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Effective Strategy (effective + strategy)
Selected AbstractsEffective Strategies for Implementing a Multicenter International Clinical TrialJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2008Leanne M. Aitken Purpose:International collaboration in research is essential in order to improve worldwide health. The purpose of this paper is to describe strategies used to administer an international multicenter trial to assess the effectiveness of a nursing educational intervention. Design:The study design was a two-group randomized multicenter international clinical trial conducted to determine whether a brief education and counselling intervention delivered by a nurse could reduce prehospital delay in the event of symptoms suggestive of acute coronary syndrome (ACS) in patients previously diagnosed with cardiovascular disease. Method:A flexible but well-defined project structure showed intervention consistency in five sites among three countries and included experienced project coordinators, multidimensional communication methods, strategies to optimize intervention fidelity, site-specific recruitment and retention techniques, centralized data management, and consideration of ethical and budgetary requirements. Findings:Staff at five sites enrolled 3,522 participants from three countries and achieved 80% follow-up obtained at both 12 and 24 months. Conclusion:Multidimensional approaches to maintain consistency across study sites, while allowing flexibility to meet local expectations and needs, contributed to the success of this trial. Clinical Relevance:In order to support appropriate development of an evidence base for practice, nursing interventions should be tested in multiple settings. A range of strategies is described in this paper that proved effective in conducting a multicenter international trial. [source] Attachment-Focused Parenting: Effective Strategies to Care for ChildrenCHILD AND ADOLESCENT MENTAL HEALTH, Issue 2 2010Jane Roberts No abstract is available for this article. [source] Photoluminescent Fibers: Anisotropic Self-Assembly of Photoluminescent Oligo(p -Phenylenevinylene) Derivatives in Liquid Crystals: An Effective Strategy for the Macroscopic Alignment of , -Gels (Adv. Mater.ADVANCED MATERIALS, Issue 40 200940/2009) Takashi Kato, Ayyappanpillai Ajayaghosh, and co-workers report on p. 4029 that aligned photoluminescent ,-conjugated fibers are formed through anisotropic self-assembly of oligo(p -phenylenevinylene) gelators in smectic and nematic liquid crystals. The aligned fibers exhibit polarized photoluminescent properties. These self-assembled liquid-crystalline composites may be applicable to new types of electro-optical and photonic materials. [source] Anisotropic Self-Assembly of Photoluminescent Oligo(p -Phenylenevinylene) Derivatives in Liquid Crystals: An Effective Strategy for the Macroscopic Alignment of , -GelsADVANCED MATERIALS, Issue 40 2009Yuki Hirai Aligned photoluminescent fibers are formed by the self assembly of an oligo-(p-phenylenevinylene) derivative (OPV) in oriented liquid crystals (see figure). The aligned fibers of OPV show polarized yellow emission in the direction of the long axis of fibers. New types of electro-optical and photonic systems can be visualized in the future as the polarized luminescence of these fibers is combined with the dynamic properties of the liquid crystals. [source] Conservative Management of Vestibular Schwannomas: An Effective Strategy,THE LARYNGOSCOPE, Issue 6 2008Gian Gaetano Ferri MD Abstract Objectives: Stimulated by the availability of a larger sample of patients and a longer follow-up period, we update our experience with conservative management of vestibular schwannomas. Study Design: Patients with intracanalicular and small/medium-sized tumors have been followed prospectively at a tertiary referral center. Methods: One hundred twenty-three patients affected by sporadic vestibular schwannoma were primarily observed by means of magnetic resonance imaging scans. In case of significant tumor growth (,2 mm), patients were either surgically treated or submitted to radiotherapy, but, not rarely, they continued to follow the "wait-and-scan" policy. Tumor-size changes over time were also evaluated with hearing function. Statistical analysis with predictive growth factors was performed. Results: Almost two thirds (64.5%) of the cases did not show tumor growth during the entire period of observation (mean follow-up period, 4.8 yrs). Among growing tumors, 16 patients were surgically treated with no complications or facial nerve palsy. Less than half (45.5%) of the patients presented useful hearing (classes A and B of the American Academy of Otolaryngology,Head and Neck Surgery classification) at diagnosis, and 41 (73.2%) patients had preserved hearing during follow-up independently from the tumor growth rate. Conclusions: Conservative management of vestibular schwannoma appears to be a safe procedure because most tumors do not grow and surgical outcomes are not affected by possible delays. In the great majority of cases, useful hearing is maintained over time. Because of the irregular behavior of the tumor, periodic neuroradiologic scans are mandatory to limit late surgical risks. [source] Screening for cervical cancer among Israeli lesbian womenINTERNATIONAL NURSING REVIEW, Issue 4 2009M. Ben-Natan rn Background:, The proportion of lesbian women who contract the human papilloma virus may reach 13% or even 21%; however, lesbian women were found to receive Pap smear tests less often or less regularly. Aim:, To explore factors influencing lesbian women to undergo Pap smear tests and to determine whether the Health Belief Model (HBM) is able to predict whether lesbian women would be willing to undergo the test. Method:, This is a correlational quantitative study guided by the HBM. A convenience sample of 108 Israeli lesbian women was recruited from local events in the lesbian community in the city of Tel Aviv, Israel. Data were collected using a self-administered