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.

Aspect selection in adult L2 Spanish and the competing systems hypothesis: when pedagogical and linguistic rules conflict.

Native-like use of preterit and imperfect morphology in all contexts by English learners of L2 Spanish is the exception rather than the rule, even for successful learners. Nevertheless, recent research has demonstrated that advanced English learners of L2 Spanish attain a native-like morphosyntactic competence for the preterit/imperfect contrast, as evidenced by their native-like knowledge of associated semantic entailments (Goodin-Mayeda and Rothman 2007, Montrul and Slabakova 2003, Slabakova and Montrul 2003, Rothman and Iverson 2007). In addition to an L2 disassociation of morphology and syntax (e.g., Bruhn de Garavito 2003, Lardiere 1998, 2000, 2005, Prévost and White 1999, 2000, Schwartz 2003), I hypothesize that a system of learned pedagogical rules contributes to target-deviant L2 performance in this domain through the most advanced stages of L2 acquisition via its competition with the generative system. I call this hypothesis the Competing Systems Hypothesis. To test its predictions, I compare and contrast the use of the preterit and imperfect in two production tasks by native, tutored (classroom), and naturalistic learners of L2 Spanish.

Location, control and innovation in knowledge-intensive industries

The rising share of intangibles in economies worldwide highlights the crucial role of knowledge-intensive and creative industries in current and future wealth generation. The recognition of this trend has led to intense competition in these industries. At the micro-level, firms from both advanced and emerging economies are globally dispersing their value chains to control costs and leverage capabilities. The geography of innovation is the outcome of a dynamic process whereby firms from emerging economies strive to catch-up with advanced economy competitors, creating strong pressures for continued innovation. However, two distinct strategies can be discerned with regard to the control of the value chain. A vertical integration strategy emphasizes taking advantage of ‘linkage economies’ whereby controlling multiple value chain activities enhances the efficiency and effectiveness of each one of them. In contrast, a specialization strategy focuses on identifying and controlling the creative heart of the value chain, while outsourcing all other activities. The global mobile handset industry is used as the template to illustrate the theory.

The aluminium content of breast tissue taken from women with breast cancer

The aetiology of breast cancer is multifactorial. While there are known genetic predispositions to the disease it is probable that environmental factors are also involved. Recent research has demonstrated a regionally specific distribution of aluminium in breast tissue mastectomies while other work has suggested mechanisms whereby breast tissue aluminium might contribute towards the aetiology of breast cancer. We have looked to develop microwave digestion combined with a new form of graphite furnace atomic absorption spectrometry as a precise, accurate and reproducible method for the measurement of aluminium in breast tissue biopsies. We have used this method to test the thesis that there is a regional distribution of aluminium across the breast in women with breast cancer. Microwave digestion of whole breast tissue samples resulted in clear homogenous digests perfectly suitable for the determination of aluminium by graphite furnace atomic absorption spectrometry. The instrument detection limit for the method was 0.48 μg/L. Method blanks were used to estimate background levels of contamination of 14.80 μg/L. The mean concentration of aluminium across all tissues was 0.39 μg Al/g tissue dry wt. There were no statistically significant regionally specific differences in the content of aluminium. We have developed a robust method for the precise and accurate measurement of aluminium in human breast tissue. There are very few such data currently available in the scientific literature and they will add substantially to our understanding of any putative role of aluminium in breast cancer. While we did not observe any statistically significant differences in aluminium content across the breast it has to be emphasised that herein we measured whole breast tissue and not defatted tissue where such a distribution was previously noted. We are very confident that the method developed herein could now be used to provide accurate and reproducible data on the aluminium content in defatted tissue and oil from such tissues and thereby contribute towards our knowledge on aluminium and any role in breast cancer.

Knowledge-based design cost estimation through extending industry foundation classes

In order to overcome divergence of estimation with the same data, the proposed digital costing process adopts an integrated design of information system to design the process knowledge and costing system together. By employing and extending a widely used international standard, industry foundation classes, the system can provide an integrated process which can harvest information and knowledge of current quantity surveying practice of costing method and data. Knowledge of quantification is encoded from literatures, motivation case and standards. It can reduce the time consumption of current manual practice. The further development will represent the pricing process in a Bayesian Network based knowledge representation approach. The hybrid types of knowledge representation can produce a reliable estimation for construction project. In a practical term, the knowledge management of quantity surveying can improve the system of construction estimation. The theoretical significance of this study lies in the fact that its content and conclusion make it possible to develop an automatic estimation system based on hybrid knowledge representation approach.

iPad use in fieldwork: formal and informal use to enhance pedagogical practice in a bring your own technology world

