problem-based learning (PBL for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT

  6. PhoneGap for enterprise

    CERN Document Server

    Shotts, Kerri

    2014-01-01

    This book is intended for developers who wish to use PhoneGap to develop useful, rich, secure mobile applications for their enterprise environment. The book assumes you have working knowledge of PhoneGap, HTML5, CSS3, and JavaScript, and a reasonable understanding of networking and n-tier architectures.

  7. Knowledge Translation from Research to Clinical Practice: Measuring Participation of Children with Disabilities.

    Science.gov (United States)

    Jeong, Yunwha; Law, Mary; DeMatteo, Carol; Stratford, Paul; Kim, Hwan

    2016-10-01

    This knowledge translation project was conducted to increase occupational therapy practitioners' awareness of the importance of measuring participation of children with disabilities. The Knowledge to Action process framework (KTA framework) guided knowledge translation via a web-based seminar (webinar) to practitioners working with children and educators teaching in occupational therapy programs in South Korea. Two hundred and seventy six views of the webinar were recorded within a month and 15 practitioners and 13 educators completed the online evaluation survey. The participants indicated that the webinar helped them understand the participation concept and its associated measures and raised awareness of practitioners' current use of measurement and intervention that do not focus on participation of children with disabilities. This project led practitioners and educators to realize the importance of measuring participation of children with disabilities and contributes to inform the importance of knowledge translation science to facilitate the evidence-based practice.

  8. Falls after Discharge from Hospital: Is There a Gap between Older Peoples' Knowledge about Falls Prevention Strategies and the Research Evidence?

    Science.gov (United States)

    Hill, Anne-Marie; Hoffmann, Tammy; Beer, Christopher; McPhail, Steven; Hill, Keith D.; Oliver, David; Brauer, Sandra G.; Haines, Terry P.

    2011-01-01

    Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. Design and Methods: We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies…

  9. The Infectious Diseases Society of America emerging infections network: bridging the gap between clinical infectious diseases and public health.

    Science.gov (United States)

    Pillai, Satish K; Beekmann, Susan E; Santibanez, Scott; Polgreen, Philip M

    2014-04-01

    In 1995, the Centers for Disease Control and Prevention granted a Cooperative Agreement Program award to the Infectious Diseases Society of America to develop a provider-based emerging infections sentinel network, the Emerging Infections Network (EIN). Over the past 17 years, the EIN has evolved into a flexible, nationwide network with membership representing a broad cross-section of infectious disease physicians. The EIN has an active electronic mail conference (listserv) that facilitates communication among infectious disease providers and the public health community, and also sends members periodic queries (short surveys on infectious disease topics) that have addressed numerous topics relevant to both clinical infectious diseases and public health practice. The article reviews how the various functions of EIN contribute to clinical care and public health, identifies opportunities to further link clinical medicine and public health, and describes future directions for the EIN.

  10. Knowledge and perception regarding clinical trials among doctors of government medical colleges: A questionnaire-based study

    Directory of Open Access Journals (Sweden)

    Supriyo Choudhury

    2016-01-01

    Full Text Available Aims: By virtue of being a specialized field by itself, the science of clinical trials (CTs may not be well understood by doctors who are not specifically trained in it. A lack of knowledge may translate to a negative perception toward CT. With the idea of getting a situational snapshot, we estimated the knowledge and perception of CTs among doctors from government medical colleges of West Bengal who are not trained on CT in their postgraduate curriculum. Several determinants of knowledge and perception regarding CT were also evaluated. Methods: We have quantified the knowledge and perception of CTs by a structured validated questionnaire. Development and validation of the questionnaire was performed prior to the study. Results: Among 133 participants, 7.5% received focused training on CT and 16.5% participated in CTs as investigators. Majority of the doctors were unfamiliar with the basic terminologies such as, “adverse event” and “good clinical practice.” Encouragingly, 93.3% doctors advised that a detailed discussion of CT methodology should be incorporated in the under graduate medical science curriculum. They had an overall positive attitude toward CTs conducted in India, with a mean score that is 72.6% of the maximum positive score. However, a large number of the doctors were skeptical about the primary motivation and operations of pharmaceutical industry sponsored CTs, with 45% of them believing that patients are exploited in these sponsored CTs. Conclusion: Participant doctors had a basic knowledge of CT methodology. The study has revealed specific areas of deficient knowledge, which might be emphasized while designing focused training on CT methodology.

  11. Can we bridge the gap? Knowledge and practices related to Diabetes Mellitus among general practitioners in a developing country: A cross sectional study

    Directory of Open Access Journals (Sweden)

    Katulanda Prasad

    2011-11-01

    Full Text Available Abstract Background Diabetes mellitus is becoming a serious public health problem in Sri Lanka and many other developing countries in the region. It is well known that effective management of diabetes reduces the incidence and progression of many diabetes related complications, thus it is important that General Practitioners (GPs have sound knowledge and positive attitudes towards all aspects of its management. This study aims to assess knowledge, awareness and practices relating to management of Diabetes Mellitus among Sri Lankan GPs. Methods A cross-sectional study was conducted among all 246 GPs registered with the Ceylon College of General Practitioners using a pre-validated self-administered questionnaire. Results 205 responded to the questionnaire(response rate 83.3%. Their mean duration of practice was 28.7 ± 11.2 years. On average, each GP had 27 ± 25 diabetic-patient consultations per-week. 96% managed diabetic patients and 24% invariably sought specialist opinion. 99.2% used blood glucose to diagnose diabetes but correct diagnostic cut-off values were known by only 48.8%. Appropriate use of HbA1c and urine microalbumin was known by 15.2% and 39.2% respectively. 84% used HbA1c to monitor glyceamic control, while 90.4% relied on fasting blood glucose to monitor glyceamic control. Knowledge on target control levels was poor. Nearly 90% correctly selected the oral hypoglyceamic treatment for obese as well as thin type 2 diabetic patients. Knowledge on the management of diabetes in pregnancy was poor. Only 23.2% knew the correct threshold for starting lipid-lowering therapy. The concept of strict glycaemic control in preference to symptom control was appreciated only by 68%. The skills for comprehensive care in subjects with multiple risk factors were unsatisfactory. Conclusions The study was done among experienced members of the only professional college dedicated to the specialty. However, we found that there is room for improvement in

  12. Mythic gaps

    Directory of Open Access Journals (Sweden)

    William Hansen

    2014-11-01

    Full Text Available Different kinds of omissions sometimes occur, or are perceived to occur, in traditional narratives and in tradition-inspired literature. A familiar instance is when a narrator realizes that he or she does not fully remember the story that he or she has begun to tell, and so leaves out part of it, which for listeners may possibly result in an unintelligible narrative. But many instances of narrative gap are not so obvious. From straightforward, objective gaps one can distinguish less-obvious subjective gaps: in many cases narrators do not leave out anything crucial or truly relevant from their exposition, and yet readers perceive gaps and take steps to fill them. The present paper considers four examples of subjective gaps drawn from ancient Greek literature (the Pandora myth, ancient Roman literature (the Pygmalion legend, ancient Hebrew literature (the Joseph legend, and early Christian literature (the Jesus legend. I consider the quite varied ways in which interpreters expand the inherited texts of these stories, such as by devising names, manufacturing motives, creating backstories, and in general filling in biographical ellipses. Finally, I suggest an explanation for the phenomenon of subjective gaps, arguing that, despite their variety, they have a single cause.

  13. The Effect of Transition Clinics on Knowledge of Diagnosis and Perception of Risk in Young Adult Survivors of Childhood Cancer

    Science.gov (United States)

    Ganju, Rohit G.; Nanda, Ronica H.; Esiashvili, Natia; Switchenko, Jeffrey M.; Wasilewski-Masker, Karen; Marchak, Jordan G.

    2016-01-01

    Background Improved treatment for pediatric cancers has ensured an evergrowing population of patients surviving into adulthood. The current study evaluated the impact of previous engagement in survivor care on patient knowledge and awareness of health risks as young adults. Procedure Young adult survivors of childhood cancers (N = 93, M age = 23.63 y) were recruited during their annual survivor clinic visit. Participants completed self-reported measures of demographics, treatment knowledge, perception of future health risks, participation in previous survivor care, and neurocognitive functioning. Results In total, 82% of patients (N = 76/93) reported previously participating in survivorship care. These patients were more likely to have knowledge of their radiation treatment (P = 0.034) and more likely to recognize risk for future health effects from their treatment (P = 0.019). Income between $10,000 and $24,999 (odds ratio = 0.168; 95% confidence interval, 0.046–0.616; P = 0.031) was associated with decreased patient knowledge regarding diagnosis. Male sex (odds ratio = 0.324; 95% confidence interval, 0.135–0.777; P = 0.012) was associated with less knowledge of future health risks. Patients with self-reported difficulties on the CCSS-NCQ were more likely to regard their cancer treatment as a future health risk. Conclusion Participation in survivor care plays an important role in imparting information to young adult survivors of pediatric cancer regarding their disease history and risk for future health problems. PMID:26925717

  14. Effects of an Art-Based Curriculum on Clinical Trials Attitudes and Breast Cancer Prevention Knowledge

    Science.gov (United States)

    Herman, Patricia M.; Larkey, Linda K.

    2006-01-01

    Although Latinos now comprise the largest minority in the U.S. population, they continue to be seriously underrepresented in clinical trials. A nonrandomized controlled study of an innovative community-developed clinical trial and breast cancer education program targeting Latinas tested whether use of an art-based curriculum could increase…

  15. GAP Analysis Program (GAP) Raster

    Data.gov (United States)

    Kansas Data Access and Support Center — The Kansas GAP Land Cover database depicts 43 land cover classes for the state of Kansas. The database was generated using a two-stage hybrid classification of...

  16. The Use of Clinical Interviews to Develop Inservice Secondary Science Teachers' Nature of Science Knowledge and Assessment of Student Nature of Science Knowledge

    Science.gov (United States)

    Peters-Burton, Erin E.

    2013-01-01

    To fully incorporate nature of science knowledge into classrooms, teachers must be both proficient in their own nature of science knowledge, but also skillful in translating their knowledge into a learning environment which assesses student knowledge. Twenty-eight inservice teachers enrolled in a graduate course which in part required a clinical…

  17. EXACKTE2: Exploiting the clinical consultation as a knowledge transfer and exchange environment: a study protocol.

    NARCIS (Netherlands)

    Legare, F.; Stewart, M.; Frosch, D.; Grimshaw, J.; Labrecque, M.; Magnan, M.; Ouimet, M.; Rousseau, M.; Stacey, D.; Weijden, G.D.E.M. van der; Elwyn, G.

    2009-01-01

    ABSTRACT: BACKGROUND: While the evidence suggests that the way physicians provide information to patients is crucial in helping patients decide upon a course of action, the field of knowledge translation and exchange (KTE) is silent about how the physician and the patient influence each other during

  18. Knowledge gaps in relation to radionuclide levels and transfer to wild plants and animals, in the context of environmental impact assessments, and a strategy to fill them

    Energy Technology Data Exchange (ETDEWEB)

    Brown, J.E. (ed.); Gjelsvik, R. (Norwegian Radiation Protection Authority (Norway)); Saxen, R.; Mattila, J. (STUK - Radiation and Nuclear Safety Authority (Finland))

    2009-01-15

    International activities with regards the development of methods for assessing impacts on the environment from ionising radiation have been substantial in recent years. In developing these methods, there are requirements (i) to determine the transfer of radionuclides within ecosystems and (ii) to determine background dose-rates arising from the presence of naturally occurring radionuclides, in a satisfactory manner. It has quickly become evident that fulfilling these 2 requirements is not entirely straightforward reflecting a lack of data in many cases. This report specifies exactly where these data-gaps lie through analyses of data generated from the most recent studies conducted internationally on this topic. It is evident that information is limited for numerous radionuclides from U-238 and Th-232 decay series and notably, in view of its importance as a contributor to dose-rates in plants and animals, Po-210. The simple way to rectify these data deficiencies is to organise target field campaigns focusing on particular species and radionuclides where information is lacking. To this end, field sampling has been conducted in a semi-natural mountain ecosystem in Norway and freshwater aquatic systems in Finland. It is envisaged that the data derived from the studies briefly described in this report will provide fundamental information for our understanding of the behaviour and fate of natural decay series radionuclides in terrestrial and aquatic systems and provide the basis for more robust way. (au)

  19. Establishing the role of honest broker: bridging the gap between protecting personal health data and clinical research efficiency

    Directory of Open Access Journals (Sweden)

    Hyo Joung Choi

    2015-12-01

    Full Text Available Background. The objective of this study is to propose the four conditions for the roles of honest brokers through a review of literature published by ten institutions that are successfully utilizing honest brokers. Furthermore, the study aims to examine whether the Asan Medical Center’s (AMC honest brokers satisfy the four conditions, and examine the need to enhance their roles.Methods. We analyzed the roles, tasks, and types of honest brokers at 10 organizations by reviewing the literature. We also established a Task Force (TF in our institution for setting the roles and processes of the honest broker system and the honest brokers. The findings of the literature search were compared with the existing systems at AMC—which introduced the honest broker system for the first time in Korea.Results. Only one organization employed an honest broker for validating anonymized clinical data and monitoring the anonymity verifications of the honest broker system. Six organizations complied with HIPAA privacy regulations, while four organizations did not disclose compliance. By comparing functions with those of the AMC, the following four main characteristics of honest brokers were determined: (1 de-identification of clinical data; (2 independence; (3 checking that the data are used only for purposes approved by the IRB; and (4 provision of de-identified data to researchers. These roles were then compared with those of honest brokers at the AMC.Discussion. First, guidelines that regulate the definitions, purposes, roles, and requirements for honest brokers are needed, since there are no currently existing regulations. Second, Korean clinical research institutions and national regulatory departments need to reach a consensus on a Korean version of Limited Data Sets (LDS, since there are no lists that describe the use of personal identification information. Lastly, satisfaction surveys on honest brokers by researchers are necessary to improve the quality of

  20. Establishing the role of honest broker: bridging the gap between protecting personal health data and clinical research efficiency.

    Science.gov (United States)

    Choi, Hyo Joung; Lee, Min Joung; Choi, Chang-Min; Lee, JaeHo; Shin, Soo-Yong; Lyu, Yungman; Park, Yu Rang; Yoo, Soyoung

    2015-01-01

    Background. The objective of this study is to propose the four conditions for the roles of honest brokers through a review of literature published by ten institutions that are successfully utilizing honest brokers. Furthermore, the study aims to examine whether the Asan Medical Center's (AMC) honest brokers satisfy the four conditions, and examine the need to enhance their roles. Methods. We analyzed the roles, tasks, and types of honest brokers at 10 organizations by reviewing the literature. We also established a Task Force (TF) in our institution for setting the roles and processes of the honest broker system and the honest brokers. The findings of the literature search were compared with the existing systems at AMC-which introduced the honest broker system for the first time in Korea. Results. Only one organization employed an honest broker for validating anonymized clinical data and monitoring the anonymity verifications of the honest broker system. Six organizations complied with HIPAA privacy regulations, while four organizations did not disclose compliance. By comparing functions with those of the AMC, the following four main characteristics of honest brokers were determined: (1) de-identification of clinical data; (2) independence; (3) checking that the data are used only for purposes approved by the IRB; and (4) provision of de-identified data to researchers. These roles were then compared with those of honest brokers at the AMC. Discussion. First, guidelines that regulate the definitions, purposes, roles, and requirements for honest brokers are needed, since there are no currently existing regulations. Second, Korean clinical research institutions and national regulatory departments need to reach a consensus on a Korean version of Limited Data Sets (LDS), since there are no lists that describe the use of personal identification information. Lastly, satisfaction surveys on honest brokers by researchers are necessary to improve the quality of honest

  1. Evidence supporting primary prevention of cardiovascular diseases with statins: Gaps between updated clinical results and actual practice.

    Science.gov (United States)

    Bruckert, Eric; Ferrières, Jean

    2014-03-01

    The use of pharmacological lipid-lowering intervention in individuals with hypercholesterolaemia and known cardiovascular disease or diabetes/chronic kidney disease is well established. Current European Society of Cardiology guidelines recommend immediate initiation of drugs in adjunct to lifestyle intervention in these patients at high or very high cardiovascular risk. In these clinical settings, statins are generally chosen as the first-choice drug intervention, in consideration of the robust evidence showing a reduction in all-cause mortality and major adverse cardiac events (MACE). In contrast, primary prevention with statins, even in the subset of patients at high-risk of cardiovascular events, is not well implemented. This might be related to a lack of public awareness regarding the actual risk associated with prolonged exposure to high concentrations of low-density lipoprotein cholesterol (LDL-C) and uncertainties in the clinical evidence coming from the earliest trials in this patient subset. However, recent observational studies suggest that lowering LDL-C earlier in life and for a longer duration can substantially decrease the burden of cardiovascular disease and mortality. Moreover, results from recent well-conducted large meta-analyses of randomized clinical trials showed that primary prevention with statins reduced all-cause mortality by 14% and MACE by > 20% - findings similar to those observed for the use of statins in secondary prevention. Recently published American Heart Association/American College of Cardiology guidelines on the treatment of blood cholesterol emphasize that primary prevention using high-dose statins in individuals with LDL-C ≥ 190 mg/dL induces a benefit in atherosclerotic cardiovascular risk reduction that clearly exceeds the potential for adverse effects. We aim in this review to discuss the new data that advocate the use of statins in primary prevention earlier and more frequently, putting the efficacy evidence into

  2. [Recent knowledge on the linkage of strain specific genotypes with clinical manifestations of human citomegalovirus disease].

    Science.gov (United States)

    Pignatelli, Sara

    2011-01-01

    Human citomegalovirus (CMV) is a beta-herpesvirus able to establish lifelong persistent infections which usually remain asymptomatic. However, severe diseases may develop in immunocompromised subjects (e.g., AIDS patients and transplant recipients) and if acquired in utero. Circulating CMV clinical strains display genetic polymorphisms in multiple genes, which may be implicated in CMV-induced immunopathogenesis, as well as strain-specific tissue-tropism, viral spread in the host cells and virulence, finally determining the wide spectrum of clinical manifestations of CMV disease. Current literature report a number of studies regarding the main CMV polymorphic genes (UL55-gB, UL144, UL73-gN, UL74-gO), their diagnostic and therapeutic impact, their potential clinical relevance as prognostic markers. This paper aims to critically analyse the results of these studies and evaluate the linkage of strain-specific genotypes with clinical manifestations of CMV disease and their perspective implications.

  3. The state of the art in organisational cognitive neuroscience: The therapeutic gap and possible implications for clinical practice

    Directory of Open Access Journals (Sweden)

    Carl eSenior

    2013-12-01

    Full Text Available In the last decade, researchers in the social sciences have increasingly adopted neuroscientific techniques, with the consequent rise of research inspired by neuroscience in disciplines such as economics, marketing, decision sciences, and leadership. In 2007, we introduced the term organizational cognitive neuroscience (OCN, in an attempt to clearly demarcate research carried out in these many areas, and provide an overarching paradigm for research utilising cognitive neuroscientific methods, theories, and concepts, within the organizational and business research fields. Here we will revisit and further refine the OCN paradigm, and define an approach where we feel the marriage of organisational theory and neuroscience will return even greater dividends in the future and that is within the field of clinical practice.

  4. Treatmnent Patterns for Pediatric Acute CHUs Media: A Gap in Evidence-Based Theory and Clinical Practice.

    Science.gov (United States)

    Boatright, Courtney; Holcomb, Lygia; Replogle, William

    2015-01-01

    Unnecessary prescribing of antibiotics is costly, leads to serious unintended side effects, and increases the risk of developing antibiotic resistance. Children are at high risk of receiving unnecessary antibiotics because they consume more antibiotics than any other age group, likely due to inaccurate prescribing by health care providers. Treatment of acute otitis media is the most common reason children are prescribed antibiotics. Evidence-based guidelines regarding the appropriate treatment of nonsevere acute otitis media in children have been established. A retrospective, descriptive, chart review project was completed comparing the diagnosis and treatment of acute otitis media in children six months to 12 years of age in clinics and the emergency department of a large academic medical center with the American Academy of Pediatrics' treatment guidelines. Findings of the chart review included 100 patient encounters. Documentation indicated that although none of these children with acute otitis media met the guideline criteria for antibiotics, 92 of the 100 children were prescribed antibiotics.

  5. Advanced Knowledge Work and Stress-related Symptoms : Epidemiology and Clinical Intervention Studies

    OpenAIRE

    Wiholm, Clairy

    2006-01-01

    Well educated knowledge workers are a growing group of the work force. Little research has been conducted on this group regarding possible work-related health symptoms, as well as interventions in order to reduce work-related stress. This thesis describes the current work-related symptoms and potential risk and salutogenic, i.e. protective factors, associated with these symptoms among software and system designers in a high tech company in Sweden. A stress management intervention program was...

  6. Closing the gap between coil and balloon in the neurointerventional armamentarium? Initial clinical experience with a nitinol vascular occlusion plug

    Energy Technology Data Exchange (ETDEWEB)

    Gralla, Jan; Schroth, Gerhard; El-Koussy, Marwan; Brekenfeld, Caspar [University of Bern, Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern (Switzerland); Kickuth, Ralph [Interventional and Pediatric Radiology, Department of Diagnostic, Bern (Switzerland); Do, Dai-Do [University of Bern, Department of Angiology, Inselspital, Bern (Switzerland)

    2008-08-15

    The use of vascular plug devices for the occlusion of high-flow lesions is a relatively new and successful procedure in peripheral and cardiopulmonary interventions. We report on the use and efficiency of the Amplatzer vascular plug in a small clinical series and discuss its potential for occlusion of large vessels and high-flow lesions in neurointerventions. Between 2005 and 2007 four patients (mean age 38.5 years, range 16-62 years) were treated with the device, in three patients to achieve parent artery occlusion of the internal carotid artery, in one patient to occlude a high-flow arteriovenous fistula of the neck. The application, time to occlusion, and angiographic and clinical results and the follow-up were evaluated. Navigation, positioning and detachment of the device were satisfactory in all cases. No flow-related migration of the plug was seen. The cessation of flow was delayed by a mean of 10.5 min after deployment of the first device. In the procedures involving vessel sacrifice, two devices had to be deployed to achieve total occlusion. No patient experienced new neurological deficits; the 3-month follow-up revealed stable results. The Amplatzer vascular plug can be adapted for the treatment of high-flow lesions and parent artery occlusions in the head and neck. In this small series the use of the devices was uncomplicated and safe. The rigid and large delivery device and the delayed cessation of flow currently limit the device's use in neurointerventions. (orig.)

