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.

Effect of the synthetic coumarin, ethyl 2-oxo-2H-chromene-3-carboxylate, on activity of Crotalus durissus ruruima sPLA2 as well as on edema and platelet aggregation induced by this factor

We show that ethyl 2-oxo-2H-chromene-3-carboxylate (EOCC), a synthetic coumarin, irreversibly inhibits phospholipase A(2) (sPLA2) from Crotalus durissus ruruima venom (sPLA2r) with an IC(50) of 3.1 +/- 0.06 nmol. EOCC strongly decreased the V(max) and K(m), and it virtually abolished the enzyme activity of sPLA2r as well as sPLA2s from other sources. The edema induced by 5PLA2r + EOCC was less than that induced by 5PLA2r treated with p-bromophenacyl bromide, which was more efficient at neutralizing the platelet aggregation activity of native 5PLA2r. Native 5PLA2r induced platelet aggregation of 91.54 +/- 9.3%, and sPLA2r +/- EOCC induced a platelet aggregation of 18.56 +/- 6.5%. EOCC treatment also decreased the myotoxic effect of sPLA2r. Mass spectrometry showed that EOCC formed a stable complex with sPLA2r, which increased the mass of native 5PLA2r from 14,299.34 da to 14,736.22 Da. Moreover, the formation of this complex appeared to be involved in the loss of 5PLA2r activity. Our results strongly suggest that EOCC can be used as a pharmacological agent against the 5PLA2 in Crotalus durissus sp. venom as well as other sPLA2s. (C) 2010 Elsevier Ltd. All rights reserved.

Guarding against the erosion of competitive advantage: a knowledge leakage mitigation model

A critical objective of knowledge-intensive organizations is to prevent erosion of their competitive knowledge base through leakage. Our review of the literature highlights the need for a more refined conceptualization of perceived leakage risk. We propose a Knowledge Leakage Mitigation (KLM) model to explain the incongruity between perceived high-risk of leakage and lack of protective actions. We argue that an organization's perceived risk of leakage increases if competitors can benefit from leakage incidents. Further, perceived leakage risk decreases if the organization is shielded from impact due to their diversity of knowledge assets and their ability to reconfigure knowledge resources to refresh their competitive knowledge base. We describe our approach to the design of a large-scale survey instrument that has been tested and refined in two stakeholder communities: 1) knowledge managers responsible for organizational strategy, and 2) Information security management consultants.

Consumers knowledge about dietary fibre : Results of a survey questionnaire in Hungary and Romania

Dietary fi bres (DFs) are essential components of the balanced diet. Even though the adequate level of their consumption can be ensured from several natural (e.g. fruit, vegetables, legumes) and ‘artifi cial’ sources (e.g. functional foods), the consumed levels are below the recommendations. To analyse the Hungarian and Romanian consumers’ knowledge level, their perceptions of the health benefi ts associated with fi bre, as well as the recognition of the potential information sources, a survey questionnaire was conducted with the total of 713 consumers. Results showed that the level of knowledge about DFs was not adequate. Internet was found to be widely used and identifi ed as one of the most appropriate information sources to encourage the consumption of DF. It was a favourable result that three-quarter of the respondents was interested in the topic of healthy food consumption; however, just less than half of them took into consideration the label information during their shopping decisions. To increase the consumption of DF and to support the responsibility and conscious consumer decisions steps must to be done (e.g. education of children, pointing out of the sources). For this purpose, modern information technology and communication channels fi tting to the consumers’ cultural and personal particularities can be utilized.

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.

‘“Glossary Islands” as sites of the “Abroad” in post-colonial literature: towards a new methodology for language and knowledge relations in Keri Hulme’s The Bone People and Melissa Lucashenko’s Mullumbimby.’

The publication of Melissa Lucashenko’s Mullumbimby in 2013 drew attention once more to the issue of how post-colonial scholars might best engage with English-language literary texts also containing a glossary of Indigenous words. This issue emerged first with the publication of Keri Hulme’s The Bone People in 1984. This article argues that, to date, scholars like Simon During and Eve Vincent have perpetuated a binary either/or approach to the interpretation of these glossaries. The result of this approach has been that either the pre-colonial Indigenous language or the colonial/post-colonizing English language has been privileged as the locus of linguistic power in the text. One problem with this approach is that it does not adequately represent the complex historical, cultural and political circumstances of post-colonial and multi-cultural nations like Australia (setting of Mullumbimby) and New Zealand (setting of The Bone People) as these link to matters of language. Another problem is that this binary approach restrains a close reading of the differences between different types of such glossaries, and of the nuanced relationship of a glossary to the text it accompanies. In place of this approach, this article proposes a new methodology that works with Elizabeth M. DeLoughrey’s notion of “tidalectics” as a way of reading island literatures. The neologism “glossary islands” allows another way into considering the function of glossaries in islandic literary texts like Lucashenko’s and Hulme’s. The post-colonial connection between islands and glossaries lies in the fact that they are each an intensified site of knowledge.