questionnaire. Findings:, Findings indicate that only 22.2% of the women had undergone Pap smear tests in the past, but a slightly higher proportion, 30.8%, intended to be tested during the next year. Older women were found to be more compliant with the test. Model-based factors affecting actual testing were perceived benefits and barriers. Factors affecting women's intention to be tested were perceived susceptibility, perceived benefits and general health motivation. Conclusions:, Effective strategies for nurses promoting cervical cancer screening among lesbians should address ways to improve familiarity with Pap smear tests, raise physicians' awareness of offering the test to lesbians and emphasize the importance of women-based medical teams. [source] Employment Status, Depressive Symptoms, and the Mediating/Moderating Effects of Single Mothers' Coping RepertoirePUBLIC HEALTH NURSING, Issue 6 2007Joan Samuels-Dennis ABSTRACT Objective: Single mothers, especially those on social assistance, report significantly more depressive symptoms than the general public. This article examines the relationships among employment status, stressful life events, and depressive symptoms among single mothers, with a special focus on the potential mediating and moderating roles of coping repertoire. Design: Cross-sectional survey design. Sample: Ninety-six single mothers (48 employed and 48 single mothers on social assistance) who were the primary caregiver for at least 1 child 4,18 years old. Measurements: Mailed questionnaires that included an adapted version of the Social Readjustment Rating Scale, the Coping Strategy Inventory, and the Beck Depression Inventory, 2nd ed. were completed by study participants. Results: Coping repertoire did not mediate the relationship between either employment status or stress exposure and depressive symptoms. Coping had an antagonistic and differential moderating effect on the association between employment status and depressive symptoms for employed single mothers and mothers receiving social assistance. Conclusion: Effective strategies aimed at promoting single mothers' mental health need to address both the severity of depressive symptoms found among single mothers, and the social-system factors that threaten single mothers' psychological well-being. The implications for practice and policy are discussed. [source] Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) modelCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2009Richard Reading Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) model . DubowitzH., FeigelmanS., LaneW. & KimJ. ( 2009 ) Pediatrics , 123 , 858 , 864 . DOI: 10.1542/peds.2008-1376 . Context Effective strategies for preventing child maltreatment are needed. Few primary care-based programmes have been developed, and most have not been well evaluated. Objective Our goal was to evaluate the efficacy of the Safe Environment for Every Kid (SEEK) model of pediatric primary care in reducing the occurrence of child maltreatment. Methods A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0,5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training; (2) the Parent Screening Questionnaire; and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in three ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. Results Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment non-adherence, fewer children with delayed immunizations and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. Conclusions The SEEK model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended. [source] Modeled Effects of Sagebrush-Steppe Restoration on Greater Sage-Grouse in the Interior Columbia Basin, U.S.A.CONSERVATION BIOLOGY, Issue 5 2002Michael J. Wisdom Consequently, managers of FS,BLM lands need effective strategies to recover sagebrush (Artemisia spp.) habitats on which this species depends. In response to this need, we evaluated the potential benefits of two restoration scenarios on Greater Sage-Grouse in the interior Columbia Basin and adjacent portions of the Great Basin of the western United States. Scenario 1 assumed a 50% reduction in detrimental grazing effects (through changes in stocking rates and grazing systems) and a six-fold increase in areas treated with active restoration (e.g., prescribed burning, native seedings, wildfire suppression) compared with future management proposed by the FS,BLM. Scenario 2 assumed a 100% reduction in detrimental grazing effects and the same increase in active restoration as scenario 1. To evaluate benefits, we estimated the risk of population extirpation for sage grouse 100 years in the future under the two scenarios and compared this risk with that estimated for proposed (100-year) FS,BLM management. We used estimates of extirpation risk for historical (circa 1850,1890) and current time periods as a context for our comparison. Under historical conditions, risk of extirpation was very low on FS,BLM lands, but increased to a moderate probability under current conditions. Under proposed FS,BLM management, risk of extirpation on FS,BLM lands increased to a high probability 100 years in the future. Benefits of the two restoration scenarios, however, constrained the future risk of extirpation to a moderate probability. Our results suggest that expansive and sustained habitat restoration can maintain desired conditions and reduce future extirpation risk for sage grouse on FS,BLM lands in western North America. The continued spread of exotic plants, however, presents a formidable challenge to successful restoration and warrants substantial research and management attention. Resumen: Los hábitats del urogallo (Centrocercus urophasianus) han disminuido a lo largo de la región occidental de Norteamérica, y la mayoría de los hábitats restantes ocurren en terrenos administrados por el Servicio Forestal de E.U.A. (SF) y el Buró de Administración de Tierras ( BAT ). Por lo tanto, los encargados de las tierras SF,BAT necesitan estrategias eficaces para recuperar los hábitats de artemisa (Artemisia spp.) de los cuales depende esta