Stumped by Headlines: Investigating a Functional Knowledge Deficit

Competing claims about the level of ignorance, or knowledge, among the current Nexus generation are addressed. The core of the paper is a theoretical analysis of ignorance in the knowledge society. Specifically, the knowledge-ignorance paradox suggests that the intense specialization demanded by a knowledge economy militates against a broader information society and gives rise to "reading reluctance." To provide evidence for this analysis, the results of a small-scale study testing the idea of a "functional knowledge deficit" are presented. Students were asked to identify metaphorical terms that are commonly used without definition in newspaper captions. The results revealed that students could only identify about 30% of these common expressions, and that they did not do better with terms derived from computers or the popular culture. Significant differences were also found between male and female responses. Both the implications of the findings and further avenues of research are discussed.Cet article discute des débats tenus au sujet du niveau d'ignorance, ou de connaissance, parmi la génération Nexus actuelle. Le coeur de l'article est une analyse théorique de l'ignorance dans la société du savoir. Particulièrement, le paradoxe connaissance-ignorance suggère que l'intense spécialisation requise par une économie du savoir milite contre une société de l'information plus avertie et donne naissance à une "répugnance de la lecture." Comme preuve à l'appui de cette analyse, les résultats d'une étude à petite échelle vérifiant la notion de "déficience de connaissance fonctionnelle" sont présentés. On a demandé à des étudiants d'identifier les métaphores utilisées couramment sans définition dans les sous-titres de journaux. Les résultats ont révélé que les étudiants pouvaient seulement identifier envion 30% de ces expressions courantes et qu'ils ne s'en étaient guère mieux tirés avec les termes dérivés de l'informatique ou de la culture populaire. On a également trouvé des différences significatives entre les résponses des deux sexes. Les répercussions de ces résultats ainsi que d'autres débouchés de recherche sont discutés

The Retention Problem: An Analysis of Enrolment Attrition at a Canadian College

A survey of returning and non-returning students at Scarborough College was undertaken to investigate the problem of declining retention rates at Ontario Universities. This study describes the opportunities available to and chosen by non-returning students, and then seeks to evaluate various hypotheses that have been proposed to account for enrolment attrition. Consistent with prior research, there was no evidence found to support the claim that students are being forced out of university by an inability to afford the costs of their education. Instead, the results suggested that enrolment attrition is produced by a combination of an attenuation of the student's commitment to obtain the degree and the student's awareness of and access to viable alternatives. As a result of a pervasive sense of uncertainty about the market value of a university degree, many students are willing to assay other opportunities. Specifically, those students who went to work appear to have been "pulled out" of university by the availability of a credible job. In addition, the contingencies affecting the commitment of the returning students and the students who transfer to other educational institutions are discussed. The conclusion addresses the relationship between financial circumstances and access to university, and raises questions about future enrolment patterns.Une enquête sur les étudiants qui continuent à fréquenter et ceux qui laissent le Collège de Scarborough fut entreprise dans le but d'étudier le problème des taux de rétention en déclin dans les universités de l'Ontario. La présente étude s'arrête à analyser les raisons d'abandon des étudiants et cherche ensuite à vérifier diverses hypothèses avancées pour expliquer la baisse des inscriptions. En conformité avec des recherches antérieures, aucune évidence n 'a pu être trouvée pour supporter l'idée que les étudiants soient forcés d'inter-rompre leurs études universitaires à cause d'une incapacité à supporter les coûts de l'en-seignement. Au contraire, les résultats de la recherche suggère que la baisse des inscriptions provient plutôt d'un manque d'intérêt pour l'obtention d'un diplôme de même que d'une meilleure connaissance de d'autres possibilités offertes sur le marché du travail. Etant donné le degré d'incertitude planant sur la valeur marchande d'un diplôme universitaire, de nombreux étudiants sont prêts à explorer d'autres avenues. Plus spécifiquement, les étudiants qui ont abandonné leurs études semblent avoir été attirés par la disponibilité d'un emploi satisfaisant. L'auteur discute également des circonstances entourant les étudiants qui retournent et ceux qui décident de transférer dans d'autres institutions d'enseignement. Les conclusions de cette étude touchent aussi au problème de l'accessi-bilité à l'université et des dépenses encourues; finalement, certaines questions sont posées au sujet des tendances futures des inscriptions universitaires

Silencing science: partisanship and the career of a publication disputing the dangers of secondhand smoke

This paper examines the silencing of science, that is, efforts to prevent the making of specific scientific claims in any or all of the arenas in which these claims are typically reported or circulated. Those trying to mute the reporting or circulation of scientific claims are termed “partisans.” The paper examines silencing through a systematic examination of the “rapid responses” to a smoking study published in the British Medical Journal claiming that secondhand smoke is not as dangerous as conventionally believed. Media coverage of the smoking study is also examined, as is the question of whether there is self-silencing by the media regarding doubts about the negative effects of passive smoke. The results suggest that the public consensus about the negative effects of passive smoke is so strong that it has become part of a regime of truth that cannot be intelligibly questioned

