Palliative care and other physicians’ knowledge, attitudes and practice relating to the law on withholding/withdrawing life-sustaining treatment: Survey results

Background: To effectively care for people who are terminally ill, including those without decision-making capacity, palliative care physicians must know and understand the legal standing of Advance Care Planning (ACP) in their jurisdiction of practice. This includes the use of advance directives/living wills (ADs) and substitute decision-makers (SDMs) who can legally consent to or refuse treatment if there is no valid AD. Aim: The study aimed to investigate the knowledge, attitudes and practices of medical specialists most often involved in end-of-life care in relation to the law on withholding/ withdrawing life-sustaining treatment (WWLST) from adults without decision-making capacity. Design/participants: A pre-piloted survey was posted to specialists in palliative, emergency, geriatric, renal and respiratory medicine, intensive care and medical oncology in three Australian States. Surveys were analysed using SPSS20 and SAS 9.3. Results: The overall response rate was 32% (867/2702); 52% from palliative care specialists. Palliative Care specialists and Geriatricians had significantly more positive attitudes towards the law (χ242 = 94.352; p < 0.001) and higher levels of knowledge about the WWLST law (χ27 = 30.033; p < 0.001), than did the other specialists, while still having critical gaps in their knowledge. Conclusions: A high level of knowledge of the law is essential to ensure that patients’ wishes and decisions, expressed through ACP, are respected to the maximum extent possible within the law, thereby according with the principles and philosophy of palliative care. It is also essential to protect health professionals from legal action resulting from unauthorised provision or removal of treatment.

Managing knowledge to promote sustainability in Australian transport infrastructure projects

To deliver tangible sustainability outcomes, the infrastructure sector of the construction industry needs to build capacities for the creation, application and management of ever increasing knowledge. This paper intends to establish the importance and key issues of promoting sustainability through knowledge management (KM). It presents a new conceptual framework for managing sustainability knowledge to raise the awareness and direct future research in the field of transport infrastructure, one of the fast growing sectors in Australia. A holistic KM approach is adopted in this research to consider the potential to “deliver the right information to the right person at the right time” in the context of sustainable development of infrastructure. A questionnaire survey among practitioners across the nation confirmed the necessity and identified priority issues of managing knowledge for sustainability. During infrastructure development, KM can help build much needed industry consensus, develop capacity, communicate decisions, and promote specific measures for the pursuit of sustainability. Six essential elements of the KM approach and their priority issues informed the establishment of a conceptual KM framework. The transport infrastructure sector has come to realise that development must not come at the expense of environmental and social objectives. In practice however, it is facing extensive challenges to deliver what has been promised in the sustainability agenda. This research demonstrates the importance of managing sustainability knowledge, integration of various stakeholders, facilitation of plans and actions and delivery of tangible benefits in real projects, as a positive step towards meeting these challenges.

Education in stroke prevention: Efficacy of an educational counselling intervention to increase knowledge in stroke survivors

BACKGROUND Motivational interviewing and stages of change are approaches to increasing knowledge and effecting behavioural change. This study examined the application of this approach on stroke knowledge acquisition and changing individual lifestyle risk factors in an outpatient clinic. METHODS RCT in which 200 participants were allocated to an education-counselling interview (ECI) or a control group. ECI group participants mapped their individual risk factors on a stage of change model and received an appointment to the next group lifestyle class. Participants completed a stroke knowledge questionnaire at baseline (T1), post-appointment, and three months (T3) post-appointment. Passive to active changes in lifestyle behaviour were self-reported at three months. RESULTS There was a statistically significant difference between groups from T1 toT3 in stroke knowledge (p < 0.001). While there was a significant shift from a passive to active stage of change for the overall study sample (p < 0.000), there was no significant difference between groups on the identified risk factors. CONCLUSIONS Although contact with patients in ambulatory clinical settings is limited due to time constraints, it is still possible to improve knowledge and initiate lifestyle changes utilizing motivational interviewing and a stage of change model. Stroke nurses may wish to consider these techniques in their practice setting.

