704 resultados para Practitioner
Resumo:
The aim of this study is to address the main deficiencies with the prevailing project cost and time control practices for construction projects in the UK. A questionnaire survey was carried out with 250 top companies followed by in-depth interviews with 15 experienced practitioners from these companies in order to gain further insights of the identified problems, and their experience of good practice on how these problems can be tackled. On the basis of these interviews and syntheses with literature, a list of 65 good practice recommendations have been developed for the key project control tasks: planning, monitoring, reporting and analysing. The Delphi method was then used, with the participation of a panel of 8 practitioner experts, to evaluate these improvement recommendations and to establish their degree of relevance. After two rounds of Delphi, these recommendations are put forward as "critical", "important", or "helpful" measures for improving project control practice.
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Background: Adherence to treatment is often reported to be low in children with cystic fibrosis. Adherence in cystic fibrosis is an important research area and more research is needed to better understand family barriers to adherence in order for clinicians to provide appropriate intervention. The aim of this study was to evaluate adherence to enzyme supplements, vitamins and chest physiotherapy in children with cystic fibrosis and to determine if any modifiable risk factors are associated with adherence. Methods: A sample of 100 children (≤18 years) with cystic fibrosis (44 male; median [range] 10.1 [0.2-18.6] years) and their parents were recruited to the study from the Northern Ireland Paediatric Cystic Fibrosis Centre. Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data. Beliefs about treatments were assessed using refined versions of the Beliefs about Medicines Questionnaire-specific. Parental depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results: Using the multi-method approach 72% of children were classified as low-adherers to enzyme supplements, 59% low-adherers to vitamins and 49% low-adherers to chest physiotherapy. Variations in adherence were observed between measurement methods, treatments and respondents. Parental necessity beliefs and child age were significant independent predictors of child adherence to enzyme supplements and chest physiotherapy, but parental depressive symptoms were not found to be predictive of adherence. Conclusions: Child age and parental beliefs about treatments should be taken into account by clinicians when addressing adherence at routine clinic appointments. Low adherence is more likely to occur in older children, whereas, better adherence to cystic fibrosis therapies is more likely in children whose parents strongly believe the treatments are necessary. The necessity of treatments should be reinforced regularly to both parents and children.
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Presbyopia is a consequence of ageing and is therefore increasing inprevalence due to an increase in the ageing population. Of the many methods available to manage presbyopia, the use of contact lenses is indeed a tried and tested reversible option for those wishing to be spectacle free. Contact lens options to correct presbyopia include multifocal contact lenses and monovision.Several options have been available for many years with available guides to help choose multifocal contact lenses. However there is no comprehensive way to help the practitioner selecting the best option for an individual. An examination of the simplest way of predicting the most suitable multifocal lens for a patient will only enhance and add to the current evidence available. The purpose of the study was to determine the current use of presbyopic correction modalities in an optometric practice population in the UK and to evaluate and compare the optical performance of four silicone hydrogel soft multifocal contact lenses and to compare multifocal performance with contact lens monovision. The presbyopic practice cohort principal forms of refractive correction were distance spectacles (with near and intermediate vision providedby a variety of other forms of correction), varifocal spectacles and unaided distance with reading spectacles, with few patients wearing contact lenses as their primary correction modality. The results of the multifocal contact lens randomised controlled trial showed that there were only minor differences in corneal physiology between the lens options. Visual acuity differences were observed for distance targets, but only for low contrast letters and under mesopic lighting conditions. At closer distances between 20cm and 67cm, the defocus curves demonstrated