The heart of the educator: aesthetic experience shaping knowledge, identity and passion

This chapter explores Dewey’s construct of aesthetic experience and the role that the aesthetic plays in knowing: knowing as a coherence of things to be known, developing one’s sense of identity in relation to that knowing, and the passions that emerge in an ‘aesthetic experience’ that lays the foundation for future knowing, identity and passions. Drawing on Dewey’s ideas, Girod, Rau and Schepige developed the construct ‘Aesthetic understanding’ to provide a theoretical lens for describing students’ experience of coming to know science content. This chapter develops the aesthetic understanding construct further into a methodological framework, called a Knowledge-Identity-Passion (KIP) Analysis, that can be applied to research exploring aesthetic experience in two ‘research moments’: the immediate effects of an aesthetic experience on knowledge, identity and passion; and the life trajectory that follows an aesthetic experience. A KIP analysis can be applied to research examining the effects and meanings attached to experiences through close analysis of knowledge, identity and passion, both individually and in relation to each other. To illustrate the power of a KIP analysis narratives of four science educators are provided. The practical applications and methodological possibilities and limitations of a KIP Analysis are then discussed.

A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women.

ISSUES: It is well established that alcohol can cross the placenta to the fetus and can affect both physical and psychological development of the infant; however, many women continue to drink during pregnancy. It is therefore important to determine whether interventions can be successful in reducing alcohol consumption among pregnant women. Past reviews have investigated the effectiveness of clinical interventions in reducing alcohol consumption in pregnancy; however, the aim of the current review was to focus on the effectiveness of public health interventions. APPROACH: A critical literature review was conducted by searching several electronic databases using key words such as 'pregnancy', 'alcohol', 'interventions' and 'public health'. Studies were included if they utilised a public health intervention and included alcohol consumption or levels of knowledge as an outcome measure. KEY FINDINGS: Seven studies were included in the review. Interventions included multimedia and educational interventions. Improvements in knowledge were reported in six studies, whereas one study found contradictory results. Four studies used alcohol consumption rates as an outcome measure, and although a reduction in consumption was reported, the results were non-significant. IMPLICATIONS: The effectiveness of public health interventions that aim to increase awareness and reduce alcohol consumption among pregnant women cannot be assessed because of the paucity of studies. CONCLUSIONS: The results of this critical review emphasise a lack of evidence and highlight the need for further evaluation research on this topic.

Layered Information Modeling and a Knowledge Organization Paradigm: Inherent Classification and the Design of Interoperable Systems

In knowledge technology work, as expressed by the scope of this conference, there are a number of communities, each uncovering new methods, theories, and practices. The Library and Information Science (LIS) community is one such community. This community, through tradition and innovation, theories and practice, organizes knowledge and develops knowledge technologies formed by iterative research hewn to the values of equal access and discovery for all. The Information Modeling community is another contributor to knowledge technologies. It concerns itself with the construction of symbolic models that capture the meaning of information and organize it in ways that are computer-based, but human understandable. A recent paper that examines certain assumptions in information modeling builds a bridge between these two communities, offering a forum for a discussion on common aims from a common perspective. In a June 2000 article, Parsons and Wand separate classes from instances in information modeling in order to free instances from what they call the “tyranny” of classes. They attribute a number of problems in information modeling to inherent classification – or the disregard for the fact that instances can be conceptualized independent of any class assignment. By faceting instances from classes, Parsons and Wand strike a sonorous chord with classification theory as understood in LIS. In the practice community and in the publications of LIS, faceted classification has shifted the paradigm of knowledge organization theory in the twentieth century. Here, with the proposal of inherent classification and the resulting layered information modeling, a clear line joins both the LIS classification theory community and the information modeling community. Both communities have their eyes turned toward networked resource discovery, and with this conceptual conjunction a new paradigmatic conversation can take place. Parsons and Wand propose that the layered information model can facilitate schema integration, schema evolution, and interoperability. These three spheres in information modeling have their own connotation, but are not distant from the aims of classification research in LIS. In this new conceptual conjunction, established by Parsons and Ward, information modeling through the layered information model, can expand the horizons of classification theory beyond LIS, promoting a cross-fertilization of ideas on the interoperability of subject access tools like classification schemes, thesauri, taxonomies, and ontologies. This paper examines the common ground between the layered information model and faceted classification, establishing a vocabulary and outlining some common principles. It then turns to the issue of schema and the horizons of conventional classification and the differences between Information Modeling and Library and Information Science. Finally, a framework is proposed that deploys an interpretation of the layered information modeling approach in a knowledge technologies context. In order to design subject access systems that will integrate, evolve and interoperate in a networked environment, knowledge organization specialists must consider a semantic class independence like Parsons and Wand propose for information modeling.