especie. En respuesta a esta necesidad, evaluamos los beneficios potenciales de dos escenarios de restauración sobre el urogallo en el interior de la Cuenca del Columbia y porciones adyacentes de la Gran Cuenca del occidente de los Estados Unidos. El escenario 1 supone una reducción del 50% en los efectos perjudiciales del pastoreo ( por medio de cambios en las tasas de aprovisionamiento y en los sistemas de pastoreo) y un incremento de seis veces en la superficie de las áreas tratadas con restauración activa ( por ejemplo, quemas prescritas, plántulas nativas, supresión de fuego no controlado) comparada con la administración futura propuesta por el SF,BAT. El escenario 2 supone una reducción del 100% en los efectos de pastoreo perjudiciales y el mismo aumento en la restauración activa que en el escenario 1. Para evaluar los beneficios, estimamos el riesgo de extirpación de la población de urogallos en 100 años bajo los dos escenarios y comparamos este riesgo con el riesgo estimado por la propuesta de manejo de SF,BAT (100-años). Utilizamos estimaciones del riesgo de extirpación en períodos históricos (entre 1850 y 1890) y actuales como contexto para nuestra comparación. Bajo condiciones históricas, el riesgo de extirpación fue muy bajo en los terrenos SF,BAT pero aumentó a una probabilidad moderada bajo condiciones actuales. Bajo la administración propuesta por SF,BAT, el riesgo de extirpación en los terrenos SF,BAT aumentó a una alta probabilidad 100 años en el futuro. Sin embargo, los beneficios de los dos escenarios de restauración constriñen el riesgo de extirpación a una probabilidad moderada. Nuestros resultados sugieren que la restauración expansiva y sostenida del hábitat puede mantener condiciones deseadas y reduce el riesgo de extirpación de urogallos en terrenos SF,BAT en la región occidental de Norteamérica. Sin embargo, la continua extensión de plantas exóticas representa un reto formidable para la restauración exitosa y justifica considerable investigación y atención de manejo. [source] State Collapse and Fresh Starts: Some Critical ReflectionsDEVELOPMENT AND CHANGE, Issue 5 2002Martin Doornbos In examining the incidence of state collapse, two central themes emerge, one concerned with the search for causalities and the other concerned with appropriate responses. There is often a misplaced tendency to look for single causes and explanations of state collapse, and similarly to propose single, preferably ,quick,fix' solutions. Instead, what seems to be called for is a more nuanced scrutiny which differentiates the factors leading to collapse in specific instances, and a reconsideration, in the light of this scrutiny, of responses and possible external actor involvement. This article addresses these two themes. Firstly, it takes a preliminary look into the complex web of conditioning and facilitating factors that may or may not set in motion a chain reaction eventually leading to state collapse, examining the extent to which any emerging patterns can be identified. Secondly, it looks more closely at the response side to incidences of state collapse, specifically external responses. Whilst external actors, notably the ,donor community', are trying to better prepare themselves for the eventualities of crises of governance and state collapse in various countries, and to design more effective strategies and instruments, it remains to be seen to what extent there is a ,fit' between the determinants and dynamics of state collapse and the responses and solutions for restoration which are offered. [source] Health-promoting physical activity of adults with mental retardationDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 1 2006Heidi I. Stanish Abstract This literature review describes the physical activity behavior of adults with mental retardation consistent with the U.S. Surgeon General's recommendation of 30 minutes of moderate intensity physical activity on 5 or more days per week. The proportion of participants achieving this criterion ranges from 17.5 to 33%. These data are likely to be generous estimates of activity as individuals included in physical activity studies to date have been relatively young and healthy volunteers with mild to moderate limitations. Major sources of physical activity were walking and cycling for transport, chores and work, dancing, and Special Olympics. There is a pressing need to conduct studies using appropriately powered representative samples and to validate measures that assess physical activity less directly; including methodologies in which proxy respondents are used. Accurate information about existing patterns of behavior will enhance the development of effective strategies to promote physical activity among persons with mental retardation. MRDD Research Reviews 2006;12:13,21. © 2006 Wiley-Liss, Inc. [source] The global challenge of type 2 diabetes and the strategies for response in ethnic minority groupsDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2010Flavio Lirussi Abstract Ethnic minorities living in high-income countries usually exhibit a greater risk of developing diabetes along with higher morbidity and mortality rates. We evaluated the effectiveness of interventions to improve glycaemic control in ethnic minority groups. Results of major controlled trials, systematic reviews and meta-analyses were included in the review. Only 1/47 studies addressing diet and exercise interventions reported details on the ethnicity of the studied population. Self-management education was successful if associated with increased self-efficacy; delivered over a longer period; of high intensity; culturally tailored; and when using community educators. Strategies adopted in community-gathering places, family-based, multifaceted, and those tackling the social context were likely to be more effective. A positive relationship was found between social support and self-management behaviour as well as quality of life, but there is little evidence about the impact of organizational changes within health-care services on diabetes control. More research is