that there were significant differences in acuity between lens designs (p < 0.001) and there was an interaction between the lens design and the level of defocus (p < 0.001). None of the lenses showed a clear near addition, perhaps due to their more aspheric rather than zoned design. As expected, stereoacuity was reduced with monovision compared with the multifocal contact lens designs, although there were some differences between the multifocal lens designs (p < 0.05). Reading speed did not differ between lens designs (F = 1.082, p = 0.368), whereas there was a significant difference in critical print size (F = 7.543, p < 0.001). Glare was quantified with a novel halometer and halo size was found to significantly differ between lenses(F = 4.101, p = 0.004). The rating of iPhone image clarity was significantly different between presbyopic corrections (p = 0.002) as was the Near Acuity Visual Questionnaire (NAVQ) rating of near performance (F = 3.730, p = 0.007).The pupil size did not alter with contact lens design (F = 1.614, p = 0.175), but was larger in the dominant eye (F = 5.489, p = 0.025). Pupil decentration relative to the optical axis did not alter with contact lens design (F = 0.777, p =0.542), but was also greater in the dominant eye (F = 9.917, p = 0.003). It was interesting to note that there was no difference in spherical aberrations induced between the contact lens designs (p > 0.05), with eye dominance (p > 0.05) oroptical component (ocular, corneal or internal: p > 0.05). In terms of subjective patient lens preference, 10 patients preferred monovision,12 Biofinity multifocal lens, 7 Purevision 2 for Presbyopia, 4 AirOptix multifocal and 2 Oasys multifocal contact lenses. However, there were no differences in demographic factors relating to lifestyle or personality, or physiological characteristics such as pupil size or ocular aberrations as measured at baseline,which would allow a practitioner to identify which lens modality the patient would prefer. In terms of the performance of patients with their preferred lens, it emerged that Biofinity multifocal lens preferring patients had a better high contrast acuity under photopic conditions, maintained their reading speed at smaller print sizes and subjectively rated iPhone clarity as better with this lens compared with the other lens designs trialled. Patients who preferred monovision had a lower acuity across a range of distances and a larger area of glare than those patients preferring other lens designs that was unexplained by the clinical metrics measured. However, it seemed that a complex interaction of aberrations may drive lens preference. New clinical tests or more diverse lens designs which may allow practitioners to prescribe patients the presbyopic contact lens option that will work best for them first time remains a hope for the future.
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Prior research on brand extension has provided little evidence on enhancing the evaluation of extremely incongruent extension. Adopting the theoretical framework of schema congruity theory, the author posits that evaluations can be improved if brand personality impressions of both parent brand and extension are complementary. The author coins this as the brand personality complementarity (BPC) principle. Prior to examining BPC effect, cultural-specific brand personality scale was developed to identify universal and indigenous brand personality dimensions. The reason is BPC requires a reliable and valid brand personality scale in order to detect its effect. Following successful identification of the cultural-specific brand personality scale, a total of three experimental studies were done to investigate BPC effect. Specifically, one experimental study identified complementary levels amongst brand personality dimensions, whereas two experimental studies investigated the moderating effect of BPC. Findings from the scale development study reveal that Malaysian brand personality (MBP) scale is a second higher-order factor reflected by first higher-order factors of sophistication, youth, competence, and sincerity. Most importantly, findings from the experimental studies revealed; 1) different BPC levels amongst all possible pairs of MBP dimensions, 2) significant interaction effect of brand extension congruity x BPC, and 3) significant mediation effect of complementarity resolution. Specific findings indicated that when iv text-based stimuli were used to form brand personality impression, even low BPC level improves the evaluations of extremely incongruent extension. However, when visualbased stimuli were used, low BPC level worsen the extension evaluation compared those of the control condition (i.e. without brand personality impression). Implications for both academician and practitioner are discussed.
