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PubMed1993

A framework for a process-driven common foundation programme for graduates.

This paper discusses some of the problems encountered in writing a shortened Common Foundation Programme in nursing for graduates, and outlines a course which takes as its starting point the particular educational needs and requirements of the student group. Thus, the first question to be addressed by the curriculum writers when designing the course was "How can we teach these students?", rather than "What can we teach them?". The resulting process-driven course is heavily influenced by the student-centred philosophy of Carl Rogers, and utilizes a variety of large- and small-group methods to facilitate the students in gradually taking responsibility for, and making decisions about, their learning needs. The paper continues with some strategies for ensuring a smooth transition from a tutor-led, syllabus-driven start to the course, to a student-led, process-driven finish for both the theoretical and clinical components, and for the assessment schedule. Finally, a student-centred approach to evaluation is briefly outlined, and the paper concludes by suggesting that the principles employed in designing and implementing this course could be successfully transferred to a wide variety of other educational settings.

Curriculum↗
PubMed1993

Alternatives to posterior complete crowns: integrating foundations with cuspal protection.

A common approach for restoring compromised posterior teeth is to reconstruct the missing anatomic crown with a dental restorative material and prepare the remaining tooth structure for an artificial veneer. Because this procedure is also compounded by designing subgingival finish lines for tooth preparations, a conservative approach for the fabrication of one-piece castings is suggested that incorporates both foundations and cuspal protection, with finish lines prepared above the gingival crest. Patient selection, advantages, disadvantages, and armamentarium are discussed.

Acrylic Resins↗
PubMed1981

The foundation of two distinct cell lineages within the mouse morula.

The division of single cells, isolated from an 8-cell mouse embryo, to give 2 x 1/16 cells has been studied by sampling cells for analysis at defined stages during and after the division. Cells were analyzed for evidence of polarity in their surface organization as assessed by fluorescent ligand binding and distribution of microvilli. Individual 1/8 cells are polarized. At division, most (82%) divide such that both the pole of ligand binding and the pole of microvilli are distributed to only one of the two daughter cells. A couplet is thereby formed with a large polar cell and a small apolar cell. Some 1/8 cells divide through the pole, generating a couplet of two polar cells, the poles being contiguous at the midbody. Elements of the surface polarity observed in the 1/8 cells can be found at all stages throughout division. Analysis of couplets of cells derived from newly formed 16-cell morulae also reveals that most consist of a polar:apolar pair and some consist of a polar:polar couplet in which the poles are contiguous at the midbody. The results indicate that two distinct cell populations are generated at division. These cells are known to occupy different positions within the morula, the polar cells being peripheral and the apolar cells being central. Since peripheral and central cells give rise to trophectoderm and inner cell mass in the blastocyst, we therefore suggest that the foundation of the trophectoderm and inner cell mass lineages may occur by a process of differential inheritance. This conclusion supports the recently proposed polarization hypothesis, which is discussed.

Animals↗
PubMed1993

From common foundation programme to branch: recognising a status transition.

The transition from the Common Foundation Programme to the Branch programmes in the Diploma in Nursing Studies course (Project 2000) is described as a major status passage. While there are many positive aspects to this transition, particular areas of concern are highlighted in the hope that these will be addressed.

Clinical Competence↗
PubMed1994

A shortened common foundation programme for graduates--the students' experience of student-centred learning.

This paper examines the students' experience of student-centred teaching and learning strategies within a shortened Common Foundation Programme (CFP) for Graduates. The perceptions of 'student-centreness' and its use as experienced by the students is addressed using material generated from on-going research using new-paradigm methodology within an action research framework. Graduates enter nurse training from the background of a subject area and possessing the academic skills required to access and assimilate knowledge effectively. These qualities underpin the design of this course, which concentrates on enabling the students to achieve the learning outcomes of the CFP within a flexible structure concentrating on skill acquisition and reflective practice according to the needs of the individual. The differing expectations of the course, the need for clear, externally set objectives, and the question of the ability of the students to self-motivate arise as the pertinent issues from the evaluation. These are discussed with reference to the students perceived needs, levels of achievement and differing learning styles. The author concludes that student-centred methods are appropriate for nurse education, but that these have significant implications for course design, course content and staff development, if the course is to satisfy both students and teachers.