  7. Increasing business resilience to flood risk: Developing an effective e-learning tool to bridge the knowledge gap between policy, practice and business owners

    Science.gov (United States)

    Wragg, Amanda; McEwen, Lindsey; Harries, Tim

    2015-04-01

    part that their knowledges and learning play in decision-making have been explored. The co-production process engages regional/national stakeholders who form a Stakeholder Competency Group (from policy and practice), and, a Business Research Partnership Group comprising local business participants. The two groups have opportunities to liaise and network in discussing the prototype for the learning tool. Whatmore et al (2008) and McEwen et al (2014) show that stakeholder views, experience and expertise can strengthen research outputs. The approach reflects current ethics and practices of stakeholder participation in that alongside an academic approach to the research, other equally valid forms of knowledge are recognised: 'a lot can be learned from exploring parallels, controversies and frictions between different forms of competency and knowledge (McEwen et al, 2014), for example, scientific, local, tacit and embedded. This paper presents concerns identified by businesses and wider stakeholders in relation to how the tool is framed and its key design premises. The tool is planned as a living resource that can support a community of learning practice among SMEs to increase flood resilience in the face of increased risk. References Federation of Small Businesses (2014) http://www.fsb.org.uk/stats Whatmore, Lane and Ward et al (2007-2010) Understanding Environmental Knowledge Controversies ESRC/NERC funded interdisciplinary research project (2007-2010) McEwen et al (2014) https://floodmemories.wordpress.com/2011/04/06/advice-from-competent-stakeholders/.

  8. Clinical practice guidelines for translating pharmacogenomic knowledge to bedside. Focus on anticancer drugs.

    Directory of Open Access Journals (Sweden)

    José A G Agúndez

    2014-08-01

    Full Text Available The development of clinical practice recommendations or guidelines for the clinical use of pharmacogenomics data is an essential issue for improving drug therapy, particularly for drugs with high toxicity and/or narrow therapeutic index such as anticancer drugs. Although pharmacogenomic-based recommendations have been formulated for over 40 anticancer drugs, the number of clinical practice guidelines available is very low. The guidelines already published indicate that pharmacogenomic testing is useful for patient selection, but final dosing adjustment should be carried out on the basis of clinical or analytical parameters rather than on pharmacogenomic information.Patient selection may seem a modest objective, but it constitutes a crucial improvement with regard to the pre-pharmacogenomics situation and it saves patients’ lives. However we should not overstate the current power of pharmacogenomics. At present the pharmacogenomics of anticancer drugs is not sufficiently developed for dose adjustments based on pharmacogenomics only, and no current guidelines recommend such adjustments without considering clinical and/or analytical parameters.

  9. Conventionalized knowledge

    DEFF Research Database (Denmark)

    Buus, Niels

    2006-01-01

    Mental health nurses routinely hand over clinical knowledge at intershift reports. In the present study, field descriptions from prolonged fieldwork and transcripts of audio recordings of handovers were analysed discursively drawing on ethnomethodology and conversation analysis. The analysis iden...... exact clinical situations. Handing over caused a silencing of the least powerful nurses' voices, generated uncertainty, and promoted knowledge about the patients' clinical situation that was not necessarily precise or up-to-date....

  10. Knowledge translation of research findings

    Directory of Open Access Journals (Sweden)

    Grimshaw Jeremy M

    2012-05-01

    Full Text Available Abstract Background One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health. We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred? Discussion We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting, and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge

  11. Evidence and evidence gaps – an introduction

    Science.gov (United States)

    Dreier, Gabriele; Löhler, Jan

    2016-01-01

    Background: Medical treatment requires the implementation of existing evidence in the decision making process in order to be able to find the best possible diagnostic, therapeutic or prognostic measure for the individual patient based on the physician’s own expertise. Clinical trials form the evidence base and ideally, their results are assembled, analyzed, summarized, and made available in systematic review articles. Beside planning, conducting, and evaluating clinical trials in conformity with GCP (good clinical practice), it is essential that all results of conducted studies are publicly available in order to avoid publication bias. This includes also the public registration of planned and cancelled trials. History: During the last 25 years, evidence-based medicine became increasingly important in medical care and research. It is closely associated with the names of Archibald Cochrane and David Sackett. About 15 years ago, the Deutsche Cochrane Zentrum (Cochrane Germany) and the Deutsche Netzwerk Evidenzbasierte Medizin e.V. (German Network for Evidence-based Medicine, DNEbM) were founded in Germany. In the International Cochrane Collaboration, clinicians and methodologists come together on an interdisciplinary level to further develop methods of evidence-based medicine and to discuss the topics of evidence generation and processing as well as knowledge transfer. Problem: Evidence is particularly important for physicians in the process of decision making, however, at the same time it is the base of a scientific proof of benefit for the patient and finally for the payers in health care. The closure of evidence gaps requires enormously high staff and financial resources, significant organizational efforts, and it is only successful when clinical and methodical expertise as well as specific knowledge in the field of clinical research are included. On the other hand, the knowledge has to be transferred into practice. For this purpose, practice guidelines, meetings

  12. Nuclear medicine. Basic knowledge and clinical applications. 7. rev. and enl. ed.; Nuklearmedizin. Basiswissen und klinische Anwendung

    Energy Technology Data Exchange (ETDEWEB)

    Schicha, Harald [Universitaetsklinikum Koeln (Germany). Medizinisches Versorgungszentrum II; Schober, Otmar [Universitaetsklinikum Muenster (Germany). Klinik fuer Nuklearmedizin

    2013-11-01

    The book on basic knowledge and clinical applications of nuclear medicine covers the following issues: The first general part: principles of nuclear medicine; physical fundamentals; radiopharmaceutical chemistry; measuring techniques: gamma detectors, gamma spectrometry, gamma camera, SPECT, PET, PET/CT, PET/NMR, image processing and communication; nuclear medical examinations: metabolic and pharmacological kinetics, scintigraphic methods, criteria for the use; quality assurance; dosimetry and radiation protection, radiation risks and patients exposure, benefit-risk considerations. The second part covers endocrine organs, carcinomas, skeleton and bone joints, inflammations, lymph system, cardiovascular system, lungs, central nervous system, kidneys and urinary system, gastrointestinal tract, other scintigraphic examinations.

  13. Dental student perception and assessment of their clinical knowledge in educating patients about preventive dentistry.

    Science.gov (United States)

    Metz, M J; Miller, C J; Lin, W S; Abdel-Azim, T; Zandinejad, A; Crim, G A

    2015-05-01

    In today's dental school curricula, an increasing amount of time is dedicated to technological advances, and preventive dentistry topics may not be adequately addressed. Freshman (D1) students participated in a new Introduction to Preventive Dentistry course, which consisted of didactic lectures, active learning breakout sessions and case-based studies. The goal of this study was to determine if D1 dental students completing the course had a better knowledge and comfort level with basic preventive dentistry concepts and caries risk assessment than the upcoming graduating senior dental students. Following the completion of the course, D1 students were administered a survey that assessed their comfort level describing preventive dentistry topics to patients. This was immediately followed by an unannounced examination over the same topics. Senior (D4) students, who had not taken a formal course, reported statistically significant higher comfort levels than D1 students. However, the D4s scored significantly lower in all of the examination areas than the D1 students. Higher scores in D1s may have been due to recent exposure to the course material. However, the basic nature of the content-specific questions should be easily answered by novice practitioners educating their patients on oral disease prevention. As the current data shows lower content-specific scores of basic preventive dentistry knowledge amongst graduating D4 students, this may indicate a need for more guidance and education of students during the patient care. This study showed that implementation of a formalised course for D1 students can successfully ameliorate deficiencies in knowledge of preventive dentistry topics.

  14. Knowledge Translation in Global Health

    Science.gov (United States)

    Pablos-Mendez, Ariel; Shademani, Ramesh

    2006-01-01

    We discuss the "know-do gap," present a definition of knowledge translation, and discuss its relative importance in bridging the know-do gap. Some of the underlying causes of the know-do gap are listed, along with ongoing efforts to address them. Knowledge translation is considered a cross-cutting, nonlinear process that involves not only recent…

  15. Building a Bridge or Digging a Pipeline? Clinical Data Mining in Evidence-Informed Knowledge Building

    Science.gov (United States)

    Epstein, Irwin

    2015-01-01

    Challenging the "bridge metaphor" theme of this conference, this article contends that current practice-research integration strategies are more like research-to-practice "pipelines." The purpose of this article is to demonstrate the potential of clinical data-mining studies conducted by practitioners, practitioner-oriented PhD…

  16. Trends in the Medical Knowledge and Clinical Competence of Graduates of Internal Medicine Residency Training Programs.

    Science.gov (United States)

    Norcini, John J.; And Others

    1991-01-01

    A study assessed the effectiveness of medical resident training programs during 1983-88 by evaluating students' certification scores and comparing them to the program's evaluation of students' clinical competence. Results are reported and analyzed for top-rated, university-affiliated, and non-university-affiliated programs, focusing on trends over…

  17. An Integrated Intervention for Increasing Clinical Nurses' Knowledge of HIV/AIDS-Related Occupational Safety.

    Science.gov (United States)

    He, Liping; Lu, Zhiyan; Huang, Jing; Zhou, Yiping; Huang, Jian; Bi, Yongyi; Li, Jun

    2016-11-07

    Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV) cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS) and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives: To assess the effectiveness of integrated interventions on nurses' knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods: We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results: Of the subjects studied, 94.3% (283/300) were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly (χ² = 86.34, p = 0.00), and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4%) and post-test (66.6%) (χ² = 73.2, p = 0.00). When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly. The pre

  18. The effects of post-exposure smallpox vaccination on clinical disease presentation: addressing the data gaps between historical epidemiology and modern surrogate model data.

    Science.gov (United States)

    Keckler, M Shannon; Reynolds, Mary G; Damon, Inger K; Karem, Kevin L

    2013-10-25

    Decades after public health interventions - including pre- and post-exposure vaccination - were used to eradicate smallpox, zoonotic orthopoxvirus outbreaks and the potential threat of a release of variola virus remain public health concerns. Routine prophylactic smallpox vaccination of the public ceased worldwide in 1980, and the adverse event rate associated with the currently licensed live vaccinia virus vaccine makes reinstatement of policies recommending routine pre-exposure vaccination unlikely in the absence of an orthopoxvirus outbreak. Consequently, licensing of safer vaccines and therapeutics that can be used post-orthopoxvirus exposure is necessary to protect the global population from these threats. Variola virus is a solely human pathogen that does not naturally infect any other known animal species. Therefore, the use of surrogate viruses in animal models of orthopoxvirus infection is important for the development of novel vaccines and therapeutics. Major complications involved with the use of surrogate models include both the absence of a model that accurately mimics all aspects of human smallpox disease and a lack of reproducibility across model species. These complications limit our ability to model post-exposure vaccination with newer vaccines for application to human orthopoxvirus outbreaks. This review seeks to (1) summarize conclusions about the efficacy of post-exposure smallpox vaccination from historic epidemiological reports and modern animal studies; (2) identify data gaps in these studies; and (3) summarize the clinical features of orthopoxvirus-associated infections in various animal models to identify those models that are most useful for post-exposure vaccination studies. The ultimate purpose of this review is to provide observations and comments regarding available model systems and data gaps for use in improving post-exposure medical countermeasures against orthopoxviruses.

  19. 医学本体临床路径知识库建设方法学研究%Construction Methodology of Medical Ontology Clinical Pathway Knowledge Base

    Institute of Scientific and Technical Information of China (English)

    郑西川; 谭申生; 于广军

    2012-01-01

    Objective To abstract practice-oriented knowledge from a cohort of real clinical pathways and to represent this knowledge as a clinical pathway ontology. Methods Engineering methodology was adopted to construct clinical pathway knowledge base, which included(l)knowledge source identification and classification of clinical pathways according to variations in setting, stage of care, patient type, outcome and specialty;(2)iterative knowledge abstraction using grounded theory; (3)ontology engineering as adapted from the Model -based Incremental Knowledge Engineering approach; and(4)ontology evaluation through encoding a sample of real clinical pathways. Results The clinical pathway ontology knowledge base was developed, which included 58 class diseases, and was applied in real clinical setting. Conclusion Clinical pathway ontology knowledge base has significant function in the electronic application of clinical pathway, which will be a reference fordeveloping a new generation of electronic medical records.%目的:从一组实际运行的临床路径应用中提取面向实践的临床知识,实现临床路径本体知识库的规范表达.方法:采取工程化方法建立临床路径知识库,包括临床路径知识源标识与分类、知识抽象方法、本体工程方法和临床路径本体评价.结果:建立了58个病种临床路径本体知识库,并在实际应用中进行了验证.结论:临床路径本体知识库建设对临床路径电子化深度应用有重要意义,对新一代电子病历研发有参考借鉴作用.

  20. Human epithelial hair follicle stem cells and their progeny: current state of knowledge, the widening gap in translational research and future challenges.

    Science.gov (United States)

    Purba, Talveen S; Haslam, Iain S; Poblet, Enrique; Jiménez, Francisco; Gandarillas, Alberto; Izeta, Ander; Paus, Ralf

    2014-05-01

    Epithelial hair follicle stem cells (eHFSCs) are required to generate, maintain and renew the continuously cycling hair follicle (HF), supply cells that produce the keratinized hair shaft and aid in the reepithelialization of injured skin. Therefore, their study is biologically and clinically important, from alopecia to carcinogenesis and regenerative medicine. However, human eHFSCs remain ill defined compared to their murine counterparts, and it is unclear which murine eHFSC markers really apply to the human HF. We address this by reviewing current concepts on human eHFSC biology, their immediate progeny and their molecular markers, focusing on Keratin 15 and 19, CD200, CD34, PHLDA1, and EpCAM/Ber-EP4. After delineating how human eHFSCs may be selectively targeted experimentally, we close by defining as yet unmet key challenges in human eHFSC research. The ultimate goal is to transfer emerging concepts from murine epithelial stem cell biology to human HF physiology and pathology.

  1. CLINICAL KNOWLEDGE AND ATTITUDES OF CLINICIANS TOWARD RABIES CAUSED BY ANIMAL BITES

    Directory of Open Access Journals (Sweden)

    Naveen Kumar

    2013-12-01

    Full Text Available ABSTRACT: INTRODUCTION : Rabies is a zoonotic disease that is typically transmitted through bites from infected animals. The majority of reported cases involve wild animals like bats , raccoons and skunks , but domesticated animals like dogs and cats are also a risk. Humans are equ ally susceptible to the rabies virus if bitten by an infected animal. Once the symptoms have appeared , Rabies is always fatal. Death usually occurs less than a week after the onset of signs. METHODOLOGY: A cross - sectional study was conducted in which all th e doctors including JRs , Interns , PG students and SRs and Consultants in the department of Surgery , Medicine , Pediatrics and Emergency Medical Officers were taken . Selection was done on the basis of consent to participate in the study by doctors of the var ious departments handling or required to handle dog /animal bite cases. RESULTS : It can be seen that only 76.92% knew all the Reservoirs of Rabies infection , and the difference in knowledge of senior doctor , 43(41.34 is comparable to junior doctors , 37(35. 57 and the difference is statistically not significant. Regarding different Modes ofTransmission , 90.38% had correct knowledge. The Junior doctors , i.e , 39(37.50 had correct answer whereas , 55(52.88 senior doctors i.e all answered correctlywhich is sta tistically significant . CONCLUSION: There is an apparent lack of awareness among doctors regarding appropriate animal wound management and vaccine administration. Reorientation programmes and continued medical education (CME for the medical practitioners are required to highlight WHO guidelines regarding treatment of animal bite

  2. Aerosol-Cloud Interactions in the South-East Atlantic: Knowledge Gaps, Planned Observations to Address Them, and Implications for Global Climate Change Modeling

    Science.gov (United States)

    Redemann, Jens; Wood, R.; Zuidema, P.; Haywood, J.; Luna, B.; Abel, S.

    2015-01-01

    Southern Africa produces almost a third of the Earth's biomass burning (BB) aerosol particles, yet the fate of these particles and their influence on regional and global climate is poorly understood. Particles lofted into the mid-troposphere are transported westward over the South-East (SE) Atlantic, home to one of the three permanent subtropical Stratocumulus (Sc) cloud decks in the world. The stratocumulus "climate radiators" are critical to the regional and global climate system. They interact with dense layers of BB aerosols that initially overlay the cloud deck, but later subside and are mixed into the clouds. These interactions include adjustments to aerosol-induced solar heating and microphysical effects. As emphasized in the latest IPCC report, the global representation of these aerosol-cloud interaction processes in climate models is one of the largest uncertainty in estimates of future climate. Hence, new observations over the SE Atlantic have significant implications for global climate change scenarios. We discuss the current knowledge of aerosol and cloud property distributions based on satellite observations and sparse suborbital sampling, and describe planned field campaigns in the region. Specifically, we describe the scientific objectives and implementation of the following four synergistic, international research activities aimed at providing a process-level understanding of aerosol-cloud interactions over the SE Atlantic: 1) ORACLES (Observations of Aerosols above Clouds and their interactions), a five-year investigation between 2015 and 2019 with three Intensive Observation Periods (IOP), recently funded by the NASA Earth-Venture Suborbital Program, 2) CLARIFY-2016 (Cloud-Aerosol-Radiation Interactions and Forcing: Year 2016), a comprehensive observational and modeling programme funded by the UK's Natural Environment Research Council (NERC), and supported by the UK Met Office. 3) LASIC (Layered Atlantic Smoke Interactions with Clouds), a funded

  3. Knowledge and willingness to provide research biospecimens among foreign-born Latinos using safety-net clinics.

    Science.gov (United States)

    Loffredo, Christopher A; Luta, Gheorghe; Wallington, Sherrie; Makgoeng, Solomon B; Selsky, Claire; Mandelblatt, Jeanne S; Adams-Campbell, Lucile L

    2013-08-01

    Latinos tend to be under-represented in cancer research and in bio-repositories. We conducted a Spanish-language, interviewer-administered cross-sectional survey of 331 foreign-born Latinos from Central and South America attending safety-net clinics in order to describe factors associated with knowledge about and intention to provide bio-specimens for research purposes. We used logistic regression and multiple imputation methods to evaluate associations between socio-cultural measures, medical trust, demographics, as well as knowledge about and intentions to provide bio-specimens. Almost half (47 %) of respondents knew what bio-specimens were, and 67 % said that they would provide a specimen after being given information about what this involved; this increased to 72 % among those with prior knowledge. Controlling for covariates, Latinos with a high school education and above were more likely to know what a bio-specimen was and to say they would provide bio-specimens than were those with lower levels of education [adjusted OR (aOR) 2.85, 95 % CI 1.37-5.96; and 3.49, 95 % CI 1.41-8.63, p ≤ 0.01, respectively]. Those with greater social integration were more likely to know about bio-specimens than those with less integration (aOR 2.54, 95 % CI 1.45-4.46, p = 0.001). Higher endorsement of family values was independently associated with intent to give bio-specimens (aOR 1.11, 95 % CI 1.02-1.20, p = 0.017 per five-point increase in "familism" score). Medical mistrust was not related to intentions to provide specimens. Our results suggest that interventions to increase willingness to provide bio-specimens could leverage trusted clinics or social networks and should consider individuals' education and socio-cultural perspectives.

  4. Reducing neonatal mortality associated with preterm birth: gaps in knowledge of the impact of antenatal corticosteroids on preterm birth outcomes in low-middle income countries.

    Science.gov (United States)

    McClure, Elizabeth M; Goldenberg, Robert L; Jobe, Alan H; Miodovnik, Menachem; Koso-Thomas, Marion; Buekens, Pierre; Belizan, Jose; Althabe, Fernando

    2016-05-24

    The Global Network's Antenatal Corticosteroids Trial (ACT), was a multi-country, cluster-randomized trial to improve appropriate use of antenatal corticosteroids (ACS) in low-resource settings in low-middle income countries (LMIC). ACT substantially increased ACS use in the intervention clusters, but the intervention failed to show benefit in the targeted < 5th percentile birth weight infants and was associated with increased neonatal mortality and stillbirth in the overall population. In this issue are six papers which are secondary analyses related to ACT that explore potential reasons for the increase in adverse outcomes overall, as well as site differences in outcomes. The African sites appeared to have increased neonatal mortality in the intervention clusters while the Guatemalan site had a significant reduction in neonatal mortality, perhaps related to a combination of ACS and improving obstetric care in the intervention clusters. Maternal and neonatal infections were increased in the intervention clusters across all sites and increased infections are a possible partial explanation for the increase in neonatal mortality and stillbirth in the intervention clusters, especially in the African sites. The analyses presented here provide guidance for future ACS trials in LMIC. These include having accurate gestational age dating of study subjects and having care givers who can diagnose conditions leading to preterm birth and predict which women likely will deliver in the next 7 days. All study subjects should be followed through delivery and the neonatal period, regardless of when they deliver. Clearly defined measures of maternal and neonatal infection should be utilized. Trials in low income country facilities including clinics and those without newborn intensive care seem to be of the highest priority.

  5. Ageism and its clinical impact in oncogeriatry: state of knowledge and therapeutic leads

    Directory of Open Access Journals (Sweden)

    Schroyen S

    2014-12-01

    Full Text Available Sarah Schroyen,1 Stéphane Adam,1 Guy Jerusalem,2,3 Pierre Missotten1 1University of Liège, Psychology of Aging Unit, 2University of Liège, Laboratory of Medical Oncology, 3CHU Sart Tilman Liege, Department of Medical Oncology, Liège, Belgium Abstract: Cancer is a major health problem that is widespread in elderly people. Paradoxically, older people suffering from cancer are often excluded from clinical trials and are undertreated when compared to younger patients. One explanation for these observations is age stigma (ie, stereotypes linked to age, and thus ageism. These stigmas can result in deleterious consequences for elderly people’s mental and physical health in “normal” aging. What, then, is the impact in a pathological context, such as oncology? Moreover, health care professionals’ attitudes can be tainted with ageism, thus leading to undesirable consequences for patients. To counter these stigmas, we can apply some possible interventions emerging from research on normal aging and from social psychology, such as intergenerational contact, activation of positive stereotypes, self-affirmation, and so on; these tools can improve opinions of aging among the elderly people themselves, as well as health care professionals, thus affecting patients’ mental and physical health. Keywords: oncogeriatry, clinical approaches, stigmatization, ageism

  6. Knowledge, attitudes and practices among people with chronic hepatitis B attending a hepatology clinic in Malaysia: A cross sectional study

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    Mohamed Rosmawati

    2012-08-01

    Full Text Available Abstract Background Hepatitis B (HBV is the leading cause of cirrhosis and hepatocellular carcinoma worldwide. This study assessed the knowledge, attitudes and practices of people with chronic HBV and the associated factors. Methods This cross-sectional study was conducted at an outpatient adult hepatology clinic at a tertiary hospital in Kuala Lumpur. A self-administered questionnaire was administered on a one-to-one basis to assess knowledge, attitudes, and lifestyle practices of people with chronic HBV. Results The response rate was 89% (n = 483/543. Participants had a mean age of 46.3 (±14.7 years and the mean duration of HBV from time of diagnosis was 12.2 (±8.8 years. The mean knowledge score was 12.57/20 (standard deviation: ±4.4, range: 0–19. Participants aged 30–39 years, with higher educational attainment, employed in professional jobs, longer duration of diagnosis and those without cirrhosis had significantly higher knowledge scores. Age, education level and duration of diagnosis were significant predictors of the knowledge score on standard multiple regression analysis. More than half of the participants were worried of spreading HBV infection to family and friends and worried since the diagnosis. A third of the participants (33.5% were embarrassed to reveal their diagnosis to the public but most of them (93.6% would inform their family. Those who reported feeling worried since their diagnosis were more likely to be middle-aged, of Malay ethnicity, have shorter duration of diagnosis of less than 10 years and have received therapy. About half of the participants (50.6% did not share dining utensils and the majority (93.2% believed that HBV can be transmitted by sharing of eating and drinking utensils. Older patients were significantly less likely to share utensils. Those who felt worried since diagnosis had significant higher knowledge of HBV. Conclusion The findings highlight the stigma and misconceptions that still

  7. Ageism and its clinical impact in oncogeriatry: state of knowledge and therapeutic leads.

    Science.gov (United States)

    Schroyen, Sarah; Adam, Stéphane; Jerusalem, Guy; Missotten, Pierre

    2015-01-01

    Cancer is a major health problem that is widespread in elderly people. Paradoxically, older people suffering from cancer are often excluded from clinical trials and are undertreated when compared to younger patients. One explanation for these observations is age stigma (ie, stereotypes linked to age, and thus ageism). These stigmas can result in deleterious consequences for elderly people's mental and physical health in "normal" aging. What, then, is the impact in a pathological context, such as oncology? Moreover, health care professionals' attitudes can be tainted with ageism, thus leading to undesirable consequences for patients. To counter these stigmas, we can apply some possible interventions emerging from research on normal aging and from social psychology, such as intergenerational contact, activation of positive stereotypes, self-affirmation, and so on; these tools can improve opinions of aging among the elderly people themselves, as well as health care professionals, thus affecting patients' mental and physical health.

