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PubMed2003

Trunk muscle response to lifting unbalanced loads with and without knowledge of centre of mass.

OBJECTIVE: To examine the effects of lifting a bin with a variable centre of mass on muscle activity, with and without knowledge of the centre of mass. BACKGROUND: Numerous parameters related to lifting have been examined yet the effects of changing the load centre of mass in two dimensions, with or without knowledge, has not been examined. METHODS: Participants lifted a 6 kg industrial tote bin with a 7 and 11 kg mass randomly placed in each of nine compartments, into which the interior of the bin was partitioned. Participants were not restricted in lifting style other than using the handles, which were equipped with force gauges. Two series (9 lifts per series) were completed using the 7 kg load without knowledge of the load placement and one series with knowledge of the load placement. One series was completed using an 11 kg mass without knowledge of load placement. Electromyographic activity of the upper and lower erector spinae, latissimus dorsi and the external obliques were collected bilaterally. RESULTS: Left and right muscle pairs demonstrated mirror images for all muscles with lowest activity levels when the load was placed nearer the lifter in the sagittal plane. Peak electromyographic activity of the upper erector spinae and latissimus dorsi increased with the weight in the compartments nearest the body and/or the ipsilateral handle. Conversely, peak electromyographic activity of the lower erector spinae and the obliques increased when the weight was on the contralateral side. Peak upper erector electromyographic activity reached up to 41% of maximum and the lower erectors reached 50% of maximum, while the obliques and latissimus dorsi were below 5% and 7%, respectively. No electromyographic activity differences were found between the known and unknown load placements. DISCUSSION: A segmental control strategy appears to exist during lifting that works from the upper to lower torso based on peak electromyographic activity activity. When lifting a bin with a varied centre of mass, highest peak electromyographic activity for the upper and lower erector spinae occurred when the load is closest to the body, regardless of load knowledge. Based on our findings with asymmetrical loads, we conclude that the moments acting on the wrist play an important role in spinal loading and must be included in future studies. RELEVANCE: Asymmetrical loads are often encountered in daily life. Regardless of the lifter's knowledge of the balance of the load, the differential and asymmetrical loading of the muscles of the back play a role in the development of low back pain.

Abdominal Muscles↗
PubMed1999

Cancer pain: knowledge and attitudes of physicians in Israel.

The effectiveness of cancer pain therapy is influenced by the attitudes and knowledge of the treating physicians. As part of a quality improvement project in the management of cancer pain, a survey of 236 medical practitioners was conducted. One hundred seventy-six respondents (74.5%) completed the survey. Fifty-two percent treated patients with cancer pain several times a week or more. Whereas 57.7% of physicians stated that 76-100% of patients could achieve a satisfactory outcome from analgesic therapy, only 17.2% of respondents reported that > 75% actually achieve a satisfactory outcome in their own experience. Unsatisfactory outcome was ascribed to inadequate pain relief (59.7%), or excessive central nervous system (CNS) side effects (43.3%). According to the responding physicians, the major barriers to effective relief include inadequate assessment of the pain and pain relief (65.3%), inadequate knowledge of pain therapy (57.9%), and physician reluctance to prescribe opioids (49.1%). Questions evaluating physician knowledge identified widely prevalent knowledge deficits in pain physiology, risk of addiction, use of adjuvant analgesics, opioid dosing, and treatment of side effects. Specialists in oncology tended to evaluate their knowledge more highly than others (P < 0.05). Despite this, there was no significant knowledge difference between oncologists and noncancer specialists. The data highlight some of the barriers to the successful management of cancer pain in Israel, the prevalence of knowledge deficits, and the common disparity between clinicians' self-assessment of clinical competence and their ability to respond correctly to questions on the management of cancer pain.

Adult↗
PubMed2003

Inductive bias strength in knowledge-based neural networks: application to magnetic resonance spectroscopy of breast tissues.

The integration of symbolic knowledge with artificial neural networks is becoming an increasingly popular paradigm for solving real-world applications. The paradigm provides means for using prior knowledge to determine the network architecture, to program a subset of weights to induce a learning bias which guide network training, and to extract knowledge from trained networks. The role of neural networks then becomes that of knowledge refinement. It thus provides a methodology for dealing with uncertainty in the prior knowledge. We address the open question of how to determine the strength of the inductive bias of programmed weights; we present a quantitative solution which takes the network architecture, the prior knowledge, and the training data into consideration. We apply our solution to the difficult problem of analyzing breast tissue from magnetic resonance spectroscopy (MRS); the available database is extremely limited and cannot be adequately explained by expert knowledge alone.