Curriculum↗
PubMed1994

Life in the universe: foundation for exciting multidisciplinary science activities for middle and elementary school classes.

Young students find extra-terrestrial life one of the most intriguing of all topics. A project funded by the National Science Foundation and NASA, and administered by the SETI Institute, is underway to devise science lessons for grades 3-9 that draw upon this fascination. The lessons are designed by teachers and persons with long experience at curriculum design, tested in classrooms, revised and retested. Six guides, each containing some 6-10 science lessons, will be finished by summer, 1994. The theme Life in the Universe lends itself naturally to integrated treatment of facts and concepts from many scientific disciplines. The lessons for two completed guides span the origin of planet systems, evolution of complex life, chemical makeup of life, astronomy, spectroscopy, continental drift, mathematics and SETI (Search for Extra-Terrestrial Intelligence). All lessons are hands-on, interesting, and successful.

Adolescent↗
PubMed1994

The cultural and philosophical foundations of normative medical ethics.

Thirty years ago, the idea that culture and philosophy could provide a foundation for normative medical ethics was more easily entertained than it is today when the very notion of a norm, whether culturally, philosophically or ethically derived, is in itself a problem. In large measure this comes from our contemporary embrace of cultural and philosophical pluralism and an increasing tendency to exchange the difficult belief in abstract and universally applicable norms for the more accessible notion that ethical values are cultural and relative derivatives. Despite this, in the face of the unprecedented ethical dilemmas presented by modern medicine, we have attempted to apply traditional ethical norms and analysis to modern medicine to establish a consensus for its right practice. Unfortunately, the attempt has not been successful, so that wherever we turn we find that ethical problems in medicine remain intractable and unresolved. That, in turn, has prompted a certain scepticism about the efficacy of ethics in medicine. In order to understand why we have reached this impasse, it is essential to realize that we have seriously underestimated the way science and technology have informed and, as a consequence, transformed the practice of medicine. Contributing to this, our tendency to think of technology simply as a way of doing things has blinded us to the fact that it is more fundamentally a way of thinking, knowing and valuing.(ABSTRACT TRUNCATED AT 250 WORDS)

Cultural Characteristics↗
PubMed1996

Origins of the Children's Vaccine Initiative: the intellectual foundations.

The Children's Vaccine Initiative (CVI) was created as an attempt to revolutionize the way vaccines are developed for the developing world. It was formed, in part, out of optimism that the scientific advances of the biotechnology revolution could be harnessed to create new and improved vaccines, and in part out of fear that the health needs, of the developing world would be ignored by the increasingly profit-oriented vaccine industry that gave low priority to countries lacking a hard currency market. The CVI was founded in 1990 1991 but its intellectual roots came out of ten years of discussion and agitation about the opportunities and dangers that faced the international health community. The article looks at the indispensable role played by pivotal individuals (William Foege of the Task Force for Child Survival. Kenneth Warren and Scott Halstead of the Rockefeller Foundation. James Grant and James Sherry of UNICEF and D.A. Henderson of Johns Hopkins University) without whom the CVI would not have come into existence. While these individuals worked within the confines created by the large social economic political changes that shaped the 1980s, their personal goals, often targeted at fairly limited objectives, were crucial in determining the final, rather unlikely, outcome. The role of both individual choice and serendipity in determining major policy decisions are often under-estimated in the social science literature.

Child↗
PubMed1991

Comparative gene frequencies between the Canchim breed of Brazil beef cattle and their foundation breeds.

1. Four hundred and seventy-five animals of the Canchim breed from EMBRAPA-UEPAE de Sao Carlos were analyzed by starch gel electrophoresis. 2. Albumin, amylase, transferrins, carbonic anhydrase, hemoglobin and nucleoside phosphorylase gene frequencies were compared with the same frequencies in the foundation breeds, Charolais and Indubrazil. 3. Theoretical values obtained considering the 5/8 European, 3/8 Zebu admixture are near the means calculated from our results and data from literature.

