AN ASSESSMENT OF KNOWLEDGE AND ATTITUDES OF GENETIC COUNSELING SERVICES IN U.S. HTCs

Hemophilia is a hereditary bleeding disorder which requires lifelong specialized care. A network of Hemophilia Treatment Centers (HTCs) exists to meet the medical needs of patients affected by hemophilia. Genetic counseling services are an integral part of the HTC model of care; however, many HTCs do not have genetic counselors on staff. As a result, the duty to provide these services must fall to other healthcare providers within the HTC. To assess the knowledge and attitudes of these providers we developed a 49 question survey that was distributed electronically to hematologists and nurses at U.S. HTCs. The survey consisted of a three sections: demographic information, knowledge of hemophilia genetics, and attitudes towards genetic services. A total of 111 complete responses were received and analyzed. The average knowledge score among all participants was 74.8% with a total of 81 participants receiving a passing score of 70% or above. Thirty participants scored below 70% in the knowledge section. In general, attitude scores were high indicating that the majority of hematologists and nurses in HTCs feel confident in their ability to provide genetic counseling services. Over 90% of participants reported that they have some form of access to genetic counseling services at their center. Hematologists and nurses practicing in U.S. HTCs demonstrate sufficient knowledge of the genetics of hemophilia, and they generally feel confident in their ability to provide genetic counseling services to their patients. While their knowledge is sufficient, the average knowledge score was lower than 75%. Certain questions covering new genetic technologies and testing practices were more commonly missed than questions asking about more basic aspects of hemophilia genetics, such as inheritance and carrier testing. Finally, many clinics report having access to a counselor, but it is oftentimes a hematologist or nurse who is providing genetic counseling services to patients. Given the inconsistency in knowledge among providers coupled with the high confidence in one’s ability to counsel patients, it leaves room to question whether information about the genetics of hemophilia is being communicated to patients in the most appropriate and accurate manner.

Benthic cover map of Heron Reef derived from a high-spatial-resolution multi-spectral satellite image using object based image analysis

Providing accurate maps of coral reefs where the spatial scale and labels of the mapped features correspond to map units appropriate for examining biological and geomorphic structures and processes is a major challenge for remote sensing. The objective of this work is to assess the accuracy and relevance of the process used to derive geomorphic zone and benthic community zone maps for three western Pacific coral reefs produced from multi-scale, object-based image analysis (OBIA) of high-spatial-resolution multi-spectral images, guided by field survey data. Three Quickbird-2 multi-spectral data sets from reefs in Australia, Palau and Fiji and georeferenced field photographs were used in a multi-scale segmentation and object-based image classification to map geomorphic zones and benthic community zones. A per-pixel approach was also tested for mapping benthic community zones. Validation of the maps and comparison to past approaches indicated the multi-scale OBIA process enabled field data, operator field experience and a conceptual hierarchical model of the coral reef environment to be linked to provide output maps at geomorphic zone and benthic community scales on coral reefs. The OBIA mapping accuracies were comparable with previously published work using other methods; however, the classes mapped were matched to a predetermined set of features on the reef.

Impact of knowledge brokering on performance heterogeneity among business models

Purpose – The strategic management literature lacks a comprehensive explanation as to why seemingly similar business models in the same industry perform differently. This paper strives to explain this phenomenon. Design/methodology/approach – The model is conceptualized and accompanied by a case study on the airline industry to explain knowledge brokerage that creates value from the effective utilization of knowledge resources acquired from intra- and inter-firm environments. Findings – The model explains a cyclical view of business model flexibility in which the knowledge-based resource accumulation of the business model is spread across the intra- and inter-firm environments. Knowledge brokerage strategies from the inter- and intra-firm environments result in improved performance of the business model. The flexibility that the business model acquires is determined by how efficiently resource accumulation is aligned with its external environment. Originality/value – The paper effectively integrates the concepts of knowledge brokerage and business models from a resource accumulation-based view and simultaneously arrives at the performance heterogeneity of seemingly similar business models within the same industry. It has performance implications for firms that start out without any distinct resources of their own, or that use an imitated business model, to attain better performance through business model evolution aligned with successful knowledge brokerage strategies. It adds to the resource accumulation literature by explaining how resources can be effectively acquired to create value.