  8. A randomized trial assessing the impact of written information on outpatients' knowledge about and attitude toward randomized clinical trials. The Info Trial Group

    DEFF Research Database (Denmark)

    Kruse, A Y; Kjaergard, L L; Krogsgaard, K;

    2000-01-01

    To improve the patient education process in clinical research, three information materials describing general aspects of design and conduct of randomized clinical trials were developed. The materials varied in length, reading ability level, and reader appeal. Their influence on knowledge about an...

  9. Surgical templates for dental implant positioning; current knowledge and clinical perspectives

    Directory of Open Access Journals (Sweden)

    Mohammed Zaheer Kola

    2015-01-01

    Full Text Available Dental implants have been used in a variety of different forms for many years. Since the mid-20 th century, there has been an increase in interest in the implant process for the replacement of missing teeth. Branemark was one of the initial pioneers who applied scientifically based research techniques to develop an endosseous implant that forms an immobile connection with bone. The need for a dental implant to completely address multiple physical and biological factors imposes tremendous constraints on the surgical and handling protocol. Metallic dental implants have been successfully used for decades, but they have serious shortcomings related to their bony union and the fact that their mechanical properties do not match those of bone. However, anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement of the implant facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an aesthetic outcome. Therefore, it is advisable to establish a logical continuity between the planned restoration and the surgical phases, it is essential to use a transfer device that for sure increases the predictability of success. The surgical guide template is fabricated by a dental technician after the presurgical restorative appointments that primarily include determination of occlusal scheme and implant angulations. Here, authors genuinely attempted to review the evolution and clinical applicability of surgical templates used in the placement of dental implants.

  10. How personality became treatable: The mutual constitution of clinical knowledge and mental health law

    Science.gov (United States)

    2013-01-01

    In recent years, personality disorders – psychiatric constructs understood as enduring dysfunctions of personality – have come into ever-greater focus for British policymakers, mental health professionals and service-users. Disputes have focussed largely on highly controversial attempts by the UK Department of Health to introduce mental health law and policy (now enshrined within the 2007 Mental Health Act of England and Wales). At the same time, clinical framings of personality disorder have dramatically shifted: once regarded as untreatable conditions, severe personality disorders are today thought of by many clinicians to be responsive to psychiatric and psychological intervention. In this article, I chart this transformation by means of a diachronic analysis of debates and institutional shifts pertaining to both attempts to change the law, and understandings of personality disorder. In so doing, I show how mental health policy and practice have mutually constituted one another, such that the aims of clinicians and policymakers have come to be closely aligned. I argue that it is precisely through these reciprocally constitutive processes that the profound reconfiguration of personality disorder from being an obdurate to a plastic condition has occurred; this demonstrates the significance of interactions between law and the health professions in shaping not only the State’s management of pathology, but also perceptions of its very nature.

  11. Antibiotic prescribing and resistance: knowledge level of medical students of clinical years of University Sultan Zainal Abidin, Malaysia

    Science.gov (United States)

    Haque, Mainul; Rahman, Nor Iza A; Zulkifli, Zainal; Ismail, Salwani

    2016-01-01

    The innovation of penicillin by Dr Alexander Fleming in 1928 and its use in clinical practice saved many lives, especially during the Second World War. Tuberculosis still carries a significant public health threat and has re-emerged over the past two decades, even in modern countries where tuberculosis was thought to be eliminated. The World Health Organization defines antimicrobial resistance as the resistance of a microorganism to an antimicrobial drug that was initially effective for treatment of infections caused by the microbe. Therefore, the findings of the current study will provide data to enable the design of a new educational program to better equip our students in confronting antimicrobial resistance. This study was a cross-sectional, questionnaire-based survey, which was undertaken in the Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia. The study participants were students of the Bachelor of Medicine and Bachelor of Surgery program (MBBS) of Year III, IV, and V. A total of 142 out of 164 (86%) medical students returned the questionnaire. Specifically, the year-wise breakdown of responses was 29% (41), 39% (55), and 32% (45) for Year III, IV, and V, respectively. Among the study respondents, 28% (40) were male, and the remaining 72% (102) were female. In all, 67% of the participants felt more confident in “making an accurate diagnosis of infection/sepsis.” The majority (88%) of the study participants stated that they would like more training on antibiotic selection. This research has found that there is a gap between theoretical input and clinical practice; the students are demanding more educational intervention to face the threat of antimicrobial resistance. PMID:27042083

  12. Fast T Wave Detection Calibrated by Clinical Knowledge with Annotation of P and T Waves

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    Mohamed Elgendi

    2015-07-01

    Full Text Available Background: There are limited studies on the automatic detection of T waves in arrhythmic electrocardiogram (ECG signals. This is perhaps because there is no available arrhythmia dataset with annotated T waves. There is a growing need to develop numerically-efficient algorithms that can accommodate the new trend of battery-driven ECG devices. Moreover, there is also a need to analyze long-term recorded signals in a reliable and time-efficient manner, therefore improving the diagnostic ability of mobile devices and point-of-care technologies. Methods: Here, the T wave annotation of the well-known MIT-BIH arrhythmia database is discussed and provided. Moreover, a simple fast method for detecting T waves is introduced. A typical T wave detection method has been reduced to a basic approach consisting of two moving averages and dynamic thresholds. The dynamic thresholds were calibrated using four clinically known types of sinus node response to atrial premature depolarization (compensation, reset, interpolation, and reentry. Results: The determination of T wave peaks is performed and the proposed algorithm is evaluated on two well-known databases, the QT and MIT-BIH Arrhythmia databases. The detector obtained a sensitivity of 97.14% and a positive predictivity of 99.29% over the first lead of the validation databases (total of 221,186 beats. Conclusions: We present a simple yet very reliable T wave detection algorithm that can be potentially implemented on mobile battery-driven devices. In contrast to complex methods, it can be easily implemented in a digital filter design.

  13. The knowledge and attitude about HIV/AIDS among Jordanian dental students: (Clinical versus pre clinical students at the University of Jordan

    Directory of Open Access Journals (Sweden)

    Shayyab Mohammad H

    2011-06-01

    Full Text Available Abstract Background The present study aimed to address the suspected deficiency in the level of understanding of HIV/AIDS among clinical and pre clinical dental students at the University of Jordan. In this cross-sectional study, structured questionnaires were distributed to fifth year dental students (n = 121 and to third year dental students (n = 144 in the academic year 2008/2009. Findings Significantly higher percentage of fifth-year students compared to third-year students felt that the teaching they received on cross-infection precautions and barrier dentistry was adequate (P Significantly higher proportion of third-year students compared to fifth-year (39.2% vs. 26.3% thought that HIV patients should be referred to other centers or support groups for treatment (P = 0.04. Conclusions The level of knowledge of Jordanian dental students about HIV and AIDS was generally acceptable; there were inadequacies, however, in their understanding regarding some aspects of AIDS epidemic which demands that dental school curriculum needs some improvement.

  14. Plant-Derived Anti-Inflammatory Compounds: Hopes and Disappointments regarding the Translation of Preclinical Knowledge into Clinical Progress

    Directory of Open Access Journals (Sweden)

    Robert Fürst

    2014-01-01

    Full Text Available Many diseases have been described to be associated with inflammatory processes. The currently available anti-inflammatory drug therapy is often not successful or causes intolerable side effects. Thus, new anti-inflammatory substances are still urgently needed. Plants were the first source of remedies in the history of mankind. Since their chemical characterization in the 19th century, herbal bioactive compounds have fueled drug development. Also, nowadays, new plant-derived agents continuously enrich our drug arsenal (e.g., vincristine, galantamine, and artemisinin. The number of new, pharmacologically active herbal ingredients, in particular that of anti-inflammatory compounds, rises continuously. The major obstacle in this field is the translation of preclinical knowledge into evidence-based clinical progress. Human trials of good quality are often missing or, when available, are frequently not suitable to really prove a therapeutical value. This minireview will summarize the current situation of 6 very prominent plant-derived anti-inflammatory compounds: curcumin, colchicine, resveratrol, capsaicin, epigallocatechin-3-gallate (EGCG, and quercetin. We will highlight their clinical potential and/or pinpoint an overestimation. Moreover, we will sum up the planned trials in order to provide insights into the inflammatory disorders that are hypothesized to be beneficially influenced by the compound.

  15. Massive Access Control Aided by Knowledge-Extraction for Co-Existing Periodic and Random Services over Wireless Clinical Networks.

    Science.gov (United States)

    Du, Qinghe; Zhao, Weidong; Li, Weimin; Zhang, Xuelin; Sun, Bo; Song, Houbing; Ren, Pinyi; Sun, Li; Wang, Yichen

    2016-07-01

    The prosperity of e-health is boosted by fast development of medical devices with wireless communications capability such as wearable devices, tiny sensors, monitoring equipments, etc., which are randomly distributed in clinic environments. The drastically-increasing population of such devices imposes new challenges on the limited wireless resources. To relieve this problem, key knowledge needs to be extracted from massive connection attempts dispersed in the air towards efficient access control. In this paper, a hybrid periodic-random massive access (HPRMA) scheme for wireless clinical networks employing ultra-narrow band (UNB) techniques is proposed. In particular, the proposed scheme towards accommodating a large population of devices include the following new features. On one hand, it can dynamically adjust the resource allocated for coexisting periodic and random services based on the traffic load learned from signal collision status. On the other hand, the resource allocation within periodic services is thoroughly designed to simultaneously align with the timing requests of differentiated services. Abundant simulation results are also presented to demonstrate the superiority of the proposed HPRMA scheme over baseline schemes including time-division multiple access (TDMA) and random access approach, in terms of channel utilization efficiency, packet drop ratio, etc., for the support of massive devices' services.

  16. A large survey among European trainees in clinical microbiology and infectious disease on training systems and training adequacy: identifying the gaps and suggesting improvements.

    Science.gov (United States)

    Yusuf, E; Ong, D S Y; Martin-Quiros, A; Skevaki, C; Cortez, J; Dedić, K; Maraolo, A E; Dušek, D; Maver, P J; Sanguinetti, M; Tacconelli, E

    2017-02-01

    The purpose of this investigation was to perform a survey among European clinical microbiology (CM) and infectious disease (ID) trainees on training satisfaction, training tools, and competency assessment. An online, anonymous survey in the English language was carried out between April and July 2015. There were 25 questions: seven in a 5-point Likert scale (1: worst scenario, 5: best scenario) and the remainder as closed multiple-choice questions in five areas (satisfaction, adequacy, system, mentorship, and evaluation of training). Included were 419 respondents (215 CM, 159 ID, and 45 combined CM/ID) from 31 European countries [mean age (standard deviation) 32.4 (5.3) years, 65.9 % women]. Regarding satisfaction on the training scheme, CM and ID scored 3.6 (0.9) and 3.2 (1.0), respectively. These scores varied between countries, ranging from 2.5 (1.0) for Italian ID to 4.3 (0.8) for Danish CM trainees. The majority of respondents considered training in management and health economics inadequate and e-learning and continuing medical education programs insufficient. Many trainees (65.3 % of CM and 62.9 % of ID) would like to have more opportunities to spend a part of their training abroad and expected their mentor to be more involved in helping with future career plans (63.5 % of CM and 53.4 % of ID) and practical skills (53.0 % of CM and 61.2 % of ID). Two-thirds of the respondents across the specialties agreed that a European exam should be developed, but half of them thought it should not be made mandatory. This survey shows high heterogeneity in training conditions in European countries, identifies perceived gaps in training, and suggests areas for improvements.

  17. Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes.

    Science.gov (United States)

    Stevens, Bonnie J; Yamada, Janet; Estabrooks, Carole A; Stinson, Jennifer; Campbell, Fiona; Scott, Shannon D; Cummings, Greta

    2014-01-01

    Hospitalized children frequently receive inadequate pain assessment and management despite substantial evidence to support effective pediatric pain practices. The objective of this study was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical and critical care units. A prospective cohort study compared 16 interventions using EPIQ and 16 standard care (SC) units in 8 Canadian pediatric hospitals. Chart reviews at baseline (time 1) and intervention completion (time 2) determined the nature and frequency of painful procedures and of pain assessment and pain management practices. Trained pain experts evaluated pain intensity 6 months post-intervention (time 3) during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time. EPIQ units used significantly more validated pain assessment tools (Ppain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4-6/10) and severe (7-10/10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (adjusted OR: 0.49, 95% CI: 0.26-0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain the variability in pain processes and clinical outcomes.

  18. UK Dermatology Clinical Trials Network’s STOP GAP trial (a multicentre trial of prednisolone versus ciclosporin for pyoderma gangrenosum: protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Craig Fiona F

    2012-04-01

    Full Text Available Abstract Background Pyoderma gangrenosum (PG is a rare inflammatory skin disorder characterised by painful and rapidly progressing skin ulceration. PG can be extremely difficult to treat and patients often require systemic immunosuppression. Recurrent lesions of PG are common, but the relative rarity of this condition means that there is a lack of published evidence regarding its treatment. A systematic review published in 2005 found no randomised controlled trials (RCTs relating to the treatment of PG. Since this time, one small RCT has been published comparing infliximab to placebo, but none of the commonly used systemic treatments for PG have been formally assessed. The UK Dermatology Clinical Trials Network’s STOP GAP Trial has been designed to address this lack of trial evidence. Methods The objective is to assess whether oral ciclosporin is more effective than oral prednisolone for the treatment of PG. The trial design is a two-arm, observer-blind, parallel-group, randomised controlled trial comparing ciclosporin (4 mg/kg/day to prednisolone (0.75 mg/kg/day. A total of 140 participants are to be recruited over a period of 4 years, from up to 50 hospitals in the UK and Eire. Primary outcome of velocity of healing at 6 weeks is assessed blinded to treatment allocation (using digital images of the ulcers. Secondary outcomes include: (i time to healing; (ii global assessment of improvement; (iii PG inflammation assessment scale score; (iv self-reported pain; (v health-related quality of life; (vi time to recurrence; (vii treatment failures; (viii adverse reactions to study medications; and (ix cost effectiveness/utility. Patients with a clinical diagnosis of PG (excluding granulomatous PG; measurable ulceration (that is, not pustular PG; and patients aged over 18 years old who are able to give informed consent are included in the trial. Randomisation is by computer generated code using permuted blocks of randomly varying size

  19. Exposing the gaps in awareness, knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia

    Directory of Open Access Journals (Sweden)

    Jason J Ong

    2015-03-01

    Full Text Available Introduction: The incidence of anal cancer is significantly higher in men who have sex with men (MSM living with HIV when compared to the general population. We aimed to assess their awareness, knowledge and perceived level of personal risk for anal cancer to help inform educational strategies targeting this group. Methods: A cross-sectional study of 327 HIV positive MSM in Melbourne, Australia, attending clinical settings (a sexual health centre, tertiary hospital HIV outpatients and high HIV caseload general practices completed a written questionnaire in 2013/14. Poor knowledge was defined as those who had never heard of anal cancer, or scored 5 or less out of 10 in knowledge questions amongst those who reported ever hearing about anal cancer. Underestimation of risk was defined as considering themselves as having the same or lower risk for anal cancer compared to the general population. Results: Of 72% (95% confidence interval (CI: 67–77 who had heard of anal cancer, 47% (95% CI: 41–53 could not identify any risk factors for anal cancer. Of total men surveyed, 51% (95% CI: 46–57 underestimated their risk for anal cancer. Multivariate analysis showed that men who underestimated their risk were older (OR 1.04 (per year increase in age, 95% CI: 1.01–1.07, had poor anal cancer knowledge (OR 2.06, 95% CI: 1.21–3.51, and more likely to have ever had an anal examination (OR 2.41, 95% CI: 1.18–4.93. They were less likely to consult a physician if they had an anal abnormality (OR 0.54, 95% CI: 0.31–0.96, to have had receptive anal sex (OR 0.12, 95% CI: 0.02–0.59 or speak English at home (OR 0.28, 95% CI: 0.09–0.90. Conclusions: This survey of MSM living with HIV demonstrated limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are urgently needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.

  20. Polyfluorinated alkyl phosphate ester surfactants - current knowledge and knowledge gaps

    DEFF Research Database (Denmark)

    Taxvig, Camilla; Rosenmai, Anna Kjerstine; Vinggaard, Anne Marie

    2014-01-01

    information on fluorochemicals. Polyfluorinated alkyl phosphate ester surfactants (PAPs) belong to the group of polyfluorinated alkyl surfactants. They have been detected in indoor dust and are widely used in food-contact materials, from which they have the ability to migrate into food. Toxicological data...

  1. A knowledge- and model-based system for automated weaning from mechanical ventilation: technical description and first clinical application.

    Science.gov (United States)

    Schädler, Dirk; Mersmann, Stefan; Frerichs, Inéz; Elke, Gunnar; Semmel-Griebeler, Thomas; Noll, Oliver; Pulletz, Sven; Zick, Günther; David, Matthias; Heinrichs, Wolfgang; Scholz, Jens; Weiler, Norbert

    2014-10-01

    To describe the principles and the first clinical application of a novel prototype automated weaning system called Evita Weaning System (EWS). EWS allows an automated control of all ventilator settings in pressure controlled and pressure support mode with the aim of decreasing the respiratory load of mechanical ventilation. Respiratory load takes inspired fraction of oxygen, positive end-expiratory pressure, pressure amplitude and spontaneous breathing activity into account. Spontaneous breathing activity is assessed by the number of controlled breaths needed to maintain a predefined respiratory rate. EWS was implemented as a knowledge- and model-based system that autonomously and remotely controlled a mechanical ventilator (Evita 4, Dräger Medical, Lübeck, Germany). In a selected case study (n = 19 patients), ventilator settings chosen by the responsible physician were compared with the settings 10 min after the start of EWS and at the end of the study session. Neither unsafe ventilator settings nor failure of the system occurred. All patients were successfully transferred from controlled ventilation to assisted spontaneous breathing in a mean time of 37 ± 17 min (± SD). Early settings applied by the EWS did not significantly differ from the initial settings, except for the fraction of oxygen in inspired gas. During the later course, EWS significantly modified most of the ventilator settings and reduced the imposed respiratory load. A novel prototype automated weaning system was successfully developed. The first clinical application of EWS revealed that its operation was stable, safe ventilator settings were defined and the respiratory load of mechanical ventilation was decreased.

  2. Development and analysis of an instrument to assess student understanding of GOB chemistry knowledge relevant to clinical nursing practice.

    Science.gov (United States)

    Brown, Corina E; Hyslop, Richard M; Barbera, Jack

    2015-01-01

    The General, Organic, and Biological Chemistry Knowledge Assessment (GOB-CKA) is a multiple-choice instrument designed to assess students' understanding of the chemistry topics deemed important to clinical nursing practice. This manuscript describes the development process of the individual items along with a psychometric evaluation of the final version of the items and instrument. In developing items for the GOB-CKA, essential topics were identified through a series of expert interviews (with practicing nurses, nurse educators, and GOB chemistry instructors) and confirmed through a national survey. Individual items were tested in qualitative studies with students from the target population for clarity and wording. Data from pilot and beta studies were used to evaluate each item and narrow the total item count to 45. A psychometric analysis performed on data from the 45-item final version was used to provide evidence of validity and reliability. The final version of the instrument has a Cronbach's alpha value of 0.76. Feedback from an expert panel provided evidence of face and content validity. Convergent validity was estimated by comparing the results from the GOB-CKA with the General-Organic-Biochemistry Exam (Form 2007) of the American Chemical Society. Instructors who wish to use the GOB-CKA for teaching and research may contact the corresponding author for a copy of the instrument.

  3. The Effect of Two Educational Methods on Knowledge and Adherence to Treatment in Hemodialysis Patients: Clinical Trial

    Directory of Open Access Journals (Sweden)

    Kobra Parvan

    2015-03-01

    Full Text Available Introduction: Patients with chronic renal disease (CRD deal with many potential problems with hemodialysis for all their life. Regarding the importance of preventing dialysis adverse effects, which are in close connection with lack of knowledge and report on how to train the patients? This study aims at comparing the impact of two methods of face to face training and training pamphlet on complying and informing of hemodialysis treatments. Methods: This clinical trial study was conducted on 58 hemodialysis patients who visited Shahid Rahnemun Teaching hospital, Yazd, Iran, and had required conditions of the research. Data were collected through a questionnaire including personal-social information, several questions to assess the level of compliance and to inform the treatment method. The quantitative analysis of this study used the Statistical Package for Social Sciences SPSS version 13 and descriptive (frequency, mean, standard deviation and inferential (Chi-square, paired t-test, ANOVA, ANCOVA statistics were employed. Results: The mean scores for informing both groups (face to face and training pamphlet were significantly increased. The mean score for adherence to treatments was also significant.Conclusion: In this research, face to face training was found to be more effective than training pamphlet. It seemed to have more strong effect on increasing the level of information and adherence to treatment. To train these people, face to face training should be, thus, preferred.