Knowledge, identity, and dilemmas of the self in physical education teacher education

This study draws on an eclectic range of influences. The early research was guided by the traditions of Personal Construct Theory. The study was later extended by drawing on theoretical tenets of social constructionism and the notion of the Saturated Self and Anthony Gidden's work on structuration and his later work on self identity. This has provided a new way of investigating how becoming a PE teacher through constructed knowledge established a professional identity. The data suggest that during the process of constructing professional knowledge, the students forge their identities by establishing 'position' and 'role'. In doing so, the participants in this study experienced a series of dilemmas of professional self. These dilemmas are a product of what Giddens calls high modernity and what Gergen refers to as postmodernity. It seems that to become a PE teacher, the dilemmas must be worked through until a position of ontological security has been achieved. For some this was profoundly difficult. In spite of this, the methods of study allowed the participants to begin to articulate their theories and visions of teaching physical education, and the therapeutic qualities of Kelly's theory encouraged many of the students to 'see it differently' (Rossi, 1997) and to begin to develop a rationale for professional work in physical education based on socially just practices.

The role of innovation intermediaries in collaborative networks of small and medium-sized enterprises

The major challenge of European Union’s agricultural industry is to ensure sustainable supply of quality food that meets the demands of a rapidly growing population, changing dietary patterns, increased competition for land use, and environmental concerns. Investments in research and innovation, which facilitate integration of external knowledge in food chain operations, are crucial to undertaking such challenges. This paper addresses how SMEs successfully innovate within collaborative networks with the assistance of innovation intermediaries. In particular, we explore the roles of innovation intermediaries in knowledge acquisition, knowledge assimilation, knowledge, transformation, and knowledge exploitation in open innovation initiatives from the wine industry through the theoretical lens of absorptive capacity. Based on two case studies from the wine industry, we identified seven key activities performed by innovation intermediaries that complement SMEs’ ability to successfully leverage external sources of knowledge for innovation purposes. These activities are articulation of knowledge needs and innovation capabilities, facilitation of social interactions, establishment of complementary links, implementation of governance structures, conflict management, enhancement of transparency, and mediation of communication. Our in-depth qualitative study of two innovation intermediaries in the wine industry has several important implications that contribute to research and practice.

Inventing life: Intellectual property and the new biology

In 2009, the National Research Council of the National Academies released a report on A New Biology for the 21st Century. The council preferred the term ‘New Biology’ to capture the convergence and integration of the various disciplines of biology. The National Research Council stressed: ‘The essence of the New Biology, as defined by the committee, is integration—re-integration of the many sub-disciplines of biology, and the integration into biology of physicists, chemists, computer scientists, engineers, and mathematicians to create a research community with the capacity to tackle a broad range of scientific and societal problems.’ They define the ‘New Biology’ as ‘integrating life science research with physical science, engineering, computational science, and mathematics’. The National Research Council reflected: 'Biology is at a point of inflection. Years of research have generated detailed information about the components of the complex systems that characterize life––genes, cells, organisms, ecosystems––and this knowledge has begun to fuse into greater understanding of how all those components work together as systems. Powerful tools are allowing biologists to probe complex systems in ever greater detail, from molecular events in individual cells to global biogeochemical cycles. Integration within biology and increasingly fruitful collaboration with physical, earth, and computational scientists, mathematicians, and engineers are making it possible to predict and control the activities of biological systems in ever greater detail.' The National Research Council contended that the New Biology could address a number of pressing challenges. First, it stressed that the New Biology could ‘generate food plants to adapt and grow sustainably in changing environments’. Second, the New Biology could ‘understand and sustain ecosystem function and biodiversity in the face of rapid change’. Third, the New Biology could ‘expand sustainable alternatives to fossil fuels’. Moreover, it was hoped that the New Biology could lead to a better understanding of individual health: ‘The New Biology can accelerate fundamental understanding of the systems that underlie health and the development of the tools and technologies that will in turn lead to more efficient approaches to developing therapeutics and enabling individualized, predictive medicine.’ Biological research has certainly been changing direction in response to changing societal problems. Over the last decade, increasing awareness of the impacts of climate change and dwindling supplies of fossil fuels can be seen to have generated investment in fields such as biofuels, climate-ready crops and storage of agricultural genetic resources. In considering biotechnology’s role in the twenty-first century, biological future-predictor Carlson’s firm Biodesic states: ‘The problems the world faces today – ecosystem responses to global warming, geriatric care in the developed world or infectious diseases in the developing world, the efficient production of more goods using less energy and fewer raw materials – all depend on understanding and then applying biology as a technology.’ This collection considers the roles of intellectual property law in regulating emerging technologies in the biological sciences. Stephen Hilgartner comments that patent law plays a significant part in social negotiations about the shape of emerging technological systems or artefacts: 'Emerging technology – especially in such hotbeds of change as the life sciences, information technology, biomedicine, and nanotechnology – became a site of contention where competing groups pursued incompatible normative visions. Indeed, as people recognized that questions about the shape of technological systems were nothing less than questions about the future shape of societies, science and technology achieved central significance in contemporary democracies. In this context, states face ongoing difficulties trying to mediate these tensions and establish mechanisms for addressing problems of representation and participation in the sociopolitical process that shapes emerging technology.' The introduction to the collection will provide a thumbnail, comparative overview of recent developments in intellectual property and biotechnology – as a foundation to the collection. Section I of this introduction considers recent developments in United States patent law, policy and practice with respect to biotechnology – in particular, highlighting the Myriad Genetics dispute and the decision of the Supreme Court of the United States in Bilski v. Kappos. Section II considers the cross-currents in Canadian jurisprudence in intellectual property and biotechnology. Section III surveys developments in the European Union – and the interpretation of the European Biotechnology Directive. Section IV focuses upon Australia and New Zealand, and considers the policy responses to the controversy of Genetic Technologies Limited’s patents in respect of non-coding DNA and genomic mapping. Section V outlines the parts of the collection and the contents of the chapters.