An approach to a model of the visual cortex: disorders of vision

One of the most challenging problems that must be solved by any theoretical model purporting to explain the competence of the human brain for relational tasks is the one related with the analysis and representation of the internal structure in an extended spatial layout of múltiple objects. In this way, some of the problems are related with specific aims as how can we extract and represent spatial relationships among objects, how can we represent the movement of a selected object and so on. The main objective of this paper is the study of some plausible brain structures that can provide answers in these problems. Moreover, in order to achieve a more concrete knowledge, our study will be focused on the response of the retinal layers for optical information processing and how this information can be processed in the first cortex layers. The model to be reported is just a first trial and some major additions are needed to complete the whole vision process.

Development of a model of cross-curricular competencies of students at the Technical University of Madrid

It is known that cross-curricular competences are required for main companies all over the world to be part of our university graduates as technical knowledge does. That is the reason which has led the university structure to include these competences in the every degree curriculo validated since the European Higher Education Area (EHEA)was introduced in the Spanish university context. But the way used for incorporating them has been developed without the necessary guidelines to generate a qualified model.

The Role of Knowledge Modeling Techniques in Software Development: A General Approach Based on a Knowledge Management Tool

The aim of the paper is to discuss the use of knowledge models to formulate general applications. First, the paper presents the recent evolution of the software field where increasing attention is paid to conceptual modeling. Then, the current state of knowledge modeling techniques is described where increased reliability is available through the modern knowledge acquisition techniques and supporting tools. The KSM (Knowledge Structure Manager) tool is described next. First, the concept of knowledge area is introduced as a building block where methods to perform a collection of tasks are included together with the bodies of knowledge providing the basic methods to perform the basic tasks. Then, the CONCEL language to define vocabularies of domains and the LINK language for methods formulation are introduced. Finally, the object oriented implementation of a knowledge area is described and a general methodology for application design and maintenance supported by KSM is proposed. To illustrate the concepts and methods, an example of system for intelligent traffic management in a road network is described. This example is followed by a proposal of generalization for reuse of the resulting architecture. Finally, some concluding comments are proposed about the feasibility of using the knowledge modeling tools and methods for general application design.

A model of air transport passenger incidents and rights

This paper describes a representation of the legal framework in the air transport passenger's rights domain and the foremost incidents that trigger the top of consumer complaints ranking in the EU. It comprises the development of a small network of three ontologies, formalisation of scenarios, specification of properties and identification of relations. The approach is illustrated by means of a case study based in the context of a real life cancelled flight incident. This is part of an intended support-system that aims to provide both consumers and companies with relevant legal information to enhance the decision-making process.

Flows of knowledge from universities and federal laboratories: Modeling the flow of patent citations over time and across institutional and geographic boundaries

The extent to which new technological knowledge flows across institutional and national boundaries is a question of great importance for public policy and the modeling of economic growth. In this paper we develop a model of the process generating subsequent citations to patents as a lens for viewing knowledge diffusion. We find that the probability of patent citation over time after a patent is granted fits well to a double-exponential function that can be interpreted as the mixture of diffusion and obsolescense functions. The results indicate that diffusion is geographically localized. Controlling for other factors, within-country citations are more numerous and come more quickly than those that cross country boundaries.

DNA-mediated immunization in a transgenic mouse model of the hepatitis B surface antigen chronic carrier state.

Transgenic mice expressing the sequences coding for the envelope proteins of the hepatitis B virus (HBV) in the liver have been used as a model of the HBV chronic carrier state. We evaluated the possibility of inducing a specific immune response to the viral envelope antigens and thus potentially controlling chronic HBV infection. Using HBV-specific DNA-mediated immunization in this transgenic model, we show that the immune response induced after a single intramuscular injection of DNA resulted in the complete clearance of circulating hepatitis B surface antigen and in the long-term control of transgene expression in hepatocytes. This response does not involve a detectable cytopathic effect in the liver. Adoptive transfer of fractionated primed spleen cells from DNA-immunized mice shows that T cells are responsible for the down-regulation of HBV mRNA in the liver of transgenic mice. To our knowledge, this is the first demonstration of a potential immunotherapeutic application of DNA-mediated immunization against an infectious disease and raises the possibility of designing more effective ways of treating HBV chronic carriers.

