Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics.

Cardiovascular risk assessment might be improved with the addition of emerging, new tests derived from atherosclerosis imaging, laboratory tests or functional tests. This article reviews relative risk, odds ratios, receiver-operating curves, posttest risk calculations based on likelihood ratios, the net reclassification improvement and integrated discrimination. This serves to determine whether a new test has an added clinical value on top of conventional risk testing and how this can be verified statistically. Two clinically meaningful examples serve to illustrate novel approaches. This work serves as a review and basic work for the development of new guidelines on cardiovascular risk prediction, taking into account emerging tests, to be proposed by members of the 'Taskforce on Vascular Risk Prediction' under the auspices of the Working Group 'Swiss Atherosclerosis' of the Swiss Society of Cardiology in the future.

Predictors of physiotherapy and occupational therapy use two years after a vocational rehabilitation for orthopaedic trauma

Introduction.- Health care utilization is an important field of our economy. Nevertheless a minority of cases induce the majority of costs. For instance, in the setting of accident insurance, the most expensive 5% of all injured cases involve 80% of the health care costs. Although physiotherapy and occupational therapy consist of only a small proportion of these costs, it is nevertheless important to evaluate the factors that predict its use in order to improve services (i.e. allocation of resources to those who need them and benefit most).Patients and methods.- In this longitudinal prospective study, the cohort consisted of 2156 consecutively included patients with orthopaedic problems attending the clinique Romande de réadaptation (CRR) at Sion for inpatient rehabilitation after a work, traffic or leisure related injury. Two years after discharge, a questionnaire regarding the use of different health cares was send to the patients (1502 patients returned their questionnaires). The aim of this study was to calculate, with a logistic multivariate model, in-patient hospitalized for orthopaedic problems, the variables that mostly predict physiotherapy use 2 years after discharge.Results.- The full multivariate model contains 46 predictors. The use of physiotherapy and occupational therapy was significantly predicted in this multivariate model by the following predictors: Patients with a spinal problem (OR 1.51 versus lower-extremity problem, 95% CI 1.01 to 2.27), a disability pension (OR 1.69, 95% CI 1.09 to 2.60), patients with sports activities (OR 1.56, 95% CI 1.26 to 1.94), patients with longer stay at the rehabilitation clinic (OR 1.22 per week, 95% CI 1.05 to 1.41), women (OR 1.64, 95% CI 1.09 to 2.48) and those consulting a psychiatrist (OR 1.66, 95% CI 1.06 to 2.60).Discussion.- In this prospective study with a 2-year follow-up, different factors predicted the use of physiotherapy and occupational therapy after an injury. Further studies are needed to clarify the impact of these factors for the health care utilization and the strategies, which would allow to improve allocation of available resources.

Supporting knowledge creation and sharing in the early phases of the strategic innovation process

The driving forces of technology and globalization continuously transform the business landscape in a way which undermines the existing strategies and innovations of organizations. The challenge for organizations is to establish such conditions where they are able to create new knowledge for innovative business ideas in interaction between other organizations and individuals. Innovation processes continuously need new external stimulations and seek new ideas, new information and knowledge locating more and more outside traditional organizational boundaries. In several studies, the early phases of the innovation process have been considered as the most critical ones. During these phases, the innovation process can emerge or conclude. External knowledge acquirement and utilization are noticed to be important at this stage of the innovation process giving information about the development of future markets and needs for new innovative businessideas. To make it possible, new methods and approaches to manage proactive knowledge creation and sharing activities are needed. In this study, knowledge creation and sharing in the early phases of the innovation process has been studied, and the understanding of knowledge management in the innovation process in an open and collaborative context advanced. Furthermore, the innovation management methods in this study are combined in a novel way to establish an open innovation process and tested in real-life cases. For these purposes two complementary and sequentially applied group work methods - the heuristic scenario method and the idea generation process - are examined by focusing the research on the support of the open knowledge creation and sharing process. The research objective of this thesis concerns two doctrines: the innovation management including the knowledge management, and the futures research concerning the scenario paradigm. This thesis also applies the group decision support system (GDSS) in the idea generation process to utilize the converged knowledge during the scenario process.