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Full text: There are phrases in daily use today which were not so common a decade or so back, such as ‘ageing population’ or ‘climate changes’ or ‘emerging markets’ or even ‘social networking’. How do these things affect our lives is certainly interesting but for us as eye care practitioners how these changes affect our clinical work may be also relevant and sometimes more interesting. A recent advertisement for recruitment to the Royal Marine Corps of the British Army ended with a comment ‘find us on Facebook!’ The BCLA, IACLE and other organisations as well as many manufacturers have their own Facebook groups. In 2011 Chandni Thakkar was awarded the BCLA summer studentship and her project was based around increasing the contact lens business of a small independent optometric practice where contact lens sales were minimal. The practice typically recruited one new wearer per month. Chandni was able to increase the number of new patient fits with various strategies (her work was presented as poster at the 2012 BCLA conference in Birmingham). One of her strategies was to start a Facebook group and 655 joined the special group she started in just over a month. Interestingly she found that the largest single factor in convincing patients to trial contact lenses was recommendation by the eye care practitioner at the end of the examination, but nonetheless it is interesting that so many people used the social networking site to find out more information regarding contact lenses in her study. Moreover, we already see the use, by some practitioners, of smart phone ‘apps’ or electronic diaries or text messages when coordinating patient check-ups. Climate change has affected the way we think and act; we now leave out special recycle bins and we hope that the items that are recyclable are actually recycled and do not just join our other refuse somewhere down the track! How environmentally friendly are contact lenses? This was discussed by various speakers at this year's BCLA conference in Birmingham. Daily disposable lenses surely produce more contact lens waste but do not involve solutions in plastic bottles like monthly lenses. It is certainly something that manufacturers are taking seriously and of course there are environmental benefits but the cynic in each of us sees the marketing potential too. The way the ageing population is certainly something that will impact all healthcare providers. In the case of eye care with people living longer they will need refractive corrections for longer. Furthermore, since presbyopes are not resigning themselves to only gentle hobbies like knitting and gardening, but instead want to continue playing tennis or skiing or whatever, their visual demands are becoming more complex. This is certainly an area that contact lens manufacturers are focussing on (pun not intended!). Again the BCLA conference in Birmingham saw the launch of various new products by different companies to help us deal with our presbyopic contact lens wearers. It is great to have such choice and now with fitting methods becoming easier too we have no excuse not to try them out with our clients. Finally to emerging markets – well there was not a specific session at the BCLA conference in May discussing this but this most certainly would have been discussed by professional services managers and marketing directors of most of the contact lens companies. ‘How will we conquer China?’ ‘How can we increase our market share in Russia?’ Or ‘How should we spend our marketing budget in India?’ These topics as well as others would certainly have cropped up in backroom discussions. Certainly groups like IACLE (International Association of CL Educators) have increasing numbers of members and activities in developing markets to ensure that educators educate, to that practitioners can practice successfully and in turn patients can become successful contact lenses wearers. Companies also wish to increase their market share in these developing markets and from the point of view of CLAE we are certainly seeing more papers being submitted from these parts of the world. The traditional centres of knowledge are being challenged, I suppose as they have been throughout history, and this can only be a good thing for the pursuit of science. The BCLA conference in Birmingham welcomed more international visitors than ever, and from more countries, and long may that continue. Similarly, CLAE looks forward to a wider audience in years to come and a wider network of authors too.
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The article offers the authors insights on how to manage children who eat a limited diet. Topics discussed include the role of parents and caregivers in helping children to develop healthy eating habits, the Child Feeding Guide consists of ways how to increase fruit and vegetable intake of children, and the Child Feeding Guide app for tablets and smartphones provides evidence-based information for people who are concerned about the eating behavior of children.