Amylases↗
PubMed1991

Evolutionary and biological foundations of malignant tumors.

A hypothesis on evolutionary and biological foundations of malignant tumors is developed. It is suggested that malignant transformation is an inevitable facet of the process of senescence, consequent on the accumulation of somatic mutations. The rate of mutation accumulation is determined by an interplay of internal damage to DNA due to metabolic production of oxidative radicals, and effectiveness of DNA-repair mechanisms. The extent of production of oxidative radicals depends on the metabolism intensity which is determined genetically, and is related to the timing of sexual maturation. The timing of sexual maturation depends on the hazard to life of species members--in species exposed to more dangers, reproduction must be set to occur earlier, at the price of having less effective DNA-repair mechanisms. Target genes for malignant transformation are cellular oncogenes. The deaths due to malignant tumors may thus be considered 'one of the mechanisms of death due to aging'. Environmental carcinogens will only modify the incidence of a small fraction of certain tumor types, as other environmental factors modify the death incidence from other causes.

Biological Evolution↗
PubMed1990

Continuing care in a medical center: the Cleveland Clinic Foundation Palliative Care Service.

Approximately 500,000 people die of cancer in the United States each year. Most attention has focused on curative approaches to cancer management. Despite the fact that 80% of persons with advanced cancer suffer from chronic pain and an equal number have a major problem with anorexia and weight loss, little systematic evaluation of these problems has been conducted, although they have a high medical, psychological, and socioeconomic impact. The need for a palliative care service (PCS) at the Cleveland Clinic Foundation was originally identified by physicians within the Department of Hematology and Medical Oncology. During 1987, a pilot study was conducted to evaluate the service, define its potential patient base, and assess its impact on patient care. It is astonishing that so little attention has been paid to this area by the major institutions and organizations involved in care of patients with advanced cancer, despite the hundreds of thousands dying of the disease each year. A dedicated palliative care service would therefore seem appropriate in any major medical institution dealing with significant numbers of cancer patients. It also seems appropriate that the provision of a PCS should be part of the requirements for a comprehensive cancer center, if a center is to claim to provide the entire spectrum of services, from diagnosis until death.

Cancer Care Facilities↗
PubMed2005

The American Association of Obstetricians and Gynecologists Foundation Scholars Program: additional data on research-related outcomes.

OBJECTIVE: The purpose of this study was to ascertain the progress of recipients of research training in obstetrics and gynecology in establishing an active research career in academic medicine. STUDY DESIGN: Existing data were used to examine the extent to which 41 individuals who had received American Association of Obstetricians and Gynecologists Foundation (AAOGF) fellowships had achieved outcomes indicative of a career in academic medicine. Outcomes included employment as a full-time faculty member, receipt of NIH research funding, number of publications, the types of journals in which these articles had appeared, and the type of research (eg, basic vs patient-oriented). RESULTS: Among individuals who were awarded their fellowship between 1984 and 1997, 88% held faculty appointments, and 40% of these positions were in institutions that were more research-intensive that the medical degree-granting institutions of fellows. Slightly more than half of former fellows had successfully competed for NIH research funding, with 22% being awarded at least one R01 grant. Overall, fellows produced a total of 878 articles, one third of which appeared in clinical journals, 18% were in basic biomedical research journals, and 48% were in journals that published both types of research. CONCLUSION: Previous AAOGF scholars have actively pursued research careers in academic obstetrics and gynecology. Their performance compares favorably with those of individuals receiving research training in other clinical specialties. A more complete understanding of their performance and the value added by the program would be possible if a core set of data on outcomes were available from other types of training efforts in both obstetrics and gynecology and other relevant disciplines.

Biomedical Research↗
PubMed2005

From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine--Part I: conceptual, moral, and legal foundations.

