Realistic Goals (realistic + goal)

Distribution by Scientific Domains


Selected Abstracts


Defining the Limits of Restoration: The Need for Realistic Goals

RESTORATION ECOLOGY, Issue 1 2000
Joan G. Ehrenfeld
The search for a universal statement of goals for ecological restoration continues to generate discussion and controversy. I discuss the diverse roots of restoration ecology, and show how the complex lineages within the field have led to diverse, and divergent, sets of goals. I then review the three major themes that currently are used to develop statements of goals: restoration of species, restoration of whole ecosystems or landscapes, and the restoration of ecosystem services, and point out both the advantages and the limitations and problems associated with each category. Finally, I suggest that restoration ecology would be better served by recognizing that the diversity of conditions requiring restoration demands much flexibility in goal setting, and that restorationists should seek to develop guidelines for defining the sets of conditions under which different kinds of goals are appropriate. I further suggest that goals would be more easily and more appropriately set if restorationists would set forth at the outset the true scope and limitations of what is possible in a given project. Key words: goal-setting, wetlands, conservation biology, ecosystem management, ecosystem services, landscape management. [source]


Controversies in the management of the cutaneous T cell lymphomas

DERMATOLOGIC THERAPY, Issue 5 2009
John A. Zic
ABSTRACT The primary cutaneous T cell lymphomas (CTCL) encompass all malignancies of the T cell where the skin is the primary organ of involvement. The diagnosis of a CTCL variant can be detoured by a number of obstacles including the slow evolution of the disease into a classic clinical and pathologic pattern. A realistic goal of early stage treatment is to reduce the likelihood of progression to a more advanced stage, not to achieve a cure. No studies have adequately compared the different systemic agents in patients with advanced CTCL so the clinician is left to act in the best interest of the patient with what evidence is available. When using the systemic agents, a "start low and go slow" strategy may offer patients several advantages. Dermatologists are uniquely trained to diagnose and to manage all but the most advanced stage patients with CTCL. [source]


Topiramate in Patients with Learning Disability and Refractory Epilepsy

EPILEPSIA, Issue 4 2002
Kevin Kelly
Summary: ,Purpose: Management of seizures in learning disabled people is challenging. This prospective study explored the efficacy and tolerability of adjunctive topiramate (TPM) in patients with learning disability and refractory epilepsy attending a single centre. Methods: Sixty-four patients (36 men, 28 women, aged 16,65 years) were begun on adjunctive TPM after a 3-month prospective baseline on unchanged medication. Efficacy end points were reached when a consistent response was achieved over a 6-month period at optimal TPM dosing. These were seizure freedom or ,50% seizure reduction (responder). Appetite, behaviour, alertness, and sleep were assessed by caregivers throughout the study. Results: Sixteen (25%) patients became seizure free with adjunctive TPM. There were 29 (45%) responders. A further 10 (16%) patients experiencing a more modest improvement in seizure control continued on treatment at the behest of their family and/or caregivers. TPM was discontinued in the remaining nine (14%) patients, mainly because of side effects. Final TPM doses and plasma concentrations varied widely among the efficacy outcome groups. Many patients responding well to adjunctive TPM did so on ,200 mg daily. Mean carer scores did not worsen with TPM therapy. Conclusions: TPM was effective as add-on therapy in learning-disabled people with difficult-to-control epilepsy. Seizure freedom is a realistic goal in this population. [source]