The genographic project: Traditional knowledge and population genetics

This article considers the debate over patent law, informed consent, and benefit-sharing in the context of biomedical research in respect of Indigenous communities. In particular, it focuses upon three key controversies over large-scale biology projects, involving Indigenous populations. These case studies are representative of the tensions between research organisations, Indigenous communities, and funding agencies. Section two considers the aims and origins of the Human Genome Diversity Project, and criticisms levelled against the venture by Indigenous peak bodies and anti-biotechnology groups, such as the Rural Advancement Foundation International. It examines the ways in which the United Nations Educational, Scientific, and Cultural Organization (UNESCO) grappled with questions of patent law, informed consent, and benefit sharing in relation to population genetics. Section three focuses upon the ongoing litigation in Tilousi v. Arizona State University, and the Havasupai Tribe v. Arizona State University. In this matter, the Havasupai tribe from the Grand Canyon in the United States brought legal action against the Arizona State University and its researchers for using genetic data for unauthorised purposes - namely, genetic research into schizophrenia, migration, and inbreeding. The litigation raises questions about informed consent, negligence, and larger matters of human rights. Section four explores the legal and ethical issues raised by the Genographic Project. It considers the aims and objectives of the venture, and the criticisms levelled against it by Indigenous communities, and anti-biotechnology groups. It examines the response of the United Nations Permanent Forum on Indigenous Issues to the Genographic Project. It charts the debate over the protection of traditional knowledge in various international fora. The conclusion recommends a number of measures to better regulate large-scale biology projects involving the participation of Indigenous communities.

Information encountering on social media and tacit knowledge sharing

The purpose of this paper is to investigate how social media may support information encountering (i.e., where individuals encounter useful and interesting information while seeking or browsing for some other information) and how this may lead to facilitation of tacit knowledge creation and sharing. The study employed a qualitative survey design that interviewed twenty-four physicians who were active users of social media to better understand the phenomenon of information encountering on social media. The data was analysed using the thematic analysis approach. The study found six main ways through which social media supports information encountering. Furthermore, drawing upon knowledge creation theories, the study concluded that information encountering on social media facilitates tacit knowledge creation and sharing among individuals. The study provides new directions for further empirical investigations to examine whether information encountering on social media actually leads to tacit knowledge creation and sharing. The findings of the study may also provide opportunities for users to adopt social media effectively or gain greater value from social media use.