needed to strengthen the evidence on effective strategies for response to diabetes in ethnic minorities. Also, there is a need to take into account diabetes beliefs and communication difficulties, as well as potential protective factors. Globally, many health-care systems are inadequately equipped to improve diabetes prevention and disease outcomes in these communities. Copyright © 2010 John Wiley & Sons, Ltd. [source] Comparative cytological study of lymph node tuberculosis in HIV-infected individuals and in patients with diabetes in a developing countryDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2002C.B. Sridhar B.Sc., M.B.B.S., M.D. Abstract Tuberculosis (TB) is a common infection affecting patients with human immunodeficiency virus (HIV) and diabetes mellitus (DM). With the increasing incidence of HIV infection and DM in a developing country like India, TB is definitely on the rise. In a given population, one expects to see these three diseases in varying combinations, such as HIV and TB, DM and TB, HIV and DM with TB. In such combinations TB may lack the characteristic clinical and histological picture due to the associated depressed cell-mediated immunity seen in both diseases and TB may have an unusual clinical presentation and cytology picture. In this retrospective study of 36 months, from January 1997 to December 1999, 109 cases diagnosed cytologically as tuberculous lymphadenitis and tested for HIV infection and investigated as well for DM were selected. Forty-six (42%) were nondiabetic HIV patients, 13 (12%) were non-HIV DM patients, and 50 (46%) had TB without HIV infection or DM. The coexistence of both HIV and DM was not noted. The cytomorphological characteristics supplemented by culture studies of each of these three groups were compared in detail and based on these four cytological patterns, Pattern 1, Pattern 2, Pattern 3, and Pattern 4 emerged and were characterized. This study highlights the usefulness of cytomorphology of the lymph nodes to characterize the cytopathological profile of TB in both HIV and DM, which have many clinical and immunological similarities, and indirectly postulate the extent of immune suppression and evolve effective strategies in the management of coexisting diseases. Such a comparative study has not been carried out in the past. Diagn. Cytopathol. 2002;26:75,80; DOI 10.1002/dc.10059 © 2002 Wiley-Liss, Inc. [source] Kanada: Deutschstudien im Wandel , von neuen Gegebenheiten zu Ansätzen einer SelbsterneuerungDIE UNTERRICHTSPRAXIS/TEACHING GERMAN, Issue 1 2010Anette Guse This contribution describes the situation of the German profession in Canada, by presenting the latest trends in trans-institutional cooperation, curriculum development, the job market, and promotion of the discipline. The author suggests that the adaptation to new realities, such as changes in student interests and the continuing cutbacks of resources, has resulted in the modernization of German programs and more effective strategies of self-marketing. Rather than succumbing to resignation, the article highlights the need to capitalize on traditional strengths as well as the demand to pursue interdisciplinary work and to embrace the concept of collaboration with other departments. [source] Simulation of nerve bundle activation by simultaneous multipoint extracellular stimulation with surface electrodesELECTRONICS & COMMUNICATIONS IN JAPAN, Issue 6 2009Hirokazu Takahashi Abstract Neural prostheses for restoring lost functions can benefit from selective activation of nerves. We previously proposed a multipoint gating stimulation, which can selectively activate a desired portion of a nerve bundle, regardless of the density of the electrode. In this paper, we discuss the design of an electrode array and effective strategies to determine the stimulus parameters. Large electrodes were less affected by the relative location of the electrodes and the nodes of Ranvier, suggesting that a rectangular electrode, whose long side along a nerve bundle is longer than the internodal distance (i.e., on the order of 1 mm), would be more effective than a disk electrode. We were able to estimate an appropriate current at each electrode on the basis of a blocking threshold, above which no spike propagation was permitted. For lateral gating stimulation, the gate current should be set above the threshold, while for depthwise gating stimulation, the gate current should be set below the threshold. The spatial resolutions of lateral and depthwise gating stimulation were theoretically estimated to be at least 50 ,m when the grid spacing of the array was 1.2 mm. © 2009 Wiley Periodicals, Inc. Electron Comm Jpn, 92(6): 31,40, 2009; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ecj.10064 [source] A risk-based approach for bidding strategy in an electricity pay-as-bid auctionEUROPEAN TRANSACTIONS ON ELECTRICAL POWER, Issue 1 2009Javad Sadeh Abstract With the reform of electric power industry and the development of electrical energy markets in many countries, it is of significance to develop bidding strategies for generation companies (GenCos). In this environment, one of the most challenging and important tasks for a GenCo is developing effective strategies to optimize hourly offer curve. In this paper, focusing on Iran's electricity market structure, we model the bidding problem from the viewpoint of a GenCo in a pay-as-bid (PAB) auction. Our goal is to present a tool for determining the optimal bidding strategy of a price-taker producer in an electricity PAB auction taking into account the relevant risks. Due to uncertainties in power market, the market-clearing price (MCP) of each hour is assumed to be known as a probability density function (pdf). The optimal solution of bidding problem is obtained analytically based on the classical optimization theory. Also, the analytical solution for a multi-step bid protocol is generalized and the properties of the generalized solution are discussed. A model is developed to consider concept of risk using two different methods. The two proposed methods are