We report on use of iPads (and other IOS devices) for student fieldwork use and as electronic field notebooks and to promote active. We have used questionnaires and interviews of tutors and students to elicit their views and technology and iPad use for fieldwork. There is some reluctance for academic staff to relinquish paper notebooks for iPad use, whether in the classroom or on fieldwork, as well as use them for observational and measurement purposes. Students too are largely unaware of the potential of iPads for enhancing fieldwork. Apps can be configured for a wide variety of specific uses that make iPads useful for educational as well as social uses. Such abilities should be used to enhance existing practice as well as make new functionality. For example, for disabled students who find it difficult to use conventional note taking. iPads can be used to develop student self-directed learning and for group contributions. The technology becomes part of the students’ personal learning environments as well as at the heart of their knowledge spaces – academic and social. This blurring of boundaries is due to iPads’ usability to cultivate field use, instruction, assessment and feedback processes. iPads can become field microscopes and entries to citizen science and we see the iPad as the main ‘computing’ device for students in the near future. As part of the Bring Your Own Technology/Device (BYOD) the iPad has much to offer although, both staff and students need to be guided in the most effective use for self-directed education via development of Personal Learning Environments. A more student-oriented pedagogy is suggested to correspond to the increasing use of tablet technologies by students

An investigation into knowledge acquisition idiosyncrasies in Ghanaian universities

Purpose This paper aims to fill the research and knowledge gap in knowledge management studies in Ghana. Knowledge acquisition is one of the unexploited areas in knowledge management literature, especially in the Ghanaian context. This study tries to ascertain the factors affecting knowledge acquisition in Ghanaian universities. Design/methodology/approach The study used the quantitative approach. The cross-sectional survey was adopted as the research design. A questionnaire consisting of Likert scale questions was used to collect data from the respondents. The items and the constructs were derived from the extant literature. The questionnaire was sent to 350 respondents, out of which 250 were returned fully completed. Data were quantitatively analysed using descriptive methods and factor analysis. Findings This study provides empirical evidence about the factors affecting knowledge acquisition in Ghanaian universities. Findings from the study show that programme content, lecturers’ competence, student academic background and attitude and facilities for teaching and learning influence knowledge acquisition in Ghanaian universities. Research limitations/implications Although the study seeks to generalize the findings, this should be cautiously done, as some scholars have advocated for large sample size. Nonetheless, there are some studies that have used sample size less than the one used in this study. Practical implications The study takes notice of the need for Ghanaian universities to use modern facilities and infrastructures such as electronic libraries and information technology equipment and also provide reading rooms to enhance teaching and learning. Originality/value Studies looking at knowledge acquisition in Ghanaian universities are virtually non-existent, and this study provides empirical findings on the factors affecting knowledge acquisition in Ghanaian universities.

Ocean heat content variability and change in an ensemble of ocean reanalyses

Accurate knowledge of the location and magnitude of ocean heat content (OHC) variability and change is essential for understanding the processes that govern decadal variations in surface temperature, quantifying changes in the planetary energy budget, and developing constraints on the transient climate response to external forcings. We present an overview of the temporal and spatial characteristics of OHC variability and change as represented by an ensemble of dynamical and statistical ocean reanalyses (ORAs). Spatial maps of the 0–300 m layer show large regions of the Pacific and Indian Oceans where the interannual variability of the ensemble mean exceeds ensemble spread, indicating that OHC variations are well-constrained by the available observations over the period 1993–2009. At deeper levels, the ORAs are less well-constrained by observations with the largest differences across the ensemble mostly associated with areas of high eddy kinetic energy, such as the Southern Ocean and boundary current regions. Spatial patterns of OHC change for the period 1997–2009 show good agreement in the upper 300 m and are characterized by a strong dipole pattern in the Pacific Ocean. There is less agreement in the patterns of change at deeper levels, potentially linked to differences in the representation of ocean dynamics, such as water mass formation processes. However, the Atlantic and Southern Oceans are regions in which many ORAs show widespread warming below 700 m over the period 1997–2009. Annual time series of global and hemispheric OHC change for 0–700 m show the largest spread for the data sparse Southern Hemisphere and a number of ORAs seem to be subject to large initialization ‘shock’ over the first few years. In agreement with previous studies, a number of ORAs exhibit enhanced ocean heat uptake below 300 and 700 m during the mid-1990s or early 2000s. The ORA ensemble mean (±1 standard deviation) of rolling 5-year trends in full-depth OHC shows a relatively steady heat uptake of approximately 0.9 ± 0.8 W m−2 (expressed relative to Earth’s surface area) between 1995 and 2002, which reduces to about 0.2 ± 0.6 W m−2 between 2004 and 2006, in qualitative agreement with recent analysis of Earth’s energy imbalance. There is a marked reduction in the ensemble spread of OHC trends below 300 m as the Argo profiling float observations become available in the early 2000s. In general, we suggest that ORAs should be treated with caution when employed to understand past ocean warming trends—especially when considering the deeper ocean where there is little in the way of observational constraints. The current work emphasizes the need to better observe the deep ocean, both for providing observational constraints for future ocean state estimation efforts and also to develop improved models and data assimilation methods.

