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A manufacturing excellence team-based learning process for our foundation workers.

Foundation workers, people who do the daily tasks to serve customers, have long been ignored and misused in the productivity equation. Every person in a company can and must contribute to improved performance. Equipping out foundation workforce with knowledge and skills via a team-based education and training process is prerequisite to their effective engagement in the business management process.

Competency-Based Education↗

Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of alcohol consumption on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: There are 2 main options for those at risk for hypertension: avert the condition by limiting alcohol consumption or by using other nonpharmacologic methods, or maintain or increase the risk of hypertension by making no change in alcohol consumption. The options for those who already have hypertension include decreasing alcohol consumption or using another nonpharmacologic method to reduce hypertension; commencing, continuing or intensifying antihypertensive medication; or taking no action and remaining at increased risk of cardiovascular disease. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 with the terms ethyl alcohol and hypertension. Other relevant evidence was obtained from the reference lists of articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design, and graded according to the level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: A reduction in alcohol consumption from more than 2 standard drinks per day reduces the blood pressure of both hypertensive and normotensive people. The lowest overall mortality rates in observational studies were associated with drinking habits that were within these guidelines. Side effects and costs were not measured in any of the studies. RECOMMENDATIONS: (1) It is recommended that health care professionals determine how much alcohol their patients consume. (2) To reduce blood pressure in the population at large, it is recommended that alcohol consumption be in accordance with Canadian low-risk drinking guidelines (i.e., healthy adults who choose to drink should limit alcohol consumption to 2 or fewer standard drinks per day, with consumption not exceeding 14 standard drinks per week for men and 9 standard drinks per week for women). (3) Hypertensive patients should also be advised to limit alcohol consumption to the levels set out in the Canadian low-risk drinking guidelines. VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension and the previous recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control and the Canadian Hypertension Society. They have not been clinically tested. The low-risk drinking guidelines are those of the Addiction Research Foundation of Ontario and the Canadian Centre on Substance Abuse. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. The low-risk drinking guidelines have been endorsed by the College of Family Physicians of Canada and several provincial organizations.

Adult↗

Prevention of infective endocarditis associated with dental treatment and other medical interventions. National Heart Foundation.

The prevention of infective endocarditis is extremely important for people with valvular heart disease and other high-risk cardiac conditions. The following is the National Heart Foundation's updated recommendations for the prophylaxis of infective endocarditis. The recommended antibiotic regimens have changed considerably from the previous guidelines. In response to these guidelines, Pharmac has instituted a number of changes to the Schedule to reduce the barriers to prescribing the recommended drugs for this indication. Pharmac expects that the last of these drugs to be listed on the Schedule (cefuroxime axetil) will be in place by 1 October 1999. Prescriptions will need to be endorsed "prophylaxis for endocarditis". Therefore, any prescriber (doctor or dentist) will be able to prescribe the recommended drugs on an endorsed prescription but, until 1 October 1999, some of the drugs may not be fully subsidised. Pharmac will be informing prescribers of the details of these changes in the near future. The Ministry of Health has recently alerted practitioners to the possible risk of heart valve damage following the long-term use of weight-loss drugs fenfluramine (Ponderax) and dexfenfluramine (Adifax). All patients who have taken these drugs for longer than 3 months should have a clinical check and, if any abnormality is detected, should be referred to a cardiologist. If mild or greater aortic or mitral regurgitation is present, antibiotic prophylaxis against endocarditis is recommended.--Boyd A Swinburn, Medical Director, National Heart Foundation.

Adult↗

Conceptualization of anatomical spatial entities in the Digital Anatomist Foundational Model.

Anatomical spatial concepts are indispensable in educational and clinical discourse, yet a system for representing these concepts has not been proposed. Guided by explicit principles and definitions of the Digital Anatomist Foundational Model, we developed an ontology of spaces, surfaces, lines and points that are associated with anatomical structures. Ontologies for Anatomical Structure and Anatomical Spatial Entity were instantiated for the thorax, abdomen, pelvis and perineum. Representing the concepts in--part of--hierarchies as well, provided formative evaluation of the classification. We invite empirical evaluation of the Foundational Model through its use for educational and clinical applications.

Anatomy↗

Semi-automatic scene generation using the Digital Anatomist Foundational Model.

A recent survey shows that a major impediment to more widespread use of computers in anatomy education is the inability to directly manipulate 3-D models, and to relate these to corresponding textual information. In the University of Washington Digital Anatomist Project we have developed a prototype Web-based scene generation program that combines the symbolic Foundational Model of Anatomy with 3-D models. A Web user can browse the Foundational Model (FM), then click to request that a 3-D scene be created of an object and its parts or branches. The scene is rendered by a graphics server, and a snapshot is sent to the Web client. The user can then manipulate the scene, adding new structures, deleting structures, rotating the scene, zooming, and saving the scene as a VRML file. Applications such as this, when fully realized with fast rendering and more anatomical content, have the potential to significantly change the way computers are used in anatomy education.