then compared and the results interpreted using numerical examples. In addition, the effect of variation of MCP's pdf parameters on supplier's profit is studied. Copyright © 2007 John Wiley & Sons, Ltd. [source] A new direction in M&A integration: How companies find solutions to value destruction in people-based activityGLOBAL BUSINESS AND ORGANIZATIONAL EXCELLENCE, Issue 4 2009Ben de Haldevang We've all heard merger-and-acquisition (M&A) horror stories in which ignoring the complex human element in integration led to problems that leached away some,or much,of the deal's hoped-for value. The success stories presented here point to effective strategies for smoothly merging organizations without compromising productivity, talent and customer retention, innovation, and other sources of value creation. The author argues that integration planning and management, which too often focus narrowly on process, should also explicitly address the people-intensive aspects of planning, speed, communication, innovation, culture, and HR issues. For each of these areas, he presents actual cases in which preparation or intervention kept a postdeal integration on track and shares specific solutions and tools that can be adapted to other M&As. © 2009 Wiley Periodicals, Inc. [source] The kidney disease wasting: Inflammation, oxidative stress, and diet-gene interactionHEMODIALYSIS INTERNATIONAL, Issue 4 2006Kamyar KALANTAR-ZADEH Abstract The 350,000 maintenance hemodialysis (MHD) patients in the United States have an unacceptably high mortality rate of >20%/year. Almost half of all deaths are assumed to be cardiovascular. Markers of kidney disease wasting (KDW) such as hypoalbuminemia, anorexia, body weight and fat loss, rather than traditional cardiovascular risk factors, appear to be the strongest predictors of early death in these patients. The KDW is closely related to oxidative stress (SOX). Such SOX markers as serum myeloperoxidase are associated with pro-inflammatory cytokines and poor survival in MHD patients. Identifying the conditions that modulate the KDW/SOX-axis may be the key to improving outcomes in MHD patients. Dysfunctional lipoproteins such as a higher ratio of the high-density lipoprotein inflammatory index (HII) may engender or aggravate the KDW, whereas functionally intact or larger lipoprotein pools, as in hypercholesterolemia and obesity, may mitigate the KDW in MHD patients. Hence, a reverse epidemiology or "bad-gone-good" phenomenon may be observed. Diet and gene and their complex interaction may lead to higher proportions of pro-inflammatory or oxidative lipoproteins such as HII, resulting in the aggravation of the SOX and inflammatory processes, endothelial dysfunction, and subsequent atherosclerotic cardiovascular disease and death in MHD patients. Understanding the factors that modulate the KDW/SOX complex and their associations with genetic polymorphism, nutrition, and outcomes in MHD patients may lead to developing more effective strategies to improve outcomes in this and the 20 to 30 million Americans with chronic disease states such as individuals with chronic heart failure, advanced age, malignancies, AIDS, or cachexia. [source] The European Male Ageing Study (EMAS): design, methods and recruitmentINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 1 2009David M. Lee Summary Life expectancy is increasing in most developed countries, in part due to improved socioeconomic conditions and in part to advances in healthcare. It is widely acknowledged that the promotion of healthy ageing by delaying, minimizing or preventing disabilities or diseases is one of the most important public health objectives in this century. In contrast to the menopausal transition in females, we know relatively little about the contribution of androgens and anabolic hormones to the quality of ageing in men. The European Male Ageing Study (EMAS) is a multicentre prospective cohort designed to examine the prevalence, incidence and geographical distribution of gender-specific and general symptoms of ageing in men, including their endocrine, genetic and psychosocial predictors. Men aged 40,79 years were recruited from eight European centres: Florence (Italy), Leuven (Belgium), Lodz (Poland), Malmö (Sweden), Manchester (UK), Santiago de Compostela (Spain), Szeged (Hungary) and Tartu (Estonia). Subjects were recruited from population registers and those who agreed to take part completed a detailed questionnaire including aspects of personal and medical history, lifestyle factors and sexual function. Objective measures of body size, cognition, vision, skeletal health and neuromuscular function were obtained. Blood and DNA specimens were collected for a range of biochemical and genetic analyses. After an average of 4 years, it is planned to resurvey the participants with similar assessments. A total of 3369 men with a mean age of 60 ± 11 years were recruited. The mean centre response rate was 43%, and highest in those aged 50,59 years. Those who participated were marginally younger than those who were invited but declined to participate (60.0 vs. 61.1 years). Participants left education slightly later than a sample of non-participants, though there were no consistent differences in levels of general health, physical activity, or smoking. EMAS will provide new population-based data concerning the main features that characterize ageing in men and its critical determinants, particularly with reference to age-related changes in hormone levels. Such information is an important prerequisite to develop effective strategies to reduce age-related disabilities and optimise health and well-being into old-age. [source] Teens' consumer interaction styles: the impact of assertive and aggressive behaviour on attitudes towards marketing practicesINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 2 2010Christy Crutsinger Abstract Over half-billion global teens between the ages of 13 and 18 years represent a dynamic opportunity for marketers who wish to grow their businesses and build consumer loyalty. Consumer interaction