External knowledge and query strategies in active learning: A study in clinical information extraction

This paper presents a new active learning query strategy for information extraction, called Domain Knowledge Informativeness (DKI). Active learning is often used to reduce the amount of annotation effort required to obtain training data for machine learning algorithms. A key component of an active learning approach is the query strategy, which is used to iteratively select samples for annotation. Knowledge resources have been used in information extraction as a means to derive additional features for sample representation. DKI is, however, the first query strategy that exploits such resources to inform sample selection. To evaluate the merits of DKI, in particular with respect to the reduction in annotation effort that the new query strategy allows to achieve, we conduct a comprehensive empirical comparison of active learning query strategies for information extraction within the clinical domain. The clinical domain was chosen for this work because of the availability of extensive structured knowledge resources which have often been exploited for feature generation. In addition, the clinical domain offers a compelling use case for active learning because of the necessary high costs and hurdles associated with obtaining annotations in this domain. Our experimental findings demonstrated that 1) amongst existing query strategies, the ones based on the classification model’s confidence are a better choice for clinical data as they perform equally well with a much lighter computational load, and 2) significant reductions in annotation effort are achievable by exploiting knowledge resources within active learning query strategies, with up to 14% less tokens and concepts to manually annotate than with state-of-the-art query strategies.

Contributing to computing services to benchmarking asset management knowledge management

Asset management has broadened from a focus on maintenance management to whole of life cycle asset management requiring a suite of new competencies from asset procurement to management and disposal. Well developed skills and competencies as well as practical experience are a prerequisite to maintain capability, to manage demand as well to plan and set priorities and ensure on-going asset sustainability. This paper has as its focus to establish critical understandings of data, information and knowledge for asset management along with the way in which benchmarking these attributes through computer-aided design may aid a strategic approach to asset management. The paper provides suggestions to improve sharing, integration and creation of asset-related knowledge through the application of codification and personalization approaches.

Review: Let's talk kinship: Innovating Australian social work education, theory, research and practice through Aboriginal knowledge

Review(s) of: Let's talk kinship: Innovating Australian social work education, theory, research and practice through Aboriginal knowledge, by Christine Fejo-King, published by Christine Fejo-King Consulting, ISBN: 978-0-9922814-0-3.

Investigating the role of knowledge management at various maturity levels of project management office

This thesis is an exploratory study to scrutinise Project Knowledge Management in Project-Based Organisations, specifically in the Project Management Office (PMO). It is the first attempt to investigate the maturity of Project Management, from a Knowledge Management perspective. The findings of this study address multiple Knowledge Management processes and practices to both assess the level of Knowledge Management Maturity in PMOs, and improve the capability of Project Knowledge Management in Project-based Organisations. This research significantly contributes to bridge the current gap in the existing Project Management Maturity Models.

Knowledge sharing success and resistance in an engineering department: A case study

The centrality of knowledge sharing to organizations’ sustainability has been established. This research explores and illustrates the influences for individual professionals and paraprofessionals – specifically civil engineers and design drafters – to share their deep, personally constructed knowledge, in a public sector provider of railways infrastructure. It investigates the extent to which: (i) knowledge sharing will be positively influenced by the professional identity, values and knowledge culture to achieve organizational and project goals, and; (ii) sharing of deep personal expertise will be influenced by the quality of relational capital among individuals and individual perspectives. It finds that knowledge sharing develops within frameworks established through the alignment among sector, profession and organization values. However, individual behavior is found to be most strongly influenced by the presence and quality of relational capital and individuals’ personal perspectives.

Awareness and knowledge of Human Papillomavirus (HPV) among ethnically diverse women varying in generation status

Although Human papillomavirus (HPV) is a common sexually transmitted infection, there is limited knowledge of HPV with ethnic/racial minorities experiencing the greatest disparities. This cross-sectional study used the most recent available data from the California Health Interview Survey to assess disparities in awareness and knowledge of HPV among ethnically/racially diverse women varying in generation status (N = 19,928). Generation status emerged as a significant predictor of HPV awareness across ethnic/racial groups, with 1st generation Asian-Americans and 1st and 2nd generation Latinas reporting the least awareness when compared to same-generation White counterparts. Also, generation status was a significant predictor of HPV knowledge, but only for Asian-Americans. Regardless of ethnicity/race, 1st generation women reported lowest HPV knowledge when compared to 2nd and 3rd generation women. These findings underscore the importance of looking at differences within and across ethnic/racial groups to identify subgroups at greatest risk for poor health outcomes. In particular, we found generation status to be an important yet often overlooked factor in the identification of health disparities.