Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi

Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers’ knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. Methods his study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). Results Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians’ place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. Conclusion Serious deficiencies in providers’ knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.

Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce

Efforts to ‘modernize’ the clinical workforce of the English National Health Service have sought to reconfigure the responsibilities of professional groups in pursuit of more effective, joined-up service provision. Such efforts have met resistance from professions eager to protect their jurisdictions, deploying legitimacy claims familiar from the insights of the sociology of professions. Yet to date few studies of professional boundaries have grounded these insights in the specific context of policy challenges to the inter- and intra-professional division of labour, in relation the medical profession and other health-related occupations. In this paper we address this gap by considering the experience of newly instituted general practitioners (family physicians) with a special interest (GPSIs) in genetics, introduced to improve genetics knowledge and practice in primary care. Using qualitative data from four comparative case studies, we discuss how an established intra-professional division of labour within medicine—between clinical geneticists and GPs—was opened, negotiated and reclosed in these sites. We discuss the contrasting attitudes towards the nature of genetics knowledge and its application of GPSIs and geneticists, and how these were used to advance conflicting visions of what the nascent GPSI role should involve. In particular, we show how the claims to knowledge of geneticists and GPSIs interacted with wider policy pressures to produce a rather more conservative redistribution of power and responsibility across the intra-professional boundary than the rhetoric of modernization might suggest.

Innovative ways of knowledge representation and management

Knowledge is the key for success. The adequate treatment you make on data for generating knowledge can make a difference in projects, processes, and networks. Such a treatment is the main goal of two important areas: knowledger representation and management. Our aim, in this book, is collecting sorne innovative ways of representing and managing knowledge proposed by several Latin American researchers under the premise of improving knowledge.

Beyond human and intellectual capital: Profiling the value of knowledge, skills and experience

The concept of human capital is associated mainly with the Nobel Laureate Gary Becker and, in his usage, has a clear conceptual basis as investment in the costs of formal education. By contrast, this paper suggests that ‘intellectual capital’ is a re-branding of knowledge, skills and experience rather than re-conceptualisation of resource based learning. Becker also chose not to include informal knowledge, skills or experience within his concept of human capital, which remains limited by its constrained premises. This paper submits that both human capital and intellectual capital advocates fail to identify or measure the tacit knowledge and implicit learning which increasingly is recognised as a key to the competitive advantage of organisations. It first focuses on the conceptual basis of claims made for human capital and intellectual capital, outlines limits in their methodology, and contrasts these with insights from theories of tacit knowledge and implicit learning and the central role within them of informal or non-formal skill acquisition. It develops and illustrates instances of interfacing tacit and explicit knowledge before introducing a methodology for profiling the acquisition of knowledge, ability and skills. It does so by introducing the concepts of non-formal learningfrom- work (LfW) and informal learning-from-life (LfL), with evidence from a four country EU case study commissioned within the lifelong learning remit of the Lisbon Agenda.

Location analysis of city sections: socio-demographic segmentation and restaurant potentiality estimation : a case study of Lisbon

One of the objectives of this study is to perform classification of socio-demographic components for the level of city section in City of Lisbon. In order to accomplish suitable platform for the restaurant potentiality map, the socio-demographic components were selected to produce a map of spatial clusters in accordance to restaurant suitability. Consequently, the second objective is to obtain potentiality map in terms of underestimation and overestimation in number of restaurants. To the best of our knowledge there has not been found identical methodology for the estimation of restaurant potentiality. The results were achieved with combination of SOM (Self-Organized Map) which provides a segmentation map and GAM (Generalized Additive Model) with spatial component for restaurant potentiality. Final results indicate that the highest influence in restaurant potentiality is given to tourist sites, spatial autocorrelation in terms of neighboring restaurants (spatial component), and tax value, where lower importance is given to household with 1 or 2 members and employed population, respectively. In addition, an important conclusion is that the most attractive market sites have shown no change or moderate underestimation in terms of restaurants potentiality.

Building genre knowledge: a case study of efl student perceptions of the argument essay

Dissertação de mest. em Didáctica das Línguas e Culturas Modernas Especialização Inglês, Faculdade de Ciências Humanas e Sociais, Univ. do Algarve, 2003

Média-arte locativa e mapeamentos dinâmicos na compreensão de fluxos urbanos : o contributo do dispositivo móvel na atividade do caminhar como prática artística