  4. TH-A-9A-08: Knowledge-Based Quality Control of Clinical Stereotactic Radiosurgery Treatment Plans

    Energy Technology Data Exchange (ETDEWEB)

    Shiraishi, S; Moore, K L [University of California, San Diego, La Jolla, CA (United States); Tan, J; Olsen, L [Washington University in St. Louis, St. Louis, MO (United States)

    2014-06-15

    Purpose: To develop a quality control tool to reduce stereotactic radiosurgery (SRS) planning variability using models that predict achievable plan quality metrics (QMs) based on individual patient anatomy. Methods: Using a knowledge-based methodology that quantitatively correlates anatomical geometric features to resultant organ-at-risk (OAR) dosimetry, we developed models for predicting achievable OAR dose-volume histograms (DVHs) by training with a cohort of previously treated SRS patients. The DVH-based QMs used in this work are the gradient measure, GM=(3/4pi)^1/3*[V50%^1/3−V100%^1/3], and V10Gy of normal brain. As GM quantifies the total rate of dose fall-off around the planning target volume (PTV), all voxels inside the patient's body contour were treated as OAR for DVH prediction. 35 previously treated SRS plans from our institution were collected; all were planned with non-coplanar volumetric-modulated arc therapy to prescription doses of 12–25 Gy. Of the 35-patient cohort, 15 were used for model training and 20 for model validation. Accuracies of the predictions were quantified by the mean and the standard deviation of the difference between clinical and predicted QMs, δQM=QM-clin−QM-pred. Results: Best agreement between predicted and clinical QMs was obtained when models were built separately for V-PTV<2.5cc and V-PTV>2.5cc. Eight patients trained the V-PTV<2.5cc model and seven patients trained the V-PTV>2.5cc models, respectively. The mean and the standard deviation of δGM were 0.3±0.4mm for the training sets and −0.1±0.6mm for the validation sets, demonstrating highly accurate GM predictions. V10Gy predictions were also highly accurate, with δV10Gy=0.8±0.7cc for the training sets and δV10Gy=0.7±1.4cc for the validation sets. Conclusion: The accuracy of the models in predicting two key SRS quality metrics highlights the potential of this technique for quality control for SRS treatments. Future investigations will seek to determine

  5. Supersize me: Cronobacter sakazakii phage GAP32

    Energy Technology Data Exchange (ETDEWEB)

    Abbasifar, Reza; Griffiths, Mansel W. [Canadian Research Institute for Food Safety, University of Guelph, Guelph, ON, Canada N1G 2W1 (Canada); Sabour, Parviz M. [Agriculture and Agri-Food Canada, Guelph Food Research Centre, Guelph, ON, Canada N1G 5C9 (Canada); Ackermann, Hans-Wolfgang [Department of Microbiology-Infectiology and Immunology, Faculty of Medicine, Université Laval, Quebec, QC (Canada); Vandersteegen, Katrien; Lavigne, Rob [Laboratory of Gene Technology, Katholieke Universiteit Leuven, Leuven (Belgium); Noben, Jean-Paul [Biomedical Research Institute and Transnational University Limburg, School of Life Sciences, Hasselt University, Diepenbeek (Belgium); Alanis Villa, Argentina; Abbasifar, Arash [Canadian Research Institute for Food Safety, University of Guelph, Guelph, ON, Canada N1G 2W1 (Canada); Nash, John H.E. [Public Health Agency of Canada, Laboratory for Foodborne Zoonoses, Guelph, ON, Canada N1G 3W4 (Canada); Kropinski, Andrew M., E-mail: akropins@uoguelph.ca [Public Health Agency of Canada, Laboratory for Foodborne Zoonoses, Guelph, ON, Canada N1G 3W4 (Canada); Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, Canada N1G 2W1 (Canada)

    2014-07-15

    Cronobacter sakazakii is a Gram-negative pathogen found in milk-based formulae that causes infant meningitis. Bacteriophages have been proposed to control bacterial pathogens; however, comprehensive knowledge about a phage is required to ensure its safety before clinical application. We have characterized C. sakazakii phage vB{sub C}saM{sub G}AP32 (GAP32), which possesses the second largest sequenced phage genome (358,663 bp). A total of 571 genes including 545 protein coding sequences and 26 tRNAs were identified, thus more genes than in the smallest bacterium, Mycoplasma genitalium G37. BLASTP and HHpred searches, together with proteomic analyses reveal that only 23.9% of the putative proteins have defined functions. Some of the unique features of this phage include: a chromosome condensation protein, two copies of the large subunit terminase, a predicted signal-arrest-release lysin; and an RpoD-like protein, which is possibly involved in the switch from immediate early to delayed early transcription. Its closest relatives are all extremely large myoviruses, namely coliphage PBECO4 and Klebsiella phage vB{sub K}leM-RaK2, with whom it shares approximately 44% homologous proteins. Since the homologs are not evenly distributed, we propose that these three phages belong to a new subfamily. - Highlights: • Cronobacter sakazakii phage vB{sub C}saM{sub G}AP32 has a genome of 358,663 bp. • It encodes 545 proteins which is more than Mycoplasma genitalium G37. • It is a member of the Myoviridae. • It is peripherally related to coliphage PBECO4 and Klebsiella phage vB{sub K}leM-RaK2. • GAP32 encodes a chromosome condensation protein.

  6. The effect of implementing undergraduate competency-based medical education on students' knowledge acquisition, clinical performance and perceived preparedness for practice : a comparative study

    NARCIS (Netherlands)

    Kerdijk, Wouter; Snoek, Jos W.; van Hell, Elisabeth A.; Cohen-Schotanus, Janke

    2013-01-01

    Background: Little is known about the gains and losses associated with the implementation of undergraduate competency-based medical education. Therefore, we compared knowledge acquisition, clinical performance and perceived preparedness for practice of students from a competency-based active learnin

  7. Locating relevant patient information in electronic health record data using representations of clinical concepts and database structures.

    Science.gov (United States)

    Pan, Xuequn; Cimino, James J

    2014-01-01

    Clinicians and clinical researchers often seek information in electronic health records (EHRs) that are relevant to some concept of interest, such as a disease or finding. The heterogeneous nature of EHRs can complicate retrieval, risking incomplete results. We frame this problem as the presence of two gaps: 1) a gap between clinical concepts and their representations in EHR data and 2) a gap between data representations and their locations within EHR data structures. We bridge these gaps with a knowledge structure that comprises relationships among clinical concepts (including concepts of interest and concepts that may be instantiated in EHR data) and relationships between clinical concepts and the database structures. We make use of available knowledge resources to develop a reproducible, scalable process for creating a knowledge base that can support automated query expansion from a clinical concept to all relevant EHR data.

  8. Intern’s knowledge of clinical pharmacology and therapeutics at Puducherry: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Nitya S

    2013-10-01

    Full Text Available Background: Internship is the intermediate period between under-graduation and general practice. The dexterity of health professional relies upon prescribing practices. Clinical pharmacology and therapeutics (CPT is a crucial discipline for interns to acquire safe and rational prescription of drugs. Cultivating sound knowledge about CPT during under graduation is, henceforth, mandatory. Aims and objectives: 1.To assess whether the undergraduate CPT teaching and internship training had prepared interns adequately for safe and rational prescription. 2.To assess the awareness and reporting of adverse drug reaction (ADR. Methods: 110 interns were enrolled after obtaining informed written consent. A structured questionnaire was given to them including basic demographic information, undergraduate CPT teaching, experience of ADR and any deficiency in the under-graduate CPT teaching. Results: Response rate was 91 % in which 53 were males and 47 females. 81 considered themselves aware of CPT. 56% & 57% interns were able to prescribe drug safely and rationally respectively. Without supervision, they were confident to prescribe antacids (93%, vitamins and minerals (90%, NSAIDS (85%, antihistamines (82%, antibiotics (75%, antiemetics (62% and antiasthmatics (52%. Only 22% had reported ADR and opined that it could lead to hospitalization (51%, prolonged hospital stay (33%, morbidity (16% and death (21%. According to interns, the topics where more emphasis needed were ADR, dosage calculation, pediatric and emergency medicine and therapeutic drug monitoring during undergraduate CPT teaching. Conclusion: CPT teaching should be improved at undergraduate level for safe and rational prescribing including ADR monitoring, ADR reporting and dosage calculation. [Int J Basic Clin Pharmacol 2013; 2(5.000: 622-628

  9. Awareness and knowledge of Human Papillomavirus (HPV infection among high-risk men of Hispanic origin attending a Sexually Transmitted Infection (STI clinic

    Directory of Open Access Journals (Sweden)

    Colón-López Vivian

    2012-12-01

    Full Text Available Abstract Background Genital Human papilloma virus (HPV is one of the most commonly diagnosed Sexually Transmitted Infection (STIs in men and women. Knowledge about HPV infection among men is limited. This study aims to determine correlates of adequate knowledge of HPV infection among men who attend an STI clinic in Puerto Rico. Methods A cross-sectional study of 206 men was conducted at an STI clinic in San Juan, PR. Adequate knowledge was defined as a score of at least 70% of correct responses among those men who reported having ever heard of HPV. Variables that achieved statistical significance in the bivariate analysis (p Results Although 52.5% of men reported having heard of HPV infection before the survey, only 29.3% of this sub-group had an adequate knowledge of HPV. Most men did not know that HPV is a risk factor for anal (38.7%, penile (50.0% and oral (72.6% cancer. Factors associated with adequate knowledge of HPV in age-adjusted models were being men who have sex with men (MSM (OR=2.6;95%CI=1.1-6.1, self-report of genital warts (OR=3.2;95%CI=1.3-7.9 and herpes (OR=7.4;95% CI=2.2-25.1. MSM was marginally associated with adequate knowledge (OR=2.3;95% CI=0.9-5.9 and self-report of herpes remained significantly associated (OR=5.0;95%CI=1.3-18.4 in multivariate logistic regression analysis. Conclusions Awareness and knowledge of HPV was very low in this group of men. Interventions to increase knowledge and awareness in this group are necessary to promote preventive practices for HPV-related cancers in high-risk groups.

  10. Gaps in Political Interest

    DEFF Research Database (Denmark)

    Robison, Joshua

    2015-01-01

    sought to measure respondents’ general interest in politics by asking them how often they follow public affairs. In this article, we uncover novel sources of measurement error concerning this question. We first show that other nationally representative surveys that frequently use this item deliver......Political interest fundamentally influences political behavior, knowledge, and persuasion (Brady, Verba, & Schlozman, 1995; Delli Carpini & Keeter, 1996; Luskin, 1990; Zukin, Andolina, Keeter, Jenkins, & Delli Carpini, 2006). Since the early 1960s, the American National Election Studies (ANES) has...... drastically higher estimates of mass interest. We then use a survey experiment included on a wave of the ANES’ Evaluating Government and Society Surveys (EGSS) to explore the influence of question order in explaining this systemic gap in survey results. We show that placing batteries of political...

  11. Knowledge and Perceptions about Clinical Trials and the Use of Biomedical Samples: Findings from a Qualitative Study in Rural Northern Ghana.

    Directory of Open Access Journals (Sweden)

    Samuel Chatio

    Full Text Available Clinical trials conducted in sub-Saharan Africa have helped to address the prevalent health challenges. The knowledge about how communities perceive clinical trials is however only now evolving. This study was conducted among parents whose children participated in past clinical trials in northern Ghana to assess their knowledge and perceptions of clinical trials and the use of biomedical samples.This was a qualitative study based on eighty in-depth interviews with parents. The participants were randomly selected from among parents whose children were enrolled in a clinical trial conducted in the Kassena-Nankana districts between 2000 and 2003. The interviews were transcribed and coded into emergent themes using Nvivo 9 software. The thematic analysis framework was used to analyze the data.Study participants reported that clinical trials were carried out to determine the efficacy of drugs and to make sure that these drugs were suitable for human beings to use. The conduct of clinical trials was perceived to have helped to reduce the occurrence of diseases such as malaria, cerebrospinal meningitis and diarrhea. Quality of care was reported to be better in clinical trials than in the routine care. Parents indicated that participation in clinical trials positively influenced their health-seeking behavior. Apprehensions about blood draw and the use to which samples were put were expressed, with suspicion by a few participants that researchers sold blood samples. The issue of blood draw was most contentious.Parents perception about the conduct of clinical trials in the study districts is generally positive. However, misconceptions made about the use of blood samples in this study must be taken seriously and strategies found to improve transparency and greater community acceptability.

  12. Traditional complementary and alternative medicine: knowledge, attitudes and practices of health care workers in HIV and AIDS clinics in Durban hospitals.

    Science.gov (United States)

    Mbutho, Nozuko P; Gqaleni, Nceba; Korporaal, Charmaine M

    2012-01-01

    Traditional complementary and alternative medicine (TCAM) has been reported to be commonly used among individuals with HIV and AIDS disease. However a lack of communication between health care workers (HCWs) and patients as well as between HCWs and TCAM practitioners has been identified as one of the challenges that may adversely affect treatment of HIV and AIDS patients. With improved and sustained communication HCWs, patients and TCAM practitioners would be able to make informed decisions with regards to best treatment practices based on the knowledge of what is safe, effective and what is not. In order to establish a baseline understanding of the current status of interaction and communication between HCWs and TCAM profession in Durban, South Africa, the purpose of the study was to investigate the knowledge, attitudes and practices of HCWs in the HIV and AIDS clinics towards TCAM professions. Data was collected by means of anonymous self-administered questionnaire which was distributed to HCWs in the HIV and AIDS clinics. Out of 161 HCWs in the HIV and AIDS clinics 81 HCWs returned the questionnaires resulting in 50% response rate. The results showed that participants did not possess a basic knowledge of TCAM. Out of 81 participants 23 (28%) scored zero in a true or false knowledge assessment question.

  13. Burkholderia pseudomallei Data Gap Analysis

    Science.gov (United States)

    2015-11-01

    conducting this review is to identify the major biodefense relevant data gaps critical to better understanding B. pseudomallei infections and how they are...of patients (Table 2-1). Much of the data has excellent demographic and clinical resolution including age, sex, symptoms, duration of illness, risk...inhalation and enteral. Presentations include pneumonia , genitourinary, cutaneous, general bacteremia, septic arthritis and neurological

  14. Improving Clinical Practices for Children with Language and Learning Disorders

    Science.gov (United States)

    Kamhi, Alan G.

    2014-01-01

    Purpose: This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development. Method: Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions,…

  15. "Teens Talk Healthy Weight": the impact of a motivational digital video disc on parental knowledge of obesity-related diseases in an adolescent clinic.

    Science.gov (United States)

    Windham, Meghan E; Hastings, Elisabeth S; Anding, Roberta; Hergenroeder, Albert C; Escobar-Chaves, Soledad Liliana; Wiemann, Constance M

    2014-10-01

    The purpose of the study was to investigate the impact of a 7-minute educational and motivational weight-management digital video disc (DVD) that uses real patient/parent testimonials and provider-patient interactions, on adolescent and parent knowledge of obesity-related diseases; readiness, motivation, and self-efficacy to lose weight; connectedness to care provider; and likelihood of return to clinic for follow-up care. A randomized controlled trial was conducted among 40 overweight/obese adolescent participants (22.5% male, 77.5% female, mean age=15.43 years) and their parents (n=38) who visited a referral-only adolescent clinic for the first time from October 2009 to March 2010. Adolescents were randomly assigned by a research assistant to standard care alone or standard care plus DVD. Standard care (protocol-driven medical and nutritional assessment and counseling) was provided to all adolescents by a registered dietitian nutritionist and physician or nurse practitioner. Adolescents in the intervention group also viewed the DVD. Adolescents and parents completed assessments pre- and post-clinic visit. Repeated measures analysis of covariance was used to evaluate group differences, while controlling for race/ethnicity and age. Parents who viewed the DVD experienced greater improvements in obesity-related disease knowledge than parents who did not view the DVD. Adolescents in both groups improved on measures of motivation to lose weight and dieting self-efficacy, based on pre and post-test questionnaires. A 7-minute educational and motivational DVD helped improve parent knowledge, but was not more powerful than standard care alone in changing other weight-related outcomes in this adolescent clinic. Because it led to increased parental knowledge, incorporating the DVD into clinical practice could also allow more time for health providers to focus on specific obesity-related treatment/education. Future research might examine whether the DVD has more utility in

  16. Increasing gap junctional coupling: a tool for dissecting the role of gap junctions.

    Science.gov (United States)

    Axelsen, Lene Nygaard; Haugan, Ketil; Stahlhut, Martin; Kjølbye, Anne-Louise; Hennan, James K; Holstein-Rathlou, Niels-Henrik; Petersen, Jørgen Søberg; Nielsen, Morten Schak

    2007-03-01

    Much of our current knowledge about the physiological and pathophysiological role of gap junctions is based on experiments where coupling has been reduced by either chemical agents or genetic modification. This has brought evidence that gap junctions are important in many physiological processes. In a number of cases, gap junctions have been implicated in the initiation and progress of disease, and experimental uncoupling has been used to investigate the exact role of coupling. The inverse approach, i.e., to increase coupling, has become possible in recent years and represents a new way of testing the role of gap junctions. The aim of this review is to summarize the current knowledge obtained with agents that selectively increase gap junctional intercellular coupling. Two approaches will be reviewed: increasing coupling by the use of antiarrhythmic peptide and its synthetic analogs and by interfering with the gating of gap junctional channels.

  17. Application of tacit knowledge in nursing clinical practice teaching%隐性知识在护理临床实习带教中的应用

    Institute of Scientific and Technical Information of China (English)

    杨淑洁; 华卓君; 葛旭玲

    2011-01-01

    Objective To discuss the application of tacit knowledge in nursing clinical teaching.Methods To select the clinical teaching teacher strictly,nursing tacit knowledge was taught,developed and classified.To establish sharing mechanism of tacit knowledge in department; advocate all kinds of activities,provide communication opportunities to promote the transfer and sharing of tacit knowledge.Results The abilities of the nurse students to analyse and solve problems had been significantly improved,the performances of theories and operation were satisfactory; and the satisfaction degree of patients was improved,excellence rate of two -way assessment was raised year by year in teaching and learning.Conclusions The clinical practice is a main process to transfer and transform nursing tacit knowledge.In nursing teaching,nursing tacit knowledge education plays a important role.The spread of tacit knowledge has the vital significance to improve nursing clinical teaching quality.%目的 探讨护理隐性知识在临床带教工作中的应用.方法 严格选拔临床带教老师;护理隐性知识培训;护理隐性知识开发、整理归类,使其显性化,建立科内隐性知识的共享机制;组织各种活动,提供交流的机会,促使护理隐性知识的传递和共享.结果 护生临床分析问题和解决问题的能力有了明显的提高;理论考试和操作考核成绩令人满意;病人满意度提高;在教与学双向测评中优良率逐年提高.结论 临床实习是护理隐性知识传递和转化的主要过程,在护理教学中护理隐性知识教育占有相当重要的地位,隐性知识的传播对于提高护理临床教学质量具有重要的意义.

  18. Cases from the Cleveland Clinic Foundation: What's Knowledge Got to Do with It? Ethics, Epistemology, and Intractable Conflicts in the Medical Setting.

    Science.gov (United States)

    Kibbe, Bryan; Ford, Paul J

    2016-01-01

    This article utilizes the case of Ms H. to examine the contrasting ways that surrogate decision makers move from simply hearing information about the patient to actually knowing and understanding the patient's medical condition. The focus of the case is on a family's request to actually see the patient's wounds instead of being told about the wounds, and the role of clinical ethicists in facilitating this request. We argue that clinical ethicists have an important role to play in the work of converting information into knowledge and that this can serve as a valuable way forward in the midst of seemingly intractable conflicts in the medical setting.

  19. Data-mining to build a knowledge representation store for clinical decision support. Studies on curation and validation based on machine performance in multiple choice medical licensing examinations.

    Science.gov (United States)

    Robson, Barry; Boray, Srinidhi

    2016-06-01

    Extracting medical knowledge by structured data mining of many medical records and from unstructured data mining of natural language source text on the Internet will become increasingly important for clinical decision support. Output from these sources can be transformed into large numbers of elements of knowledge in a Knowledge Representation Store (KRS), here using the notation and to some extent the algebraic principles of the Q-UEL Web-based universal exchange and inference language described previously, rooted in Dirac notation from quantum mechanics and linguistic theory. In a KRS, semantic structures or statements about the world of interest to medicine are analogous to natural language sentences seen as formed from noun phrases separated by verbs, prepositions and other descriptions of relationships. A convenient method of testing and better curating these elements of knowledge is by having the computer use them to take the test of a multiple choice medical licensing examination. It is a venture which perhaps tells us almost as much about the reasoning of students and examiners as it does about the requirements for Artificial Intelligence as employed in clinical decision making. It emphasizes the role of context and of contextual probabilities as opposed to the more familiar intrinsic probabilities, and of a preliminary form of logic that we call presyllogistic reasoning.

  20. Overcoming gaps to advance global health equity: a symposium on new directions for research.

    Science.gov (United States)

    Frenk, Julio; Chen, Lincoln

    2011-02-22

    The 20th anniversary of the groundbreaking report of the Commission on Health Research for Development inspired a Symposium to assess progress made in strengthening essential national health research capacity in developing countries and in global research partnerships. Significant aspects of the health gains achieved in the 20th century can be attributed to the advancement and translation of knowledge, and knowledge continues to occupy center stage amidst growing complexity that characterizes the global health field. The way forward will entail a reinvigoration of research-generated knowledge as a crucial ingredient for global cooperation and global health advances. To do this we will need to overcome daunting gaps, including the divides between domestic and global health, among the disciplines of research (biomedical, clinical, epidemiological, health systems), between clinical and public health approaches, public and private investments, and between knowledge gained and action implemented. Overcoming systematically these obstacles can accelerate progress towards research for equity in health and development.

  1. Overcoming gaps to advance global health equity: a symposium on new directions for research

    Directory of Open Access Journals (Sweden)

    Chen Lincoln

    2011-02-01

    Full Text Available Abstract The 20th anniversary of the groundbreaking report of the Commission on Health Research for Development inspired a Symposium to assess progress made in strengthening essential national health research capacity in developing countries and in global research partnerships. Significant aspects of the health gains achieved in the 20th century can be attributed to the advancement and translation of knowledge, and knowledge continues to occupy center stage amidst growing complexity that characterizes the global health field. The way forward will entail a reinvigoration of research-generated knowledge as a crucial ingredient for global cooperation and global health advances. To do this we will need to overcome daunting gaps, including the divides between domestic and global health, among the disciplines of research (biomedical, clinical, epidemiological, health systems, between clinical and public health approaches, public and private investments, and between knowledge gained and action implemented. Overcoming systematically these obstacles can accelerate progress towards research for equity in health and development.

  2. The National Drug Abuse Treatment Clinical Trials Network: forging a partnership between research knowledge and community practice

    Directory of Open Access Journals (Sweden)

    Liu D

    2011-03-01

    Full Text Available Betty Tai, Steven Sparenborg, David Liu, Michele StrausCenter for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, USAAbstract: The National Drug Abuse Treatment Clinical Trials Network (CTN has faced many challenges over its first eleven years. This review explores some of these challenges and the paths the CTN took to meet these challenges, including: designing clinical trials that reflect the CTN’s mission and changing public health needs, finding the synergies in the varied expertise of clinical treatment providers and academic researchers, promoting evidence-based practices and expanding the Network into mainstream medical practices to reach a broader patient population. Included in this exploration are specific examples from CTN clinical trials.Keywords: Clinical Trials Network, drug abuse, addiction 

  3. Knowledge management: organizing nursing care knowledge.

    Science.gov (United States)

    Anderson, Jane A; Willson, Pamela

    2009-01-01

    Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the "know-how" of clinical experience. This "know-how" knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical "know-how" and investigational (evidence-based) knowledge culminate into the "knowledge of caring" that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.

  4. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey.

    Science.gov (United States)

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-02-01

    [Purpose] This study aimed to investigate Japanese physical therapists' attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.

  5. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey

    Science.gov (United States)

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-01-01

    [Purpose] This study aimed to investigate Japanese physical therapists’ attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions. PMID:28265139

  6. The Case Anatomical Knowledge Index (CAKI): A Novel Method Used to Assess Anatomy Content in Clinical Cases

    Science.gov (United States)

    Banda, Sekelani S.

    2009-01-01

    There are concerns in the literature that the use of case-based teaching of anatomy could be compromising the depth and scope of anatomy learned by students in a problem-based learning curriculum. Poor selection of clinical cases that are used as vehicles for teaching/learning anatomy may be the root problem because some clinical cases do not…

  7. Pilot Test of Survey to Assess Dental and Dental Hygiene Student Human Papillomavirus-Related Oropharyngeal Cancer Knowledge, Perceptions, and Clinical Practices.

