Data,information, knowledge and wisdom

The relationship between data, information, knowledge and wisdom is explained. The growth of the Internet is changing the traditional hierarchies of ‘experts’ and changing ways of disseminating information.In the growing area of knowledge management, the Internet is enabling new ways of collecting, organizing and disseminating knowledge. Data mining is the application of improved techniques of data organization and storage and analysis to large datasets and has led to the discovery of previously unknown knowledge and relationships.     

Data,information, knowledge and wisdom

The relationship between data, information, knowledge and wisdom is explained. The growth of the Internet is changing the traditional hierarchies of ‘experts’ and changing ways of disseminating information.In the growing area of knowledge management, the Internet is enabling new ways of collecting, organizing and disseminating knowledge. Data mining is the application of improved techniques of data organization and storage and analysis to large datasets and has led to the discovery of previously unknown knowledge and relationships.     

Knowledge management

The relationship between data, knowledge, wisdom and understanding is explained in this article. There is a need to convert implicit knowledge to explicit knowledge to support several projects within the NHS (and elsewhere), to disseminate good practice, and to provide a sound basis for the different levels of developing clinical decision support systems. Stimulated by increasing access to the Internet, there is a tension between traditional sources of knowledge (e.g. books, individuals recognized as experts), and many different and varied sources of information and knowledge (a wide range of online resources that often are freely available).     

Surgical mentoring: a critical skill

Surgeons routinely share medical knowledge, surgical techniques, and medical judgment with junior colleagues in their everyday practice. Most information is transferred by chance encounters, i.e., a patient in the clinic or a patient in the operating room. An understanding of principles of adult learning can aid a senior surgeons' ability to convey this information. Formalizing this transfer of knowledge through a mentoring program allows wisdom and skills to be passed on in a manner that accelerates the lessons for the recipient. In addition, a formal program allows the inclusion of a diverse group of protégés and not just the chosen "golden few."     

Positive Adaptation to Trauma: Wisdom as Both Process and Outcome

Positive adaptation to psychological trauma and wisdom both have a rich history in European literature and philosophy. Although the literature on posttraumatic growth has recognized the possibility of wisdom as an outcome of adaptation, its role in the process of adaptation has been neglected. A theoretical framework is presented that conceptualizes three dimensions of wisdom as crucial to an understanding of the role it can play in posttraumatic positive adaptation. These dimensions are the recognition and management of uncertainty; the integration of affect and cognition; and the recognition and acceptance of human limitation. The role of these dimensions in the process and outcome of traumatic adaptation is considered, together with limitations of the framework and directions for future research.     

Cyclooxygenase-2 as a potential target in the prevention and treatment of genitourinary tumors: a review

PURPOSE: Recent years have seen a dramatic expansion in our discovery and knowledge of the molecular mechanisms of cancer development and progression. The discovery and elucidation of prostaglandin pathways, in particular the molecular and clinical role of cyclooxygenase (COX)-2 function, has had important application to neoplasms. Current understanding of the role of COX-2 activity and, thereby, the potential clinical usefulness of COX-2 specific inhibitors as they apply to urological oncology are discussed. MATERIALS AND METHODS: The discovery of prostaglandin pathways, the molecular and clinical role of COX-2 function, and the corresponding application to neoplasms were reviewed in the scientific literature (MEDLINE from 1960 to the present). In particular, a thorough review of the current literature and recent abstract presentations at scientific meetings was done regarding the potential role of COX-2 in urological cancers (MEDLINE from 1960 to the present, and American Urological Association and American Society of Clinical Oncology annual meeting abstracts from1998 to the present). RESULTS: Decreased apoptosis, increased angiogenesis and immunosuppression are just some of the known sequelae of COX-2 over expression and each effect may have an important role in tumor formation and progression. Preclinical research and pilot clinical studies in urological oncology, in particular prostate, bladder and kidney cancer, have proved to be quite promising to date. CONCLUSIONS: Currently we are just beginning to understand the molecular mechanisms and clinical effects of COX-2 function and inhibition, and the potential for COX-2 specific inhibitors to affect potentially tumor biology and growth and, thereby, serve as antitumor drugs with therapeutic and chemopreventive roles for urological cancers. The absence of complete scientific understanding in these areas provides a generous opportunity for innovative and important scientific study.     