Reference Minerals for the Microanalysis of Light Elements

GEOSTANDARDS & GEOANALYTICAL RESEARCH, Issue 2-3 2001
M. Darby Dyar
tourmaline; danburite; spodumène; muscovite; isotopes The quantitative determination of light element concentrations in geological specimens represents a major analytical challenge as the electron probe is generally not suited to this task. With the development of new in situ analytical techniques, and in particular the increasing use of secondary ion mass spectrometry, the routine determination of Li, Be and B contents has become a realistic goal. However, a major obstacle to the development of this research field is the critical dependence of SIMS on the availability of well characterized, homogeneous reference materials that are closely matched in matrix (composition and structure) to the sample being studied. Here we report the first results from a suite of large, gem crystals which cover a broad spectrum of minerals in which light elements are major constituents. We have characterized these materials using both in situ and wet chemical techniques. The samples described here are intended for distribution to geochemical laboratories active in the study of light elements. Further work is needed before reference values for these materials can be finalized, but the availability of this suite of materials represents a major step toward the routine analysis of the light element contents of geological specimens. La détermination quantitative des concentrations en éléments légers dans les échantillons géologiques représente un défi analytique majeur, la sonde électronique ne convenant généralement pas pour ce travail. Avec le développement de nouvelles techniques analytiques in situ, en particulier l'utilisation grandissante de la spectrométrie ionique secondaire, la détermination en routine des teneurs en Li, Be et B est devenue un objectif réaliste. Toutefois, un obstacle majeur dans le développement de cette recherche subsiste : la technique SIMS est dépendante de la disponibilité de matériaux de référence bien caractérisés et homogènes proches en composition et en structure de l'échantillon étudié. Nous rapportons ici les premiers résultats obtenus à partie d'un groupe de grands cristaux de qualité gemme recouvrant un large spectre de minéraux composés essentiellement d'éléments légers. Nous avons caractérisé ces matériaux en utilisant à la fois des techniques in situ et par voie humide. Les échantillons décrits ici vont être distribués dans les laboratoires de géochimie spécialisés dans l'étude des éléments légers. Avant la conclusion des valeurs de référence de ces matériaux, des travaux ultérieurs seront nécessaires, mais la disponibilité de l'ensemble de ces matériaux représente une étape importante vers l'analyse en routine des teneurs en éléments légers d'échantillons géologiques. [source]


Good Enough Governance: Poverty Reduction and Reform in Developing Countries

GOVERNANCE, Issue 4 2004
Merilee S. Grindle
The good governance agenda is unrealistically long and growing longer over time. Among the multitude of governance reforms that "must be done" to encourage development and reduce poverty, there is little guidance about what's essential and what's not, what should come first and what should follow, what can be achieved in the short term and what can only be achieved over the longer term, what is feasible and what is not. If more attention is given to sorting out these questions, "good enough governance" may become a more realistic goal for many countries faced with the goal of reducing poverty. Working toward good enough governance means accepting a more nuanced understanding of the evolution of institutions and government capabilities; being explicit about trade-offs and priorities in a world in which all good things cannot be pursued at once; learning about what's working rather than focusing solely on governance gaps; taking the role of government in poverty alleviation seriously; and grounding action in the contextual realities of each country. [source]


Can Public Housing Authorities Attract and Hold Upwardly Mobile Households?: A Report from Cincinnati

JOURNAL OF URBAN AFFAIRS, Issue 3-4 2001
David P. Varady
Logistic regression analysis is applied to a pooled, cross sectional data set containing results from approximately 1,300 interviews with Cincinnati Metropolitan Housing Authority (CMHA) residents, carried out between 1995 and 1998 to determine overall levels of residential attachment, and to test whether socially mobile householders had especially weak attachments to their locations. The results highlighted a strong propensity to move among CMHA residents generally. Although most residents stated that they were satisfied with their home, nearly three-fifths said that they expected to move within five years. Multivariate results suggested that socially mobile residents (college educated householders, workers, moderate-income households) were using the CMHA stock as a stepping-stone to better rental housing or homeownership. Public housing officials need to decide whether to make a special effort to hold these upwardly mobile households. A more realistic goal would be to minimize residential turnover caused by environmental problems (e.g., crime), regardless of income level. Policies to achieve this goal are discussed. [source]


Asthma: tips and pitfalls in diagnosis and treatment

PRESCRIBER, Issue 15-16 2010
Chris Corrigan PhD
Perfect control of asthma is now a realistic goal for many patients and several management guidelines are available. Here, Professor Corrigan considers some aspects of diagnosis and treatment and gives some tips and pitfalls in management, followed by sources of further information and an analysis of prescription data. [source]


A Comparison of the Attitudes of Learners, Instructors, and Native French Speakers About the Pronunciation of French: An Exploratory Study

FOREIGN LANGUAGE ANNALS, Issue 3 2007
Isabelle Drewelow
The stereotype has it that native French Speakers are annoyed by foreign Speakers' errors in pronunciation. The purpose of this pilot study was to assess beliefs about the importance of accurate pronunciation in French held by three afferent groups: (1) 73 second- and third-semester students of French at a large midwestern research university in the United States, (2) 16 nonnative-speaker instructors of French at the same institution, and (3) 24 native Speakers of French living in France. In a fall Semester, each of the three groups received near mirror-image versions of a questionnaire, ranging from 33 items (for the learners) to 29 items (for the instructors) to 26 items (for the native French Speakers) in true/false format. Acknowledging that attitudes toward foreign accents might be language- and nationality-specific, all questions pertained to Americans speaking French. Percentages were calculated, and corresponding questions on all three questionnaires were grouped according to theme, then compared and cross-referenced with participants' backgrounds. Generally, this study revealed a gap between the attitudes of hypothetical native Speakers, promoted in teaching on the one hand, and the attitudes professed by real native Speakers on the other hand. The results of this study discredit the myth that native French Speakers have a low tolerance for an American accent in French. Instructors, and nonnative Speaker instructors specifically, need to project more realistic goals and refrain from misinforming their students that a perfect native-like pronunciation is vital to successful communication with native Speakers. [source]