Anatomy↗

Talbot Hospice Foundation. A successful community endeavor.

Since it opened its doors 20 years ago, the Talbot Hospice Foundation, located in Talbot County, Maryland, has grown to be one of the most highly respected service organizations in the county. A professional, non-medical staff of about five full-time employees manages some 800 volunteers who offer free hospice services to anyone in the community. It is dedicated to the concept that dying is not just a medical event, and that trained community lay people can play a significant role in providing practical and emotional support to their neighbors. The Foundation is supported completely by donations and receives no reimbursement from Medicare or other insurers.

Bereavement↗

DNA evidence will be admissible if the proper foundation is laid: advice for a forensic medicine expert.

The use and advance of DNA evidence in courts of law has mushroomed in the last few years to the point that it can almost be assumed that DNA evidence will be admitted if the proper foundation is laid. While a few basic principles are necessary for admissibility in all cases, each case stands on its own and depends upon its own fact situation and evidence to determine admissibility. The more advanced the science and specificity in each case, the easier for admissibility. To challenge admissibility, a lawyer has to challenge the foundation laid for the evidence. It only stands to reason that if you cannot attack the science, you have to attack the scientist, ie, the expert witness. This presentation is based upon the author's six years as a prosecutor and almost 23 years as a judge. It will give attendees some helpful advice on the purpose of an expert witness, how to be qualified as an expert witness, and some dos and don'ts, as well as hints as to how to become a better expert witness.

DNA Fingerprinting↗

[Experience of pediatric cardiac transplantation in the Cleveland Clinic Foundation].

Brain death was not approved on the patients under 6 years old in Japan now. It is impossible to perform cardiac transplantation on the small children. Between October 1997 and November 1998, cardiac transplantation was performed by pediatric cardiac surgical team in 11 children at the Cleveland Clinic Foundation. 7 patients were cardiomyopathy under 18 years old and 4 were congenital heart diseases in all ages. 8 were status 1 and 2 were requiring extracorporeal membrane support. Bicaval technique was exclusively utilized. There was one early death due to multiple organ failure. 10 patients underwent myocardial biopsy and the half of them had more than 3 A rejection. These acute rejections were controlled with steroid pulse therapy and OKT-3 treatment. We took part in the management of patients with pediatric cardiac transplantation at the Cleveland Clinic Foundation. Practical patient cares were described in this report.

Adolescent↗

The chair of dermatovenerology at Zagreb School of Medicine. On occasion of the 80th anniversary of its foundation (1921-2001).

The development of dermatovenerology in Croatia parallelled more or less this process in other parts of the Austro-Hungarian Monarchy throughout the 19th century. The foundation of the first specialized hospitals as well as the establishment of dermatovenerological units and their transformation into academic departments and chairs in the early 20th century was a slow growth provoked by the spread of syphilis and Skrljevo disease. A group of Zagreb physicians were instrumental in this regard. Based on archival sources, this paper illustrates the chronology and circumstances of the foundation of the first chair, on the occasion of its 80th anniversary.

Croatia↗

Building the legal foundation for an effective public health system.

Work has been underway nationally since the mid-1990s to equip state and community public health systems with the infrastructure needed to perform essential public health services. Key components of that infrastructure are a competent workforce, information and communication systems, health department and laboratory capacity, and legal authorities. As part of this transformative work, standards and assessment tools have been developed to measure the capacity and actual performance of public health systems. In addition, a number of states have examined the legal foundation for public health services and have revised and updated those authorities to improve their system's capacity in the context of evolving health challenges. Among those states are Nebraska, New Jersey, and Texas, all of which, beginning in 1999, have adopted dynamic new approaches to aligning public health's legal authorities with new missions and expectations for performance and accountability. This article describes the approaches that these three states have taken to strengthen their legal foundation for public health practice, to illuminate the perspectives legislators and health officials bring to the process, and to give decision makers in other states practical insight into the potential benefits of reviewing and restructuring public health's legal authorities. The underlying stimuli for the states' initiatives differed significantly, yet shared an important, common core. What they held in common was concern that outdated elements of the public health system and infrastructure hindrered delivery of essential public health services at the community level. Where they differed was in the type of tools they found most suitable for the job of rejuvenating those structures. The approaches taken, and the policy tools selected, reflect the unique health needs of each state, establish relationships among state and community health authorities and agencies, and provide guidance by elected and appointed policy makers. Each state continues to refine its approach as it gains experience with the new authorities.

Community Health Services↗

[Epidemiologic foundation for population studies of program MZ-XVII].