Adult↗
PubMed2004

Nurses' acquisition and retention of knowledge after trauma training.

The Advanced Trauma Nursing Course (ATNC) aims to equip nurses with the appropriate knowledge in order to skilfully care for the trauma patient. In this study, knowledge gained from the course, and its subsequent retention, was used as a measure of the course's effectiveness. Fourteen nurses participated in the study. The ATNC short answer papers were used to assess knowledge levels of the participants at four separate stages. Statistical analysis demonstrated a highly significant change (p<0.001) in the knowledge levels of ATNC participants following attendance on the course. However, three months after the ATNC knowledge levels appeared not to be statistically significantly different from pre-course levels, which suggested that retention of knowledge was poor. The findings of this study highlight the importance of continuous professional development and, in particular, the need to implement local initiatives aimed at improving the retention of knowledge gained by ATNC participants.

Education, Nursing, Continuing↗
PubMed2002

Supporting decisions in medical applications: the knowledge management perspective.

In the medical domain, different knowledge types are typically available. Operative knowledge, collected during every day practice, and reporting expert's skills, is stored in the hospital information system (HIS). On the other hand, well-assessed, formalised medical knowledge is reported in textbooks and clinical guidelines. We claim that all this heterogeneous information should be secured and distributed, and made available to physicians in the right form, at the right time, in order to support decision making: in our view, therefore, a decision support system cannot be conceived as an independent tool, able to substitute the human expert on demand, but should be integrated with the knowledge management (KM) task. From the methodological viewpoint, case based reasoning (CBR) has proved to be a very well suited reasoning paradigm for managing knowledge of the operative type. On the other hand, rule based reasoning (RBR) is historically one of the most successful approaches to deal with formalised knowledge. To take advantage of all the available knowledge types, we propose a multi modal reasoning (MMR) methodology, that integrates CBR and RBR, for supporting context detection, information retrieval and decision support. Our methodology has been successfully tested on an application in the field of diabetic patients management.

Adolescent↗
PubMed1999

Evaluating the relationship between explicit and implicit knowledge in a sequential reaction time task.

Can knowledge underlying a simple perceptual-motor skill be unconscious? Three experiments (a) trained participants on a 4-choice reaction time (RT) task in which the stimulus on each trial was determined by a repeating 12-element sequence and (b) studied the extent to which participants' knowledge of this sequence was implicit, that is, unavailable for conscious access. Participants proved via an indirect test to have acquired knowledge of the sequence, because their RTs increased when the sequence was changed. To evaluate whether this knowledge was consciously accessible, participants were asked to perform an "objective" free-generation or recognition test of sequence knowledge. Results show that sequence knowledge is fully accessible on these objective tests. Moreover, it is demonstrated in this procedure that old-new recognition cannot be explained by unconscious attribution of perceptual-motor fluency. The question is raised whether distinct implicit (procedural) and explicit (declarative) forms of knowledge are acquired when participants learn a perceptual-motor skill.

Cognition↗
PubMed2003

Context-gated knowledge partitioning in categorization.

According to the knowledge partitioning framework, people sometimes master complex tasks by creating multiple independent parcels of partial knowledge. Research has shown that knowledge parcels may contain mutually contradictory information, and that each parcel may be used without regard to knowledge that is demonstrably present in other parcels. This article reports 4 experiments that investigated knowledge partitioning in categorization. When component boundaries of a complex categorization were identified by a context cue, a significant proportion of participants learned partial and independent categorization strategies that were chosen on the basis of context. For those participants, a strategy used in one context was unaffected by knowledge demonstrably present in other contexts, suggesting that knowledge partitioning in categorization can be complete.

Cognition↗
PubMed2001

Reading both high-coherence and low-coherence texts: effects of text sequence and prior knowledge.