Sustaining appearances: sustainable development and the fisheries of Lake Victoria

NATURAL RESOURCES FORUM, Issue 3 2001
Kevin Crean
Abstract The fisheries of Lake Victoria have undergone a major transformation over the last three decades. The character of the lake has been subject to the influence of many powerful factors including: substantial increases in fishing effort; growing integration into the global fish market; acceleration of anthropogenic activities in the catchment area; demographic change; the influence of adverse shifts in the climate; and introduction of exotic plant and animal species. The task of managing the lake's resources, therefore, has never been more daunting. This article argues that, in most cases, the authorities charged with achieving the goal of sustainable development for the fishery, have failed to address the symptoms,let alone the origins,of the current unsustainable tendencies embedded in the social, economic and political fabric of Lake Victoria's riparian States. It is these factors that directly impinge upon the success of management initiatives for the lake. The article argues that if sustainable development is to be achieved, then stakeholders must act in concert, eliminate unsustainable practices and reprogramme development plans to focus on realistic goals. A possible way forward will be to develop a participatory management system. [source]


The completely dry rate: A critical re-evaluation of the outcomes of slings

NEUROUROLOGY AND URODYNAMICS, Issue 7 2005
Kathleen C. Kobashi
Abstract Objective To critically evaluate sling outcomes and revisit the realistic goals of anti-incontinence surgery. Materials and Methods A review of an Institutional Review Board-approved prospective database revealed the outcomes of four different sling techniques that are utilized at our institution. Results Four hundred ninety-eight patients had a mean follow-up varying from 9 to 24 months (range 6,50) after undergoing one of four different sling techniques utilized at our institution. The techniques had similar results with regard to completely dry rate, overall success rate, and rate of urgency regardless of the variation in follow-up time. Success was defined as completely dry or leakage =,1/week or =,70% improved by questionnaire in those patients who leaked 1/week. Success, by this definition, varied from 74.9% to 85.7%, but the completely dry rate varied from 36.1% to 45.2%. An additional 31.0% to 33.3% leaked =,1/week, and of the remaining patients, 24.5% to 44.4% considered themselves =,70% improved despite leakage >,1/week. Urge incontinence was reported by 24.4% to 33.3% of patients. Conclusion As surgeons, we must constantly reevaluate the outcomes and purposes of the procedures we perform on our patients. © 2005 Wiley-Liss, Inc. [source]


Exomphalos , a major or minor problem?

PEDIATRIC ANESTHESIA, Issue 9 2002
T. O'Neill
Introduction The mortality and morbidity statistics associated with exomphalos major remain discouraging despite advances in management techniques (1). Congenital lung pathology, in particular pulmonary hypoplasia, and thoracic maldevelopment, have been strongly allied to this condition, accounting for the high incidence of pulmonary insufficiency necessitating prolonged ventilatory support in these infants (2). We discuss the respiratory issues in an infant with a particularly severe form of exomphalos major, and the impact of a comprehensive parental website devoted to the infants' management and progress. Case Report A female infant, born at 38 weeks' gestation, was referred for management of exomphalos major. Due to the extensive nature of the abdominal wall defect, primary surgical closure was impossible and initial management consisted of staged reduction by external compression of the exomphalos. This resulted in escalating cardiovascular and respiratory embarrassment, and was abandoned in favour of conservative treatment, whereby the sac was dressed and allowed to epithelialise. Thereafter the clinical course was characterised by chronic pulmonary insufficiency requiring prolonged ventilatory support. Ventilator dependence did not significantly decrease until lung growth occurred and the sitting position was adopted, enabling weaning from conventional ventilation to genuine BIPAP at 6 months. Currently, after 11 months, we are preparing her for entry into a home ventilation programme. Throughout this period, progress and realistic goals were discussed at multidisciplinary case conferences involving the parents. The interpreted medical management has subsequently been displayed by the parents on an elaborate, up-to-date website, which is part of a larger ,Mother Of Omphalocele' network. Although innovative, this highlights the fact that we the medical profession, should be vigilant with regard to potential public exposure of patient management. Whilst the Internet has become an integral part of our own continuing education, this case highlights a new aspect of how it may be used by our patients and their relatives to compare and contrast management policies in various institutions. [source]