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The year so far has been a slow start for many businesses, but at least we have not seen the collapse of as many businesses that we were seeing around two years ago. We are, however, still well and truly in the midst of a global recession. Interest rates are still at an all time low, UK house prices seem to be showing little signs of increase (except in London where everyone still seems to want to live!) and for the ardent shopper there are bargains to be had everywhere. It seems strange that prices on the high street do not seem to have increased in over ten years. Mobile phones, DVD players even furniture seems to be cheaper than they used to be. Whist much of this is down to cheaper manufacturing and the rest could probably be explained by competition within the market place. Does this mean that quality suffered too? Now that we live in a world when if a television is not working it is thrown away and replaced. There was a time when you would take it to some odd looking man that your father would know who could fix it for you. (I remember our local television fix-it man, with his thick rimmed bifocal spectacles and a poor comb-over; he had cardboard boxes full of resistors and electrical wires on the floor of his front room that smelt of soldering irons!) Is this consumerism at an extreme or has this move to disposability made us a better society? Before you think these are just ramblings there is a point to this. According to latest global figures of contact lens sales the vast majority of contact lenses fitted around the world are daily, fortnightly or monthly disposable hydrogel lenses. Certainly in the UK over 90% of lenses are disposable (with daily disposables being the most popular, having a market share of over 50%). This begs the question – is this a good thing? Maybe more importantly, do our patients benefit? I think it is worth reminding ourselves why we went down the disposability route with contact lenses in the first place, and unlike electrical goods it was not just so we did not have to take them for repair! There are the obvious advantages of overcoming problems of breakage and tearing of lenses and the lens deterioration with age. The lenses are less likely to be contaminated and the disinfection is either easier or not required at all (in the case of daily disposable lenses). Probably the landmark paper in the field was the work more commonly known as the ‘Gothenburg Study’. The paper, entitled ‘Strategies for minimizing the Ocular Effects of Extended Contact Lens Wear’ published in the American Journal of Optometry in 1987 (volume 64, pages 781-789) by Holden, B.A., Swarbrick, H.A., Sweeney, D.F., Ho, A., Efron, N., Vannas, A., Nilsson, K.T. They suggested that contact lens induced ocular effects were minimised by: •More frequently removed contact lenses •More regularly replaced contact lenses •A lens that was more mobile on the eye (to allow better removal of debris) •Better flow of oxygen through the lens All of these issues seem to be solved with disposability, except the oxygen issue which has been solved with the advent of silicone hydrogel materials. Newer issues have arisen and most can be solved in practice by the eye care practitioner. The emphasis now seems to be on making lenses more comfortable. The problems of contact lens related dry eyes symptoms seem to be ever present and maybe this would explain why in the UK we have a pretty constant contact lens wearing population of just over three million but every year we have over a million dropouts! That means we must be attracting a million new wearers every year (well done to the marketing departments!) but we are also losing a million wearers every year. We certainly are not losing them all to the refractive surgery clinics. We know that almost anyone can now wear a contact lens and we know that some lenses will solve problems of sharper vision, some will aid comfort, and some will be useful for patients with dry eyes. So if we still have so many dropouts then we must be doing something wrong! I think the take home message has to be ‘must try harder’! I must end with an apology for two errors in my editorial of issue 1 earlier this year. Firstly there was a typo in the first sentence; I meant to state that it was 40 years not 30 years since the first commercial soft lens was available in the UK. The second error was one that I was unaware of until colleagues Geoff Wilson (Birmingham, UK) and Tim Bowden (London, UK) wrote to me to explain that soft lenses were actually available in the UK before 1971 (please see their ‘Letters to the Editor’ in this issue). I am grateful to both of them for correcting the mistake.
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Research Question/Issue - Which forms of state control over corporations have emerged in countries that made a transition from centrally-planned to marked-based economies and what are their implications for corporate governance? We assess the literature on variation and evolution of state control in transition economies, focusing on corporate governance of state-controlled firms. We highlight emerging trends and identify future research avenues. Research Findings/Insights - Based on our analysis of more than 100 articles in leading management, finance, and economics journals since 1989, we demonstrate how research on state control evolved from a polarized approach of public–private equity ownership comparison to studying a variety of constellations of state capitalism. Theoretical/Academic Implications - We identify theoretical perspectives that help us better understand benefits and costs associated with various forms of state control over firms. We encourage future studies to examine how context-specific factors determine the effect of state control on corporate governance. Practitioner/Policy Implications - Investors and policymakers should consider under which conditions investing in state-affiliated firms generates superior returns.