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.

Form, Intention, and Indexing: The Liminal and Integrated Conceptions of Work in Knowledge Organization

This paper proposes a dual conception of work in knowledge organization. The first part is a conception of work as liminal, set apart from everyday work. The second is integrated, without separation. This talk is the beginning of a larger project where we will characterize work in knowledge organization, both as it is set out in our literature (Šauperl, 2004; Hjørland 2003 Wilson, 1968), and in a philosophical argument for its fundamental importance in the activities of society (Shera, 1972; Zandonade, 2004).But in order to do this, we will co-opt the conception of liminality from the anthropology of religion (Turner, 1967), and Zen Buddhist conceptions of moral action, intention, and integration (Harvey, 2000 and cf., Harada, S., 2008).The goal for this talk is to identify the acts repeated (form) and the purpose of those acts (intention), in knowledge organization, with specific regard to thresholds (liminal points) of intention present in those acts.We can then ask the questions: Where is intention in knowledge organization liminal and where is it integrated? What are the limits of knowledge organization work when considered at a foundational level of the intention labor practices? Answering such questions, in this context, allows us to reconsider the assumptions we have about knowledge organization work and its increasingly important role in society. As a consequence, we can consider the limits of classification research if we see the foundations of knowledge organization work when we see forms and intentions. I must also say that incorporating Zen Buddhist philosophy into knowledge organization research seems like it fits well with ethics and ethical responses the practice of knowledge organization. This is because 20th Century Western interpretations of Zen are often rooted in ethical considerations. This translates easily to work.

Forms, Foundations, and the Ethos of Foremost: Zen Practice, Epistemology, and Ontology in Reflective Knowledge Organization

In reflecting on the practice of knowledge organization, we tacitly or explicitly root our conceptions of work and its value in some epistemic and ontological foundation. Zen Buddhist philosophy offers a unique set of conceptions vis-à-vis organizing, indexing, and describing documents.When we engage in knowledge organization, we are setting our mind to work with an intention. We intend to make some sort of intervention. We then create a form a realization of an abstraction (like classes or terms) [1], we do this from a foundation of some set of beliefs (epistemology, ontology, and ethics), and because we have to make decisions about what to privilege, we need to decide what is foremost in our minds. We must ask what is the most important thing?Form, foundation, and the ethos of foremost require evoke in our reflection on work number of ethical, epistemic, and ontological concerns that ripple throughout our conceptions of space, “good work”, aesthetics, and moral mandate [2,3]. We reflect on this.

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.

"Portuguese Observatory of Taeniasis and Cysticercosis": A "One Health" example for epidemiological surveillance of one neglected disease in a European country