Previous research (e.g., McNamara, Kintsch, Songer, & Kintsch, 1996) has demonstrated that high-knowledge readers learn more from low-coherence than high-coherence texts. This study further examined the assumption that this advantage is due to the use of knowledge to fill in the gaps in the text, resulting in an integration of the text with prior knowledge. Participants read either a high- or low-coherence text twice, or they read both the high- and low-coherence texts in one order or the other. Reading the low-coherence text first should force the reader to use prior knowledge to fill in the conceptual gaps. However, reading the high-coherence text first was predicted to negate the necessity of using prior knowledge to understand the low-coherence text when the latter was presented second. As predicted, high-knowledge readers benefited from the low-coherence only text when it was read first. Low-knowledge readers benefited from the high-coherence text, regardless of whether it was read first, second, or twice.

Cognition↗
PubMed2005

Neonatal encephalopathy and cerebral palsy revisited: the current state of knowledge and the impact of american college of obstetricians and gynecologists task force report.

OBJECTIVES: To re-assess obstetrician-gynecologists' knowledge of neonatal encephalopathy and cerebral palsy after publication of the ACOG/AAP Task Force report. STUDY DESIGN: A questionnaire investigating knowledge of neonatal encephalopathy and cerebral palsy was mailed to 1060 members of ACOG, 337 of whom participated in a similar study in 2001. RESULTS: There was a strong association between familiarity with ACOG documentation and knowledge of neonatal encephalopathy (NE) and cerebral palsy (CP) (p<0.001). As with obstetricians surveyed in 2001, knowledge gaps remain. Performance was better on practices questions than knowledge questions. About one-third (34.2%) of the physicians said their knowledge of neonatal encephalopathy was poor or deficient; the majority (76%) rated their residency training as inadequate to marginal. CONCLUSION: The results indicate better knowledge of neonatal encephalopathy and cerebral palsy among physicians more familiar with the Task Force report. There is a clear need for emphasis on these topics during training and continuing medical education.

Brain Diseases↗
PubMed2001

Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients.

Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university-affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse-patient combinations. Nurses' knowledge scores were not significantly related to their patients' pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurses as resources with their pain were not positive. Nurses' knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses' stated pain knowledge was not associated with their assigned patients' pain ratings or the amount of analgesia they received.

Adult↗
PubMed2000

Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians.

OBJECTIVE: We evaluated the effect of implementing quality improvement (QI) programs for depression, relative to usual care, on primary care clinicians' knowledge about treatment. DESIGN AND METHODS: Matched primary care clinics (46) from seven managed care organizations were randomized to usual care (mailed written guidelines only) versus one of two QI interventions. Self-report surveys assessed clinicians' knowledge of depression treatments prior to full implementation (June 1996 to March 1997) and 18 months later. We used an intent-to-treat analysis to examine intervention effects on change in knowledge, controlling for clinician and practice characteristics, and the nested design. PARTICIPANTS: One hundred eighty-one primary care clinicians. INTERVENTIONS: The interventions included institutional commitment to QI, training local experts, clinician education, and training nurses for patient assessment and education. One intervention had resources for nurse follow-up on medication use (QI-meds) and the other had reduced copayment for therapy from trained, local therapists (QI-therapy). RESULTS: Clinicians in the intervention group had greater increases compared with clinicians in the usual care group over 18 months in knowledge of psychotherapy (by 20% for QI-meds, P =.04 and by 33% for QI-therapy, P =.004), but there were no significant increases in medication knowledge. Significant increases in knowledge scores (P =.01) were demonstrated by QI-therapy clinicians but not clinicians in the QI-meds group. Clinicians were exposed to multiple intervention components. CONCLUSIONS: Dissemination of QI programs for depression in managed, primary care practices improved clinicians' treatment knowledge over 18 months, but breadth of learning was somewhat greater for a program that also included active collaboration with local therapists.

Adult↗
PubMed2005

[Knowledge of colorectal cancer prevention in the Bavarian population above 50 years--survey in two districts].