styles are the consistent behaviour patterns that individuals employ in transactions or exchanges in the marketplace. Assertiveness and aggressiveness represent two distinct interaction styles that enable individuals to achieve a desired outcome. Because teen consumers are an important consumer segment and subscribe to the notion that their voices must be heard, understanding their interaction styles is necessary for businesses and marketers. The purpose of this study was to examine teens' consumer interaction styles according to specific demographic and lifestyle characteristics and investigate the impact of assertive and aggressive interaction styles on attitudes towards marketing practices (i.e. product, retailing, advertising, and pricing). Data were collected from a US teen sample (n = 467) at both rural and urban high schools. Independent t -tests compared the propensity of teens' assertive and aggressive consumer interaction styles according to specific demographic and lifestyle characteristics. Structural Equation Modeling using AMOS 6.0 program was performed to test the hypothesized relationships. Results indicated that an assertive interaction style was pervasive among US teen consumers, while the aggressive interaction style had disparities according to unique demographic and lifestyle characteristics. Assertive and aggressive interaction styles demonstrated negative influences on teen consumers' attitudes towards products and retailing practices. By interpreting the negative impact of teens' assertive and aggressive consumer interaction styles, marketers can develop effective strategies that appeal to this demanding consumer. [source] Magnet Recognition and Practice Development: Two journeys towards practice improvement in health careINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2009Zoe Jordan BA MA (Communications Studies) Health service providers continue to struggle with recruitment, retention, evidence-based practice and practice improvement in order to provide high-quality care for the communities they serve. In doing so, they are often required to implement strategies, which require considerable change at both organizational and ward/unit levels. The question remains, how do health service providers instigate processes that will result in positive and sustainable changes to practice and better outcomes for staff and patients? This paper outlines two increasingly used strategies for practice improvement (namely Magnet Recognition and Practice Development), their points of convergence and divergence and makes some broad recommendations for those seeking effective strategies for change that are cognizant of context and culture. [source] At-destination visitor information search and venue decision strategiesINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 3 2007Robin B. DiPietro Abstract Numerous studies have been conducted on consumers' information search prior to arrival at a destination. This study attempts to continue to fill a research gap focusing on travellers' information search behaviour for services not only before the trip but in transit to the destination and once at a destination. In particular, the research explores service-related decisions before and during a trip, the sources of information utilised, which include locals residing at a destination, and how demographic and trip purpose characteristics influence decision-making. Using the results of this study, practitioners and academics alike can design effective strategies for marketing to travellers. Copyright © 2007 John Wiley & Sons, Ltd. [source] Risk modelling in blood safety , review of methods, strengths and limitationsISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue n1 2010B. Custer Risk modelling studies in blood safety play an important but occasionally misunderstood role. These studies are intended to quantify and contrast risks and benefits. This information is critical for policy development and intervention decision-making. The limitations of risk modelling should be considered alongside the results obtained. The goal of this manuscript and presentation is to review current risk modelling techniques used in blood safety and to discuss the pros and cons of using this information in the decision-making process. The types of questions that can be answered include the extent of a risk or threat; implications of action or inaction; identification of effective strategies for risk management; or whether to adopt specific interventions. These analyses can be focused on a risk alone but are often combined with economic information to gain an understanding of feasible risk interventions given budgetary or other monetary considerations. Thus, analyses that include risk modelling provide insights along multiple lines. As important, the analyses also provide information on what is not known or uncertain about a potential hazard and how much that uncertainty may influence the decision-making process. Specific examples of the range of risk analyses in which the author has participated will be reviewed and will include ongoing process improvement in testing laboratories such as error identification/eradication, estimation of the risk of malaria exposure based on the specific locations of travel, evaluation of blood supply and demand during an influenza pandemic, cost-utility analyses of screening interventions for infectious diseases in countries with different human development indices, and insurance against emerging pathogen risk. Each of these analyses has a different purpose and seeks to answer different questions, but all rely on similar methods. The tool kit for risk analysis is broad and varied but does have limitations. The chief limitation of risk modelling is that risk analyses are not scientific experiments or otherwise controlled studies. Consequently, the analyses are more apt to be influenced by assumptions. These assumptions may be necessary to structure a problem in a way that will allow the question of interest to be answered or may result from incomplete or missing