Cysticercosis results from the ingestion Taenia solium eggs directly by faecal-oral route or contaminated food or water. Human tapeworm carriers who have become infected after ingesting pork meat contaminated with cysticerci release these eggs. Cysticercosis occurs after tapeworm eggs are ingested by an intermediate host (pig or human) and then hatch, migrate, and lodge in the host's tissues, where they develop onto larval cysticerci. When they lodged in the central nervous system of humans, results in the disease condition called Neurocysticercosis (NCC), with a heterogeneous manifestations depending of the locations of cysts, number, size and their stage of evolution (1). Consequently the prognostic ranges from asymptomatic to situations leading to death in 2% to 9.8%. of cases (7) In swine’s there are few studies, but recent works have proved that animals, for the same reasons, also have neurological abnormalities, expressed by seizures, stereotypic walk in circles, chewing motions with foamy salivation included tonic muscle contractions followed by a sudden diminution in all muscle tone leading to collapse (2). Conventional domestic wastewater treatment processes may not be totally effective in inactivating parasites eggs from Taenia solium, allowing some contamination of soils and agricultural products (11). In Portugal there are some evidence of aggregation of human cysticercosis cases in specific regions, bases in ecological design studies (6). There are few information about human tapeworm carriers and social and economic factors associated with them. Success in knowledge and consequently in lowering transmission is limited by the complex network of biological and social factors that maintain the spread. Effective control of mostly zoonosis require One Health approach, after a real knowledge and transparency in the information provided by the institutions responsible for both animal and human health, allowing sustained interventions targeted at the transmission cycle's crucial nodes. In general, the model used to control, reflects a rural reality, where pigs are raised freely, poor sanitation conditions and incipient sanitary inspection. In cysticercosis, pigs are obligate intermediate hosts and so considered as first targets for control and used as sentinels to monitor environmental T. solium contamination (3). Usually environmental contamination with Taenia spp. eggs is a key issue in most of studies with landscape factors influencing presence of Taenia spp. antigens in both pigs and humans (5). Soil-related factors as well as socio-economic and behavioural factors are associated with the emergence of significant clustering human cysticercosis (4,5). However scarce studies has been produced in urban environmental and in developed countries with the finality to characterize the spatial pattern. There are still few data available regarding its prevalence and spatial distribution; Transmission patterns are likely to exhibit correlations as housing conditions, water supply, basic sanitation, schooling and birthplace of the individual or relatives, more than pigs rearing free, soil conditions (9). As a matter of fact, tapeworm carriers from endemic zones can auto-infect or transmit infection to other people or arrive already suffering NCC (as a result of travelling to or being a citizen from an endemic cysticercosis country) to a free cysticercosis country. Transmission is fecal-oral; this includes transmission through person-to-person contact, through autoinfection, or through contaminated food This has been happening in different continents as North America (5.4–18% been autochthonous), Europe and Australia (7). Recently, case reports of NCC have also emerged from Muslim countries. (10). Actually, different papers relate an epidemic situation in Spain and Portugal (7, 8). However the kind of study done does not authorize such conclusion. There are no evidence that infections were acquired in Portugal and there are not characterized the mode of transmission. Papers with these kind of information will be allow to have economic consequences resulted from artificial trade barriers with serious consequences for pig producers and pig meat trade. We need transparency in information’s that allow provide the basis to support the development and targeting of future effective control programmes (and prove we need that). So, to have a real picture of the disease, it is necessary integrate data from human, animal and environmental factors surrounding human and pig cases to characterize the pattern of the transmission. The design needs to be able to capture unexpected, and not common outcomes (routine data). We need to think “One Health” to get a genuine image of the situation.

Knowledge, perceptions and attitudes on the sexuality of nursing students and teachers

Introduction: The personal attitudes regarding specific aspects of sexuality are of interest to practices of personal concern, as they are to practices inserted in professional roles. General attitudes towards sexuality and sexual health were evaluated. Objectives: To describe the perceptions and attitudes of students and nursing teachers about sexuality. Methods: We used a mixed methods design with a sequential strategy: QUAN→qual of descriptive and explanatory type. 646 students and teachers participated. The Sexual Attitudes Scale (EAS) of Hendrick & Hendrick (Alferes, 1999) and Attitude Scale Address Sexual and Reproductive Health (EAFSSR) of Nemčić et al (Abreu, 2008) were used. Results: There are significant differences in the level of knowledge about sexuality depending on the sample (χ2KW (2)=18.271; p=.000): students of 1st year have lower levels. The profile of the four dimensions of EAS per sample is identical in all 3 samples, having responsibility the highest average value. In subscales EAFSSR per sample and sex there are significant diferences (p<.05) for all samples and uniform pattern was noted: females have higher median values, indicating that they have more favorable attitudes towards sexual health. Conclusions: Sexual attitudes reveal a multidimensional structure based in the female identity, that shows responsibility towards family planning and sexual education, as well as towards individual self-care regarding the body and sexual and reproductive health. An attitudinal profile by gender emerges, accentuating the polarity between male and female. The importance of the training process in nursing following the personal and social development of students is corroborated.