Epidemiological foundation included: aim of studies, knowledge about epidemiology of thyroid disorders in Poland, evaluation of radioiodine dose accumulated in thyroids of inhabitants of different age living in different par of Poland, information about relative diet iodine deficiency in different parts of Poland and identification of research teams (manpower) capable to carry on population studies. The final identification of epidemiological foundation was proceeded by pilot studies performed in 4 different regions of Poland. Finally it was decided that population studies would be performed in so called Regions of 6 different University Medical Schools (Białystok, Kraków, Lódź, Poznań, Szczecin, Wrocław). The sample will be selected randomly on the base of information from the voting lists (random selection of vovoidoship, then towns and villages, then streets and number of houses, then number of flats. All living in selected flat or house during Czernobyl accident and born between January 1974 and December 1985 (children) and between January 1926 and December 1973 (adults) will be considered "the sample". In all cases the sample will be examined by means of unified questionnaire and protocol of medical and laboratory examination. The same kits (of the same producers) will be used to evaluate serum TSH, T4, T3 and thyroid autoantibodies. The data obtained will be evaluated by unified computerized system. Separate studies involved the sample of newborns exposed to radioiodine during last trimester of pregnancy, found to be euthyroid and given potassium iodide in first days of life. Separate system was also used to investigate effect of radioiodine and of prophylactic dose of potassium iodide in those with past history of thyroid disorders.

Adult↗

[The neuronal foundations of human violence].

AIMS: The purpose of this work was to collect and integrate the information available from different studies on the neuronal foundations of human violence and to highlight the most recent fundamental contributions made by neuroimaging techniques. DEVELOPMENT: First, we offer a general view of the studies carried out in animals and then a description of the first approximations to the study of this subject. Following that, some of the most recent neuroimaging studies are outlined and the relationship between cerebral lateralisation and aggression is analysed. Finally, we consider the role played by the autonomous nervous system and several explanatory theoretical models are put forward. CONCLUSIONS: Broadly speaking, research conducted in animals and in humans coincides to a large extent. Although the first approximations to the study of aggression and violence offered a large amount of information about the neuronal foundations of these kinds of conduct, the most recent studies using neuroimaging have meant an important step forward in this field. These studies have shown that different samples of violent subjects present a number of structural and functional anomalies in the temporal and frontal lobes, which differ according to the type of aggression. It has also been suggested that there could be a higher rate of antisocial conduct among left-handed individuals. In addition, for several different psychophysiological variables, such as electrodermal activity and heart rate, there is a lower level and a lower response to stimulation, and a number of different integrating theoretical models have been proposed in an attempt to account for aggression and violence in humans.

Aggression↗

Evolution of a Foundational Model of Physiology: symbolic representation for functional bioinformatics.

We describe the need for a Foundational Model of Physiology (FMP) as a reference ontology for "functional bioinformatics". The FMP is intended to support symbolic lookup, logical inference and mathematical analysis by integrating descriptive, qualitative and quantitative functional knowledge. The FMP will serve as a symbolic representation of biological functions initially pertaining to human physiology and ultimately extensible to other species. We describe the evolving architecture of the FMP, which is based on the ontological principles of the BioD biological description language and the Foundational Model of Anatomy (FMA).

Computational Biology↗

[Steadiness and progress. Medicine in Würzburg in the mirror of the centuries - a contribution to the foundation of the University of Würzburg 600 years ago].

In the year 1402 one of the first German universities was founded by bishop Johann von Egloffstein, but it had last in its full composition for only a few decades. Nevertheless, the 600th anniversary has a great importance, because in the 16th century, during the second foundation, there was an adequate tradition of university in Würzburg to lean on and go back to.Although, in a medical-history view, in 1402 this university had been without a greater importance, the medicine in Würzburg in the Middle Ages and the Early modern Times had been on a high level, what is shown by representatives like Ortolf von Baierland (13th century) and Berthold Blumentrost (14th century) or by documents like the 'Würzburger Wundarznei' at the end of the 15th century and the 'Nüttzlicher Bericht' by Walther Hermann Ryff, printed 1548 in Würzburg, as one of the first dental mongraphies.A lasting success was finally the university opened in the year 1582. In 1575/6 bishop Julius Echter von Mespelbrunn had reached, using the traditions of the university of 1402, a new privilege by the pope and the emperor. The medical faculty which was functional deeply connected with the Juliusspital as a kind of hospital right from the beginning, was determined by Wilhelm Schefferlein, Gottfriedt van der Steighe and Adriaen van Roomen. In the beginning of the 17th century the medical faculty turned pale, but two representatives of the philosophic faculty, Athanasius Kircher and Caspar Schott, accomplished remarkable outcomes in medical fields. Heavily stricken by the Thirty Years' War the medicine at the University of Würzburg was changed by the prince-bishops to the model of the University of Leiden, in order to improve the feeble position of the medical faculty. After not being successful in the beginning, the foundation of the blossom and of its worldwide importance had been laid in the last third of the 18th century. Karl Kaspar Siebold had, with the help of some of his fellows, students, and his family (like his sons Johann Barthel and Adadam Elias von Siebold), reorganized the medical faculty, which had brought her in the byname 'Academia Sieboldiana". In the beginning of the 19th century the recovery of the faculty moved on more and more: OUtstanding representatives like Ignaz Döllinger, Johann Lukas Schoenlein and Franz von Rinecker founded by their great medical-scientific and organizational achievements, the high reputation of the medical faculty of Würzburg. Especially in the second half of the 19th century the University of Würzburg was in a leading position in a lot of traditional disciplines and in the developing and establishing of new medical fields, shown by names like Franz Kiwisch Ritter von Rotterau and Friedrich Wilhelm Scanzoni von Lichtenfels, Cajetan von Textor and Wenzel von Linhart, Rudolf Virchow, Albert Kölliker, Franz von Leydig, Carl Joseph von Ringelmann, Johann Joseph von Scherer, Johann Georg Heine, Adolf Fick or Carl Gerhardt.