Personalized risk stratification through attribute matching for clinical decision making in clinical conditions with aspecific symptoms: the example of syncope

Background Risk stratification is challenging in conditions, such as chest pain, shortness of breath and syncope, which can be the manifestation of many possible underlying diseases. In these cases, decision tools are unlikely to accurately identify all the different adverse events related to the possible etiologies. Attribute matching is a prediction method that matches an individual patient to a group of previously observed patients with identical characteristics and known outcome. We used syncope as a paradigm of clinical conditions presenting with aspecific symptoms to test the attribute matching method for the prediction of the personalized risk of adverse events. Methods We selected the 8 predictor variables common to the individual-patient dataset of 5 prospective emergency department studies enrolling 3388 syncope patients. We calculated all possible combinations and the number of patients in each combination. We compared the predictive accuracy of attribute matching and logistic regression. We then classified ten random patients according to clinical judgment and attribute matching. Results Attribute matching provided 253 of the 384 possible combinations in the dataset. Twelve (4.7%), 35 (13.8%), 50 (19.8%) and 160 (63.2%) combinations had a match size 6550, 6530, 6520 and <10 patients, respectively. The AUC for the attribute matching and the multivariate model were 0.59 and 0.74, respectively. Conclusions Attribute matching is a promising tool for personalized and flexible risk prediction. Large databases will need to be used in future studies to test and apply the method in different conditions

Syncope Time Frames for Adverse Events after Emergency Department Presentation: An Individual Patient Data Meta-Analysis

Background and Objectives: Knowledge of the incidence and time frames of the adverse events of patients presenting syncope at the ED is essential for developing effective management strategies. The aim of the present study was to perform a meta-analysis of the incidence and time frames of adverse events of syncope patients. Materials and Methods: We combined individual patients’ data from prospective observational studies including adult patients who presented syncope at the ED. We assessed the pooled rate of adverse events at 24 h, 72 h, 7–10 days, 1 month and 1 year after ED evaluation. Results: We included nine studies that enrolled 12,269 patients. The mean age varied between 53 and 73 years, with 42% to 57% females. The pooled rate of adverse events was 5.1% (95% CI 3.4% to 7.7%) at 24 h, 7.0% (95% CI 4.9% to 9.9%) at 72 h, 8.4% (95% CI 6.2% to 11.3%) at 7–10 days, 10.3% (95% CI 7.8% to 13.3%) at 1 month and 21.3% (95% CI 15.8% to 28.0%) at 1 year. The pooled death rate was 0.2% (95% CI 0.1% to 0.5%) at 24 h, 0.3% (95% CI 0.1% to 0.7%) at 72 h, 0.5% (95% CI 0.3% to 0.9%) at 7–10 days, 1% (95% CI 0.6% to 1.7%) at 1 month and 5.9% (95% CI 4.5% to 7.7%) at 1 year. The most common adverse event was arrhythmia, for which its rate was 3.1% (95% CI 2.0% to 4.9%) at 24 h, 4.8% (95% CI 3.5% to 6.7%) at 72 h, 5.8% (95% CI 4.2% to 7.9%) at 7–10 days, 6.9% (95% CI 5.3% to 9.1%) at 1 month and 9.9% (95% CI 5.5% to 17) at 1 year. Ventricular arrhythmia was rare. Conclusions: The risk of death or life-threatening adverse event is rare in patients presenting syncope at the ED. The most common adverse events are brady and supraventricular arrhythmias, which occur during the first 3 days. Prolonged ECG monitoring in the ED in a short stay unit with ECG monitoring facilities may, therefore, be beneficial

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness. Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN)

An expert committee was formed to reach consensus on the use of tilt table testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous events. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to the performance of (1) additional provocation tests, such as the active standing test, carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, NIRS, end-tidal CO2 or neuro-endocrine tests; and (3) tailor-made provocation procedures in those with a specific and consistent trigger of TLOC. TTT and other provocative cardiovascular autonomic tests are indicated if the initial evaluation does not yield a definite or highly likely diagnosis, but raises a suspicion of (1) reflex syncope, (2) the three forms of orthostatic hypotension (OH), i.e. initial, classic and delayed OH, as well as delayed orthostatic blood pressure recovery, (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT is to teach patients with reflex syncope and OH to recognise hypotensive symptoms and to perform physical counter manoeuvres

Priorities for Emergency Department Syncope Research

Study objectives There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of ED-based syncope research. Methods We recruited a multinational panel of syncope experts. A preconference survey identified research priorities, which were refined during and after the conference through an iterative review process. Results There were 31 participants from 7 countries who represented 10 clinical and methodological specialties. High-priority research recommendations were organized around a conceptual model of ED decisionmaking for syncope, and they address definition, cohort selection, risk stratification, and management. Conclusion We convened a multispecialty group of syncope experts to identify the most pressing knowledge gaps and defined a high-priority research agenda to improve the care of patients with syncope in the ED