    Science.gov (United States)

    Rutkoski, Holdunn; Fowler, Brynn; Mooney, Ryan; Pappas, Lisa; Dixon, Barbara L; Pinzon, Lilliam M; Winkler, James; Kepka, Deanna

    2017-01-14

    This was the first study to develop and pilot test an assessment tool for the examination of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) knowledge, perceptions, and clinical practices of oral health students. An interdisciplinary team developed the tool using surveys that examined this topic in other populations. The tool was then pilot tested at two different dental programs. Results from the pilot informed revisions to the final version of the tool. Of the 46 student participants, 18 were first-year dental hygiene and 28 were first-year dental students. The majority of participants were female (N = 29, 63%) and ages 18 to 29 years old (N = 41, 89%). Four scales used in the questionnaire were analyzed for reliability. Of these, the HPV and HPV-OPC knowledge and the HPV vaccination knowledge scales had Cronbach alphas of 0.71 and 0.79, respectively. Questions assessing HPV and the role of dental professionals had a correlation coefficient of 0.71. Questions assessing willingness to administer vaccines in the dental office had a correlation coefficient of 0.85. Assessing oral health students' HPV-OPC knowledge, perceptions, and clinical practices are important for future assessment of possible HPV-OPC cases. Dental professionals may be optimally positioned to provide HPV patient education. The tool developed and pilot tested in this study can help schools assess their students' knowledge and guide their dental curriculum to address deficiencies. Since this topic has not been effectively examined with dental health students, the results could help improve dental education and dental care.

  8. Evaluation of the PharmGKB knowledge base as a resource for efficiently assessing the clinical validity and utility of pharmacogenetic assays.

    Science.gov (United States)

    Kawamoto, Kensaku; Orlando, Lori A; Voora, Deepak; Lobach, David F; Joy, Scott; Cho, Alex; Ginsburg, Geoffrey S

    2009-11-14

    Prior to clinical use, pharmacogenetic tests should be systematically evaluated for their clinical validity and utility. Here, we evaluated whether the publicly available, online Pharmacogenomics Knowledge Base (PharmGKB) could facilitate such assessments by efficiently identifying relevant peer-reviewed manuscripts. The search targets were 55 manuscripts regarding clinical validity and utility included in systematic reviews of warfarin, antidepressant, and irinotecan pharmacogenetics. When direct inclusion in PharmGKB was the search criterion, recall was 33% and precision was 16%. However, recall increased to 78% when citation within a PharmGKB-identified manuscript was added as a search criterion. These recalled manuscripts accounted for 87% of the study subjects, and domain experts determined that the omission of the remaining manuscripts was unlikely to have changed the conclusions of the reviews. Thus, we conclude that PharmGKB can facilitate the systematic assessment of pharmacogenetic assays through the efficient identification of relevant peer-reviewed manuscripts.

  9. Gaps in nutritional research among older adults with cancer.

    Science.gov (United States)

    Presley, Carolyn J; Dotan, Efrat; Soto-Perez-de-Celis, Enrique; Jatoi, Aminah; Mohile, Supriya G; Won, Elizabeth; Alibhai, Shabbir; Kilari, Deepak; Harrison, Robert; Klepin, Heidi D; Wildes, Tanya M; Mustian, Karen; Demark-Wahnefried, Wendy

    2016-07-01

    Nutritional issues among older adults with cancer are an understudied area of research despite significant prognostic implications for treatment side effects, cancer-specific mortality, and overall survival. In May of 2015, the National Cancer Institute and the National Institute on Aging co-sponsored a conference focused on future directions in geriatric oncology research. Nutritional research among older adults with cancer was highlighted as a major area of concern as most nutritional cancer research has been conducted among younger adults, with limited evidence to guide the care of nutritional issues among older adults with cancer. Cancer diagnoses among older adults are increasing, and the care of the older adult with cancer is complicated due to multimorbidity, heterogeneous functional status, polypharmacy, deficits in cognitive and mental health, and several other non-cancer factors. Due to this complexity, nutritional needs are dynamic, multifaceted, and dependent on the clinical scenario. This manuscript outlines the proceedings of this conference including knowledge gaps and recommendations for future nutritional research among older adults with cancer. Three common clinical scenarios encountered by oncologists include (1) weight loss during anti-cancer therapy, (2) malnutrition during advanced disease, and (3) obesity during survivorship. In this manuscript, we provide a brief overview of relevant cancer literature within these three areas, knowledge gaps that exist, and recommendations for future research.

  10. Knowledge and risk perception of late effects among childhood cancer survivors and parents before and after visiting a childhood cancer survivor clinic.

    Science.gov (United States)

    Cherven, Brooke; Mertens, Ann; Meacham, Lillian R; Williamson, Rebecca; Boring, Cathy; Wasilewski-Masker, Karen

    2014-01-01

    Survivors of childhood cancer are at risk for a variety of treatment-related late effects and require lifelong individualized surveillance for early detection of late effects. This study assessed knowledge and perceptions of late effects risk before and after a survivor clinic visit. Young adult survivors (≥ 16 years) and parents of child survivors (survivor program. Sixty-five participants completed a baseline survey and 50 completed both a baseline and follow-up survey. Participants were found to have a low perceived likelihood of developing a late effect of cancer therapy and many incorrect perceptions of risk for individual late effects. Low knowledge before clinic (odds ratio = 9.6; 95% confidence interval, 1.7-92.8; P = .02) and low perceived likelihood of developing a late effect (odds ratio = 18.7; 95% confidence interval, 2.7-242.3; P = .01) were found to predict low knowledge of late effect risk at follow-up. This suggests that perceived likelihood of developing a late effect is an important factor in the individuals' ability to learn about their risk and should be addressed before initiation of education.

  11. Increasing gap junctional coupling: a tool for dissecting the role of gap junctions

    DEFF Research Database (Denmark)

    Axelsen, Lene Nygaard; Haugan, Ketil; Stahlhut, Martin;

    2007-01-01

    . In a number of cases, gap junctions have been implicated in the initiation and progress of disease, and experimental uncoupling has been used to investigate the exact role of coupling. The inverse approach, i.e., to increase coupling, has become possible in recent years and represents a new way of testing......Much of our current knowledge about the physiological and pathophysiological role of gap junctions is based on experiments where coupling has been reduced by either chemical agents or genetic modification. This has brought evidence that gap junctions are important in many physiological processes...... the role of gap junctions. The aim of this review is to summarize the current knowledge obtained with agents that selectively increase gap junctional intercellular coupling. Two approaches will be reviewed: increasing coupling by the use of antiarrhythmic peptide and its synthetic analogs...

  12. Conflicts Between Parents and Health Professionals About a Child's Medical Treatment: Using Clinical Ethics Records to Find Gaps in the Bioethics Literature.

    Science.gov (United States)

    McDougall, Rosalind; Notini, Lauren; Phillips, Jessica

    2015-09-01

    Clinical ethics records offer bioethics researchers a rich source of cases that clinicians have identified as ethically complex. In this paper, we suggest that clinical ethics records can be used to point to types of cases that lack attention in the current bioethics literature, identifying new areas in need of more detailed bioethical work. We conducted an analysis of the clinical ethics records of one paediatric hospital in Australia, focusing specifically on conflicts between parents and health professionals about a child's medical treatment. We identified, analysed, and compared cases of this type from the clinical ethics records with cases of this type discussed in bioethics journals. While the cases from journals tended to describe situations involving imminent risk to the child's life, a significant proportion of the clinical ethics records cases involved different stakes for the child involved. These included distress, poorer functional outcome, poorer psychosocial outcome, or increased risk of surgical complications. Our analysis suggests that one type of case that warrants more detailed ethics research is parental refusal of recommended treatment, where the refusal does not endanger the child's life but rather some other aspect of the child's well-being.

  13. Exploration of knowledge, attitudes and percepions regarding sexually transmitted infections among patients attending a primary health care clinic in Gauteng--part 1.

    Science.gov (United States)

    Molapo, T J; Maja, T M M; Wright, S C D

    2007-12-01

    Sexually transmitted infections are a major public health problem in South Africa. The high incidence and prevalence of sexually transmitted infections in South Africa pose a serious threat to public health for two main reasons. Firstly, the long-term consequences of these infections are a major cause of loss of health or life, and secondly, sexually transmitted infections are important co-factors in driving the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. The control and prevention of sexually transmitted infections has become an urgent priority. At a primary health care clinic, the nursing personnel experienced an increasing number of persons daily seeking treatment for sexually transmitted infections. The purpose of the study was therefore to investigate the knowledge, attitudes and perceptions of people seeking treatment at Stanza Bopape Clinic regarding sexually transmitted infections. The study was a contextual, quantitative survey. The population was all patients (15 years and older) who visited the clinic for a health-related problem during November 2004 to January 2005. The sampling method was convenient. The data gathering method was self-report using a structured questionnaire basic on current knowledge. The data analysis was done with descriptive statistics.

  14. Exploration of knowledge, attitudes and percepions regarding sexually transmitted infections among patients attending a primary health care clinic in Gauteng - Part 1

    Directory of Open Access Journals (Sweden)

    T.J. Molapo

    2007-09-01

    Full Text Available Sexually transmitted infections are a major public health problem in South Africa. The high incidence and prevalence of sexually transmitted infections in South Africa pose a serious threat to public health for two main reasons. Firstly, the long-term consequences of these infections are a major cause of loss of health or life, and secondly, sexually transmitted infections are important co-factors in driving the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS epidemic. The control and prevention of sexually transmitted infections has become an urgent priority. At a primary health care clinic, the nursing personnel experienced an increasing number of persons daily seeking treatment for sexually transmitted infections. The purpose of the study was therefore to investigate the knowledge, attitudes and perceptions of people seeking treatment at Stanza Bopape Clinic regarding sexually transmitted infections. The study was a contextual, quantitative survey. The population was all patients (15 years and older who visited the clinic for a health-related problem during November 2004 to January 2005. The sampling method was convenient. The data gathering method was self-report using a structured questionnaire basic on current knowledge. The data analysis was done with descriptive statistics.

  15. Towards smaller gap microbulks

    CERN Document Server

    Attié, D.; Dafni, T; Ferrer-Ribas, E.; Ferrer-Ribas, E; Ferry, S; Giomataris, Y; Herrera, D C; Iguaz, F J; Irastorza, I G; Kebbiri, M; Papaevangelou, T; de Oliveira, R; Seguí, L; Tomás, A

    2014-01-01

    Small gap Micromegas detectors ( < 50 μm) are expected to be optimal for high pressure applications. Combining the microbulk manufacturing technique with a small gap can result in attractive detectors for rare event detection, in particular double beta decay or dark matter searches. We present novel results obtained with small gap microbulks (25 and 12.5 μm) that have been manufactured recently. For the first time for this type of detectors, we show experimentally that for each amplification gap there is an optimal pressure and that smaller gaps are more suitable for higher pressures.

  16. Engaging the learner by bridging the gap between theory and clinical competence: the impact of concept mapping and simulation as innovative strategies for nurse-sensitive outcome indicators.

    Science.gov (United States)

    Jamison, Therese; Lis, Gail A

    2014-03-01

    Concept mapping and simulation provide professional nurses in the academic and practice environment with an opportunity for experiential learning. This integral combination allows for learning to be congruent with the national clinical practice guidelines that support and promote nurse-sensitive indicators. Implications for practice are forthcoming as data are collected on the impact on health outcomes when using concept mapping and simulation.

  17. Knowledge, attitude, perception of malaria and evaluation of malaria parasitaemia among pregnant women attending antenatal care clinic in metropolitan Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    N.C. Iriemenam, A.O. Dosunmu, W.A. Oyibo & A.F. Fagbenro-Beyioku

    2011-03-01

    Full Text Available Background & objectives: Little information exists on the compliance of pregnant women to malaria managementin malaria endemic countries. This study was designed to access knowledge, attitude, perception and homemanagement of malaria among consenting pregnant women attending antenatal care (ANC clinic.Methods: In total, 350 pregnant women were randomly recruited during their ANC Clinic in Lagos. Structuredquestionnaires were administered in a two-stages research design; first during their early months of ANC visitand the second approximately 1–2 months before delivery. Information on occupation, parity, symptoms used torecognise malaria, treatment sources, control measures, knowledge factors, anti-vector measures, health-seekingpractices, malaria parasitaemia and packed cell volume (PCV were recorded.Results: The results revealed that 78.9% of the pregnant women identified infected mosquitoes as the cause ofmalaria while 86% of the pregnant women identified stagnant water as its breeding sites. Knowledge of thebenefit of insecticide-treated mosquito bednets was less prominent as most of the selected subjects decried itshigh market price. Our data also showed that educational programme targeted on potential mothers is beneficial.Overall, 27.4% (96/350 of the pregnant women had peripheral malaria infection with 88.5% (85/96 of theparasite positive women infected with Plasmodium falciparum and 11.5% (11/96 with P. malariae. PCV rangedfrom 20–40% (median 33.9% with 25.7% (90/350 of the pregnant women being anaemic with PCV <33%. Wefound an association between malaria infection and occupation, and this association was not influenced byparity.Interpretation & conclusion: Our findings revealed that improvement in knowledge and education of women ofchild-bearing age has an influential impact on malaria control

  18. A pilot study of BRCA mutation carriers' knowledge about the clinical impact of prophylactic-oophorectomy and views on fertility consultation: a single-center pilot study.

    Science.gov (United States)

    Kim, J; Skrzynia, C; Mersereau, J E

    2015-02-01

    BRCA mutation carriers will experience early surgically induced menopause following prophylactic bilateral salpingo-oophorectomy (PBSO). This pilot study aimed to investigate their (1) knowledge about the clinical impact of PBSO; (2) views on fertility consultation (FC)/fertility preservation (FP) treatment; and (3) difficulties in conceiving compared to non-carriers. A cross-sectional, single institution web-survey was performed at a university-based IVF center. Women aged 18-50 years who were screened for BRCA gene mutations from 2005 to 2013 were recruited via mail. Forty-one BRCA-positive and 110 BRCA-negative women completed the survey (response rate: 50 %). The knowledge about the reproductive impact of PBSO was limited, with the majority of women in this highly educated sample only identifying the correct response 64 % of the time. Among BRCA mutation carriers, 24 (59 %) had positive views about FC/FP treatments. A larger proportion of women with no children at the time of BRCA testing, and those who were non-white tended to have positive views toward FP. Women with, versus without, BRCA mutations were more likely to have difficulty in conceiving (p = 0.08). This well-educated group had limited knowledge about the reproductive clinical impact of PBSO, or the benefit of a FP before PBSO. Most women with BRCA mutations were interested in FC/FP treatment if they had not completed childbearing at the time of screening. Targeted referrals for FC at the time of BRCA screening may help women improve knowledge and allow improved decision-making about reproductive options.

  19. HIV prevalence, risk behavior, knowledge, and beliefs among women seeking care at a sexually transmitted infection clinic in Mumbai, India.

    Science.gov (United States)

    Cooperman, Nina A; Shastri, Jayanthi S; Shastri, Aditi; Schoenbaum, Ellie

    2014-01-01

    Three hundred women presenting to a sexually transmitted infection (STI) clinic in Mumbai, India were surveyed and HIV tested. Thirty-nine percent were HIV infected; 80% were current sex workers, and HIV infection was not significantly associated with past-year sex work. Only 44% always used condoms with their noncommercial sex partners. Most believed that condom preparation is a male responsibility (58%); that condom use is a sign that partner trust is lacking (84%); and that if a woman asks her partner to use a condom, he will lose respect for her (65%). All women at STI clinics in India need HIV testing and culturally sensitive risk interventions.

  20. Knowledge management

    OpenAIRE

    Jarošová, Milena

    2008-01-01

    Theoretical part: Basic terms of knowledge management, knowledge worker, knowledge creation and conversion process, prerequisites and benefits of knowledge management. Knowledge management and it's connection to organizational culture and structure, result measurements of knowledge management, learning organization and it's connection to knowledge management. Tacit knowledge management tools -- stories -- types, how to create, practical use, communities, coaching. Value Based Organization. Pr...

  1. Integrating clinical research into clinical decision making

    Directory of Open Access Journals (Sweden)

    Mark R Tonelli

    2011-01-01

    Full Text Available Evidence-based medicine has placed a general priority on knowledge gained from clinical research for clinical decision making. However, knowledge derived from empiric, population-based research, while valued for its ability to limit bias, is not directly applicable to the care of individual patients. The gap between clinical research and individual patient care centers on the fact that empiric research is not generally designed to answer questions of direct relevance to individual patients. Clinicians must utilize other forms of medical knowledge, including pathophysiologic rationale and clinical experience, in order to arrive at the best medical decision for a particular patient. In addition, clinicians must also elucidate and account for the goals and values of individual patients as well as barriers and facilitators of care inherent in the system in which they practice. Evidence-based guidelines and protocols, then, can never be prescriptive. Clinicians must continue to rely on clinical judgment, negotiating potentially conflicting warrants for action, in an effort to arrive at the best decision for a particular patient.

  2. Development and evaluation of a clinical model for lung cancer patients using stereotactic body radiotherapy (SBRT) within a knowledge-based algorithm for treatment planning.

    Science.gov (United States)

    Snyder, Karen Chin; Kim, Jinkoo; Reding, Anne; Fraser, Corey; Gordon, James; Ajlouni, Munther; Movsas, Benjamin; Chetty, Indrin J

    2016-11-08

    The purpose of this study was to describe the development of a clinical model for lung cancer patients treated with stereotactic body radiotherapy (SBRT) within a knowledge-based algorithm for treatment planning, and to evaluate the model performance and applicability to different planning techniques, tumor locations, and beam arrangements. 105 SBRT plans for lung cancer patients previously treated at our institution were included in the development of the knowledge-based model (KBM). The KBM was trained with a combination of IMRT, VMAT, and 3D CRT techniques. Model performance was validated with 25 cases, for both IMRT and VMAT. The full KBM encompassed lesions located centrally vs. peripherally (43:62), upper vs. lower (62:43), and anterior vs. posterior (60:45). Four separate sub-KBMs were created based on tumor location. Results were compared with the full KBM to evaluate its robustness. Beam templates were used in conjunction with the optimizer to evaluate the model's ability to handle suboptimal beam placements. Dose differences to organs-at-risk (OAR) were evaluated between the plans gener-ated by each KBM. Knowledge-based plans (KBPs) were comparable to clinical plans with respect to target conformity and OAR doses. The KBPs resulted in a lower maximum spinal cord dose by 1.0 ± 1.6 Gy compared to clinical plans, p = 0.007. Sub-KBMs split according to tumor location did not produce significantly better DVH estimates compared to the full KBM. For central lesions, compared to the full KBM, the peripheral sub-KBM resulted in lower dose to 0.035 cc and 5 cc of the esophagus, both by 0.4Gy ± 0.8Gy, p = 0.025. For all lesions, compared to the full KBM, the posterior sub-KBM resulted in higher dose to 0.035 cc, 0.35 cc, and 1.2 cc of the spinal cord by 0.2 ± 0.4Gy, p = 0.01. Plans using template beam arrangements met target and OAR criteria, with an increase noted in maximum heart dose (1.2 ± 2.2Gy, p = 0.01) and GI (0.2 ± 0.4, p = 0.01) for the nine

  3. Primary Healthcare Provider Knowledge, Beliefs and Clinic-Based Practices Regarding Alternative Tobacco Products and Marijuana: A Qualitative Study

    Science.gov (United States)

    Bascombe, Ta Misha S.; Scott, Kimberly N.; Ballard, Denise; Smith, Samantha A.; Thompson, Winifred; Berg, Carla J.

    2016-01-01

    Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This…

  4. Effects of a Lifestyle Modification Program on Knowledge, Attitude and Practice of Hypertensive Patients with Angioplasty: A Randomized Controlled Clinical Trial

    Science.gov (United States)

    Jafari, Fahimeh; Shahriari, Mohsen; Sabouhi, Fakhri; Khosravi Farsani, Alireza; Eghbali Babadi, Maryam

    2016-01-01

    ABSTRACT Background: Lack of knowledge, attitude and practice are some of the barriers of having a healthy lifestyle and controlling high blood pressure. This study aimed to determine the effectiveness of a lifestyle modification program on knowledge, attitude and practice of hypertensive patients with angioplasty. Methods: This study was a randomized controlled clinical trial conducted from November to April 2014 on 60 hypertensive patients with angioplasty in Shahid Chamran hospital of Isfahan, Iran. The samples were randomly assigned to two equal groups. Data collection was performed in three stages by a researcher-made questionnaire. The intervention plan was 6 education sessions and then follow up were done by phone call. The gathered data were analyzed via SPSS (V.20), using t-test, Chi-square, repeated measurement, and post hoc LSD test and ANOVA statistics. Results: The mean score of knowledge, attitude and practice in the experimental group immediately after the intervention was 77.8±7.2, 88.3±6.4 and 86.2±6.5, respectively and one month after the intervention was 80.8±7.4, 91.1±3.5 and 92.5±2.2, respectively. But in the control group, the mean score of knowledge, attitude and practice immediately after the intervention (34.90±11.23, 61.11±6.28, and 38.64±7.15) and one month after the intervention was (38.64±7.15, 59.56±6.31 and 37.27±7.26. Conclusion: Lifestyle modification program can be effective in promoting the knowledge, attitude and practice of hypertensive patients with angioplasty. Nurses can use this program in their care provision programs for these patients. Trial Registration Number:IRCT2015062420912N3 PMID:27713892

  5. Knowledge, perceived stigma, and care-seeking experiences for sexually transmitted infections: a qualitative study from the perspective of public clinic attendees in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Cunnigham Shayna D

    2007-02-01

    Full Text Available Abstract Background An estimated 12 million sexually transmitted infections (STIs are documented in Brazil per year. Given the scope of this public health challenge and the importance of prompt treatment and follow-up counseling to reduce future STI/HIV-related risk behavior, we sought to qualitatively explore STI clinic experiences among individuals diagnosed with STIs via public clinics in Rio de Janeiro, Brazil. The study focused on eliciting the perspective of clinic users with regard to those factors influencing their STI care-seeking decisions and the health education and counseling which they received during their clinic visit. Methods Thirty semi-structured interviews were conducted with heterosexual men and women and men who have sex with men presenting with STIs at two public clinics. Content analysis was conducted by coding transcripts of audio-taped interviews for key domains of interest and comparing and synthesizing code output across participants and sub-groups. Thematic narratives were then developed per each of the study sub-groups. Results Salient themes that emerged from participant narratives included the importance of low STI-related knowledge and high perceived stigma, both STI-related and other types of social stigma, on STI care-seeking delays. However, there are indications in the data that the level of STI-related knowledge and the amount and types of stigma experienced vary across the study sub-groups suggesting the need for further research on the significance and program relevance of these potential differences. Interview findings also suggest that such barriers to care seeking are not adequately addressed through ongoing health education and counseling efforts at public STI clinics and in turn critical opportunities for STI/HIV prevention are currently being missed. Conclusion Information, communication and education regarding early recognition and prompt care-seeking for STIs should be developed, with consideration

  6. Prescribing knowledge in the light of undergraduate clinical pharmacology and therapeutics teaching in India: views of first-year postgraduate students

    Directory of Open Access Journals (Sweden)

    Upadhyaya P

    2012-06-01

    Full Text Available Prerna Upadhyaya,1 Vikas Seth,2 Monika Sharma,1 Mushtaq Ahmed,1 Vijay Vasant Moghe,1 Zafar Yab Khan,1 Vinay Kumar Gupta,1 Shipra Vikram Jain,1 Utkarsh Soni,1 Manohar Bhatia,1 Kumar Abhijit,1 Jaswant Goyal11Department of Pharmacology, Mahatma Gandhi Medical College, Jaipur, 2Department of Pharmacology, Hind Institute of Medical Sciences, Lucknow, IndiaObjectives: The study aimed to review the prescribing knowledge of first-year postgraduate doctors in a medical college in India, using the principles of good prescribing, to suggest strategies to improve rational prescribing, and to recommend what curriculum planners can do to accomplish this objective.Methods: Fifty first-year postgraduate doctors were asked to fill in a structured questionnaire that sought information regarding their undergraduate training in clinical pharmacology and therapeutics, prescribing habits, and commonly consulted drug information sources. Also, the questionnaire assessed any perceived deficiencies in their undergraduate clinical pharmacology teaching and sought feedback regarding improvement in the teaching.Results: Eighty-eight percent of residents said that they were taught prescription writing in undergraduate pharmacology teaching; 48% of residents rated their prescribing knowledge at graduation as average, 28% good, 4% excellent, 14% poor, and 4% very poor; 58% felt that their undergraduate training did not prepare them to prescribe safely, and 62% felt that their training did not prepare them to prescribe rationally. Fifty-eight percent of residents felt that they had some specific problems with writing a prescription during their internship training, while 92% thought that undergraduate teaching should be improved. Their suggestions for improving teaching methods were recorded.Conclusions: This study concludes that efforts are needed to develop a curriculum that encompasses important aspects of clinical pharmacology and therapeutics along with incorporation of

  7. Impact of a Multifaceted and Clinically Integrated Training Program in Evidence-Based Practice on Knowledge, Skills, Beliefs and Behaviour among Clinical Instructors in Physiotherapy: A Non-Randomized Controlled Study.

