Growth hormone replacement in adults with growth hormone deficiency: assessment of current knowledge

The recent availability of recombinant human growth hormone (GH) has led to intense investigation of the consequences of adult GH deficiency (GHD) and the effects of GH replacement. These studies have led to the identification of a characteristic syndrome of GHD consisting of decreased mood and well-being, with alterations in body composition and substrate metabolism. In both placebo-controlled and open studies, GH replacement therapy has consistently been shown to reverse or correct these features. Whether long-term GH replacement will result in a reduction of osteoporotic fractures, cardiovascular morbidity and mortality is not yet known. To date, no permanent serious adverse effects have been associated with GH replacement in GHD, and although currently expensive, it is anticipated that GH replacement will become routine in the treatment of the severely hypopituitary adult.

Education and Ideologies of the Knowledge Economy: Europe and the Politics of Emulation

The Austrian philosopher Ludwig Wittgenstein famously proposed a style of philosophy that was directed against certain pictures [bild] that tacitly direct our language and forms of life. His aim was to show the fly the way out of the fly bottle and to fight against the bewitchment of our intelligence by means of language: “A picture held us captive. And we could not get outside it, for it lay in our language and language seemed to repeat it to us inexorably” (Wittgenstein 1953, 115). In this context Wittgenstein is talking of philosophical pictures, deep metaphors that have structured our language but he does also use the term picture in other contexts (see Owen 2003, 83). I want to appeal to Wittgenstein in my use of the term ideology to refer to the way in which powerful underlying metaphors in neoclassical economics have a strong rhetorical and constitutive force at the level of public policy. Indeed, I am specifically speaking of the notion of ‘the performative’ in Wittgenstein and Austin. The notion of the knowledge economy has a prehistory in Hayek (1937; 1945) who founded the economics of knowledge in the 1930s, in Machlup (1962; 1970), who mapped the emerging employment shift to the US service economy in the early 1960s, and to sociologists Bell (1973) and Touraine (1974) who began to tease out the consequences of these changes for social structure in the post-industrial society in the early 1970s. The term has been taken up since by economists, sociologists, futurists and policy experts recently to explain the transition to the so-called ‘new economy’. It is not just a matter of noting these discursive strands in the genealogy of the ‘knowledge economy’ and related or cognate terms. We can also make a number of observations on the basis of this brief analysis. First, there has been a succession of terms like ‘postindustrial economy’, ‘information economy’, ‘knowledge economy’, ‘learning economy’, each with a set of related concepts emphasising its social, political, management or educational aspects. Often these literatures are not cross-threading and tend to focus on only one aspect of phenomena leading to classic dichotomies such as that between economy and society, knowledge and information. Second, these terms and their family concepts are discursive, historical and ideological products in the sense that they create their own meanings and often lead to constitutive effects at the level of policy. Third, while there is some empirical evidence to support claims concerning these terms, at the level of public policy these claims are empirically underdetermined and contain an integrating, visionary or futures component, which necessarily remains untested and is, perhaps, in principle untestable.

Transfer of spatial knowledge from a virtual environment to reality: Impact of route complexity and subject’s strategy on the exploration mode

The use of virtual reality as tool in the area of spatial cognition raises the question of the quality of learning transfer from a virtual to a real environment. It is first necessary to determine with healthy subjects, the cognitive aids that improve the quality of transfer and the conditions required, especially since virtual reality can be used as effective tool in cognitive rehabilitation. The purpose of this study was to investigate the influence of the exploration mode of virtual environment (Passive vs. Active) according to Route complexity (Simple vs. Complex) on the quality of spatial knowledge transfer in three spatial tasks. Ninety subjects (45 men and 45 women) participated. Spatial learning was evaluated by Wayfinding, sketch-mapping and picture classification tasks in the context of the Bordeaux district. In the Wayfinding task, results indicated that active learning in a Virtual Environment (VE) increased the performances compared to the passive learning condition, irrespective of the route complexity factor. In the Sketch-mapping task, active learning in a VE helped the subjects to transfer their spatial knowledge from the VE to reality, but only when the route was complex. In the Picture classification task, active learning in a VE when the route was complex did not help the subjects to transfer their spatial knowledge. These results are explained in terms of knowledge levels and frame/strategy of reference [SW75, PL81, TH82].

Is VHB-JOURQUAL2 a Good Measure of Scientific Quality? Assessing the Validity of the Major Business Journal Ranking in German-Speaking Countries

This study examines the question of whether the journal ranking VHB-JOURQUAL 2 can be considered as a good measure for the construct “scientific quality”. Various rankings in business research provide the database for the analysis. The correlations between theses rankings are used to assess the validity of VHB-JOURQUAL 2 along various validity criteria. The correlations with rankings that measure the same construct based on different methods show that VHB-JOURQUAL 2 has acceptable, but moderate convergent validity. The validity varies considerably across disciplines, showing that the heterogeneity of business administration is not sufficiently represented by this overall ranking. The variability is related to the variation in members per discipline represented by the German Association for Business Research. Furthermore, the measure shows a weak correlation with acceptance rates as an indicator of nomological validity in some disciplines.

Meeting the Challenges of Transdisciplinary Knowledge Production for Sustainable Water Governance

Increasing pressure on mountain water resources is making it necessary to address water governance issues in a transdisciplinary way. This entails drawing on different disciplinary perspectives, different types of knowledge, and different interests to answer complex governance questions. This study identifies strategies for addressing specific challenges to transdisciplinary knowledge production aiming at sustainable and reflective water governance. The study draws on the experiences of 5 large transdisciplinary water governance research projects conducted in Austria and Switzerland (Alp-Water-Scarce, MontanAqua, Drought-CH, Sustainable Water Infrastructure Planning, and an integrative river management project in the Kamp Valley). Experiences were discussed and systematically analyzed in a workshop and subsequent interviews. These discussions identified 4 important challenges to interactions between scientists and stakeholders—ensuring stakeholder legitimacy, encouraging participation, managing expectations, and preventing misuse of data and research results—and explored strategies used by the projects to meet them. Strategies ranged from key points to be considered in stakeholder selection to measures that enhance trustful relationships and create commitment.

Tailored instructional methods for students with diverse levels of computer knowledge and skills

The purpose of this online course is to ensure new nursing graduate students know how to use computer technologies required to complete academic and research activities. Powerful computers, high speed internet, digitalized resources and databases are widely available in educational institutes. New renovation and updates are being released at faster pace than ever. All these developments are necessary for a student to utilize computer programs and synthesize large amount of data in a limited time for any given academic research project. [See PDF for complete abstract]

Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records.

BACKGROUND: We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria. METHODS: We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content. RESULTS: All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified. CONCLUSION: If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.