Data,information and knowledge

The relationship between data, knowledge, and wisdom is explained in this article. Codifying knowledge will help to disseminate good practice and provide a sound basis for developing clinical decision-support systems. Stimulated by increasing access to the Internet, there is a tension between traditional sources of knowledge (e.g. books, individuals recognized as experts), and sources facilitated by ready access to the Internet (e.g. wikis, blogs and other social networking resources).     

Pain and systematic reviews

There is a huge medical literature, with very large amounts of information. Some of that information is useful, some not. The task is to distil the information, apply quality filters, and place it into context so that we can use the knowledge we have with wisdom. The process of systematically reviewing the literature helps us generate solid, unbiased knowledge. Using appropriate tools, like numbers needed to treat (NNT), we can provide a solid basis to allow practitioners and their patients to make the best, and best informed, choices about their care.     

The importance of klotho in phosphate metabolism and kidney disease

The discovery of fibroblast growth factor‐23 (FGF23) and its co‐receptor α‐klotho has broadened our understanding of mineral metabolism and led to a renewed research focus on phosphate homeostatic pathways in kidney disease. Expanding knowledge of these mechanisms, both in normal physiology and in pathology, identifies targets for potential interventions designed to reduce the complications of renal disease, particularly the cardiovascular sequelae. FGF23 has emerged as a major α‐klotho‐dependent endocrine regulator of mineral metabolism, functioning to activate vitamin D and as a phosphatonin. However, increasingly there is an appreciation that klotho may act independently as a phosphate regulator, as well as having significant activity in other key biological processes. This review outlines our current understanding of klotho, and its potential contribution to kidney disease and cardiovascular health.     

Integrative systems biology for data-driven knowledge discovery

Integrative systems biology is an approach that brings together diverse high-throughput experiments and databases to gain new insights into biological processes or systems at molecular through physiological levels. These approaches rely on diverse high-throughput experimental techniques that generate heterogeneous data by assaying varying aspects of complex biological processes. Computational approaches are necessary to provide an integrative view of these experimental results and enable data-driven knowledge discovery. Hypotheses generated from these approaches can direct definitive molecular experiments in a cost-effective manner. By using integrative systems biology approaches, we can leverage existing biological knowledge and large-scale data to improve our understanding of as yet unknown components of a system of interest and how its malfunction leads to disease.     

Global analysis of gene expression: methods, interpretation, and pitfalls

Over the past 15 years, global analysis of mRNA expression has emerged as a powerful strategy for biological discovery. Using the power of parallel processing, robotics, and computer-based informatics, a number of high-throughput methods have been devised. These include DNA microarrays, serial analysis of gene expression, quantitative RT-PCR, differential-display RT-PCR, and massively parallel signature sequencing. Each of these methods has inherent advantages and disadvantages, often related to expense, technical difficulty, specificity, and reliability. Further, the ability to generate large data sets of gene expression has led to new challenges in bioinformatics. Nonetheless, this technological revolution is transforming disease classification, gene discovery, and our understanding of regulatory gene networks.     

The impact of the Biomolecular Era on breast cancer surgery

Surgery has always played a central role in the management of breast cancer, with local control via complete tumour resection long established as the cornerstone of effective breast cancer therapy. While extensive surgical resection in the form of the Halstead radical mastectomy dominated treatment up until at least the 1970s, the advent of adjuvant loco-regional and systemic therapies has resulted in a decrease in the magnitude of surgical intervention in recent decades. The Biomolecular or “-omics” era initiated with the discovery of the DNA double helix in 1953 and intensified by the completion of the human genome project in 2003 has seen an unprecedented expansion in our understanding of the molecular and genetic heterogeneity of cancer. This review will discuss how the clinical application of this knowledge in the direction of personalised risk assessment and breast cancer treatment has significant implications for modern surgical practice.     