information. Another potential limitation is that commissioners of such studies, those who undertake them, and the intended audience, such as regulatory agencies, may have distinct and differing interpretations of the results. Risk modelling is a set of techniques that can be used to inform and support decision-making at all levels in transfusion medicine. Advances in risk modelling techniques allow for continued expansion in the scope of possible questions that can be analysed. Expanded use also improves the acceptance of the utility of these studies in blood safety and transfusion medicine. [source] Transnational Organizing in Agrarian Central America: Histories, Challenges, ProspectsJOURNAL OF AGRARIAN CHANGE, Issue 2-3 2008MARC EDELMAN Central America was one of the principal regions where transnational peasant organizing emerged and from which it spread in the late 1980s and early 1990s. Yet by the late 1990s the seemingly powerful transnational peasant coalitions were in disarray. Their successors have had only a modest impact since 2001. The article points to two main sources of weakness in Central America's transnational peasant coalitions: first, a variety of intra-organizational problems, including political differences, disputes over resources, over-funding by cooperation agencies, and an emphasis on networking activity, rather than concrete gains, as a measure of success; and second, an external political, economic and demographic environment that has become increasingly unfavourable. Elements of the latter include the long-term declines in maize and coffee prices, only recently reversed in 2006; the declining importance of agriculture and the imposition of a new economic model centred around industrial and financial activities; and the rapidly growing levels of out-migration and of dependence of those remaining in the countryside on family remittances and non-agricultural activities. The article concludes not with definitive arguments, but rather with a series of questions about what might constitute effective strategies for transnational peasant organizing in an extremely problematic context, such as contemporary Central America. [source] Impacts of land use change on South-east Asian forest butterflies: a reviewJOURNAL OF APPLIED ECOLOGY, Issue 4 2007LIAN PIN KOH Summary 1South-east Asia has the highest relative rate of habitat loss and degradation in the humid tropics. The responses of less ,charismatic' groups, including butterflies, to habitat disturbance remain relatively poorly understood. Many South-east Asian butterflies are endemic to the region and face global extinction if current levels of deforestation were to continue. 2Here, I highlight South-east Asia as a region urgently in need of butterfly conservation research and review empirical studies of the responses of South-east Asian butterflies to land use change. Additionally, I discuss some methodological pitfalls for such studies. Furthermore, I argue for the importance of identifying the ecological correlates of sensitivity of butterfly species to forest modification and the potential biological mechanisms underlying their responses to land use change. 3There has been no consensus among previous studies on the effects of land use change on butterfly communities in South-east Asia. Of the 20 studies I reviewed, seven reported higher species richness/diversity in undisturbed (or the least disturbed) forest than in disturbed habitats, nine reported the opposite trend, three reported no difference and one reported a strong influence of seasonality on the impacts of logging. 4Some of these studies may contain inherent methodological biases resulting from the failure to control for sampling effects, the lack of consideration for the spatial scale of analysis and incomplete sampling of the vertical strata in tropical rainforests. 5Synthesis and applications. Empirical studies of the effects of land use change on tropical forest insects are sorely lacking from South-east Asia. Butterflies are an ideal taxonomic group for such investigations. Future studies should be designed carefully to avoid the methodological pitfalls highlighted here. Determining the ecological correlates of sensitivity of butterflies to forest modification is important for the pre-emptive identification of species of conservation concern and for generating testable hypotheses on the differential responses of species to forest modification. Experimental studies are needed to determine the mechanisms underlying the responses of species to land use change in order to develop effective strategies for the conservation of butterflies in human disturbed landscapes. [source] Approaches for testing herbivore effects on plant population dynamicsJOURNAL OF APPLIED ECOLOGY, Issue 5 2006STACEY L. HALPERN Summary 1As plant invasions pose one of the greatest threats to biodiversity, it is critical to improve both our understanding of invasiveness and strategies for control. Much research into plant invasions and their management, including biological control, assumes strong demographic effects by natural enemies, including herbivores. However, the importance of natural enemies in the regulation of plant populations remains controversial: some ecologists contend that they rarely affect plant populations, and others that they can strongly limit plant population sizes. 2We briefly review the conflicting views and suggest that new approaches to gather and analyse data are needed before the effects of natural enemies on plant populations can be fully characterized. 