Police work and new 'security devices' : a tale from the beat

Mobile technologies have brought about major changes in police equipment and police work. If a utopian narrative remains strongly linked to the adoption of new technologies, often formulated as 'magic bullets' to real occupational problems, there are important tensions between their 'imagined' outcomes and the (unexpected) effects that accompany their daily 'practical' use by police officers. This article offers an analysis of police officers' perceptions and interactions with security devices. In so doing, it develops a conceptual typology of strategies for coping with new technology inspired by Le Bourhis and Lascoumes: challenging, neutralizing and diverting. To that purpose, we adopt an ethnographic approach that focuses on the discourses, practices and actions of police officers in relation to three security devices: the mobile digital terminal, the mobile phone and the body camera. Based on a case study of a North American municipal police department, the article addresses how these technological devices are perceived and experienced by police officers on the beat.

Knowledge misallocation and growth

We develop a growth model where knowledge is embodied in individuals and diffused across sectors through labor mobility. The existence of labor mobility costs constrains mobility and, thus, generates labor misallocation. Different levels of labor misallocation imply different levels of exploitation of available knowledge and, therefore, different total factor productivity across countries. We derive a positive relationship between growth and labor mobility, which is consistent with the empirical evidence, by assuming aggregate constant returns to capital. We also analyze the short and long run effects of labor mobility costs in the case of decreasing returns to capital. It turns out that changes in mobility costs have larger economic effects when different types of worker have small rather than large complementarities. Finally, we show that different labor income taxes or labor market tightness imply different rates of labor mobility and, therefore, can explain differences in Gross Domestic Product across countries.

Role of culture in knowledge transfer and sharing - case ERP implementation

The main objective of this study was to examine how culture influences knowledge transfer and sharing within multicultural ERP project implementation in China. The main interest was to explain how national culture and knowledge are linked by understanding how culture influences knowledge transfer and sharing in a project organization. The other objective of this work was to discuss what Chinese cultural characteristic inhibit and en-hance knowledge sharing in ERP project. The perspective of this study was qualitative and the empirical material was collected from theme interviews among Stora Enso employees. Conclusion of this thesis is that Finns have a very direct style of communication and sharing knowledge whereas Chinese respect face shaving and indirect communication. Another conclusion is that knowledge sharing does not “just happen”, it is needed that project members understand national culture to get all project members commitment to project. In China most important is understand local business processes and understand role of trust and guanxi.

Searchig the links between "knowledge governance mechanisms", "the individual conditions of knowledge sharing", and "individual's knowledge sharing behaviour".

The objective of this study was to understand how organizational knowledge governance mechanisms affect individual motivation, opportunity, and the ability to share knowledge (MOA framework), and further, how individual knowledge-sharing conditions affect actual knowledge sharing behaviour. The study followed the knowledge governance approach and a micro-foundations perspective to develop a theoretical model and hypotheses, which could explain the casual relationships between knowledge governance mechanisms, individual knowledge sharing conditions, and individual knowledge sharing behaviour. The quantitative research strategy and multivariate data analysis techniques (SEM) were used in the hypotheses testing with a survey dataset of 256 employees from eleven military schools of Finnish Defence Forces (FDF). The results showed that “performance-based feedback and rewards” affects employee’s “intrinsic motivation towards knowledge sharing”, that “lateral coordination” affects employee’s “knowledge self-efficacy”, and that ”training and development” is positively related to “time availability” for knowledge sharing but affects negatively employee’s knowledge self-efficacy. Individual motivation and knowledge self-efficacy towards knowledge sharing affected knowledge sharing behaviour when work-related knowledge was shared 1) between employees in a department and 2) between employees in different departments, however these factors did not play a crucial role in subordinate–superior knowledge sharing. The findings suggest that individual motivation, opportunity, and the ability towards knowledge sharing affects individual knowledge sharing behaviour differently in different knowledge sharing situations. Furthermore, knowledge governance mechanisms can be used to manage individual-level knowledge sharing conditions and individual knowledge sharing behaviour but their affect also vary in different knowledge sharing situations.

Our future in geriatrics : an examination of the knowledge, attitudes and career choices of physical therapy students in Ontario : a pretest-posttest study /