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INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.
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Engineering education in the United Kingdom is at the point of embarking upon an interesting journey into uncharted waters. At no point in the past have there been so many drivers for change and so many opportunities for the development of engineering pedagogy. This paper will look at how Engineering Education Research (EER) has developed within the UK and what differentiates it from the many small scale practitioner interventions, perhaps without a clear research question or with little evaluation, which are presented at numerous staff development sessions, workshops and conferences. From this position some examples of current projects will be described, outcomes of funding opportunities will be summarised and the benefits of collaboration with other disciplines illustrated. In this study, I will account for how the design of task structure according to variation theory, as well as the probe-ware technology, make the laws of force and motion visible and learnable and, especially, in the lab studied make Newton's third law visible and learnable. I will also, as a comparison, include data from a mechanics lab that use the same probe-ware technology and deal with the same topics in mechanics, but uses a differently designed task structure. I will argue that the lower achievements on the FMCE-test in this latter case can be attributed to these differences in task structure in the lab instructions. According to my analysis, the necessary pattern of variation is not included in the design. I will also present a microanalysis of 15 hours collected from engineering students' activities in a lab about impulse and collisions based on video recordings of student's activities in a lab about impulse and collisions. The important object of learning in this lab is the development of an understanding of Newton's third law. The approach analysing students interaction using video data is inspired by ethnomethodology and conversation analysis, i.e. I will focus on students practical, contingent and embodied inquiry in the setting of the lab. I argue that my result corroborates variation theory and show this theory can be used as a 'tool' for designing labs as well as for analysing labs and lab instructions. Thus my results have implications outside the domain of this study and have implications for understanding critical features for student learning in labs. Engineering higher education is well used to change. As technology develops the abilities expected by employers of graduates expand, yet our understanding of how to make informed decisions about learning and teaching strategies does not without a conscious effort to do so. With the numerous demands of academic life, we often fail to acknowledge our incomplete understanding of how our students learn within our discipline. The journey facing engineering education in the UK is being driven by two classes of driver. Firstly there are those which we have been working to expand our understanding of, such as retention and employability, and secondly the new challenges such as substantial changes to funding systems allied with an increase in student expectations. Only through continued research can priorities be identified, addressed and a coherent and strong voice for informed change be heard within the wider engineering education community. This new position makes it even more important that through EER we acquire the knowledge and understanding needed to make informed decisions regarding approaches to teaching, curriculum design and measures to promote effective student learning. This then raises the question 'how does EER function within a diverse academic community?' Within an existing community of academics interested in taking meaningful steps towards understanding the ongoing challenges of engineering education a Special Interest Group (SIG) has formed in the UK. The formation of this group has itself been part of the rapidly changing environment through its facilitation by the Higher Education Academy's Engineering Subject Centre, an entity which through the Academy's current restructuring will no longer exist as a discrete Centre dedicated to supporting engineering academics. The aims of this group, the activities it is currently undertaking and how it expects to network and collaborate with the global EER community will be reported in this paper. This will include explanation of how the group has identified barriers to the progress of EER and how it is seeking, through a series of activities, to facilitate recognition and growth of EER both within the UK and with our valued international colleagues.
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This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) affects either the health status of patients or their pharmacy costs. To this end, it measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. In strong GP–SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. To test these hypotheses and compare the characteristics of the strongest GP–SP connections with those of the weakest, this article concentrates on diabetes—a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest traffic of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health statuses. Key points for decision makers • The number of shared patients may be used to measure the strength of formal professional relationships between general practitioners and specialists. • A large number of shared patients indicates a strong, collaborative tie between general practitioners and specialists, whereas a low number indicates a weak, fragmented tie. • Tie strength does not affect patient health—strong, collaborative ties between general practitioners and specialists do not involve better patient health than weak, fragmented ties. • Tie strength does affect pharmacy costs—strong, collaborative ties between general practitioners and specialists involve significantly lower pharmacy costs than weak, fragmented ties. • Pharmacy costs may be reduced by lowering patient care fragmentation through channelling a general practitioner’s patients to a small number of specialists and increasing collaboration between general practitioner and specialists. • Limited patient choice is financially more beneficial than complete freedom of choice, and no more detrimental to patient health.