Respect for patient privacy and confidentiality is an ancient and a contemporary professional responsibility of physicians. Carrying out this responsibility may be more challenging and more important in the emergency department than in many other clinical settings. Part I of this 2-part article outlines the basic concepts of privacy and confidentiality, reviews the moral and legal foundations and limits of these concepts, and highlights the new federal privacy regulations implemented under the Health Insurance Portability and Accountability Act of 1996. Part II of the article examines specific privacy and confidentiality issues commonly encountered in the ED.

Codes of Ethics↗
PubMed2006

From vagueness in medical thought to the foundations of fuzzy reasoning in medical diagnosis.

OBJECTIVE: This article delineates a relatively unknown path in the history of medical philosophy and medical diagnosis. It is concerned with the phenomenon of vagueness in the physician's "style of thinking" and with the use of fuzzy sets, systems, and relations with a view to create a model of such reasoning when physicians make a diagnosis. It represents specific features of medical ways of thinking that were mentioned by the Polish physician and philosopher Ludwik Fleck in 1926. The paper links Lotfi Zadeh's work on system theory before the age of fuzzy sets with system-theory concepts in medical philosophy that were introduced by the philosopher Mario Bunge, and with the fuzzy-theoretical analysis of the notions of health, illness, and disease by the Iranian-German physician and philosopher Kazem Sadegh-Zadeh. MATERIAL: Some proposals to apply fuzzy sets in medicine were based on a suggestion made by Zadeh: symptoms and diseases are fuzzy in nature and fuzzy sets are feasible to represent these entity classes of medical knowledge. Yet other attempts to use fuzzy sets in medicine were self-contained. The use of this approach contributed to medical decision-making and the development of computer-assisted diagnosis in medicine. CONCLUSION: With regard to medical philosophy, decision-making, and diagnosis; the framework of fuzzy sets, systems, and relations is very useful to deal with the absence of sharp boundaries of the sets of symptoms, diagnoses, and phenomena of diseases. The foundations of reasoning and computer assistance in medicine were the result of a rapid accumulation of data from medical research. This explosion of knowledge in medicine gave rise to the speculation that computers could be used for the medical diagnosis. Medicine became, to a certain extent, a quantitative science. In the second half of the 20th century medical knowledge started to be stored in computer systems. To assist physicians in medical decision-making and patient care, medical expert systems using the theory of fuzzy sets and relations (such as the Viennese "fuzzy version" of the Computer-Assisted Diagnostic System, CADIAG, which was developed at the end of the 1970s) were constructed. The development of fuzzy relations in medicine and their application in computer-assisted diagnosis show that this fuzzy approach is a framework to deal with the "fuzzy mode of thinking" in medicine.

Diagnosis↗
PubMed2005

A seven-year epidemiology study of 12,381 admitted burn patients in Taiwan--using the Internet registration system of the Childhood Burn Foundation.

This study described the epidemiological characteristics of the 12,381 admitted burn patients in Taiwan. The data was from 43 contracted hospitals of the Childhood Burn Foundation, in the years from 1997 to 2003. This descriptive study included 8172 males and 4206 females, with a male to female ratio of 1.94 and an average age of 29.3 years. There were 3993 (33.4%) patients under 18 years old; and 26.4% of the patients were children under 7 years old. First and second years of life were the peak of incidence. The mean extent of burn was 14.0% total body surface area with 950 patients (7.7%) suffering from a burn extent >/=40% TBSA. Scalds resulted in 5085 admissions (43.2%) and flame burns accounted for 3825 admissions (32.5%). In patient group under 18 years old, 76.8% were scald burn and 14.1% were flame burn. The majority of the burn injuries (53.3%) occurred in the dwelling place; 1122 patients had inhalation injuries and required admission to the burn center for pulmonary support. In addition, suicide attempts were recorded in 2.4% (300 cases) of all burn patients with a mean burn size of 40.7% total body surface and mortality rate of 29.3%. The overall mortality rate is 381 out of 12,381 patients (3.1%). The LA(50) was around 80% TBSA. The significant effects of risk factors, such as old age, large burn extent, combined inhalation injury and suicide were demonstrated. Adequate first aid by water cooling affected the outcome of the patient group with burn extent less than 30% TBSA, which was shown by the decrease of length of stay. These results showed some unique distributions that reflected certain socio-economic and cultural background of Taiwan.