There continues to be a shortage of health professionals interested in providing care for the older adult. Part of the problem seems to stem from the negative perceptions of geriatrics as a clinical speciality. This study examines the knowledge, attitudes and career decisions of physical therapy students in Ontario before and after an educational intervention. Surveys were conducted with 144 physical therapy students from five universities before and after their geriatrics course in order to measure their knowledge, attitudes and interest in working with older adults. The incoming class of physical therapy students (n = 1 86) acted as control subjects for the study. The Revised Palmore Facts On Aging Quiz measured the students' knowledge of aging (Miller & Dodder, 1980). The Revised Tuckman-Lorge (Axelrod & Eisdorfer, 1961) and the Kogan Old People Scales (Kogan, 1961) were used to examine attitude. An environmental scale was developed based on the work of Snape (1986) to measure the impact of the working conditions on the students' career choices. A 10-point Likert-type scale based on the work of Michlelutte & Diseker (1985) was modified and used to measure career interest in working with the elderly. On independent sample t-tests, positive attitudes were related to the demographic characteristic of gender; ethnicity was negatively related; and marital status was found to be unrelated to attitude (fi<.05). Having a relationship with an older adult and taking courses in gerontology were also found to be positively related to attitude (fi<.05). Results on a betweensubjects design which compared students before and after the course found that knowledge scores improved from pretest to posttest (fi<.05). In general, attitude scores improved from T1 to T2 on both measurement tools (b<.05). The environmental and vocational interest scales yielded statistically significant differences between the control and experimental groups during the intervention period (p<.05). The results of this research indicated that knowledge and attitudes improve after an educational intervention; however, there was little impact on the students' overall career decisions. Further research is indicated to examine the complex relationship between attitude and behaviour and its impact on students' career choices. In addition, the impact of geriatric clinical environment on students' attitudes and career decisions needs to be further explored.

Educator Evaluation of Academic and Social Competence in Students with Acquired Brain Injury (ABI) Relative to Assessed Performance and Sense of Belonging

Acquired brain injury (ABI) is the leading cause of death and disability amongst children and adolescents andpresents itself with challenges associated in cognitive, social, emotional, and behavioural domains. These changes may interfere with academic performance and social inclusion, influencing self-esteem and personal success. The current study examined a subset of data to capture the sense of academic and social belonging for students with ABI as a function of the classroom teachers’ subjective perception of ability, their ABI knowledge, and student identification. Overall, a discrepancy was found between educators’ subjective ratings of student performance and students’ neurocognitive capacity. Educator knowledge and identification of ABI influenced student success in academic and social domains independent of teaching approach. This research has implications for the identification of ABI in the classroom and related challenges students experience. Educators are underprepared for the reintegration of students returning to school and lack appropriate knowledge and strategies to accommodate individual needs.

Web2.0, knowledge sharing and privacy in E-learning

Quand le E-learning a émergé il ya 20 ans, cela consistait simplement en un texte affiché sur un écran d'ordinateur, comme un livre. Avec les changements et les progrès dans la technologie, le E-learning a parcouru un long chemin, maintenant offrant un matériel éducatif personnalisé, interactif et riche en contenu. Aujourd'hui, le E-learning se transforme de nouveau. En effet, avec la prolifération des systèmes d'apprentissage électronique et des outils d'édition de contenu éducatif, ainsi que les normes établies, c’est devenu plus facile de partager et de réutiliser le contenu d'apprentissage. En outre, avec le passage à des méthodes d'enseignement centrées sur l'apprenant, en plus de l'effet des techniques et technologies Web2.0, les apprenants ne sont plus seulement les récipiendaires du contenu d'apprentissage, mais peuvent jouer un rôle plus actif dans l'enrichissement de ce contenu. Par ailleurs, avec la quantité d'informations que les systèmes E-learning peuvent accumuler sur les apprenants, et l'impact que cela peut avoir sur leur vie privée, des préoccupations sont soulevées afin de protéger la vie privée des apprenants. Au meilleur de nos connaissances, il n'existe pas de solutions existantes qui prennent en charge les différents problèmes soulevés par ces changements. Dans ce travail, nous abordons ces questions en présentant Cadmus, SHAREK, et le E-learning préservant la vie privée. Plus précisément, Cadmus est une plateforme web, conforme au standard IMS QTI, offrant un cadre et des outils adéquats pour permettre à des tuteurs de créer et partager des questions de tests et des examens. Plus précisément, Cadmus fournit des modules telles que EQRS (Exam Question Recommender System) pour aider les tuteurs à localiser des questions appropriées pour leur examens, ICE (Identification of Conflits in Exams) pour aider à résoudre les conflits entre les questions contenu dans un même examen, et le Topic Tree, conçu pour aider les tuteurs à mieux organiser leurs questions d'examen et à assurer facilement la couverture des différent sujets contenus dans les examens. D'autre part, SHAREK (Sharing REsources and Knowledge) fournit un cadre pour pouvoir profiter du meilleur des deux mondes : la solidité des systèmes E-learning et la flexibilité de PLE (Personal Learning Environment) tout en permettant aux apprenants d'enrichir le contenu d'apprentissage, et les aider à localiser nouvelles ressources d'apprentissage. Plus précisément, SHAREK combine un système recommandation multicritères, ainsi que des techniques et des technologies Web2.0, tels que le RSS et le web social, pour promouvoir de nouvelles ressources d'apprentissage et aider les apprenants à localiser du contenu adapté. Finalement, afin de répondre aux divers besoins de la vie privée dans le E-learning, nous proposons un cadre avec quatre niveaux de vie privée, ainsi que quatre niveaux de traçabilité. De plus, nous présentons ACES (Anonymous Credentials for E-learning Systems), un ensemble de protocoles, basés sur des techniques cryptographiques bien établies, afin d'aider les apprenants à atteindre leur niveau de vie privée désiré.

