Knowledge-based clinical pathway for medical quality improvement

Clinical pathways have been adopted for various diseases in clinical departments for quality improvement as a result of standardization of medical activities in treatment process. Using knowledge-based decision support on the basis of clinical pathways is a promising strategy to improve medical quality effectively. However, the clinical pathway knowledge has not been fully integrated into treatment process and thus cannot provide comprehensive support to the actual work practice. Therefore this paper proposes a knowledgebased clinical pathway management method which contributes to make use of clinical knowledge to support and optimize medical practice. We have developed a knowledgebased clinical pathway management system to demonstrate how the clinical pathway knowledge comprehensively supports the treatment process. The experiences from the use of this system show that the treatment quality can be effectively improved by the extracted and classified clinical pathway knowledge, seamless integration of patient-specific clinical pathway recommendations with medical tasks and the evaluating pathway deviations for optimization.

Species distribution models for crop pollination: a modelling framework applied to Great Britain

Insect pollination benefits over three quarters of the world's major crops. There is growing concern that observed declines in pollinators may impact on production and revenues from animal pollinated crops. Knowing the distribution of pollinators is therefore crucial for estimating their availability to pollinate crops; however, in general, we have an incomplete knowledge of where these pollinators occur. We propose a method to predict geographical patterns of pollination service to crops, novel in two elements: the use of pollinator records rather than expert knowledge to predict pollinator occurrence, and the inclusion of the managed pollinator supply. We integrated a maximum entropy species distribution model (SDM) with an existing pollination service model (PSM) to derive the availability of pollinators for crop pollination. We used nation-wide records of wild and managed pollinators (honey bees) as well as agricultural data from Great Britain. We first calibrated the SDM on a representative sample of bee and hoverfly crop pollinator species, evaluating the effects of different settings on model performance and on its capacity to identify the most important predictors. The importance of the different predictors was better resolved by SDM derived from simpler functions, with consistent results for bees and hoverflies. We then used the species distributions from the calibrated model to predict pollination service of wild and managed pollinators, using field beans as a test case. The PSM allowed us to spatially characterize the contribution of wild and managed pollinators and also identify areas potentially vulnerable to low pollination service provision, which can help direct local scale interventions. This approach can be extended to investigate geographical mismatches between crop pollination demand and the availability of pollinators, resulting from environmental change or policy scenarios.

Teachers’ action research in a culture of performativity

In a culture of performativity, action research offers teachers an opportunity to step back and reflect on their practice. This paper reports on a collaborative project carried out between a university and a secondary school in England, in which the university staff supported an action research project within the school. Five school teachers volunteered to engage in this project. They were given an introduction to action research and were assigned a university researcher to support them. Despite the common input and a common school culture, the teachers engaged in very different models of action research. This article reports on two teachers whose approaches were dissimilar. It examines these differences and suggests that they can be explained by considering the teachers’ different responses to a performativity culture.

Prefrontal cortical-ventral striatal interactions involved in affective modulation of attentional performance: implications for corticostriatal circuit function

Anatomically segregated systems linking the frontal cortex and the striatum are involved in various aspects of cognitive, affective, and motor processing. In this study, we examined the effects of combined unilateral lesions of the medial prefrontal cortex (mPFC) and the core subregion of the nucleus accumbens (AcbC) in opposite hemispheres (disconnection) on a continuous performance, visual attention test [five-choice serial reaction-time task (5CSRTT)]. The disconnection lesion produced a set of specific changes in performance of the 5CSRTT, resembling changes that followed bilateral AcbC lesions while, in addition, comprising a subset of the behavioral changes after bilateral mPFC lesions previously reported using the same task. Specifically, both mPFC/AcbC disconnection and bilateral AcbC lesions markedly affected aspects of response control related to affective feedback, as indexed by perseverative responding in the 5CSRTT. These effects were comparable, although not identical, to those in animals with either bilateral AcbC or mPFC/AcbC disconnection lesions. The mPFC/AcbC disconnection resulted in a behavioral profile largely distinct from that produced by disconnection of a similar circuit described previously, between the mPFC and the dorsomedial striatum, which were shown to form a functional network underlying aspects of visual attention and attention to action. This distinction provides an insight into the functional specialization of corticostriatal circuits in similar behavioral contexts.