3We outline experimental and analytical approaches that incorporate density dependence into population models and thus provide a more complete test of the long-term effects of natural enemies on plant populations. We also introduce new methods for obtaining stochastic estimates of equilibrium density, which will provide a key test of enemy effects on plant population size. 4Synthesis and applications. Designing effective strategies for invasive plant management requires information about the factors that limit plant population size. Together, the experiments and analyses we describe measure more clearly how natural enemies influence plant population dynamics. They will provide an important tool in evaluating the role of enemy release in plant invasions and for predicting the potential success of biological control. Such information should help to prioritize strategies that are most likely to control invasive plants effectively and will contribute to risk assessment when considering the release of non-native natural enemies as biological control agents. [source] Brain death and its implications for management of the potential organ donorACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009J. F. BUGGE The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed. [source] Supervising medication administration by undergraduate nursing students: influencing factorsJOURNAL OF CLINICAL NURSING, Issue 5-6 2010Kerry Reid-Searl Background., The administration of medication is an important skill nursing students need to learn in the clinical setting to develop safe practices. Legally within Queensland, registered nurses are required to provide personal supervision for this process. Research undertaken by the authors suggests the supervision students receive frequently falls short of what is legally required. Aims and objectives., The aim of the study was to examine the factors that influence the experiences of final-year undergraduate nursing students when administering medications in the clinical setting. Design., A grounded theory approach was used with constant comparative analysis to identify categories from the data. Methods., The experiences of final-year nursing students were explored using a grounded theory approach. In-depth, semi-structured interviews were conducted with 28 final-year undergraduate nursing students in Queensland, Australia. Results., Supervision was found to be the central issue influencing medication administration for students. Three main factors were identified as influencing the supervision provided by registered nurses: attitudes of the registered nurse, communication from the university, and busyness and having time. Conclusions., The extent to which registered nurses provide direct supervision to nursing students when administering medication is influenced by factors inherent within the clinical environment. Relevance to clinical practice., The factors influencing the supervision provided by registered nurses needs further exploration that effective strategies can be implemented to ensure safe practices in relation to medication administration can be implemented. [source] ADHD couple and family relationships: Enhancing communication and understanding through Imago Relationship TherapyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2005Carol Ann Robbins This article reviews the relationship deficits experienced by many individuals who have attention deficit hyperactivity disorder (ADHD) and proposes effective strategies, based on Imago Relationship Therapy (IRT), to assist them in communicating more effectively. The neurological underpinnings of the disorder often contribute to the development of poor social and communication skills and can lead to a lifetime of relationship difficulties. IRT, a brain-based approach, is compatible with the neurological challenges of living with ADHD because it slows the communication process, provides structure, reduces reactivity, and helps individuals to be fully present so that their loved one can feel fully heard and understood. The couple's dialogue strengthens relationships by encouraging the development of stronger listening skills, better self-control, and problem solving. Two case examples illustrate the clinical methods used. © 2005 Wiley Periodicals, Inc. J Clin Psychol/In Session 61: 565,577, 2005. [source] A systematic review on communicating with patients about evidenceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2006Lyndal J Trevena MBBS (Hons) MPhilPH Abstract Objective, To conduct a systematic search for (1) the effectiveness of evidence-based communication tools to increase patient understanding of evidence, (2) effective formats for representing probabilistic information and (3) effective strategies for eliciting patient preferences about evidence. A case scenario is used to illustrate some of the difficulties of putting these results into practice., ,Data sources, Systematic search of The Cochrane Library, Medline, Psychinfo, Embase and Cancerlit. Review methods, Systematic reviews of randomized controlled trials (RCTs) and high quality RCTs were included. Studies were excluded if they did not address the question, were focused on behavioural outcomes without attempting to increase understanding, were concerned with counselling as a therapeutic intervention, or were specific to communication regarding clinical trial participation., ,Results, We found 10 systematic reviews of RCTs and 30 additional RCTs addressing our questions. Communication tools in most formats (verbal, written, video, provider-delivered, computer-based) will increase patients' understanding but are more likely to do so if structured, tailored and/or interactive. Probabilistic information is best represented as event rates (natural frequencies) in relevant groups of people, rather than words, probabilities or summarized as effect measures such as relative risk reduction. Illustrations such as cartoons, or graphs (vertical bar charts) appear to aid understanding. Values clarification exercises may be better than standard utility techniques for eliciting preferences in individual decision making. Looking for effective evidence-based communication tools for prostatic specific antigen testing highlighted the challenges for clinicians and consumers in accessing tools that are evidence-based in design as well as content. Conclusion, There is an increasing body of evidence supporting the design of effective evidence-based communication tools but variable access to such tools in practice. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||