O interesse pela análise de espaços urbanos através de dispositivos comunicacionais móveis (de meios digitais) – perspetivando a sua transformação contando com a participação colaborativa da população – traduz o enquadramento geral da investigação. As práticas artísticas, complementadas por métodos de estudo de cidades (capazes de abordarem a respetiva complexidade de modo multioperativo e flexível), foram integradas na pesquisa tendo em linha de conta o acentuado desenvolvimento que as mesmas têm conhecido para a compreensão da atual condição urbana. O resultado foca a hibridização de processos que permitem acrescentar conhecimento coletivo sobre estruturas urbanas, expresso em mapeamentos dinâmicos que promovem leituras aumentadas de realidades urbanas. Assente no enquadramento teórico e respetiva revisão da literatura (abrangendo áreas disciplinares da média-arte locativa, da análise urbana e dos mapeamentos dinâmicos), procedeu-se ao desenvolvimento de dois artefactos complementares, cuja elaboração implicou três fases: i) pré-produção; ii) produção; iii) pós-produção. Na primeira, conceptualizaram-se os artefactos, definindo-se critérios e especificando parâmetros de análise. Complementarmente, consideraram-se softwares a utilizar bem como a seleção de atores urbanos que participaram em experiências associadas à investigação. No que se refere à produção, encetaram-se diversas ações de apropriação e apreensão de espaços urbanos selecionados na Vila de Caminha, recorrendo à técnica do caminhar mediado pela tecnologia. Na terceira fase, a informação resultante foi analisada, comparada e sistematizada através de uma reflexão final. Registaram-se marcas e apropriações na Vila de Caminha, integrando abordagens da média-arte locativa, da morfologia urbana e tecnologias digitais. A partir desta metodologia, a resposta aos objetivos da investigação contribui para a colmatação da lacuna identificada no estado arte, dado demonstrar-se a relevância da convergência operativa entre a apreensão urbana e os fluxos informacionais e comunicacionais para o revelar de vivências espaciais urbanas quotidianas (passadas e presentes) que ocorrem sobre a estrutura física das cidades. Em síntese, as práticas artísticas, provindas da média-arte locativa, expressam – em mapeamentos dinâmicos e através de realidade aumentada – o devir coletivo de experiências individuais nos espaços das cidades, acrescentando histórias à sua memória e história urbana.

A PHENOMENOLOGY OF MIMETIC LEARNING AND MULTIMODAL COGNITION: INTEGRATING EXPERIENTIAL KNOWLEDGE INTO PROGRAMS IN RHETORIC, COMPOSITION, AND TECHNICAL COMMUNICATION

My dissertation emphasizes a cognitive account of multimodality that explicitly integrates experiential knowledge work into the rhetorical pedagogy that informs so many composition and technical communication programs. In these disciplines, multimodality is widely conceived in terms of what Gunther Kress calls “socialsemiotic” modes of communication shaped primarily by culture. In the cognitive and neurolinguistic theories of Vittorio Gallese and George Lakoff, however, multimodality is described as a key characteristic of our bodies’ sensory-motor systems which link perception to action and action to meaning, grounding all communicative acts in knowledge shaped through body-engaged experience. I argue that this “situated” account of cognition – which closely approximates Maurice Merleau-Ponty’s phenomenology of perception, a major framework for my study – has pedagogical precedence in the mimetic pedagogy that informed ancient Sophistic rhetorical training, and I reveal that training’s multimodal dimensions through a phenomenological exegesis of the concept mimesis. Plato’s denigration of the mimetic tradition and his elevation of conceptual contemplation through reason, out of which developed the classic Cartesian separation of mind from body, resulted in a general degradation of experiential knowledge in Western education. But with the recent introduction into college classrooms of digital technologies and multimedia communication tools, renewed emphasis is being placed on the “hands-on” nature of inventive and productive praxis, necessitating a revision of methods of instruction and assessment that have traditionally privileged the acquisition of conceptual over experiential knowledge. The model of multimodality I construct from Merleau-Ponty’s phenomenology, ancient Sophistic rhetorical pedagogy, and current neuroscientific accounts of situated cognition insists on recognizing the significant role knowledges we acquire experientially play in our reading and writing, speaking and listening, discerning and designing practices.

Geographical literacy, attitudes, and experiences of freshman students: A qualitative study at Florida International University

The purpose of the study was to explore the geography literacy, attitudes and experiences of Florida International University (FIU) freshman students scoring at the low and high ends of a geography literacy survey. The Geography Literacy and ABC Models formed the conceptual framework. Participants were freshman students enrolled in the Finite Math course at FIU. Since it is assumed that students who perform poorly on geography assessments do not have an interest in the subject, testing and interviewing students allowed the researcher to explore the assumption. ^ In Phase I, participants completed the Geography Literacy Survey (GLS) with items taken from the 2010 NAEP Geography Subject Area Assessment. The low 35% and high 20% performers were invited for Phase II, which consisted of semi-structured interviews. A total of 187 students participated in Phase I and 12 in Phase II. ^ The primary research question asked was what are the geography attitudes and experiences of freshman students scoring at the low and high ends of a geographical literacy survey? The students had positive attitudes regardless of how they performed on the GLS. ^ The study included a quantitative sub-question regarding the performance of the students on the GLS. The students’ performance on the GLS was equivalent to the performance of 12th grade students from the NAEP Assessment. There were three qualitative sub-questions from which the following themes were identified: the students’ definition of geography is limited, students recall more out of school experiences with geography, and students find geography valuable. In addition, there were five emergent themes: there is a concern regarding a lack of geographical knowledge, rote memorization of geographical content is overemphasized, geographical concepts are related to other subjects, taking the high school level AP Human Geography course is powerful, and there is a need for real-world applications of geographical knowledge. ^ The researcher offered as suggestions for practice to reposition geography in our schools to avoid misunderstandings, highlight its interconnectedness to other fields, connect the material to real world events/daily decision-making, make research projects meaningful, partner with local geographers, and offer a mandatory geography courses at all educational levels.^