    Directory of Open Access Journals (Sweden)

    Nina Rydland Olsen

    Full Text Available Physiotherapists practicing at clinical placement sites assigned the role as clinical instructors (CIs, are responsible for supervising physiotherapy students. For CIs to role model evidence-based practice (EBP they need EBP competence. The aim of this study was to assess the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs supervising physiotherapy students.We invited 37 CIs to participate in this non-randomized controlled study. Three self-administered questionnaires were used pre- and post-intervention, and at six-month follow-up: 1 The Adapted Fresno test (AFT, 2 the EBP Belief Scale and 3 the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations.In total, 29 CIs agreed to participate in the study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for the AFT (mean difference = 37, 95% CI (15.9 -58.1, p < 0.001 and the EBP Beliefs scale (mean difference = 8.1, 95% CI (3.1 -13.2, p = 0.002, but not for the EBP Implementation scale (mean difference = 1.8. 95% CI (-4.5-8.1, p = 0.574. Comparing measurements over time, we found a statistically significant increase in mean scores related to all outcome measures for the intervention group only.A multifaceted and clinically integrated training program in EBP was successful in improving EBP knowledge, skills and beliefs among CIs. Future studies need to ensure long-term EBP behaviour change, in addition to assessing CIs' abilities to apply EBP knowledge and skills when supervising students.

  8. A Comparison Between Caucasians and African Americans in Willingness to Participate in Cancer Clinical Trials: The Roles of Knowledge, Distrust, Information Sources, and Religiosity.

    Science.gov (United States)

    Meng, Jingbo; McLaughlin, Margaret; Pariera, Katrina; Murphy, Sheila

    2016-06-01

    This study aims to (a) examine the roles of knowledge, distrust in medical professionals, information sources, and 2 dimensions of religiosity (i.e., religious activity and religious belief) in influencing willingness to participate (WTP) in cancer clinical trials and to (b) compare the results for Caucasians and African Americans in order to inform future recruitment. An online survey was fielded via a Knowledge Networks panel with a nationally representative sample including 478 Caucasians and 173 African Americans. The results showed that distrust in medical professionals was a strong barrier to WTP for both ethnic groups, whereas factual knowledge about trial procedures was not associated with WTP for either ethnic group. Seeking trial information from doctors was positively associated with WTP for Caucasians; seeking trial information from hospitals was positively associated with WTP for African Americans. More interestingly, levels of religious activity negatively predicted WTP for Caucasians but positively predicted WTP for African Americans. Self-reported religious belief was not associated with WTP for either ethnic group. In sum, although distrust is a common barrier to WTP, the influence of preferred information sources and religious activity on WTP varies as a function of ethnicity.

  9. Bridging the Gap

    OpenAIRE

    Kramer Overgaard, Majken; Broeng, Jes; Jensen, Monika Luniewska; Murdock, Karen; Schmidt, Iben Julie

    2015-01-01

    Bridging the Gap (BtG) is a 2-year project funded by The Danish Industry Foundation. The goal of Bridging the Gap has been to create a new innovation model which will increase the rate at which Danish universities can spinout new technology ventures. Bridging the Gap (BtG) is a 2-year project funded by The Danish Industry Foundation. The goal of Bridging the Gap has been to create a new innovation model which will increase the rate at which Danish universities can spinout new technology ve...

  10. Bridging the Gap

    DEFF Research Database (Denmark)

    Kramer Overgaard, Majken; Broeng, Jes; Jensen, Monika Luniewska;

    Bridging the Gap (BtG) is a 2-year project funded by The Danish Industry Foundation. The goal of Bridging the Gap has been to create a new innovation model which will increase the rate at which Danish universities can spinout new technology ventures.......Bridging the Gap (BtG) is a 2-year project funded by The Danish Industry Foundation. The goal of Bridging the Gap has been to create a new innovation model which will increase the rate at which Danish universities can spinout new technology ventures....

  11. 临床护士对造口认知的现状调查分析%The investigation on the cognition of clinical nurses to colostomy knowledge

    Institute of Scientific and Technical Information of China (English)

    魏苏艳; 梁宗桦; 赵婉青

    2012-01-01

    Objective To study the cognition of clinical nurses to colostomy knowledge.Methods A total of 180 clinical nurses were selected randomly and investigated by self-designed questionnaire.Results Self-assessment total average score of clinical nursing staff to colostomy basic knowledge was 48.94±0.835,grade was poor; evaluation of colostomy complications total average score was 63.06±0.889,grade was good.Colostomy related behavior evaluation total average score was 18.06±0.726.So self-assessment grade was lower than the evaluation grade (P<0.05).There were differences in colostomy knowledge and complication knowledge of nurses in different departments (P<0.05).Conclusions The cognitive level of clinical nurse to colostomy knowledge is poor,so the management staff should enhance the training of clinical nurse on colostomy knowleage,and use effective method to provide new skills and advance,so as to improve the quality of nursing for colostomy and the life quality of patients.%目的 了解临床护理人员对造口的认知现状.方法 对于随机抽取的180名临床护理人员采用自行设计的问卷进行调查.结果 临床护理人员对于造口基础知识的自评总平均分48.94±0.835,等级属差;测评造口并发症总平均分为63.06±0.889,等级属良;造口相关行为测评总平均分为18.06±0.726,自评等级低于测评等级(P<0.05).不同民族、年龄、职称护理人员对造口知识的自评分值和测评分值差异无统计学意义(P>0.05);不同科室护士对造口基础知识及造口并发症知识的自评分值存在差异(P<0.05),且外科>内科>儿科.结论 临床护理人员对造口的认知还处于较低的水平,应加强临床护理人员造口知识的培训,采用有效的方式或途径,提供新技术、新进展、改善造口护理实践以提高造口护理质量.从而提升造口患者生活质量水平.

  12. ADDRESSING THE GAP:

    DEFF Research Database (Denmark)

    Bagger, Bettan; Taylor Kelly, Hélène

    2013-01-01

    for clinical practice. Moreover, posters help the students to put into perspective complex nursing practice, problems and dilemmas so they become understandable for themselves and their audiences. Students evaluate posters as a valuable and concrete and useable tool in the development of their roles......Abstract Content: Bologna recommendations shifting the focus of nurse education away from the acquirement of formal qualifications towards the development of nurse competencies calls for a change in pedagogical approach. Posterpresentations have been successfully used when developing nursing...... students’ intellectual, professional and academic competences as well as in the development of competencies relevant for nursing practice. Working with posters forces students to organize, evaluate and reflect upon information and develops their abilities to communicate health promotion knowledge...

  13. Academic Performance on First-Year Medical School Exams: How Well Does It Predict Later Performance on Knowledge-Based and Clinical Assessments?

    Science.gov (United States)

    Krupat, Edward; Pelletier, Stephen R; Dienstag, Jules L

    2017-01-01

    Number of appearances in the bottom quartile of 1st-year medical school exams were used to represent the extent to which students were having academic difficulties. Medical educators have long expressed a desire to have indicators of medical student performance that have strong predictive validity. Predictors traditionally used fell into 4 general categories: demographic (e.g., gender), other background factors (e.g., college major), performance/aptitude (e.g., medical college admission test scores), and noncognitive factors (e.g., curiosity). These factors, however, have an inconsistent record of predicting student performance. In comparison to traditional predictive factors, we sought to determine the extent to which academic performance in the 1st-year of medical school, as measured by examination performance in the bottom quartile of the class in 7 required courses, predicted later performance on a variety of assessments, both knowledge based (e.g., United States Medical Licensing Examination Step 1 and Step IICK) and clinical skills based (e.g., clerkship grades and objective structured clinical exam performance). Of all predictors measured, number of appearances in the bottom quartile in Year 1 was the most strongly related to performance in knowledge-based assessments, as well as clinically related outcomes, and, for each outcome, bottom-quartile performance accounted for additional variance beyond that of the traditional predictors. Low academic performance in the 1st year of medical school is a meaningful risk factor with both predictive validity and predictive utility for low performance later in medical school. The question remains as to how we can incorporate this indicator into a system of formative assessment that effectively addresses the challenges of medical students once they have been identified.

  14. Mothers knowledge on the cause, prevention and symptoms of malaria in a university staff clinic in an urban setting in Southwestern Nigeria.

    Science.gov (United States)

    Omole, M K; Alabi, O M; Ayoola, O O

    2007-03-01

    This prospective study was carried out at Jaja Clinic, University of Ibadan, Nigeria. The study documented the knowledge of mothers of children about the cause, prevention and symptoms of malaria. These were mothers of children between ages 1 month to 12 years that presented with fever at the clinic for the first time during the current illness. Data was collected with structured questionnaires administered to the mothers of the enrolled children. The children were clinically examined by clinicians and blood films for malaria parasites were taken and examined in the laboratory using Giemsa stain. The haematocrit level of each child was also determined. 60.4% of the children were 1 month-5 years (mean age 33.0 +/- 15.2 months) while 39.6% of them were over 5-12 years (mean 8.1 +/- 2.1 years). Most of the mothers (58.3%) had above secondary school education. Blood films for malaria parasites were positive in 76% of the children that presented with fever. 74.2% of the mothers knew mosquito bite as the cause of malaria while 13.2% of them were ignorant of the cause of malaria. The main protective measures practiced by the mothers against mosquito bites were netted windows (86.2%), use of aerosol insecticides (76.1%), and mosquito coil (17.0%). Most mothers were not knowledgeable about the use of insecticide treated nets (ITN) which is the most recently introduced protective measure against mosquito bite. Ninety percent of the mothers knew fever as the major symptom of malaria. The degree of parasitaemia affected the PCV level. The greater the parasite count, the lower the PCV level.

  15. Hippocampal-dependent neurocognitive impairment following cranial irradiation observed in pre-clinical models: current knowledge and possible future directions.

    Science.gov (United States)

    Tomé, Wolfgang A; Gökhan, Şölen; Gulinello, Maria E; Brodin, N Patrik; Heard, John; Mehler, Mark F; Guha, Chandan

    2016-01-01

    We reviewed the literature for studies pertaining to impaired adult neurogenesis leading to neurocognitive impairment following cranial irradiation in rodent models. This compendium was compared with respect to radiation dose, converted to equivalent dose in 2 Gy fractions (EQD2) to allow for direct comparison between studies. The effects of differences between animal species and the dependence on animal age as well as for time after irradiation were also considered. One of the major sites of de novo adult neurogenesis is the hippocampus, and as such, this review also focuses on assessing evidence related to the expression and potential effects of inflammatory cytokines on neural stem cells in the subgranular zone of the dentate gyrus and whether this correlates with neurocognitive impairment. This review also discusses potential strategies to mitigate the detrimental effects on neurogenesis and neurocognition resulting from cranial irradiation, and how the rationale for these strategies compares with the current outcome of pre-clinical studies.

  16. Educating DNP students about critical appraisal and knowledge translation.

    Science.gov (United States)

    Moore, Elizabeth R; Watters, Richard

    2013-01-01

    Consumers expect that health care providers will use the best evidence when assisting them in making decisions about treatment options. Nurses at all educational levels report that they lack knowledge to critically appraise research studies and the skills to effectively implement evidence-based practice (EBP) in their clinical settings. Organizational culture and management support of innovation are critical factors in the adoption of EBP. Doctor of Nursing Practice (DNP) graduates can have a pivotal role in the transfer of knowledge to practice, yet critical appraisal and EBP competencies for DNP and Master of Science in Nursing (MSN) students have not been well differentiated in nursing curricula. Also students' attitudes toward EBP, self-efficacy beliefs, utilization, and knowledge gaps are rarely evaluated before courses are designed. This article reports on the development of a DNP-level EBP course to help students evaluate and apply research findings to clinical practice.

  17. Bridging a Cultural Gap

    Science.gov (United States)

    Leviatan, Talma

    2008-01-01

    There has been a broad wave of change in tertiary calculus courses in the past decade. However, the much-needed change in tertiary pre-calculus programmes--aimed at bridging the gap between high-school mathematics and tertiary mathematics--is happening at a far slower pace. Following a discussion on the nature of the gap and the objectives of a…

  18. Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome.

    Science.gov (United States)

    Bansal, V; Singh, S; Garg, N; Dubey, P

    2014-02-01

    This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via 'lazy-S' incision. A gap arthroplasty was performed, followed by a 'reverse L' osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13-27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients.

  19. Changes in Colorectal Cancer Screening Knowledge, Behavior, Beliefs, Self-Efficacy, and Barriers among Community Health Clinic Patients after a Health Literacy Intervention

    Science.gov (United States)

    Arnold, Connie L.; Rademaker, Alfred; Liu, Dachao; Davis, Terry C.

    2017-01-01

    Objective The objective in this pre- and post-survey assessment was to compare the effectiveness of a health literacy-directed intervention designed to increase knowledge, beliefs, barriers, self-efficacy and behavior associated with CRC screening with FOBT among patients cared for in predominantly rural community clinics and the change in these characteristics over the first 15 months after enrolling in a study designed to assess screening strategies. Methods Between 2008 and 2011, a quasi-experimental intervention was conducted in 8 predominantly rural Federally Qualified Health Centers. Patients were orally administered a 15-minute survey at enrollment by a clinic research assistant (RA) and at 15 months by phone by a central RA. Participants included 428 community clinic patients aged 50–85 (mean 58.5); the majority (79%) were female, 69% were African American, and 54% had limited health literacy. Results There was significant improvement across all groups with the number of patients reporting they had been given information /education on CRC testing (p83%) as confirmed by study records.

  20. Inhibition of the PI3K/Akt/mTOR signaling pathway in diffuse large B-cell lymphoma: current knowledge and clinical significance.

    Science.gov (United States)

    Majchrzak, Agata; Witkowska, Magdalena; Smolewski, Piotr

    2014-09-11

    Diffuse large B-cell lymphoma (DLBCL) is one of the most common non-Hodgkin lymphomas in adults. The disease is very heterogeneous in its presentation, that is DLBCL patients may differ from each other not only in regard to histology of tissue infiltration, clinical course or response to treatment, but also in respect to diversity in gene expression profiling. A growing body of knowledge on the biology of DLBCL, including abnormalities in intracellular signaling, has allowed the development of new treatment strategies, specifically directed against lymphoma cells. The phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway plays an important role in controlling proliferation and survival of tumor cells in various types of malignancies, including DLBCL, and therefore it may be a promising target for therapeutic intervention. Currently, novel anticancer drugs are undergoing assessment in different phases of clinical trials in aggressive lymphomas, with promising outcomes. In this review we present a state of art review on various classes of small molecule inhibitors selectively involving PI3K/Akt/mTOR pathway and their clinical potential in this disease.

  1. Inhibition of the PI3K/Akt/mTOR Signaling Pathway in Diffuse Large B-Cell Lymphoma: Current Knowledge and Clinical Significance

    Directory of Open Access Journals (Sweden)

    Agata Majchrzak

    2014-09-01

    Full Text Available Diffuse large B-cell lymphoma (DLBCL is one of the most common non-Hodgkin lymphomas in adults. The disease is very heterogeneous in its presentation, that is DLBCL patients may differ from each other not only in regard to histology of tissue infiltration, clinical course or response to treatment, but also in respect to diversity in gene expression profiling. A growing body of knowledge on the biology of DLBCL, including abnormalities in intracellular signaling, has allowed the development of new treatment strategies, specifically directed against lymphoma cells. The phosphoinositide 3-kinase (PI3K/protein kinase B (Akt/mammalian target of rapamycin (mTOR signaling pathway plays an important role in controlling proliferation and survival of tumor cells in various types of malignancies, including DLBCL, and therefore it may be a promising target for therapeutic intervention. Currently, novel anticancer drugs are undergoing assessment in different phases of clinical trials in aggressive lymphomas, with promising outcomes. In this review we present a state of art review on various classes of small molecule inhibitors selectively involving PI3K/Akt/mTOR pathway and their clinical potential in this disease.

  2. 活动翼矫治技术关闭拔牙间隙的临床研究%Clinical study on technical activities wing correction closing tooth extraction gap of

    Institute of Scientific and Technical Information of China (English)

    吴惠平

    2015-01-01

    Objective To study the clinical effect of the treatment of the closed tooth extraction with the active wing. Methods A total of 2013 during January to December 2013 in our hospital accepted treatment of 60 cases of canine orthodontic patients as the research object,randomly divided into treatment group and control group,two groups with 30 cases in each patient.Treatment group were used active wing appliance treatment,the control group were treated with edgewise appliance,the variation in the canine root length of two groups of patients,canine alveolar bone height changes,the gap closed speed,patient satisfaction,and other indicators were compared.Observation and comparison of two groups of patients with specific treatment effect,including treatment time, effective time, there is no recurrence,etc. Results in closing the gap rate,treatment group were(0.95±0.03) months,control group (0.80 ± 0.03)months,the two groups of patients with significant difference compared,with statistical significance(P0.05) compared to the;in patient satisfaction,the satisfaction rate of patients of the treatment group was 93.33,the control group of patients satisfaction was 73.33%,two groups in patient satisfaction compared with significant difference, with statistical significance(P0.05);在患者满意度上,治疗组患者满意度为93.33%,对照组患者满意度为73.33%,差异有统计学意义(P<0.05).结论:活动翼矫治技术能更加快速地关闭拔牙间隙,而且比较安全,疼痛感也较少,值得临床推广应用.

  3. Effectiveness of current teaching methods in Cardiology: the SKILLS (medical Students Knowledge Integration of Lower Level clinical Skills) study

    Science.gov (United States)

    Lavranos, G; Koliaki, C; Briasoulis, A; Nikolaou, A; Stefanadis, C

    2013-01-01

    Introduction: The aim of the study is to assess reported changes in medical students’ capacity to attain five basic cardiological clinical skills, following a one-month intensive cardiology course provisioned in the core curriculum. Materials and Methods: An anonymous questionnaire comprising self reported performance in the five skills, namely 1) arterial blood pressure measurement, 2) cardiac auscultation, 3) electrocardiogram (ECG) carry out, 4) ECG interpretation and 5) defibrillation, was distributed to 177 fifth year students of the Athens Medical School upon initiating the cardiology course (pre-training group) and to 59 students matched for sex, age, year of study and training centre, following completion of the course (post training group). Comparison of pre- and post- training performance was evaluated using the χ2 test. Results: No change was noted with regards to blood pressure measurement, cardiac auscultation or defibrillation. By contrast, a statistically significant improvement was reported for ECG execution (54.3 versus 81.4%; p<0.001) and interpretation (from 33.1 to 89.8%; p<0.001). Conclusions: Improvement in the execution and interpretation of ECGs seems to be among the strengths of the cardiology training program. Further studies including larger samples from multiple medical schools and objective assessment of skill execution might facilitate accurate training evaluation and define opportunities for improvement. PMID:23935341

  4. Clinical Practice and Knowledge in Caring: Breastfeeding Ties and the Impact on the Health of Latin-American Minor Migrants.

    Science.gov (United States)

    Castaldo, Miriam; Marrone, Rosalia; Costanzo, Gianfranco; Mirisola, Concetta

    2015-10-01

    In the context of the project "Clinical and social evaluation of medical practices in the treatment of infectious diseases in pediatrics for children of vulnerable population" carried out in 2013 by a multidisciplinary team at the National Institute for Health, Migration and Poverty (NIHMP) in Rome, a study in medical anthropology on the incorporation of illnesses that mothers feel they transmit to their children through breastfeeding was conducted. The results of the anthropological study, that targeted 34 children and adolescents from the age of 3 to the age of 17, all immigrants from Latin America residing in Italy, show that some forms of suffering in minors are described by women as being connected to factors such as susto ("fright"), coraje, muina, enojo ("anger") and mal de ojo ("evil eye"), and are in relation to a specific cultural frame. It is clear that barriers that prevent the access to the healthcare system must be removed, barriers that are accentuated by linguistic and cultural incomprehension, through adequate multidisciplinary healthcare settings such as the one we are presenting, composed of a medical doctor, an anthropologist and a cultural mediator.

  5. Filling the Income Gap

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    @@ Income distribution has become one of the people's main concerns in China where more than 30years of reform and opening up have also resulted in an ever-expanding wealth gap.But narrowing down the rich-poor disparity will prove to be no easy task.Wei Zhong,a researcher with the Institute of Economics under the Chinese Academy of Social Sciences,elaborated on the origins and trends of China's widening income gap,and discussed solutions to curb the gap,in a recent article.Edited excerpts follow:

  6. Small-Gap Flows

    Science.gov (United States)

    1984-04-01

    34’OF CALIFORNIA# BERKELEY, CA 5.1720 ft (45 642-141 SMALL- GAP FLOWS BY E. 0. TUCK REPORT No. NAUE 84-1 CONTRACT N00014-84-K-OU26 APRIL i984...Mechanics, 41 (1970) 769-792. 11 3. Shallow-Water Waves at Discontinuities Shallow-water waves represent perhaps the prototype small- gap flow , the...solving (4.4) we need "initial" conditions at the starting station z = 0, and "exit" conditions at the station z = L where the gap flow merges with the

  7. Modelling Gender Pay Gaps

    OpenAIRE

    2004-01-01

    EXECUTIVE SUMMARYIntroductionThere has been little change in the full-time gender pay gap since the mid 1990s andin the female part-time/male full-time pay gap since the mid 1970s. The gender gapin hourly earnings for those employed full-time in Britain in 2003 was 18 per cent,while that between women working part-time and men working full-time was 40 percent.This research uses statistical methods to identify how much of the gender pay gap isassociated with different factors. The data set ana...