An overview of matrix metalloproteinases in the pathogenesis and treatment of abdominal aortic aneurysms

Recent basic and clinical research has established a link between the pathogenesis of abdominal aortic aneurysms (AAA) and matrix metalloproteinases (MMP). The discovery of the influence of MMPs on in vitro and in vivo aneurysm development has yielded promising information that may eventually decode the pathogenetic factors affecting the initiation and growth rate of AAAs. In this review, an analysis of MMPs involved in AAA disease is presented, including the data from recent research studies and planned clinical drug trails designed to retard the AAA growth by inhibiting MMP activity.     

Automatische Anästhesieprotokollsysteme

The introduction of electronic anaesthesia documentation systems was attempted as early as in 1979, although their efficient application has become reality only in the past few years. The advantages of the electronic protocol are apparent: · Continuous high quality documentation, · comparability of data due to the availability of a data bank, · reduction in the workload of the anaesthesist and · availability of additional data. Disadvantages of the electronic protocol have also been discussed in the literature. By going through the process of entering data on the course of the anaesthetic procedure on the protocol sheet, the information is mentally absorbed and evaluated by the anaesthesist. This information may, however, be lost when the data are recorded fully automatically – without active involvement on the part od the anaesthesist. Recent publications state that by using intelligent alarms and/or integrated displays manual record keeping is no longer necessary for anaesthesia vigilance. The technical design of automated anaesthesia records depends on an integration of network technology into the hospital. It will be appropriate to connect the systems to the Internet, but safety requirements have to be followed strictly. Concerning the database, client server architecture as well as language standards like SQL should be used. Object oriented databases will be available in the near future. Another future goal of automated anaesthesia record systems will be using knowledge based technologies within these systems. Drug interactions, disease related anaesthetic techniques and other information sources can be integrated. At this time, almost none of the commercially available systems has matured to a point where their purchase can be recommended without reservation. There is still a lack of standards for the subsequent exchange of data and a solution to a number of ergonomic problems still remains to be found. Nevertheless, electronic anaesthesia protocols will be required in the near future. The advantages of accurate documentation and quality control in the presence of careful planning outweigh cost considerations by far.     

Mutations in renal cell carcinoma

Renal cell carcinoma (RCC) is a commonly diagnosed and histologically diverse urologic malignancy. Clear cell RCC (ccRCC) is by far the most common, followed by the papillary and chromophobe subtypes. Sarcomatoid differentiation is a morphologic change that can be seen in all subtypes that typically portends a poor prognosis. In the past, treatment options for RCC were limited to cytokine-based therapy with a high-toxicity profile and low response rate. An increased understanding of the molecular basis of RCC has led to substantial improvement in treatment options in the form of targeted therapy and immunotherapy. A significant early discovery in RCC was frequent inactivation of the Von Hippel Lindau gene in ccRCC, which ultimately led to the development of vascular endothelial growth factor and mammalian target of rapamycin inhibitors. Further genomic sequencing of ccRCC tumors has identified other common mutations including BAP-1, PBRM1, SETD2, and PIK3CA. Many recent studies have explored how these mutations can affect prognosis and response to treatment. Likewise, papillary RCC has also been studied at the molecular level, which has shown a high level of mutations in the MET gene; early clinical data suggest the utility of MET targeted therapy. Finally, regarding the rarer sarcomatoid tumors, mutations in TP53 and NF2 may be important to their development. As we continue to learn more about what drives RCC at the molecular level, treatment options for RCC patients are diversifying.     

Role of Leptin in Farm Animals: a Review

The discovery of hormone leptin has led to better understanding of the energy balance control. In addition to its effects on food intake and energy expenditure, leptin has now been implicated as a mediator of diverse physiological functions. Recently, leptin has been cloned in several domestic species. The sequence similarity suggests a common function or mechanism of this peptide hormone across species. Leptin receptors are expressed in most of tissues, which is consistent with the multiplicity of leptin functions. The main goal of this review was to summarize knowledge about effect of leptin on physiology of farm animals. Experiments point to a stimulatory action of leptin on growth hormone (GH) secretion, normal growth and development of the brain. Surprisingly, leptin is synthesized at a high rate in placenta and may function as a growth factor for fetus, signalling the nutritional status from the mother to her offspring. Maturation of reproductive system can be stimulated by leptin administration. Morphological and hormonal changes, consistent with a major role of leptin in the reproductive system, have also been described, including the stimulation of the release of luteinizing hormone (LH), follicle‐stimulating hormone (FSH) and prolactin. Leptin has a substantial effect on food intake and feeding behaviour in animals. Administration of leptin reduces food intake. Its level decrease within hours after initiation of fasting. Leptin also serves as a mediator of the adaption to fasting, and this role may be the primary function for which was the molecule evolved.     