Idiom comprehension in French-speaking children and adolescents with Williams syndrome

This study looks at idiom comprehension by French-speaking people with Williams’ syndrome (WS) and metapragmatic knowledge is examined. Idiomatic expressions are a nonliteral form of language where there is a considerable difference between what is said (literal interpretation) and what is meant (idiomatic interpretation). WS is characterized by a relatively preserved formal language, social interest and poor conversational skills. Using this framework, the present study aims to explore the comprehension of idiomatic expressions by 20 participants with WS. Participants performed a story completion task (comprehension task), and a task of metapragmatic knowledge to justify their chosen answers. WS performances were compared to typically developing children with the same verbal mental age. The main results can be summarized as follows: (1) People with WS have difficulties to understand idioms; (3) WS group seems to perform partly as typically developing children for the acquisition of metapragmatic knowledge of linguistic convention: there is a progressive increase in metapragmatic knowledge of linguistic convention as age increased. Our results indicate a delay of acquisition in idiom comprehension in Williams’ syndrome.

On the question of proportionality of the count of observed Scrapie cases and the size of holding

Background: The present paper investigates the question of a suitable basic model for the number of scrapie cases in a holding and applications of this knowledge to the estimation of scrapie-ffected holding population sizes and adequacy of control measures within holding. Is the number of scrapie cases proportional to the size of the holding in which case it should be incorporated into the parameter of the error distribution for the scrapie counts? Or, is there a different - potentially more complex - relationship between case count and holding size in which case the information about the size of the holding should be better incorporated as a covariate in the modeling? Methods: We show that this question can be appropriately addressed via a simple zero-truncated Poisson model in which the hypothesis of proportionality enters as a special offset-model. Model comparisons can be achieved by means of likelihood ratio testing. The procedure is illustrated by means of surveillance data on classical scrapie in Great Britain. Furthermore, the model with the best fit is used to estimate the size of the scrapie-affected holding population in Great Britain by means of two capture-recapture estimators: the Poisson estimator and the generalized Zelterman estimator. Results: No evidence could be found for the hypothesis of proportionality. In fact, there is some evidence that this relationship follows a curved line which increases for small holdings up to a maximum after which it declines again. Furthermore, it is pointed out how crucial the correct model choice is when applied to capture-recapture estimation on the basis of zero-truncated Poisson models as well as on the basis of the generalized Zelterman estimator. Estimators based on the proportionality model return very different and unreasonable estimates for the population sizes. Conclusion: Our results stress the importance of an adequate modelling approach to the association between holding size and the number of cases of classical scrapie within holding. Reporting artefacts and speculative biological effects are hypothesized as the underlying causes of the observed curved relationship. The lack of adjustment for these artefacts might well render ineffective the current strategies for the control of the disease.

Motor brain regions are involved in the encoding of delayed intentions: a fMRI study

In studies of prospective memory, recall of the content of delayed intentions is normally excellent, probably because they contain actions that have to be enacted at a later time. Action words encoded for later enactment are more accessible from memory than those encoded for later verbal report [Freeman, J.E., and Ellis, J.A. 2003a. The representation of delayed intentions: A prospective subject-performed task? Journal of Experimental Psychology: Learning, Memory, and Cognition, 29, 976-992.]. As this higher assessibility is lost when the intended actions have to be enacted during encoding, or when a motor interference task is introduced concurrent to intention encoding, Freeman and Ellis suggested that the advantage of to-be-enacted actions is due to additional preparatory motor operations during encoding. Accordingly, in a fMRI study with 10 healthy young participants, we investigated whether motor brain regions are differentially activated during verbal encoding of actions for later enactment with the right hand in contrast to verbal encoding of actions for later verbal report. We included an additional condition of verbal encoding of abstract verbs for later verbal report to investigate whether the semantic motor information inherent in action verbs in contrast to abstract verbs activates motor brain regions different from those involved in the verbal encoding of actions for later enactment. Differential activation for the verbal encoding of to-be-enacted actions in contrast to to-be-reported actions was found in brain regions known to be involved in covert motor preparation for hand movements, i.e. the postcentral gyrus, the precuneus, the dorsal and ventral premotor cortex, the posterior middle temporal gyrus and the inferior parietal lobule. There was no overlap between these brain regions and those differentially activated during the verbal encoding of actions in contrast to abstract verbs for later verbal report. Consequently, the results of this fMRI study suggest the presence of preparatory motor operations during the encoding of delayed intentions requiring a future motor response, which cannot be attributed to semantic information inherent to action verbs. (c) 2006 Elsevier B.V. All rights reserved.