The dietetic treatment of obesity

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 9 2001
Alison H. Beattie BSc Hons, SRD Senior Dietitian
Abstract Obesity has a direct, proportional link to morbidity and mortality, and despite the proven medical benefits of weight loss treatment failure rates are high. Historical approaches to weight management within the health service have focused solely on dietary issues. It is now widely accepted that dietary advice given in isolation is ineffective in inducing and sustaining significant weight loss. Obesity is a complex, multifactorial disease and any successful weight management programme should provide tailored dietary advice and facilitate permanent behavioural and lifestyle change. In addition, realistic goals (10% body weight loss) should be recommended. Exercise and physical activity suggested should be geared to individual capabilities. This article addresses how dietitians are treating obesity and what factors other than traditional diet sheets are essential components of a weight management programme. Copyright © 2001 John Wiley & Sons, Ltd. [source]


Working toward consensus: Providers' strategies to shift patients from curative to palliative treatment choices

RESEARCH IN NURSING & HEALTH, Issue 4 2001
Sally A. Norton
Abstract End-of-life decision making is a complex phenomenon and providers, patients, and families often have different views about the appropriateness of treatment choices. The results presented here are part of a larger grounded-theory study of reconciling decisions near the end of life. In particular, we examined how providers (N,=,15) worked near the end of patients' lives toward changing the treatment decisions of patients and families from those decisions that providers described as unrealistic (i.e., curative) to those that providers described as more realistic (i.e., palliative). According to providers, shifting patients' and families' choices from curative to palliative was usually accomplished by changing patients' and families' understanding of the patient's overall "big picture" to one that was consistent with the providers' understanding. Until patients and families shifted their understanding of the patient's condition,the big picture,they continued to make what providers judged as unrealistic treatment choices based on an inaccurate understanding of what was really going on. These unrealistic choices often precluded possibilities for a "good death." According to providers, the purpose of attempting to shift the patient or proxy's goals was that realistic goals lead to realistic palliative treatment choices that providers associated with a good death. In this article we review strategies used by providers when they believed a patient's death was imminent to attempt to shift patients' and families' understandings of the big picture, thus ultimately shifting their treatment decisions. © 2001 John Wiley & Sons, Inc. Res Nurs Health 24:258,269, 2001 [source]


Breastfeeding Rates in Hong Kong: A Comparison of the 1987 and 1997 Birth Cohorts

BIRTH, Issue 3 2002
Gabriel M. Leung MD
ABSTRACT: Background: Low breastfeeding rates are an issue of international public health concern. Anecdotal reports suggest very low breastfeeding rates in Asia, but no population-based studies have been conducted in the region. To determine the secular trend in breastfeeding practice in an Asian postindustrialized metropolitan community, we examined data from two population-based birth cohorts of Hong Kong infants in 1987 and 1997. Methods: Annual population rates of breastfeeding initiation and duration were estimated from the birth cohorts, considering the change in breastfeeding rates over 10 years with correction for sociodemographic and birth characteristics. Factors associated with breastfeeding practice were identified using multivariate logistic regression modeling in a pooled analysis of individual data of both cohorts. Results: Overall, 26.8 percent of mothers initiated breastfeeding in 1987, and the rate increased to 33.5 percent in 1997. The rate would have been 27.4 percent in 1987 if the distributions of method of delivery, birthweight, birth order, maternal age, education, and employment status had been the same as in 1997. Only 7.6 percent of infants remained on the breast for more than 1 month in 1987 compared with 20.4 percent a decade later. Similarly, the rate for breastfeeding more than 3 months increased from 3.9 to 10.3 percent. Total breastfeeding duration was significantly longer in 1997 than 10 years earlier. Conclusions: This is the first systematic report of secular variations of breastfeeding rates in Asia. Hong Kong should set higher but realistic goals for breastfeeding that emphasize both initiation and maintenance. Given the wide latitude for improvement in terms of readily modifiable risk factors, such as smoking and cesarean section, these new goals should focus on improving rates in these targeted groups where breastfeeding rates are lowest. (BIRTH 29:3 September 2002) [source]