Accidents, Home↗
PubMed2005

Law and order: assessing and enforcing compliance with ontological modeling principles in the Foundational Model of Anatomy.

The objective of this study is to provide an operational definition of principles with which well-formed ontologies should comply. We define 15 such principles, related to classification (e.g., no hierarchical cycles are allowed; concepts have a reasonable number of children), incompatible relationships (e.g., two concepts cannot stand both in a taxonomic and partitive relation), dependence among concepts, and the co-dependence of equivalent sets of relations. Implicit relations--embedded in concept names or inferred from a combination of explicit relations--are used in this process in addition to the relations explicitly represented. As a case study, we investigate the degree to which the Foundational Model of Anatomy (FMA)--a large ontology of anatomy--complies with these 15 principles. The FMA succeeds in complying with all the principles: totally with one and mostly with the others. Reasons for non-compliance are analyzed and suggestions are made for implementing effective enforcement mechanisms in ontology development environments. The limitations of this study are also discussed.

Anatomy↗
PubMed2026

Antibody-drug conjugates in selected solid tumours: a position statement update based on findings from the third workshop held by the ETOP IBCSG Partners Foundation.

The European Thoracic Oncology Platform (ETOP) International Breast Cancer Study Group (IBCSG) Partners Foundation initiated a series of workshops for experts to review current evidence and offer recommendations to guide future antibody-drug conjugate (ADC) research. Here, we summarise key findings from the third workshop, which included experts in various solid tumours, basic/translational research scientists and pharmaceutical industry representatives. Recent positive phase III trial data have further incorporated ADCs into the standard of care [e.g. lung: sacituzumab tirumotecan; breast: trastuzumab deruxtecan (T-DXd), sacituzumab govitecan, datopotamab deruxtecan; muscle-invasive bladder cancer: enfortumab vedotin; ovarian cancer: mirvetuximab soravastine; cervical cancer: tisotumab vedotin]. Thus, research priorities must be tailored according to tumour type, potentially focussing initially on settings where ADCs could replace chemotherapy. Many phase III ADC trials have been initiated based on positive phase I data and although these trials are larger than those conducted historically, prespecified criteria (e.g. patient numbers and magnitude of efficacy) should be met to justify proceeding directly to phase III. Importantly, although several ADCs have been successfully developed without mandatory biomarker selection, biomarker-driven ADC development enables rational patient selection, as illustrated by multiple ADCs (e.g. T-DXd, mirvetuximab soravtansine and telisotuzumab vedotin). The identification, development and validation of predictive biomarkers are therefore essential, particularly given several critical nuances, including the algorithms used to assess biomarker status and the type of specimen analysed, all of which may be influenced by temporal and spatial heterogeneity. Additional ADC research priorities include the optimisation of ADC constructs to enhance efficacy/tolerability and the identification of reliable ADC targets, including work to elucidate attributes of already-identified targets. Finally, considering the vast amount of ADC-related data being generated, artificial intelligence could be leveraged to analyse combined datasets and generate composite biomarkers, including tumour histology, optimal target expression thresholds, molecular alterations and activated pathways affecting payload activity and target function, to accelerate research.

Humans↗
PubMed2003

A reference ontology for biomedical informatics: the Foundational Model of Anatomy.

The Foundational Model of Anatomy (FMA), initially developed as an enhancement of the anatomical content of UMLS, is a domain ontology of the concepts and relationships that pertain to the structural organization of the human body. It encompasses the material objects from the molecular to the macroscopic levels that constitute the body and associates with them non-material entities (spaces, surfaces, lines, and points) required for describing structural relationships. The disciplined modeling approach employed for the development of the FMA relies on a set of declared principles, high level schemes, Aristotelian definitions and a frame-based authoring environment. We propose the FMA as a reference ontology in biomedical informatics for correlating different views of anatomy, aligning existing and emerging ontologies in bioinformatics ontologies and providing a structure-based template for representing biological functions.

Abstracting and Indexing↗