Nurses knowledge of health effects of dietary fibre

Introduction: Nurses accompany patients throughout their health care to prevent and treat disease, so their knowledge about diet and dietary fibre is key to successful diet therapy, which is an essential part of a patient's non-pharmacological treatment. It is known from the literature that a high proportion of nurses have limited knowledge about diet therapy and about sources of soluble fibre and other foods that can prevent or treat certain diseases. Given the position of nurses as key providers of dietary guidance, and given the health benefits of dietary fibre, we wanted to assess the level of fibre-related knowledge among nurses in Croatia. Material and Methods: Cross-sectional study based on data collected between October 2014 and March 2015 using a survey developed by the CI&DETS Polytechnic Institute in Viseu, Portugal. The survey contains questions about demographic characteristics as well as about knowledge of sources of dietary fibre, recommended daily intake and effects of fibre intake on particular diseases. The study included a total of 369 nurses from two health institutions and one nursing school from Croatia older than 18 years. Differences in knowledge were assessed for significance using the non-parametric Mann-Whitney U test. Possible associations among variables were explored using Spearman's rank correlation. For all statistical analyses, the threshold of significance was defined as P<0.05. Results: The level of knowledge among nurses in Croatia about dietary fibre varied from «undecided» to «partial knowledge». The median for level of knowledge ranged from 3 to 4 with low variability ranging from 0.11 to 0.33. Average levels of knowledge in percentages varied from 57.6% to 82.1%. Nurses with higher education levels showed significantly higher knowledge levels about the influence of dietary fiber intake on the risk of certain diseases (p = 0.007), constipation (p = 0.016), bowel cancer (p = 0.005) and breast cancer (p = 0.039). Conclusion: The level of nurses’ knowledge about dietary fiber is suboptimal. This indicates the need to strengthen nurse education in the areas of diet and diet therapy. Increase the level of knowledge of nurses about nutrition can positively influence the quality of care.

Metaphors of Time and Installed Knowledge Organization Systems: Ouroboros, Architectonics, or Lachesis?

This paper describes three metaphors for time drawn from contemporary and historical literature on knowledge organization systems (KOS). It then links these metaphors to the evaluation of knowledge organization by describing the dominant paradigm in KOS evaluation to be judging whether a KOS is correct. We conclude by saying a foundational view of evaluating and theorizing about KOS must account for change and time in order for us to take a long view of improving knowledge organization and our understanding of KOS.

Virtual knowledge brokering : describing the roles and strategies used by knowledge brokers in a pediatric physiotherapy virtual community of practice

Introduction: Knowledge transfer in pediatric rehabilitation is challenging and requires active, multifaceted strategies. The use of knowledge brokers (KBs) is one such strategy noted to promote clinician behavior change. The success of using KBs to transfer knowledge relies on their ability to adapt to ever-changing clinical contexts. In addition, with the rapid growth of online platforms as knowledge transfer forums, KBs must become effective in virtual environments. Although the role of KBs has been studied in various clinical contexts, their emerging role in specific online environments designed to support evidence-based behavior change has not yet been described. Our objective is to describe the roles of, and strategies used by, four KBs involved in a virtual community of practice to guide and inform future online KB interventions. Methods: A descriptive design guided this study and a thematic content analysis process was used to analyze online KB postings. The Promoting Action on Research in Health Sciences knowledge transfer framework and online andragogical learning theories assisted in the coding. A thematic map was created illustrating the links between KBs' strategies and emerging roles in the virtual environment. Results: We analyzed 95 posts and identified three roles: 1) context architect: promoting a respectful learning environment, 2) knowledge sharing promoter: building capacity, and 3) linkage creator: connecting research-to-practice. Strategies used by KBs reflected invitational, constructivism, and connectivism approaches, with roles and strategies changing over time. Discussion: This study increases our understanding of the actions of KBs in virtual contexts to foster uptake of research evidence in pediatric physiotherapy. Our results provide valuable information about the knowledge and skills required by individuals to fulfill this role in virtual environments.