PURPOSE: Colorectal cancer is the second main cause of cancer death in Germany, although several measures related to primary prevention are described, and the utilisation of existing diagnostic tools (faecal occult blood test = FOBT, colonoscopy) is known to significantly decrease incidence and mortality. However, screening rates remain low in Germany, and insufficient knowledge of prevention possibilities is assumed to be responsible. The aim of this study was to investigate the knowledge related to colorectal cancer prevention in a Bavarian population, in the context of a regional public awareness campaign ("Active against Colorectal Cancer"). METHODS: 618 individuals between 50 and 90 ys of age participated in a telephone survey (m: 219, f: 399, 63.2 +/- 9.17 ys); the participants were inhabitants of two Bavarian districts. The questionnaire consisted of open-ended questions concerning preventive behaviour, colorectal cancer screening, risk factors, early warning signs and knowledge of colorectal cancer information. RESULTS: More than 80% of participants recalled healthy diet as a possible protective factor against colorectal cancer; a distinctly smaller percentage, however, could correctly define concrete dietary factors: e. g., fruit and vegetables were named by 54.5%. 66% of participants knew that unusual rectal bleeding might be a warning sign of cancer. Colonoscopy was the screening test that was most frequently recalled (61.5%); fewer participants named FOBT (32.8%) and rectal examination (11.5%). The results demonstrate that for many knowledge items, females proved to be significantly better informed than males. The most frequent sources of colorectal cancer information were newspapers, magazines, television and/or radio (named by 76.7%), as well as physicians and pharmacies (45.1%). 11.5% of participants attended the regional public awareness campaign "Action against colorectal cancer"; this subgroup had a better knowledge of some aspects related to colorectal cancer prevention. CONCLUSION: Evidently, the interviewed Bavarian population of 50 years or older lack knowledge of risk or protection factors for colorectal cancer. Knowledge of existing screening tests was also poor. These findings can serve as starting point for information campaigns tailored for target groups.

Age Factors↗
PubMed2000

The development of children's knowledge of attention and resource allocation in single and dual tasks.

Developmental changes in kindergarten, 1st-, and 4th-grade children's knowledge about the variables that affect attention sharing and resource allocation were examined. Findings from the 2 experiments showed that kindergartners understood that person and strategy variables affect performance in attention-sharing tasks. However, knowledge of how task variables affect performance was not evident to them and was inconsistent for 1st and 4th graders. Children's knowledge about resource allocation revealed a different pattern and varied according to the dissimilarity of task demands in the attention-sharing task. In Experiment 1, in which the dual attention tasks were similar (i.e., visual detection), kindergarten and 1st-grade children did not differentiate performance in single and dual tasks. Fourth graders demonstrated knowledge that performance on a single task would be better than performance on the dual tasks for only 2 of the variables examined. In Experiment 2, in which the dual attention tasks were dissimilar (i.e., visual and auditory detection), kindergarten and 1st-grade children demonstrated knowledge that performance in the single task would be better than in the dual tasks for 1 of the task variables examined. However, 4th-grade children consistently gave higher ratings for performance on the single than on the dual attention tasks for all variables examined. These findings (a) underscore that children's meta-attention is not unitary and (b) demonstrate that children's knowledge about variables affecting attention sharing and resource allocation have different developmental pathways. Results show that knowledge about attention sharing and about the factors that influence the control of attention develops slowly and undergoes reorganization in middle childhood.

Attention↗
PubMedDate not supplied

Do children still pick and choose? The relationship between phonological knowledge and lexical acquisition beyond 50 words.

Previous studies document an influence of phonological knowledge on word learning that differs across development. Specifically, children with expressive lexicons of fewer than 50 words learn words composed of IN sounds more rapidly than those composed of OUT sounds. In contrast, preschool children with larger expressive lexicons show the reverse effect. The goal of the current study was to provide a re-analysis of existing data to determine if this discrepancy across studies may be related to how phonological knowledge has been defined. This study defines knowledge on a continuum from most to more to less. Results showed a continuous inverse relationship between phonological knowledge and word learning by preschool children. Specifically, most phonological knowledge was associated with poorest word learning, more knowledge with intermediate word learning, and less knowledge with best word learning. Theoretical implications are discussed.

Child, Preschool↗
PubMed2005

Contributions of processing ability and knowledge to verbal memory tasks across the adult life-span.