Axial and random skin flaps

Skin replacement by using pedicle flaps has undergone a change in attitudes during the recent 20 years. The most important results have been collected on the basis of literary data which, in our opinion, served as bases for the changes most decisively influencing flap grafting. A better understanding of the structure and blood supply of the skin and of the subcutaneous tissues led to the discovery and extensive use of regional pedicle grafts. By differentiating between axial and random flaps, various types of flaps with different biological behaviours could be classified. In possession of our current knowledge the method using surgical tube flap is considered to be outdated not playing any more a role in circular reconstruction. The axial skin flap does not need delay procedures, since on transferring the flap its blood supply remains unchanged. Only the transplanted random flap should be delayed or if it is larger than usual, an independent random flap should be used. Reduction of the pedicle of the axial skin flap has led to the discovery of the island flap, which can also be applied for regional, but--by using the microvascular method--also for distant replacement. The conception of musculocutaneous skin flaps has been based on these experimental and clinical results.     

Translational systems biology using an agent-based approach for dynamic knowledge representation: An evolutionary paradigm for biomedical research

The greatest challenge facing the biomedical research community is the effective translation of basic mechanistic knowledge into clinically effective therapeutics. This challenge is most evident in attempts to understand and modulate "systems" processes/disorders, such as sepsis, cancer, and wound healing. Formulating an investigatory strategy for these issues requires the recognition that these are dynamic processes. Representation of the dynamic behavior of biological systems can aid in the investigation of complex pathophysiological processes by augmenting existing discovery procedures by integrating disparate information sources and knowledge. This approach is termed Translational Systems Biology. Focusing on the development of computational models capturing the behavior of mechanistic hypotheses provides a tool that bridges gaps in the understanding of a disease process by visualizing "thought experiments" to fill those gaps. Agent-based modeling is a computational method particularly well suited to the translation of mechanistic knowledge into a computational framework. Utilizing agent-based models as a means of dynamic hypothesis representation will be a vital means of describing, communicating, and integrating community-wide knowledge. The transparent representation of hypotheses in this dynamic fashion can form the basis of "knowledge ecologies," where selection between competing hypotheses will apply an evolutionary paradigm to the development of community knowledge.     

Biomechanics of the foot and ankle during gait

Running is a very popular activity, whether for competition or fitness. Breakdown injuries related to training errors, shoe wear, or change in intensity are frequently seen by the sports medicine physician. In order to understand and treat the pathologic situation, a fundamental understanding of the biomechanics of walking and running is essential. The treating practitioner must appreciate the distinct differences between the walking and running gait. These differences transcend a simple increase in speed of gait and include distinct changes in joint range of motion and electromyographic activity. Armed with this knowledge, the practitioner treating a breakdown injury can work to a solution based on scientific understanding rather than anecdotal information.     

Automated analysis of spines from confocal laser microscopy images: application to the discrimination of androgen and estrogen effects on spinogenesis

Accurate 3D determination of postsynaptic structures is essential to our understanding memory-related function and pathology in neurons. However, current methods of spine analysis require time-consuming and labor-intensive manual spine identification in large image data sets. Therefore, a realistic implementation of algorithm is necessary to replace manual identification. Here, we describe a new method for the automated detection of spines and dendrites based on analysis of geometrical features. Our "Spiso-3D" software carries out automated dendrite reconstruction and spine detection using both eigenvalue images and information of brightness, avoiding detection of pseudo-spines. To demonstrate the potential application of Spiso-3D automated analysis, we distinguished the rapid effects of androgen and estrogen on rapid modulation of spine head diameter in the hippocampus. These findings advance our understanding of neurotrophic function of brain sex steroids. Our method is expected to be valuable to analyze vast amounts of dendritic spines in neurons in the mammalian cerebral cortex.