Bio-QA-GNN: Reasoning with Language Models and Knowledge Graphs for Interpretable Biomedical Question Answering

Nowadays the idea of injecting world or domain-specific structured knowledge into pre-trained language models (PLMs) is becoming an increasingly popular approach for solving problems such as biases, hallucinations, huge architectural sizes, and explainability lack—critical for real-world natural language processing applications in sensitive fields like bioinformatics. One recent work that has garnered much attention in Neuro-symbolic AI is QA-GNN, an end-to-end model for multiple-choice open-domain question answering (MCOQA) tasks via interpretable text-graph reasoning. Unlike previous publications, QA-GNN mutually informs PLMs and graph neural networks (GNNs) on top of relevant facts retrieved from knowledge graphs (KGs). However, taking a more holistic view, existing PLM+KG contributions mainly consider commonsense benchmarks and ignore or shallowly analyze performances on biomedical datasets. This thesis start from a propose of a deep investigation of QA-GNN for biomedicine, comparing existing or brand-new PLMs, KGs, edge-aware GNNs, preprocessing techniques, and initialization strategies. By combining the insights emerged in DISI's research, we introduce Bio-QA-GNN that include a KG. Working with this part has led to an improvement in state-of-the-art of MCOQA model on biomedical/clinical text, largely outperforming the original one (+3.63\% accuracy on MedQA). Our findings also contribute to a better understanding of the explanation degree allowed by joint text-graph reasoning architectures and their effectiveness on different medical subjects and reasoning types. Codes, models, datasets, and demos to reproduce the results are freely available at: \url{https://github.com/disi-unibo-nlp/bio-qagnn}.

The Effect Of Celastrol, A Triterpene With Antitumorigenic Activity, On Conformational And Functional Aspects Of The Human 90kda Heat Shock Protein Hsp90α, A Chaperone Implicated In The Stabilization Of The Tumor Phenotype.

Hsp90 is a molecular chaperone essential for cell viability in eukaryotes that is associated with the maturation of proteins involved in important cell functions and implicated in the stabilization of the tumor phenotype of various cancers, making this chaperone a notably interesting therapeutic target. Celastrol is a plant-derived pentacyclic triterpenoid compound with potent antioxidant, anti-inflammatory and anticancer activities; however, celastrol's action mode is still elusive. In this work, we investigated the effect of celastrol on the conformational and functional aspects of Hsp90α. Interestingly, celastrol appeared to target Hsp90α directly as the compound induced the oligomerization of the chaperone via the C-terminal domain as demonstrated by experiments using a deletion mutant. The nature of the oligomers was investigated by biophysical tools demonstrating that a two-fold excess of celastrol induced the formation of a decameric Hsp90α bound throughout the C-terminal domain. When bound, celastrol destabilized the C-terminal domain. Surprisingly, standard chaperone functional investigations demonstrated that neither the in vitro chaperone activity of protecting against aggregation nor the ability to bind a TPR co-chaperone, which binds to the C-terminus of Hsp90α, were affected by celastrol. Celastrol interferes with specific biological functions of Hsp90α. Our results suggest a model in which celastrol binds directly to the C-terminal domain of Hsp90α causing oligomerization. However, the ability to protect against protein aggregation (supported by our results) and to bind to TPR co-chaperones are not affected by celastrol. Therefore celastrol may act primarily by inducing specific oligomerization that affects some, but not all, of the functions of Hsp90α. To the best of our knowledge, this study is the first work to use multiple probes to investigate the effect that celastrol has on the stability and oligomerization of Hsp90α and on the binding of this chaperone to Tom70. This work provides a novel mechanism by which celastrol binds Hsp90α.

Phenotypic Polymorphism Of Chrysomya Albiceps (wiedemann) (diptera: Calliphoridae) May Lead To Species Misidentification.

Species identification is an essential step in the progress and completion of work in several areas of biological knowledge, but it is not a simple process. Due to the close phylogenetic relationship of certain species, morphological characters are not always sufficiently distinguishable. As a result, it is necessary to combine several methods of analysis that contribute to a distinct categorization of taxa. This study aimed to raise diagnostic characters, both morphological and molecular, for the correct identification of species of the genus Chrysomya (Diptera: Calliphoridae) recorded in the New World, which has continuously generated discussion about its taxonomic position over the last century. A clear example of this situation was the first record of Chrysomya rufifacies in Brazilian territory in 2012. However, the morphological polymorphism and genetic variability of Chrysomya albiceps studied here show that both species (C. rufifacies and C. albiceps) share very similar character states, leading to misidentification and subsequent registration error of species present in our territory. This conclusion is demonstrated by the authors, based on a review of the material deposited in major scientific collections in Brazil and subsequent molecular and phylogenetic analysis of these samples. Additionally, we have proposed a new taxonomic key to separate the species of Chrysomya found on the American continent, taking into account a larger number of characters beyond those available in current literature.