  8. Knowledge Management and Transfer

    Energy Technology Data Exchange (ETDEWEB)

    Sennanye, D.M.; Thugwane, S.J.; Rasweswe, M.A. [South African Young Nuclear Professionals Society, South African Nuclear Energy Cooperation, National Nuclear Regulator, P O Box 7106, Centurion 0046 (South Africa)

    2008-07-01

    Knowledge management has become an important concept in the nuclear industry globally. This has been driven by the fact that new reactors are commissioned and some are decommissioned. Since most old experts are near retirement then there is a need to capture the nuclear knowledge and expertise and transfer it to the new generation. Knowledge transfer is one of the important building blocks of knowledge management. Processes and strategies need to be developed in order to transfer this knowledge. South African Young Nuclear Professionals Society (SAYNPS) has established a document to address strategies that can be used to close the knowledge gap between the young less experienced and experts in the field. This action will help the young generation to participate in knowledge management. The major challenges will be the willingness of the experts to share and making sure that all knowledge is captured, stored and kept up to date. The paper presents the SAYNPS point of view with regard to knowledge transfer. (authors)

  9. Survey of knowledge and perception on the access to evidence-based practice and clinical practice change among maternal and infant health practitioners in South East Asia

    Directory of Open Access Journals (Sweden)

    Crowther Caroline A

    2008-08-01

    Full Text Available Abstract Background Evidence-based practice (EBP can provide appropriate care for women and their babies; however implementation of EBP requires health professionals to have access to knowledge, the ability to interpret health care information and then strategies to apply care. The aim of this survey was to assess current knowledge of evidence-based practice, information seeking practices, perceptions and potential enablers and barriers to clinical practice change among maternal and infant health practitioners in South East Asia. Methods Questionnaires about IT access for health information and evidence-based practice were administered during August to December 2005 to health care professionals working at the nine hospitals participating in the South East Asia Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID project in Indonesia, Malaysia, Thailand and The Philippines. Results The survey was completed by 660 staff from six health professional groups. Overall, easy IT access for health care information was available to 46% of participants. However, over a fifth reported no IT access was available and over half of nurses and midwives never used IT health information. Evidence-based practice had been heard of by 58% but the majority did not understand the concept. The most frequent sites accessed were Google and PubMed. The Cochrane Library had been heard of by 47% of whom 51% had access although the majority did not use it or used it less than monthly. Only 27% had heard of the WHO Reproductive Health Library and 35% had been involved in a clinical practice change and were able to identify enablers and barriers to change. Only a third of participants had been actively involved in practice change with wide variation between the countries. Willingness to participate in professional development workshops on evidence-based practice was high. Conclusion This survey has identified the need to improve IT access to health care

  10. Knowledge Sharing is Knowledge Creation

    DEFF Research Database (Denmark)

    Greve, Linda

    2015-01-01

    Knowledge sharing and knowledge transfer are important to knowledge communication. However when groups of knowledge workers engage in knowledge communication activities, it easily turns into mere mechanical information processing despite other ambitions. This article relates literature of knowledge...... reducing complexity and dividing knowledge into to dichotomies or hierarchies, knowledge workers should be enabled to use different strategies for knowledge sharing, -transfer and –creation depending on the task and the nature of the knowledge. However if the ambition is to have a strategy for sharing...

  11. Filling the Income Gap

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Income distribution has become one of the people’s main concerns in China where more than 30 years of reform and opening up have also resulted in an ever-expanding wealth gap. But narrowing down the

  12. 以"归零"的心态寻找"差距"促进人才知识和文化融合%Looking for the gap with the mind-set of 'Return to Zero' to promote knowledge and cultural integration of introduced talents

    Institute of Scientific and Technical Information of China (English)

    陈莉

    2011-01-01

    探析了人才引进和使用存在的误区,提出通过建立"归零"心态、"差距观"以及合理的人力资源管理体系,促进对引进人才的激励、使用和知识、文化的融合,使人才引进真正成为提高医院的核心竞争力的手段,促进医院文化和谐发展.%By Exploring and analyzing the mistaken ideas in the talent introduction and management,the mind set of'return to zero'and the sense of gap should be proposed,also the rationality of hospital talent management should be established to promote knowledge and cultureintegration in order to promote hospital core competitiveness and harmonious hospital cultural construction so as to better service the patients.

  13. Iran’s Approach to Knowledge Translation

    OpenAIRE

    R Majdzadeh; S Nedjat; Fotouhi, A; H. Malekafzali

    2009-01-01

    "nKnowledge translation was created in response to the knowledge-do gap. With the growing number of research projects, utilization of research knowledge roused interest. One of its defects, which are seen more in developing countries, is the scarcity of recognized practical knowledge translation applications. The actions taken to strengthen knowledge translation can be classified into three categories of ‘push, pull and exchange'. In Iran, some of the interventions effecti...

  14. Knowledge and perception of Prevention of Mother to Child services amongst pregnant women accessing antenatal clinic in a Primary Health Care centre in Nigeria

    Directory of Open Access Journals (Sweden)

    Eme T. Owoaje

    2012-10-01

    Full Text Available Background: Few studies have assessed pregnant women’s perceptions regarding prevention of mother to child of HIV and the available services at the primary health care level in Nigeria.Objective: Assessment of knowledge and perception of antenatal clinic (ANC attendees regarding Prevention of Mother to Child Transmission (PMTCT of HIV at primary health care facilities in south-west Nigeria.Method: A cross-sectional survey was conducted amongst 400 antenatal attendees in a Primary Health Care centre in Ibadan, Nigeria.Results: Known methods of PMTCT were: use of anti-retroviral treatment (ART during pregnancy (75.0%, ART at birth (65.8% and not breastfeeding (61.8%. Previous HIV Counselling and Testing (HCT was reported by 71%, significantly higher proportions of thosewho were married, in the third trimester of pregnancy or engaged in professional and/or skilled occupations had been tested. Regarding the HCT services provided, 92.2% understood the HIV-related health education provided, 89.7.2% reported that the timing was appropriate, 92.6% assessed the nurses’ approach as acceptable but 34.0% felt the test was forced upon them. Majority (79.6% were aware of non-breastfeeding options of infant feeding, but only 3.5% were aware of exclusive breastfeeding for a stipulated period as an infant feeding option. Nevertheless, the majority of the women found the non-breast feeding option culturally unacceptable.Conclusion: Women in this survey were knowledgeable about the methods of PMTCT, but had negative perceptions regarding certain aspects of the HCT services and the recommended non-breastfeeding infant feeding option. Health workers should provide client friendly services and infant feeding counselling that is based on current WHO recommendations and culturally acceptable.

  15. Knowledge translation for nephrologists: strategies for improving the identification of patients with proteinuria.

    Science.gov (United States)

    Hemmelgarn, Brenda R; Manns, Braden J; Straus, Sharon; Naugler, Christopher; Holroyd-Leduc, Jayna; Braun, Ted C; Levin, Adeera; Klarenbach, Scott; Lee, Patrick F; Hafez, Kevin; Schwartz, Daniel; Jindal, Kailash; Ervin, Kathy; Bello, Aminu; Turin, Tanvir Chowdhury; McBrien, Kerry; Elliott, Meghan; Tonelli, Marcello

    2012-01-01

    For health scientists, knowledge translation refers to the process of facilitating uptake of knowledge into clinical practice or decision making. Since high-quality clinical research that is not applied cannot improve outcomes, knowledge translation is critical for realizing the value and potential for all types of health research. Knowledge translation is particularly relevant for areas within health care where gaps in care are known to exist, which is the case for some areas of management for people with chronic kidney disease (CKD), including assessment of proteinuria. Given that proteinuria is a key marker of cardiovascular and renal risk, forthcoming international practice guidelines will recommend including proteinuria within staging systems for CKD. While this revised staging system will facilitate identification of patients at higher risk for progression of CKD and mortality who benefit from intervention, strategies to ensure its appropriate uptake will be particularly important. This article describes key elements of effective knowledge translation strategies based on the knowledge-to-action cycle framework and describes options for effective knowledge translation interventions related to the new CKD guidelines, focusing on recommendations related to assessment for proteinuria specifically. The article also presents findings from a multidisciplinary meeting aimed at developing knowledge translation intervention strategies, with input from key stakeholders (researchers, knowledge users, decision makers and collaborators), to facilitate implementation of this guideline. These considerations are relevant for dissemination and implementation of guidelines on other topics and in other clinical settings.

  16. Specialty clinic's influence on parents' asthma knowledge%专科门诊对患儿家长哮喘知识掌握的影响

    Institute of Scientific and Technical Information of China (English)

    王娟梅; 李云; 方亦兵

    2011-01-01

    Objective: To explore the most effective control methods of asthma in the comparison between the parents of the first visit children and the return visit children, who had known well in the asthma knowledge. Methods: We made a investigation of the parents' asthma knowledge and behavior between 62 first visit children and 85 return visit children who have been done treatment for more than 3 months, the differences of two groups were evaluated and compared. Results: On the nature of the asthma, symptoms, incitingfactors, acute performance and the connections between asthma and rhinitis, passive smoking and access to plush toys, as well as whether they could participate in sports during asthma control period and whether to insist in using medicines, the parents of the return visit children knew more and done better than the parents of the first visit children (ρ<0.05). But parents of two groups did not know enough about the knowledge of whether regular use of inhaled steroid would affect the growth and development of the children and how to do emergency treatment of acute attacks, there was no significant differences in the groups (ρ>0.05). Conclusion: Continuous education on the parents of asthma children in the specialty clinic can deepen the understanding about asthma, but strengthen education repeatedly is necessary.%目的:通过对比哮喘门诊复诊与首诊患儿家长对哮喘知识的掌握,探索有利的哮喘防治方式.方法:对85例治疗>3个月的复诊患儿家长及62例首诊患儿家长进行哮喘知识及行为调查,评价并比较两组的差异.结果:通过调查家长对哮喘本质、症状、诱发因素、急性发作表现,其与鼻炎、被动吸烟、接触毛绒玩具的关系及哮喘控制可否参加运动、是否坚持用药等方面的知识的掌握情况,两组比较差异有统计学意义(P0.05).结论:哮喘门诊的不断教育可加深患儿家长对哮喘的认识,但仍需反复加强教育.

  17. Knowledge of Chlamydial Infection among University Students.

    Science.gov (United States)

    White, David M.; Felts, W. Michael

    1989-01-01

    Results of a study designed to assess knowledge about chlamydial infection among university students (N=258) revealed serious gaps in knowledge. Data suggests that students held several misconceptions, or had no knowledge, regarding symptoms, transmission, treatment, and testing for chlamydial infection. (IAH)

  18. "Tacit Knowledge" versus "Explicit Knowledge"

    DEFF Research Database (Denmark)

    Sanchez, Ron

    2004-01-01

    and carriers. By contrast, theexplicit knowledge approach emphasizes processes for articulating knowledge held byindividuals, the design of organizational approaches for creating new knowledge, andthe development of systems (including information systems) to disseminate articulatedknowledge within......This paper explains two fundamental approaches to knowledge management. The tacitknowledge approach emphasizes understanding the kinds of knowledge that individualsin an organization have, moving people to transfer knowledge within an organization,and managing key individuals as knowledge creators...... an organization. The relative advantages and disadvantages of bothapproaches to knowledge management are summarized. A synthesis of tacit andknowledge management approaches is recommended to create a hybrid design for theknowledge management practices in a given organization....

  19. Missing the gap

    DEFF Research Database (Denmark)

    Tanggaard, Lene; Glaveanu, Vlad Petre

    creative learning at the borders need not minimize differences, but handle and learn from them? If not, schools and educational institutions risk becoming bad copies of the labour marked instead of enabling students to enter the market with something new, something radically dissimilar from what......Missing the gap This paper is focused on an exploration of creative learning involved in boundary crossing (Tanggaard, 2007). Our aim is to explore the trajectories and pathways realised by students as they move from education to work and vice versa (Tanggaard & Beghetto, 2015), guided...... by the premise that difference and gaps are places where creative learning is intensified (Glaveanu & Gillespie, 2015). The public discourse around education is often concerned with minding or avoiding the gap by making education more relevant for or similar to the labour market, but what if facilitating...

  20. Gap Cycling for SWIFT

    CERN Document Server

    Corum, Curtis A; Snyder, Carl J; Garwood, Michael

    2013-01-01

    Purpose: SWIFT (SWeep Imaging with Fourier Transformation) is a non- Cartesian MRI method with unique features and capabilities. In SWIFT, radiofrequency (RF) excitation and reception are performed nearly simultaneously, by rapidly switching between transmit and receive during a frequency-swept RF pulse. Because both the transmitted pulse and data acquisition are simultaneously amplitude-modulated in SWIFT (in contrast to continuous RF excitation and uninterrupted data acquisition in more familiar MRI sequences), crosstalk between different frequency bands occurs in the data. This crosstalk leads to a "bulls-eye" artifact in SWIFT images. We present a method to cancel this inter-band crosstalk by cycling the pulse and receive gap positions relative to the un-gapped pulse shape. We call this strategy "gap cycling." Methods: We carry out theoretical analysis, simulation and experiments to characterize the signal chain, resulting artifacts, and their elimination for SWIFT. Results: Theoretical analysis reveals t...

  1. Semantic Gaps Are Dangerous

    DEFF Research Database (Denmark)

    Ejstrup, Michael; le Fevre Jakobsen, Bjarne

    Semantic gaps are dangerous Language adapts to the environment where it serves as a tool to communication. Language is a social agreement, and we all have to stick to both grammaticalized and non-grammaticalized rules in order to pass information about the world around us. As such language develops...... unpolite language and tend to create dangerous relations where specialy language creates problems and trouble that could be avoided if we had better language tools at hand. But we have not these tools of communication, and we are in a situation today where media and specially digital and social media......, supported by new possibilities of migration, create dangerous situations. How can we avoid these accidental gaps in language and specially the gaps in semantic and metaphoric tools. Do we have to keep silent and stop discusing certain isues, or do we have other ways to get acces to sufficient language tools...

  2. Knowledge Management

    CERN Document Server

    Gerami, Mohsen

    2010-01-01

    This paper discusses the important process of knowledge and its management, and differences between tacit and explicit knowledge and understanding the culture as a key issue for the successful implementation of knowledge management, in addition to, this paper is concerned with the four-stage model for the evolution of information technology (IT) support for knowledge management in law firms.

  3. A descriptive study of knowledge of Pharmacovigilance and adverse drug reactions among second professional undergraduate medical students in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Rehana Tabassum

    2015-10-01

    Conclusions: Our study revealed that there are gaps between knowledge regarding ADRs and Pharmacovigilance that needs to be addressed on priority basis for the success of the Pharmacovigilance program and better clinical management of patients in general. [Int J Basic Clin Pharmacol 2015; 4(5.000: 1016-1020

  4. Fios ortodônticos: conhecer para otimizar a aplicação clínica Orthodontic wires: knowledge to optimize clinical application

    Directory of Open Access Journals (Sweden)

    Cátia Cardoso Abdo Quintão

    2009-12-01

    Full Text Available A grande variedade de fios ortodônticos presente no mercado pode gerar dúvidas quanto à melhor escolha para situações clínicas. Assim, o conhecimento das propriedades mecânicas dos mesmos facilita a escolha para aplicação do movimento ortodôntico na dependência da fase em que o tratamento se encontra. A evolução da tecnologia de manufatura dos fios e a elaboração de novas técnicas ortodônticas geraram a busca por uma melhor qualidade das ligas, a fim de torná-los biologicamente mais efetivos no que diz respeito aos dentes e tecidos de suporte. O presente artigo resume as principais características dos fios utilizados em Ortodontia, em relação ao histórico, propriedades mecânicas e aplicação clínica, de acordo com fases específicas de tratamento.The huge variety of orthodontic wires brands available in market might generate confusion as regard to the best choice for clinical application. Therefore mechanical properties knowledge about wires would help the professional to apply the best orthodontic technique depending on the treatment phase. The wires manufacturing evolution and the new orthodontic techniques proposed guided the market into the search for better quality alloys, in order to make them biologically more effective to teeth and support tissues. This paper aims to summarize some main characteristics of orthodontic wires related to their history, mechanical properties and clinical application as regard to individual phase of treatment.

  5. The longevity gender gap

    DEFF Research Database (Denmark)

    Aviv, Abraham; Shay, Jerry; Christensen, Kaare

    2005-01-01

    In this Perspective, we focus on the greater longevity of women as compared with men. We propose that, like aging itself, the longevity gender gap is exceedingly complex and argue that it may arise from sex-related hormonal differences and from somatic cell selection that favors cells more...... resistant to the ravages of time. We discuss the interplay of these factors with telomere biology and oxidative stress and suggest that an explanation for the longevity gender gap may arise from a better understanding of the differences in telomere dynamics between men and women....

  6. Research gaps in the care of women with female genital mutilation: an analysis.

    Science.gov (United States)

    Abdulcadir, J; Rodriguez, M I; Say, L

    2015-02-01

    Female genital mutilation (FGM) includes procedures involving the partial or total removal of the external female genitals for non-therapeutic reasons. They can have negative psychosexual and health consequences that need specific care. In this paper, we review some key knowledge gaps in the clinical care of women with FGM, focusing on obstetric outcomes, surgical interventions (defibulation and clitoral reconstruction), and the skills and training of healthcare professionals involved in the prevention and management of FGM. We identify research priorities to improve the evidence necessary to establish guidelines for the best multidisciplinary care, communication, and prevention, and to improve health-promotion measures for women with FGM.

  7. Knowledge Sharing is Knowledge Creation

    DEFF Research Database (Denmark)

    Greve, Linda

    2015-01-01

    communication and knowledge creation to an intervention study in a large Danish food production company. For some time a specific group of employees uttered a wish for knowledge sharing, but it never really happened. The group was observed and submitted to metaphor analysis as well as analysis of co......Knowledge sharing and knowledge transfer are important to knowledge communication. However when groups of knowledge workers engage in knowledge communication activities, it easily turns into mere mechanical information processing despite other ambitions. This article relates literature of knowledge......-creation strategies. Confronted with the results, the group completely altered their approach to knowledge sharing and let it become knowledge co-creation. The conclusions are, that knowledge is and can only be a diverse and differentiated concept, and that groups are able to embrace this complexity. Thus rather than...

  8. Crowdsourcing knowledge discovery and innovations in medicine.

    Science.gov (United States)

    Celi, Leo Anthony; Ippolito, Andrea; Montgomery, Robert A; Moses, Christopher; Stone, David J

    2014-09-19

    Clinicians face difficult treatment decisions in contexts that are not well addressed by available evidence as formulated based on research. The digitization of medicine provides an opportunity for clinicians to collaborate with researchers and data scientists on solutions to previously ambiguous and seemingly insolvable questions. But these groups tend to work in isolated environments, and do not communicate or interact effectively. Clinicians are typically buried in the weeds and exigencies of daily practice such that they do not recognize or act on ways to improve knowledge discovery. Researchers may not be able to identify the gaps in clinical knowledge. For data scientists, the main challenge is discerning what is relevant in a domain that is both unfamiliar and complex. Each type of domain expert can contribute skills unavailable to the other groups. "Health hackathons" and "data marathons", in which diverse participants work together, can leverage the current ready availability of digital data to discover new knowledge. Utilizing the complementary skills and expertise of these talented, but functionally divided groups, innovations are formulated at the systems level. As a result, the knowledge discovery process is simultaneously democratized and improved, real problems are solved, cross-disciplinary collaboration is supported, and innovations are enabled.

  9. From the description of activities to the identification of risks for clinical management: a proposal of building, merging and sharing knowledge representations of care processes.

    Science.gov (United States)

    Staccini, Pascal; Joubert, Michel; Collomp, Rémy; Quaranta, Jean-François; Fieschi, Marius

    2007-01-01

    Management of clinical processes and hospital activities takes advantage of business process reengineering methodology. It is now recognized that care process modeling must integrate the definition of goals and the assessment of risk. Two kinds of issues have been outlined: 1) the lack of an integrated model to identify and describe processes and their components according to a functional point of view; and 2) an increasing amount of documents that hospital staff members have to create, collect, index and maintain. As initial models focused only on a structural view of activities, we reviewed different sources of standards and norms to extract and classify a set of metadata aimed at describing any activity and its outcomes. The model includes links to structured terminologies to name attributes or value them. An object-oriented information model has been created and implemented to test the relevance and the feasibility of the modeling approach. Conceptually speaking, this model gives opportunity to bridge tacit and explicit knowledge. Practically speaking, limits to generalization remain partly due to the lack of a template processes database.

  10. The Impact of Knowledge of Suicide Prevention and Work Experience among Clinical Staff on Attitudes towards Working with Suicidal Patients and Suicide Prevention.

    Science.gov (United States)

    Ramberg, Inga-Lill; Di Lucca, Maria Anna; Hadlaczky, Gergö

    2016-02-04

    Suicide-preventive training has shown to influence attitudes. This study aimed at investigating what impact other factors than knowledge might have on attitudes towards work with suicidal patients and suicide prevention. In 2007, 500 health-care staff working in a psychiatric clinic in Stockholm received a questionnaire with items concerning work with suicidal patients to which 358 (71.6%) responded. A set of attitude items were tested using structural equation modelling (LISREL). Three models were found to be satisfactory valid and reliable: Job clarity, Job confidence and Attitudes towards prevention. These were then used in regression analyses as dependent variables with predictors such as experience of work with suicidal patients, perceived sufficient training, age and gender. Perceived sufficient training was consistently the most important predictor for all three attitude concepts (p suicide for Job confidence (p suicide preventive education is likely to improve attitudes towards the prevention of suicide, clarity and confidence regarding their role in the care for suicidal patients. These improvements may contribute to the prevention of suicide in health care settings.

  11. The Impact of Knowledge of Suicide Prevention and Work Experience among Clinical Staff on Attitudes towards Working with Suicidal Patients and Suicide Prevention

    Directory of Open Access Journals (Sweden)

    Inga-Lill Ramberg

    2016-02-01

    Full Text Available Suicide-preventive training has shown to influence attitudes. This study aimed at investigating what impact other factors than knowledge might have on attitudes towards work with suicidal patients and suicide prevention. In 2007, 500 health-care staff working in a psychiatric clinic in Stockholm received a questionnaire with items concerning work with suicidal patients to which 358 (71.6% responded. A set of attitude items were tested using structural equation modelling (LISREL. Three models were found to be satisfactory valid and reliable: Job clarity, Job confidence and Attitudes towards prevention. These were then used in regression analyses as dependent variables with predictors such as experience of work with suicidal patients, perceived sufficient training, age and gender. Perceived sufficient training was consistently the most important predictor for all three attitude concepts (p < 0.01, β = 0.559 for Job clarity; p < 0.01, β = 0.53 for Job confidence; p < 0.01, β = 0.191 for Attitudes towards prevention. Age was another significant predictor for Job clarity (p < 0.05, β = 0.134, as was experience of patient suicide for Job confidence (p < 0.05, β = 0.137. It is concluded that providing suicide preventive education is likely to improve attitudes towards the prevention of suicide, clarity and confidence regarding their role in the care for suicidal patients. These improvements may contribute to the prevention of suicide in health care settings.