The DREAM Framework: using a network of scalable ontologies for intelligent indexing and retrieval of visual content

There are still major challenges in the area of automatic indexing and retrieval of digital data. The main problem arises from the ever increasing mass of digital media and the lack of efficient methods for indexing and retrieval of such data based on the semantic content rather than keywords. To enable intelligent web interactions or even web filtering, we need to be capable of interpreting the information base in an intelligent manner. Research has been ongoing for a few years in the field of ontological engineering with the aim of using ontologies to add knowledge to information. In this paper we describe the architecture of a system designed to automatically and intelligently index huge repositories of special effects video clips, based on their semantic content, using a network of scalable ontologies to enable intelligent retrieval.

The need for sustainable remediation

Humanity requires healthy soil in order to flourish. Soil is central to food production, the regulation of greenhouse gases, recreational areas such as parks and sports fields and the creation of an environment pleasing to the eye. But soil is fragile and easily damaged by uninformed management or accidents. One type of damage is contamination by chemicals that provide the lifestyles to which the developed world has become accustomed. Traditional soil "clean-up" has entailed either simple disposal or isolation of contaminated soil. Clearly this is not sustainable. Modern remedial techniques apply mineralogical and geochemical knowledge to clean up contaminated soil and make it good for reuse, rather than simply discarding this precious and finite resource.

Ontology supported comparison in vague domains

It is problematic to use standard ontology tools when describing vague domains. Standard ontologies are designed to formally define one view of a domain, and although it is possible to define disagreeing statements, it is not advisable, as the resulting inferences could be incorrect. Two different solutions to the above problem in two different vague domains have been developed and are presented. The first domain is the knowledge base of conversational agents (chatbots). An ontological scripting language has been designed to access ontology data from within chatbot code. The solution developed is based on reifications of user statements. It enables a new layer of logics based on the different views of the users, enabling the body of knowledge to grow automatically. The second domain is competencies and competency frameworks. An ontological framework has been developed to model different competencies using the emergent standards. It enables comparison of competencies using a mix of linguistic logics and descriptive logics. The comparison results are non-binary, therefore not simple yes and no answers, highlighting the vague nature of the comparisons. The solution has been developed with small ontologies which can be added to and modified in order for the competency user to build a total picture that fits the user’s purpose. Finally these two approaches are viewed in the light of how they could aid future work in vague domains, further work in both domains is described and also in other domains such as the semantic web. This demonstrates two different approaches to achieve inferences using standard ontology tools in vague domains.

Contested H2O: science, policy and politics in water resources management in Chile

This paper critically explores the politics that mediate the use of environmental science assessments as the basis of resource management policy. Drawing on recent literature in the political ecology tradition that has emphasised the politicised nature of the production and use of scientific knowledge in environmental management, the paper analyses a hydrological assessment in a small river basin in Chile, undertaken in response to concerns over the possible overexploitation of groundwater resources. The case study illustrates the limitations of an approach based predominantly on hydrogeological modelling to ascertain the effects of increased groundwater abstraction. In particular, it identifies the subjective ways in which the assessment was interpreted and used by the state water resources agency to underpin water allocation decisions in accordance with its own interests, and the role that a desocialised assessment played in reproducing unequal patterns of resource use and configuring uneven waterscapes. Nevertheless, as Chile’s ‘neoliberal’ political-economic framework privileges the role of science and technocracy, producing other forms of environmental knowledge to complement environmental science is likely to be contentious. In conclusion, the paper considers the potential of mobilising the concept of the hydrosocial cycle to further critically engage with environmental science.

Good practice transfer within small construction specialist trade contractors

Government and institutionally-driven ‘good practice transfer’ initiatives are consistently presented as a means to enhance construction firm and industry performance. Two implicit tenets of these initiatives appear to be: knowledge embedded in good practice will transfer automatically; and, the potential of implementing good practice will be capitalised regardless of the context where it is to be used. The validity of these tenets is increasingly being questioned and, concurrently, more nuanced knowledge production understandings are being developed which recognise and incorporate context-specificity. This research contributes to this growing, more critical agenda by examining the actual benefits accrued from good practice transfer from the perspective of a small specialist trade contracting firm. A concept model for successful good practice transfer is developed from a single longitudinal case study within a small heating and plumbing firm. The concept model consists of five key variables: environment, strategy, people, technology, and organisation of work. The key findings challenge the implicit assumptions prevailing in the existing literature and support a contingency approach that argues successful good practice transfer is not just adopting and mechanistically inserting into the firm, but requires addressing ‘behavioural’ aspects. For successful good practice transfer, small specialist trade contracting firms need to develop and operationalise organisation slack, mechanisms for scanning external stimuli and absorbing knowledge. They also need to formulate and communicate client-driven external strategies; to motive and educate people at all levels; to possess internal or accessible complementary skills and knowledge; to have ‘soft focus’ immediate/mid-term benefits at a project level; and, to embed good practice in current work practices.