Germany↗

Understanding the foundation: the state of generalist search education in library schools as related to the needs of expert searchers in medical libraries.

PURPOSE: The paper explores the current state of generalist search education in library schools and considers that foundation in respect to the Medical Library Association's statement on expert searching. SETTING/SUBJECTS: Syllabi from courses with significant searching components were examined from ten of the top library schools, as determined by the U.S. News & World Report rankings. METHODOLOGY: Mixed methods were used, but primarily quantitative bibliometric methods were used. RESULTS: The educational focus in these searching components was on understanding the generalist searching resources and typical users and on performing a reflective search through application of search strategies, controlled vocabulary, and logic appropriate to the search tool. There is a growing emphasis on Web-based search tools and a movement away from traditional set-based searching and toward free-text search strategies. While a core set of authors is used in these courses, no core set of readings is used. DISCUSSION/CONCLUSION: While library schools provide a strong foundation, future medical librarians still need to take courses that introduce them to the resources, settings, and users associated with medical libraries. In addition, as more emphasis is placed on Web-based search tools and free-text searching, instructors of the specialist medical informatics courses will need to focus on teaching traditional search methods appropriate for common tools in the medical domain.

Curriculum↗

Steps to a HealthierUS Cooperative Agreement Program: foundational elements for program evaluation planning, implementation, and use of findings.

The Steps to a HealthierUS Cooperative Agreement Program (Steps Program) enables funded communities to implement chronic disease prevention and health promotion efforts to reduce the burden of diabetes, obesity, asthma, and related risk factors. At both the national and community levels, investment in surveillance and program evaluation is substantial. Public health practitioners engaged in program evaluation planning often identify desired outcomes, related indicators, and data collection methods but may pay only limited attention to an overarching vision for program evaluation among participating sites. We developed a set of foundational elements to provide a vision of program evaluation that informs the technical decisions made throughout the evaluation process. Given the diversity of activities across the Steps Program and the need for coordination between national- and community-level evaluation efforts, our recommendations to guide program evaluation practice are explicit yet leave room for site-specific context and needs. Staff across the Steps Program must consider these foundational elements to prepare a formal plan for program evaluation. Attention to each element moves the Steps Program closer to well-designed and complementary plans for program evaluation at the national, state, and community levels.

Benchmarking↗

[The scope of the foundation of the "Victor Babeş" Institute for the development of public health in Romania].

Presentation of the unpublished documents, deposited with the State Archives Dept. in bucharest, referring to the foundation of "V. Babeş" Institute enriches the specialty literature, vouching the medical-historic significance of the very moment it was founded. It is through the foundation of the Institute of Pathology and Bacteriology in 1887 under the leadership of prof. dr. V. Babeş, that new perspectives are opening towards a bright tradition of he Romanian medicine regarding public health development in Romania. Major tool in researching and solving of some main preventive medical public health questions, the "V. Babeş" Institute represented both a true center for training some outstanding personalities of the Romanian medicine within the field of the pathologic and microbiologic anatomy, and a model of organizing and developing some new research institutes, in the medical and pharmaceutical field.

Academies and Institutes↗

Optometric expert testimony: foundation for the horizontal gaze nystagmus test.

The courts require that a foundation be laid for admission of the Horizontal Gaze Nystagmus Test into evidence. Some courts will not accept peace officers as experts, but will instead require that an optometrist provide the necessary foundation. The optometrist will be expected to establish the correlation between nystagmus and alcohol consumption, and to educate the court on the desirability of the test for use by the law enforcement community. The optometrist should prepare prior to trial to assist the prosecutor in achieving these goals.

Alcoholic Intoxication↗