Order and the literary rendering of chaos : children's literature as knowledge, order, and social foundation

Depuis que l'animal humain a conçu un système de technologies pour la pensée abstraite grâce au langage, la guerre contre le monde sauvage est devenu une voie à sens unique vers l'aliénation, la civilisation et la littérature. Le but de ce travail est d'analyser comment les récits civilisationnels donnent une structure à l'expérience par le biais de la ségrégation, de la domestication, de la sélection, et de l'extermination, tandis que les récits sauvages démontrent les possibilités infinies du chaos pour découvrir le monde en toute sa diversité et en lien avec sa communauté de vie. Un des objectifs de cette thèse a été de combler le fossé entre la science et la littérature, et d'examiner l'interdépendance de la fiction et la réalité. Un autre objectif a été de mettre ces récits au cœur d'un dialogue les uns avec les autres, ainsi que de tracer leur expression dans les différentes disciplines et œuvres pour enfants et adultes mais également d’analyser leur manifestations c’est redondant dans la vie réelle. C'est un effort multi-disciplinaires qui se reflète dans la combinaison de méthodes de recherche en anthropologie et en études littéraires. Cette analyse compare et contraste trois livres de fiction pour enfants qui présentent trois différents paradigmes socio-économiques, à savoir, «Winnie-l'Ourson» de Milne qui met en place un monde civilisé monarcho-capitaliste, la trilogie de Nosov sur «les aventures de Neznaika et ses amis» qui présente les défis et les exploits d'une société anarcho-socialiste dans son évolution du primitivisme vers la technologie, et les livres de Moomines de Jansson, qui représentent le chaos, l'anarchie, et l'état sauvage qui contient tout, y compris des épisodes de civilisation. En axant la méthodologie de ma recherche sur la façon dont nous connaissons le monde, j'ai d'abord examiné la construction, la transmission et l'acquisition des connaissances, en particulier à travers la théorie de praxis de Bourdieu et la critique de la civilisation développée dans les études de Zerzan, Ong, et Goody sur les liens entre l'alphabétisation, la dette et l'oppression. Quant à la littérature pour enfants, j'ai choisi trois livres que j’ai connus pendant mon enfance, c'est-à-dire des livres qui sont devenus comme une «langue maternelle» pour moi. En ce sens, ce travail est aussi de «l’anthropologie du champ natif». En outre, j’analyse les prémisses sous-jacentes qui se trouvent non seulement dans les trois livres, mais dans le déroulement des récits de l'état sauvage et de la civilisation dans la vie réelle, des analyses qui paraissent dans cette thèse sous la forme d'extraits d’un journal ethnographique. De même que j’examine la nature de la littérature ainsi que des structures civilisées qui domestiquent le monde au moyen de menaces de mort, je trace aussi la présence de ces récits dans l'expression scientifique (le récit malthusien-darwinien), religieuse, et dans autres expressions culturelles, et réfléchis sur les défis présentés par la théorie anarchiste (Kropotkine) ainsi que par les livres pour enfants écrits du point de vue sauvage, tels que ceux des Moomines.

Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties.

Didactics–promoting collaborative work and personal learning environment. Critical, creative and autonomous roles in a competitive society

School has evolved from a place where knowledge is provided to a place where learners are helped to develop their professional and social skills. Consequently, education must evolve through big challenges in order to face the changes of society in the XXIst century

Technology sourcing, knowledge management and governance in international inter-organizational innovation networks

This conceptual paper aims to improve our understanding of how internationalised firms use outsourcing and offshoring strategies to manage knowledge and information through the life-cycle of integrated product-service solutions. More precisely, we identify the appropriate theoretical framework for this analysis and investigate through in-depth case studies how UK engineering firms organise, coordinate, and incentivise work that is executed in globally distributed teams. Our research focuses on their UK and India offices to study the organisation and governance of distributed teams. The research has several theoretical dimensions - organization; geography; time and knowledge - that it addresses as boundary challenges.