Constructing an Indigenous Model of the Self to Address Cultural and Mental Health Issues in the Canadian Subarctic

Since the last decades, academic research has paid much attention to the phenomenon of revitalizing indigenous cultures and, more precisely, the use of traditional indigenous healing methods both to deal with individuals' mental health problems and with broader cultural issues. The re-evaluation of traditional indigenous healing practices as a mode of psychotherapeutic treatment has been perhaps one of the most interesting sociocultural processes in the postmodern era. In this regard, incorporating indigenous forms of healing in a contemporary framework of indigenous mental health treatment should be interpreted not simply as an alternative therapeutic response to the clinical context of Western psychiatry, but also constitutes a political response on the part of ethno-cultural groups that have been stereotyped as socially inferior and culturally backward. As a result, a postmodern form of "traditional healing" developed with various forms of knowledge, rites and the social uses of medicinal plants, has been set in motion on many Canadian indigenous reserves over the last two decades.

Functional-structural plant modelling using a combination of architectural analysis, L-systems and a canonical model of function

This paper presents a new method for producing a functional-structural plant model that simulates response to different growth conditions, yet does not require detailed knowledge of underlying physiology. The example used to present this method is the modelling of the mountain birch tree. This new functional-structural modelling approach is based on linking an L-system representation of the dynamic structure of the plant with a canonical mathematical model of plant function. Growth indicated by the canonical model is allocated to the structural model according to probabilistic growth rules, such as rules for the placement and length of new shoots, which were derived from an analysis of architectural data. The main advantage of the approach is that it is relatively simple compared to the prevalent process-based functional-structural plant models and does not require a detailed understanding of underlying physiological processes, yet it is able to capture important aspects of plant function and adaptability, unlike simple empirical models. This approach, combining canonical modelling, architectural analysis and L-systems, thus fills the important role of providing an intermediate level of abstraction between the two extremes of deeply mechanistic process-based modelling and purely empirical modelling. We also investigated the relative importance of various aspects of this integrated modelling approach by analysing the sensitivity of the standard birch model to a number of variations in its parameters, functions and algorithms. The results show that using light as the sole factor determining the structural location of new growth gives satisfactory results. Including the influence of additional regulating factors made little difference to global characteristics of the emergent architecture. Changing the form of the probability functions and using alternative methods for choosing the sites of new growth also had little effect. (c) 2004 Elsevier B.V. All rights reserved.

A probabilistic switch model of information flow in social networks: Application for virtual circuits to organizational design

Network building and exchange of information by people within networks is crucial to the innovation process. Contrary to older models, in social networks the flow of information is noncontinuous and nonlinear. There are critical barriers to information flow that operate in a problematic manner. New models and new analytic tools are needed for these systems. This paper introduces the concept of virtual circuits and draws on recent concepts of network modelling and design to introduce a probabilistic switch theory that can be described using matrices. It can be used to model multistep information flow between people within organisational networks, to provide formal definitions of efficient and balanced networks and to describe distortion of information as it passes along human communication channels. The concept of multi-dimensional information space arises naturally from the use of matrices. The theory and the use of serial diagonal matrices have applications to organisational design and to the modelling of other systems. It is hypothesised that opinion leaders or creative individuals are more likely to emerge at information-rich nodes in networks. A mathematical definition of such nodes is developed and it does not invariably correspond with centrality as defined by early work on networks.

Neuromarketing and the perceptions of knowledge

The emerging field of neuromarketing reveals that knowledge has plasticity. In other words, different stakeholders, marketing researchers and practitioners, perceive the development and application of neuromarketing knowledge in different ways. Having different perceptions of knowledge is not a new issue, but finding new interconnections between those perceptions is beneficial to knowledge creation and diffusion. The research-practice gap in neuromarketing is briefly discussed and then resolved through the contribution of this commentary, the proposal of a novel Neuromarketing Research Model. The Model interconnects basic research reporting, applied research reporting, media reporting and power processes.

Using a simulation model for knowledge elicitation and knowledge management

The work reported in this paper is part of a project simulating maintenance operations in an automotive engine production facility. The decisions made by the people in charge of these operations form a crucial element of this simulation. Eliciting this knowledge is problematic. One approach is to use the simulation model as part of the knowledge elicitation process. This paper reports on the experience so far with using a simulation model to support knowledge management in this way. Issues are discussed regarding the data available, the use of the model, and the elicitation process itself. © 2004 Elsevier B.V. All rights reserved.