Heritage speaker competence differences, language change and input type: inflected infinitives in Heritage Brazilian Portuguese

It has been argued that colloquial dialects of Brazilian Portuguese (BP) have undergone significant linguistic change resulting in the loss of inflected infinitives (e.g., Pires, 2002, 2006). Since BP adults, at least educated ones, have complete knowledge of inflected infinitives, the implicit claim is that they are transmitted via formal education in the standard dialect. In the present article, I test one of the latent predictions of such claims; namely, the fact that heritage speakers of BP who lack formal education in the standard dialect should never develop native-like knowledge of inflected infinitives. In doing so, I highlight two significant implications (a) that heritage speaker grammars are a good source for testing dialectal variation and language change proposals and (b) incomplete acquisition and/or attrition are not the only sources of heritage language competence differences. Employing the syntactic and semantic tests of Rothman and Iverson (2007), I compare heritage speakers' knowledge to Rothman and Iverson's advanced adult L2 learners and educated native controls. Unlike the latter groups, the data for heritage speakers indicate that they do not have target knowledge of inflected infinitives, lending support to Pires' claims, suggesting that literacy plays a significant role in the acquisition of this grammatical property in BP.

‘Low carbon’ scenarios, roadmaps, transitions and pathways: an overview and discussion

There are a range of studies based in the low carbon arena which use various ‘futures’- based techniques as ways of exploring uncertainties. These techniques range from ‘scenarios’ and ‘roadmaps’ through to ‘transitions’ and ‘pathways’ as well as ‘vision’-based techniques. The overall aim of the paper is therefore to compare and contrast these techniques to develop a simple working typology with the further objective of identifying the implications of this analysis for RETROFIT 2050. Using recent examples of city-based and energy-based studies throughout, the paper compares and contrasts these techniques and finds that the distinctions between them have often been blurred in the field of low carbon. Visions, for example, have been used in both transition theory and futures/Foresight methods, and scenarios have also been used in transition-based studies as well as futures/Foresight studies. Moreover, Foresight techniques which capture expert knowledge and map existing knowledge to develop a set of scenarios and roadmaps which can inform the development of transitions and pathways can not only help potentially overcome any ‘disconnections’ that may exist between the social and the technical lenses in which such future trajectories are mapped, but also promote a strong ‘co-evolutionary’ content.

Camera and performer: energetic engagement with the shield

The stylistic strategies, in particular those concerning camera placement and movement, of The Shield (FX, 2002-08) seem to directly fit into an aesthetic tradition developed by US cop dramas like Hill Street Blues (NBC, 1981-87), Homicide: Life on the Street (NBC, 1993-99) and NYPD Blue (ABC, 1993-2005). In these precinct dramas, decisions concerning spatial arrangements of camera and performer foreground a desire to present and react to action while it is happening, and with a minimum of apparent construction. As Jonathan Bignell (2009) has argued, the intimacy and immediacy of this stylistic approach, which has at its core an attempt at a documentary-like realism, is important to the police drama as a genre, while also being tendencies that have been taken as specific characteristics of television more generally. I explore how The Shield develops this tradition of a reactive camera style in its strategy of shooting with two cameras rather than one, with specific attention to how this shapes the presentation of performance. Through a detailed examination of the relationship between performer and camera(s) the chapter considers the way the series establishes access to the fictional world, which is crucial to the manner of police investigation central to its drama, and the impact of this on how we engage with performance. The cameras’ placement appears to balance various impulses, including: the demands of attending to an ensemble cast, spontaneous performance style, and action that is physically dynamic and involving. In a series that makes stylistic decisions around presentation of the body on-screen deliberately close yet obstructive, involving yet fleeting, the chapter explores the affect of this on the watching experience.