Dokumentationens dilemman : Förskollärare samtalar om pedagogisk dokumentation

Abstract  Pedagogical documentation is a certain procedure for documenting that, in recent years, has been embraced in several Swedish preschools. Teachers document children’s actions and conversations usually by photos or video recordings. This documentation is to be used for a pedagogical purpose. However, studies and governmental inspections have shown that pedagogical documentation gives rise to many questions among preschool teachers. The purpose of this study is to gain insight into what is being expressed when preschool teachers discuss pedagogical documentation, focusing on themes of content and on the participants’ expressions of their points of view. The data is comprised of transcriptions from audio recordings of discussions conducted in a research circle. The participants are eight preschool teachers that met over the course of one year. Each meeting focused on the documentation provided by a different participant. In that way the contents of the discussions were framed by the teachers own questions and narratives. Theoretically, the study departs from Social Constructionism and Discursive Psychology. The preschool teachers’ utterances have been analyzed using concepts of interpretative repertoires and ideological dilemmas. The results show the main themes to be: Knowledge content in a preschool setting, children’s learning, the teacher’s role and implementation of pedagogical documentation. The participants’ joint position is that the knowledge content at the preschool level is defined by the curriculum for the preschool. Concerning children’s learning and the teacher’s role, two main standpoints are disclosed. Ideologically those standpoints derive from two opposing theories of education. Based on how the standpoints have been expressed I have called them ”predetermined learning” versus ”non-predetermined learning”. One main distinction between the standpoints is that predetermined learning emphasizes the results of learning, while non-predetermined learning emphasizes the processes of learning. The participants’ utterances show that teachers tend to subscribe to the idea that there is only one acceptable way of working with pedagogical documentation. This sometimes creates performance anxiety and feelings of not succeeding and has led to arguments advocating an alternate approach; pedagogical documentation can be done in many ways. The ideological dilemmas within the discourse can be perceived as resources by which the participants argue about knowledge, learning, teaching and about the implementation of pedagogical documentation.

Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

Ontology-based metadata for e-learning content

Nowadays, the popularity of the Web encourages the development of Hypermedia Systems dedicated to e-learning. Nevertheless, most of the available Web teaching systems apply the traditional paper-based learning resources presented as HTML pages making no use of the new capabilities provided by the Web. There is a challenge to develop educative systems that adapt the educative content to the style of learning, context and background of each student. Another research issue is the capacity to interoperate on the Web reusing learning objects. This work presents an approach to address these two issues by using the technologies of the Semantic Web. The approach presented here models the knowledge of the educative content and the learner’s profile with ontologies whose vocabularies are a refinement of those defined on standards situated on the Web as reference points to provide semantics. Ontologies enable the representation of metadata concerning simple learning objects and the rules that define the way that they can feasibly be assembled to configure more complex ones. These complex learning objects could be created dynamically according to the learners’ profile by intelligent agents that use the ontologies as the source of their beliefs. Interoperability issues were addressed by using an application profile of the IEEE LOM- Learning Object Metadata standard.

Does absorptive capacity affect project performance? A study based on project management practices, organization learning, and knowledge

The literature has emphasized that absorptive capacity (AC) leads to performance, but in projects its influences still unclear. Additionally, the project success is not well understood by the literature, and AC can be an important mechanism to explain it. Therefore, the purpose of this study is to investigate the effect of absorptive capacity on project performance in the construction industry of São Paulo State. We study this influence through potential and realized absorptive capacity proposed by Zahra and George (2002). For achieving this goal, we use a combination of qualitative and quantitative research. The qualitative research is based on 15 interviews with project managers in different sectors to understand the main constructs and support the next quantitative phase. The content analysis was the technique used to analyze those interviews. In quantitative phase through a survey questionnaire, we collected 157 responses in the construction sector with project managers. The confirmatory factor analysis and hierarchical linear regression were the techniques used to assess the data. Our findings suggest that the realized absorptive capacity has a positive influence on performance, but potential absorptive capacity and the interactions effect have no influence on performance. Moreover, the planning and monitoring have a positive impact on budget and schedule, and customer satisfaction while risk coping capacity has a positive impact on business success. In academics terms, this research enables a better understanding of the importance of absorptive capacity in the construction industry and it confirms that knowledge application in processes and routines enhances performance. For management, the absorptive capacity enables the improvements of internal capabilities reflected in the increased project management efficiency. Indeed, when a company manages project practices efficiently it enhances business and project performance; however, it needs initially to improve its internal abilities to enrich processes and routines through relevant knowledge.