  12. Knowledge typology for imprecise probabilities.

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, G. D. (Gregory D.); Zucker, L. J. (Lauren J.)

    2002-01-01

    When characterizing the reliability of a complex system there are often gaps in the data available for specific subsystems or other factors influencing total system reliability. At Los Alamos National Laboratory we employ ethnographic methods to elicit expert knowledge when traditional data is scarce. Typically, we elicit expert knowledge in probabilistic terms. This paper will explore how we might approach elicitation if methods other than probability (i.e., Dempster-Shafer, or fuzzy sets) prove more useful for quantifying certain types of expert knowledge. Specifically, we will consider if experts have different types of knowledge that may be better characterized in ways other than standard probability theory.

  13. Combined Clinical and Home Rehabilitation : Case Report of an Integrated Knowledge-to-Action Study in a Dutch Rehabilitation Stroke Unit

    NARCIS (Netherlands)

    Nanninga, Christa S.; Postema, Klaas; Schonherr, Marleen C.; van Twillert, Sacha; Lettinga, Ant T.

    2015-01-01

    BACKGROUND: There is growing awareness that the poor uptake of evidence in healthcare is not a knowledge-transfer problem but rather one of knowledge-production. This calls for re-examination of the evidence produced and assumptions that underpin existing Knowledge-To-Action (KTA)-activities. Accord

  14. GFAP-BDP as an acute diagnostic marker in traumatic brain injury: results from the prospective transforming research and clinical knowledge in traumatic brain injury study.

    Science.gov (United States)

    Okonkwo, David O; Yue, John K; Puccio, Ava M; Panczykowski, David M; Inoue, Tomoo; McMahon, Paul J; Sorani, Marco D; Yuh, Esther L; Lingsma, Hester F; Maas, Andrew I R; Valadka, Alex B; Manley, Geoffrey T

    2013-09-01

    Reliable diagnosis of traumatic brain injury (TBI) is a major public health need. Glial fibrillary acidic protein (GFAP) is expressed in the central nervous system, and breakdown products (GFAP-BDP) are released following parenchymal brain injury. Here, we evaluate the diagnostic accuracy of elevated levels of plasma GFAP-BDP in TBI. Participants were identified as part of the prospective Transforming Research And Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. Acute plasma samples (<24 h post-injury) were collected from patients presenting with brain injury who had CT imaging. The ability of GFAP-BDP level to discriminate patients with demonstrable traumatic lesions on CT, and with failure to return to pre-injury baseline at 6 months, was evaluated by the area under the receiver operating characteristic curve (AUC). Of the 215 patients included for analysis, 83% had mild, 4% had moderate, and 13% had severe TBI; 54% had acute traumatic lesions on CT. The ability of GFAP-BDP level to discriminate patients with traumatic lesions on CT as evaluated by AUC was 0.88 (95% confidence interval [CI], 0.84-0.93). The optimal cutoff of 0.68 ng/mL for plasma GFAP-BDP level was associated with a 21.61 odds ratio for traumatic findings on head CT. Discriminatory ability of unfavorable 6 month outcome was lower, AUC 0.65 (95% CI, 0.55-0.74), with a 2.07 odds ratio. GFAP-BDP levels reliably distinguish the presence and severity of CT scan findings in TBI patients. Although these findings confirm and extend prior studies, a larger prospective trial is still needed to validate the use of GFAP-BDP as a routine diagnostic biomarker for patient care and clinical research. The term "mild" continues to be a misnomer for this patient population, and underscores the need for evolving classification strategies for TBI targeted therapy. (ClinicalTrials.gov number NCT01565551; NIH Grant 1RC2 NS069409).

  15. Unintentional injury and its prevention in infant: knowledge and self-reported practices of main caregivers

    OpenAIRE

    Ramdzan, Siti Nurkamilla; Liew, Su May; Khoo, Ee Ming

    2014-01-01

    Background Unintentional injuries are the major cause of morbidity and mortality in infants. Prevention of unintentional injuries has been shown to be effective with education. Understanding the level of knowledge and practices of caregivers in infant safety would be useful to identify gaps for improvement. Methods A cross-sectional study was conducted in an urban government health clinic in Malaysia among main caregivers of infants aged 11 to 15 months. Face-to-face interviews were conducted...

  16. 'Mind the Gap!'

    DEFF Research Database (Denmark)

    Persson, Karl Gunnar

    This paper challenges the widely held view that sharply falling real transport costs closed the transatlantic gap in grain prices in the second half of the 19th century. Several new results emerge from an analysis of a new data set of weekly wheat prices and freight costs from New York to UK mark...

  17. Bridging the Technological Gap.

    Science.gov (United States)

    Lazow, Robert; And Others

    The aim of "Bridging the Technological Gap" (BTG), a federally funded demonstration project, is to use microcomputer technology in the rehabilitation of the psychiatrically disabled. Through the use of a custom designed microcomputer software package, clients receive remediation in areas of specific cognitive and behavioral deficits. The project…

  18. Closing the Gap

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    China's recent economic success has brought positive changes to its urban population,but left those in the countryside way behind.The gap in income and living standrs that always existed between urban and rural dwellers has widened alarmingly in the past two decades,causing serious problems.

  19. Estimating Gender Wage Gaps

    Science.gov (United States)

    McDonald, Judith A.; Thornton, Robert J.

    2011-01-01

    Course research projects that use easy-to-access real-world data and that generate findings with which undergraduate students can readily identify are hard to find. The authors describe a project that requires students to estimate the current female-male earnings gap for new college graduates. The project also enables students to see to what…

  20. Structuring the Information Gap.

    Science.gov (United States)

    Edge, Julian

    1984-01-01

    Describes an information gap procedure to teach a new structure which requires students to look for and exchange information in order to complete a task in an English as a second language class. Illustrates the method with a set of materials and suggests ways for teachers to produce similar materials. (SED)

  1. Knowledge Technologies

    CERN Document Server

    Milton, Nick

    2008-01-01

    Several technologies are emerging that provide new ways to capture, store, present and use knowledge. This book is the first to provide a comprehensive introduction to five of the most important of these technologies: Knowledge Engineering, Knowledge Based Engineering, Knowledge Webs, Ontologies and Semantic Webs. For each of these, answers are given to a number of key questions (What is it? How does it operate? How is a system developed? What can it be used for? What tools are available? What are the main issues?). The book is aimed at students, researchers and practitioners interested in Knowledge Management, Artificial Intelligence, Design Engineering and Web Technologies. During the 1990s, Nick worked at the University of Nottingham on the application of AI techniques to knowledge management and on various knowledge acquisition projects to develop expert systems for military applications. In 1999, he joined Epistemics where he worked on numerous knowledge projects and helped establish knowledge management...

  2. Knowledge Sharing

    DEFF Research Database (Denmark)

    Holdt Christensen, Peter

    The concept of knowledge management has, indeed, become a buzzword that every single organization is expected to practice and live by. Knowledge management is about managing the organization's knowledge for the common good of the organization -but practicing knowledge management is not as simple...... as that. This article focuses on knowledge sharing as the process seeking to reduce the resources spent on reinventing the wheel.The article introduces the concept of time sensitiveness; i.e. that knowledge is either urgently needed, or not that urgently needed. Furthermore, knowledge sharing...... is considered as either a push or pull system. Four strategies for sharing knowledge - help, post-it, manuals and meeting, and advice are introduced. Each strategy requires different channels for sharing knowledge. An empirical analysis in a production facility highlights how the strategies can be practiced....

  3. Tire Crumb Research Study Literature Review / Gap ...

    Science.gov (United States)

    In order to more fully understand data gaps in human exposure and toxicity to tire crumb materials, ATSDR, CPSC and EPA undertook a collaborative effort in the form of a scientific literature review and subsequent gaps analysis. The first objective of the Literature Review and Gap Analysis (LRGA) collaboration was to identify the existing body of literature related specifically to human exposure to tire crumb materials through the use of synthetic turf athletic fields and playgrounds. The second objective was to characterize and summarize the relevant data from the scientific literature. The final objective was to review the summary information and identify data gaps to build on the current understanding of the state-of-the-science and inform the development of specific research efforts that would be most impactful in the near-term. Because of the need for additional information, the U.S. Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (ATSDR), and the U.S. Consumer Product Safety Commission (CPSC) launched a multi-agency action plan to study key environmental human health questions. The Federal Research Action Plan includes numerous activities, including research studies (U.S. EPA, 2016). A key objective of the Action Plan is to identify key knowledge gaps.

  4. 临床护理人员输血相关知识掌握程度的调查与分析%Investigation and Analysis of Acquisition Status of Transfusion-related Knowledge in Clinical Nursing Staff

    Institute of Scientific and Technical Information of China (English)

    付淑珍

    2011-01-01

    Objective To comprehend the acquisition status of the transfusion-related knowledge in clinical nursing staff,so as to provide the basis for normalizing the transfusion procedures and establishing the specific nursing countermeasures. Methods The acquisition status of the transfusion-related knowledge in 169 clinical nurses in Longquan People's Hospital was evaluated by questionnaires. Results The level of transfusion-related knowledge in clinical nursing staff was generally low. Of the nurses, the highest and lowest rates of correct answers of transfusion-related knowledge were transfusion matching procedures(99. 8%) and recycling system of blood transfusion bags(10. 0%). Significant differences were detected in transfusion-related knowledge of nurses with different work experience(P0.05).结论 临床护理人员的输血知识和技能掌握欠扎实,对规范输血的重要性认识不足,需要进一步加强学习,更新知识,规范各项输血操作,以提高临床输血安全性.

  5. Knowledge management

    DEFF Research Database (Denmark)

    Foss, Nicolai Juul; Mahnke, Volker

    2003-01-01

    Knowledge management has emerged as a very successful organization practice and has beenextensively treated in a large body of academic work. Surprisingly, however, organizationaleconomics (i.e., transaction cost economics, agency theory, team theory and property rightstheory) has played no role...... in the development of knowledge management. We argue thatorganizational economics insights can further the theory and practice of knowledge managementin several ways. Specifically, we apply notions of contracting, team production,complementaries, hold-up, etc. to knowledge management issues (i.e., creating...... and integrationknowledge, rewarding knowledge workers, etc.) , and derive refutable implications that are novelto the knowledge management field from our discussion....

  6. Knowledge management at ELETRONUCLEAR

    Energy Technology Data Exchange (ETDEWEB)

    Lepecki, W. [ELETRONUCLEAR, Rua da Candelaria, 65, 20091 020 RJ Rio de Janeiro (Brazil)]. E-mail: lepecki@terra.com.br

    2005-07-01

    ELETRONUCLEAR, a state-owned company responsible for design, construction, ownership and operation of nuclear power plants in Brazil, is applying systematic measures to preserve its essential technological know-how. A special project called 'Determination of Technological Know-How of ELETRONUCLEAR' was established in January 2001 for this purpose. The extent and location of the existing know-how was identified and the gaps in the essential know-how were evaluated. A multidisciplinary team was established to implement the project. The team interacted with experts both in Brazil and abroad to achieve a sound technical basis as far as knowledge identification and preservation techniques are concerned. The results of this know-how survey were stored in an electronic data bank, which facilitated the creation of several types of reports, according to various criteria. An in-depth analysis of the survey pointed to the gaps in essential know-how. Proposals for solutions to fill in the know-how gaps were set up, comprising both short-term, as well as long-term, solutions. This project was the first work by ELETRONUCLEAR in the field of Knowledge Management. An indirect consequence was the creation of a nucleus of personnel competent in this new discipline, which had a multiplying effect throughout ELETRONUCLEAR, allowing the execution of other new projects in KM. (author)

  7. Artisanal knowledge

    Directory of Open Access Journals (Sweden)

    Raven, Diederick

    2013-03-01

    Full Text Available This essay is about the ensuing problem that in general it is nothelpful to talk about non-standard knowledge practices as modeled after our Western ideas of what knowledge is. It negotiates this problem by arguing that artisanal knowledge is an independent and self-contained mode of knowledge and is arranged in three parts. In the first part an outline is given of the key assumptions of the interactionist conception of knowledge that needs to be put in place as an alternative to the basically Kantian mixture of empiricist and rationalist assumptions of the folk model of Western academic thinking about knowledge. In this interactionist conception of knowledgeartisanal knowledge gets center stage. In the second part, the notion of craftknowledge is opened up as much as possible. The third and final part takes upthe question whether craft knowledge is a cultural universal.

  8. Malaysian nurses' skin care practices of preterm infants: experience vs. knowledge.

    Science.gov (United States)

    Mohamed, Zainah; Newton, Jennifer Margaret; Lau, Rosalind

    2014-04-01

    This study sought to explore the impact of Malaysian nurses' perceptions, knowledge and experiences in preterm infant skin care practices using a descriptive approach. Questionnaires were distributed to Neonatal Intensive Care Unit (NICU) nurses in one teaching hospital in Malaysia. A knowledge gap was revealed among nurses in both theoretical and practical knowledge of preterm infant skin. Nurses working for more than 5 years in NICU or having a Neonatal Nursing Certificate (NNC) were not predictors of having adequate knowledge of preterm infants' skin care. The results highlight the complex issue of providing effective skin care to preterm infants. However, a specific finding related to nurses' confidence provides some direction for future practice and research initiatives. Clear clinical evidence-based guidelines and Continuing Nursing Education on relevant topics of preterm infants' care may provide the required knowledge for the nurses.

  9. Caring for women living with HIV: gaps in the evidence

    Directory of Open Access Journals (Sweden)

    Mona R Loutfy

    2013-10-01

    Full Text Available Introduction: In the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration. This is in spite of accumulating evidence that there are a number of potential differences between women and men which may affect response to treatment, pharmacokinetics, toxicities and coping. There are also notable psychological, behavioural, social and structural factors that may have a unique impact on women living with HIV (WLWH. Despite our increasing knowledge of HIV and advances in treatment, there are significant gaps in the data relating specifically to women. One of the factors contributing to this situation is the under-representation of women in all aspects of HIV clinical research. Furthermore, there are clinical issues unique to women, including gynaecologic and breast diseases, menopause-related factors, contraception and other topics related to women's and sexual health. Methods: Using scoping review methodology, articles from the literature from 1980 to 2012 were identified using appropriate MeSH headings reflecting the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. Titles and abstracts were scanned to determine whether they were relevant to non-reproductive health in WLWH, and papers meeting inclusion criteria were reviewed. Results: This review summarizes our current knowledge of the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. It suggests that there are a number of gender differences in disease and treatment outcomes, and distinct women-specific issues, such as menopause and co-morbidities, that pose significant challenges to the care of WLWH. Conclusions: Based on a review of this evidence, outstanding questions and areas where further studies are required to determine gender differences in the

  10. Accessible Knowledge - Knowledge on Accessibility

    DEFF Research Database (Denmark)

    Kirkeby, Inge Mette

    2015-01-01

    Although serious efforts are made internationally and nationally, it is a slow process to make our physical environment accessible. In the actual design process, architects play a major role. But what kinds of knowledge, including research-based knowledge, do practicing architects make use of when...... designing accessible environments? The answer to the question is crucially important since it affects how knowledge is distributed and how accessibility can be ensured. In order to get first-hand knowledge about the design process and the sources from which they gain knowledge, 11 qualitative interviews...... were conducted with architects with experience of designing for accessibility. The analysis draws on two theoretical distinctions. The first is research-based knowledge versus knowledge used by architects. The second is context-independent knowledge versus context-dependent knowledge. The practitioners...

  11. Cultural Intersection of Asian Indian Ethnicity and Presenting Problem: Adapting Multicultural Competence for Clinical Accessibility

    Science.gov (United States)

    Bean, Roy A.; Titus, Gayatri

    2009-01-01

    A more accessible approach to using multicultural counseling competence is presented to bridge the researcher-practitioner gap and increase the likelihood of quality clinical services. The focus of the approach is on counselor awareness, knowledge, and skills as they relate to the most important contextualizing factors: ethnic culture and the…

  12. Managing Low Back Pain in the Primary Care Setting: The Know-Do Gap

    Directory of Open Access Journals (Sweden)

    N Ann Scott

    2010-01-01

    Full Text Available OBJECTIVE: To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta’s primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline.

  13. Clinical Holistic Medicine: Factors Influencing The Therapeutic Decision-Making. From Academic Knowledge to Emotional Intelligence and Spiritual “Crazy” Wisdom

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available Scientific holistic medicine is built on holistic medical theory, on therapeutic and ethical principles. The rationale is that the therapist can take the patient into a state of salutogenesis, or existential healing, using his skills and knowledge. But how ever much we want to make therapy a science it remains partly an art, and the more developed the therapist becomes, the more of his/her decisions will be based on intuition, feeling and even inspiration that is more based on love and human concern and other spiritual motivations than on mental reason and rationality in a simple sense of the word. The provocative and paradoxal medieval western concept of the “truth telling clown”, or the eastern concepts of “crazy wisdom” and “holy madness” seems highly relevant here. The problem is how we can ethically justify this kind of highly “irrational” therapeutic behavior in the rational setting of a medical institution. We argue here that holistic therapy has a very high success rate and is doing no harm to the patient, and encourage therapists, psychiatrists, psychologist and other academically trained “helpers” to constantly measure their own success-rate. This paper discusses many of the important factors that influence clinical holistic decision-making. Sexuality could, as many psychoanalysts from Freud to Reich and Searles have believed, be the most healing power that exists and also the most difficult for the mind to comprehend, and thus the most “crazy-wise” tool of therapy.

  14. Small Generation Gap

    Institute of Scientific and Technical Information of China (English)

    JANE SHAW

    1994-01-01

    IT was while I was making milk for my son that I discovered the generation gap between us. A little thing of two years and three months, my son stood on a big chair I brought him and joined me to make milk. Holding a small spoon in his plump little hand, he scooped flour out of a jar and poured it into the feeding bottle and then scooped milk powder and

  15. Minding the Gap

    Energy Technology Data Exchange (ETDEWEB)

    Firestone, Millicent Anne [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-02-23

    Neutron & X-ray scattering provides nano- to meso-scale details of complex fluid structure; 1D electronic density maps dervied from SAXS yield molecular level insights; Neutron reflectivity provides substructure details of substrate supported complex fluids; Complex fluids composition can be optimized to support a wide variety of both soluble and membrane proteins; The water gap dimensions can be finely tuned through polymer component.

  16. Knowledge spaces

    CERN Document Server

    Doignon, Jean-Paul

    1999-01-01

    Knowledge spaces offer a rigorous mathematical foundation for various practical systems of knowledge assessment. An example is offered by the ALEKS system (Assessment and LEarning in Knowledge Spaces), a software for the assessment of mathematical knowledge. From a mathematical standpoint, knowledge spaces generalize partially ordered sets. They are investigated both from a combinatorial and a stochastic viewpoint. The results are applied to real and simulated data. The book gives a systematic presentation of research and extends the results to new situations. It is of interest to mathematically oriented readers in education, computer science and combinatorics at research and graduate levels. The text contains numerous examples and exercises and an extensive bibliography.

  17. Knowledge Translation in Developing Countries

    Science.gov (United States)

    Santesso, Nancy; Tugwell, Peter

    2006-01-01

    There is increasing evidence that the application of knowledge in developing countries is failing. One reason is the woeful shortage of health workers, but as this is redressed, it is also crucial that we have an evidence base of what works to minimize the "know-do gap." The World Health Organization and other international organizations are…

  18. Knowledge Management

    Science.gov (United States)

    Shariq, Syed Z.; Kutler, Paul (Technical Monitor)

    1997-01-01

    The emergence of rapidly expanding technologies for distribution and dissemination of information and knowledge has brought to focus the opportunities for development of knowledge-based networks, knowledge dissemination and knowledge management technologies and their potential applications for enhancing productivity of knowledge work. The challenging and complex problems of the future can be best addressed by developing the knowledge management as a new discipline based on an integrative synthesis of hard and soft sciences. A knowledge management professional society can provide a framework for catalyzing the development of proposed synthesis as well as serve as a focal point for coordination of professional activities in the strategic areas of education, research and technology development. Preliminary concepts for the development of the knowledge management discipline and the professional society are explored. Within this context of knowledge management discipline and the professional society, potential opportunities for application of information technologies for more effectively delivering or transferring information and knowledge (i.e., resulting from the NASA's Mission to Planet Earth) for the development of policy options in critical areas of national and global importance (i.e., policy decisions in economic and environmental areas) can be explored, particularly for those policy areas where a global collaborative knowledge network is likely to be critical to the acceptance of the policies.

  19. GapBlaster-A Graphical Gap Filler for Prokaryote Genomes.

    Science.gov (United States)

    de Sá, Pablo H C G; Miranda, Fábio; Veras, Adonney; de Melo, Diego Magalhães; Soares, Siomar; Pinheiro, Kenny; Guimarães, Luis; Azevedo, Vasco; Silva, Artur; Ramos, Rommel T J

    2016-01-01

    The advent of NGS (Next Generation Sequencing) technologies has resulted in an exponential increase in the number of complete genomes available in biological databases. This advance has allowed the development of several computational tools enabling analyses of large amounts of data in each of the various steps, from processing and quality filtering to gap filling and manual curation. The tools developed for gap closure are very useful as they result in more complete genomes, which will influence downstream analyses of genomic plasticity and comparative genomics. However, the gap filling step remains a challenge for genome assembly, often requiring manual intervention. Here, we present GapBlaster, a graphical application to evaluate and close gaps. GapBlaster was developed via Java programming language. The software uses contigs obtained in the assembly of the genome to perform an alignment against a draft of the genome/scaffold, using BLAST or Mummer to close gaps. Then, all identified alignments of contigs that extend through the gaps in the draft sequence are presented to the user for further evaluation via the GapBlaster graphical interface. GapBlaster presents significant results compared to other similar software and has the advantage of offering a graphical interface for manual curation of the gaps. GapBlaster program, the user guide and the test datasets are freely available at https://sourceforge.net/projects/gapblaster2015/. It requires Sun JDK 8 and Blast or Mummer.

  20. GapBlaster-A Graphical Gap Filler for Prokaryote Genomes.

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    Pablo H C G de Sá

    Full Text Available The advent of NGS (Next Generation Sequencing technologies has resulted in an exponential increase in the number of complete genomes available in biological databases. This advance has allowed the development of several computational tools enabling analyses of large amounts of data in each of the various steps, from processing and quality filtering to gap filling and manual curation. The tools developed for gap closure are very useful as they result in more complete genomes, which will influence downstream analyses of genomic plasticity and comparative genomics. However, the gap filling step remains a challenge for genome assembly, often requiring manual intervention. Here, we present GapBlaster, a graphical application to evaluate and close gaps. GapBlaster was developed via Java programming language. The software uses contigs obtained in the assembly of the genome to perform an alignment against a draft of the genome/scaffold, using BLAST or Mummer to close gaps. Then, all identified alignments of contigs that extend through the gaps in the draft sequence are presented to the user for further evaluation via the GapBlaster graphical interface. GapBlaster presents significant results compared to other similar software and has the advantage of offering a graphical interface for manual curation of the gaps. GapBlaster program, the user guide and the test datasets are freely available at https://sourceforge.net/projects/gapblaster2015/. It requires Sun JDK 8 and Blast or Mummer.