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The purpose of this study was to determine the emergency department (ED) length of stay (LOS) of patients admitted to inpatient telemetry and critical care units and to identify the factors that contribute to a prolonged ED LOS. It also examined whether there was a difference in ED LOS between clients evaluated by an ED physician, an Advanced Registered Nurse Practitioner (ARNP) or a Physician's Assistant (PA).^ A data collection tool was devised and used to record data obtained by retrospectively reviewing 110 charts of patients from this sample. The mean ED LOS was 286.75 minutes. Multiple factors were recorded as affecting the ED LOS of this sample, including: age, diagnosis, consultations, multiple radiographs, pending admission orders, nurse unable to call report/busy, relatives at bedside, observation or stabilization necessary, bed not ready and infusion in progress. No significant difference in ED LOS was noted between subjects initially evaluated by a physician, an ARNP or a PA. ^
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The Unified Modeling Language (UML) has quickly become the industry standard for object-oriented software development. It is being widely used in organizations and institutions around the world. However, UML is often found to be too complex for novice systems analysts. Although prior research has identified difficulties novice analysts encounter in learning UML, no viable solution has been proposed to address these difficulties. Sequence-diagram modeling, in particular, has largely been overlooked. The sequence diagram models the behavioral aspects of an object-oriented software system in terms of interactions among its building blocks, i.e. objects and classes. It is one of the most commonly-used UML diagrams in practice. However, there has been little research on sequence-diagram modeling. The current literature scarcely provides effective guidelines for developing a sequence diagram. Such guidelines will be greatly beneficial to novice analysts who, unlike experienced systems analysts, do not possess relevant prior experience to easily learn how to develop a sequence diagram. There is the need for an effective sequence-diagram modeling technique for novices. This dissertation reports a research study that identified novice difficulties in modeling a sequence diagram and proposed a technique called CHOP (CHunking, Ordering, Patterning), which was designed to reduce the cognitive load by addressing the cognitive complexity of sequence-diagram modeling. The CHOP technique was evaluated in a controlled experiment against a technique recommended in a well-known textbook, which was found to be representative of approaches provided in many textbooks as well as practitioner literatures. The results indicated that novice analysts were able to perform better using the CHOP technique. This outcome seems have been enabled by pattern-based heuristics provided by the technique. Meanwhile, novice analysts rated the CHOP technique more useful although not significantly easier to use than the control technique. The study established that the CHOP technique is an effective sequence-diagram modeling technique for novice analysts.
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Critical reflection is imperative for the practitioner who seeks to grow and improve in the important work of teaching. This paper is a critical reflection of one author’s experience in creating a faculty development initiative.
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During the past decade, metacognition has been identified not only as a component of cognition but also as an important factor in learning. This practitioner proposes that educators and educational researchers should focus on the development and implementation of metacognitive learning strategies. The existing metacognitive studies have concentrated on several areas. One area centers on the continuing efforts to identify all the elements of metacognition. Another area concentrates on the roles that metacognition plays in specific learning behaviors that occur at various ages and levels of complexity. The third area investigates the relationships of metacognition to specific content areas of learning by focusing on the effects of metacognitive learning strategies. The most common areas of study have been reading comprehension, math skills, writing skills, and applying metacognitive strategies to learn various subjects using the computer. Directly or indirectly, the existing studies relate to the expanding applications of the relationships and relevancies of metacognition to learning. Considerable evidence confirms that when students use metacognitive strategies they often experience a higher level of learning. This practitioner believes that experiencing higher levels of learning gives students the confidence they need to construct knowledge which promotes lifelong learning.