This study investigated the relationships of processing capacity and knowledge to memory measures that varied in retrieval difficulty and reliance on verbal knowledge in an adult life-span sample (N = 341). It was hypothesized that processing ability (speed and working memory) would have the strongest relationship to tasks requiring active retrieval and that knowledge (vocabulary ability) would be related to verbal fluency and cued recall, as participants relied upon verbal knowledge to retrieve category items (fluency) or develop associations (cued recall). Measurement and structural equation models were developed for the entire sample and separately for younger (aged 20-54 years, n = 168) and older (aged 55-92 years, n = 173) subgroups. In accordance with the hypotheses, processing ability was found to be most highly related to free recall, with additional significant relationships to cued recall, verbal fluency, and recognition. Knowledge was found to be significantly related only to verbal fluency and to cued recall. Moreover, knowledge was more important for older than for younger adults in mediating variance in cued recall, suggesting that older adults may use age-related increases in knowledge to partially compensate for processing declines when environmental support is available in memory tasks.

Adult↗
PubMed1988

A comparison of nutrition knowledge of freshmen and senior medical students: a collaborative study of southeastern medical schools.

It has been documented previously that nutrition knowledge of senior medial students at ten southeastern medical schools varies and is positively correlated with student assessment of the quantity and quality of nutrition education. To determine whether the differences in knowledge are related to the medical educational experience or are simply a reflection of differences in the students' knowledge on entry to medical school, the same examination was administered to entering freshmen at eight of the medical schools. The knowledge scores of freshmen were remarkably homogeneous from school to school (53 +/- 1%, range 51-55%), and nutrition knowledge was significantly higher for seniors than for the freshmen at all schools (mean 69 vs 53%, p less than 0.0001). On the basis of responses to survey items on the examination, the freshman medical students were more inclined than senior students to take a nutrition elective (62 vs 34%, p less than 0.0001), and more freshman rated nutrition as being important to their careers (74 vs 59%, p less than 0.05). These data indicate that 1) entering freshman medical students at the different schools studied have comparable levels of nutrition knowledge and are receptive to nutrition education, and 2) differences in medical training programs most likely explain the previously documented variability in nutrition knowledge of graduating medical students. These findings have important implications for professionals planning curricula for medical-nutrition education.

Education, Medical, Undergraduate↗
PubMed2002

Pattern of responses to HIV transmission questions: rethinking HIV knowledge and its relevance to AIDS prejudice.

This paper intends to investigate the connection between HIV transmission knowledge and prejudicial attitudes towards people with HIV/AIDS (PWAs), with an emphasis on exploring the pattern of cognitive profile in response to knowledge questions. Data for the present study were derived from the 'Health Attitudes and Health Seeking Behavior Study', a telephone survey of a nationally representative sample, aged 20 to 70, from April to May 1997 in Taiwan. A total of 2,471 respondents who had heard of AIDS and knew that it was infectious were included in the analysis. Based on answers to four transmission-route items (blood transfusion, mother-foetus, sexual contacts, needle sharing) and two casual-contact items (shaking hands and sharing utensil), a variable 'pattern of knowledge performance' was constructed, by which the respondents were clustered into five knowledge groups. Bivariate and multivariate analyses illustrated the greater explanatory power of pattern of knowledge performance rather than additive scoring of knowledge items to PWAs' prejudice. Moreover, it was the responses to casual-contact rather than transmission-route questions that made a greater contribution to PWAs' prejudice. Special attention is given to the possible perceptual undertaking inherent in the five types of knowledge group. To implement effective AIDS prevention campaigns and interventions, the design for increasing the risk perception of the correct HIV transmission routes should differ from that of reducing the risk perception of the casually transmitted routes.

Adult↗
PubMedDate not supplied

Preservation of categorical knowledge in Alzheimer's disease: a computational account.

The distinction between knowledge of specific exemplars and knowledge of their general categories is central to much theorising on the nature of semantic memory. The dissociation between exemplar and category knowledge observed in Alzheimer's Disease (AD) would appear to support this distinction, and to suggest that different neural systems are involved in the representation of exemplar and category knowledge. We review the evidence for preserved category knowledge in the semantic memory impairment of AD, and propose an alternative interpretation, according to which category and exemplar knowledge are both represented in the same distributed neural substrate. The relative preservation of category knowledge is a consequence of the greater frequency, and hence greater robustness, of the representation of attributes shared by all or most members of a category, compared to exemplar-unique attributes. We test and confirm the computational adequacy of this hypothesis in two computer simulations.

Aged↗