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Developing Strategies (developing + strategy)
Selected AbstractsVulvar Pain: A Phenomenological Study of Couples in Search of Effective Diagnosis and TreatmentFAMILY PROCESS, Issue 2 2008JENNIFER J. CONNOR PH.D. Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of, the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships. RESUMEN Dolor vulvar: estudio fenomenológico de parejas que buscan un diagnóstico y tratamiento efectivos El síndrome de vestibulitis vulvar (svv), un trastono de dolor vulvar, continúa dejando perplejos a los profesionales de la salud física y mental debido a su etiología desconocida y a la inexistencia de un tratamiento efectivo. Este estudio utilizó metodología fenomenológica experimental para explorar las experiencias de parejas en que a la mujer se le ha diagnosticado el svv. Se llevaron a cabo dieciséis entrevistas (en profundidad y semiestructuradas) con 13 parejas heterosexuales y 3 mujeres, de las que se obtuvieron cuatro conclusiones esenciales: (1) En busca de , la investigación médica requería una búsqueda más exhaustiva de médicos eruditos y respetuosos que aportasen un tratamiento. (2) El proceso de desarrollar una comprensión personal del trastorno condujo a varias parejas a plantearse su papel en la causa y la prolongación del svv. (3) Desarrollar estrategias para afrontar un coito doloroso condujo a tres estrategias: prescindir del sexo, optar por alternativas al sexo vaginal y modificar o soportar el coito doloroso. (4) Se experimentaron sensaciones de aislamiento, pues el proceso de adaptación a este síndrome de dolor crónico resultó, a menudo, un proceso solitario. Entre los consejos clínicos se incluyen tratar a la pareja, y no sólo a la mujer con svv; animar a las parejas a ampliar las definiciones de la importancia y preferencia por el coito vaginal, así como sugerir actividades sexuales con menor riesgo de causar dolor vulvar; desarrollar un significado común como pareja; y ayudar a las parejas a encontrar médicos y recursos. Palabras clave: síndrome de vestibulitis vulvar; dolor vulvar; terapia de pareja. [source] Translating Research into Clinical Practice: Making Change HappenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2004Elizabeth H. Bradley PhD Objectives: To describe the process of adoption of an evidence-based, multifaceted, innovative program into the hospital setting, with particular attention to issues that promoted or impeded its implementation. This study examined common challenges faced by hospitals implementing the Hospital Elder Life Program (HELP) and strategies used to address these challenges. Design: Qualitative study design based on in-depth, open-ended telephone interviews. Setting: Nine hospitals implementing HELP throughout the United States. Participants: Thirty-two key staff members (physician, nursing, volunteer, and administrative staff) who were directly involved with the HELP implementation. Measurements: Staff experiences implementing the program, including challenges and strategies they viewed as successful in overcoming challenges of implementation. Results: Six common challenges faced hospital staff: (1) gaining internal support for the program despite differing requirements and goals of administration and clinical staff, (2) ensuring effective clinician leadership, (3) integrating with existing geriatric programs, (4) balancing program fidelity with hospital-specific circumstances, (5) documenting positive outcomes of the program despite limited resources for data collection and analysis, and (6) maintaining the momentum of implementation in the face of unrealistic time frames and limited resources. Strategies perceived to be successful in addressing each challenge are described. Conclusion: Translating research into clinical practice is challenging for staff across disciplines. Developing strategies to address common challenges identified in this study may facilitate the adoption of innovative programs within healthcare organizations. [source] The age-related decrease in CNS remyelination efficiency is caused by an impairment of both oligodendrocyte progenitor recruitment and differentiationNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 2 2002C. Zhao Developing strategies to reverse the age-associated decline in CNS remyelination requires the identification of how the regenerative process is impaired. We have addressed whether remyelination becomes slower because of an impairment of recruitment of oligodendrocyte progenitors (OPs) or, an impairment of OP differentiation into remyelinating oligodendrocytes. The OP response during remyelination of focal, toxin-induced CNS demyelination in young and old rats was compared by in situ hybridization using probes to PGDF-,R, and the OP transcription factor, MyT1. The expression patterns for both OP markers are very similar and reveal a delay in the colonization of the demyelinated focus with OPs in the old animals compared to young. By comparing the mRNA expression pattern MyT1 with that of the myelin proteins MBP and Gtx, we have found that in the old animals there is also a delay in OP differentiation, which increases with longer survival times. These results indicate that the age-associated decrease in remyelination efficiency occurs because of an impairment of OP recruitment and their subsequent differentiation into remyelinating oligodendrocytes, and that strategies aimed at ameliorating the age-associated decline in remyelination efficiency will therefore need to promote both components of the regenerative process. [source] Developing strategies for detection of gene dopingTHE JOURNAL OF GENE MEDICINE, Issue 1 2008Anna Baoutina Abstract It is feared that the use of gene transfer technology to enhance athletic performance, the practice that has received the term ,gene doping', may soon become a real threat to the world of sport. As recognised by the anti-doping community, gene doping, like doping in any form, undermines principles of fair play in sport and most importantly, involves major health risks to athletes who partake in gene doping. One attraction of gene doping for such athletes and their entourage lies in the apparent difficulty of detecting its use. Since the realisation of the threat of gene doping to sport in 2001, the anti-doping community and scientists from different disciplines concerned with potential misuse of gene therapy technologies for performance enhancement have focused extensive efforts on developing robust methods for gene doping detection which could be used by the World Anti-Doping Agency to monitor athletes and would meet the requirements of a legally defensible test. Here we review the approaches and technologies which are being evaluated for the detection of gene doping, as well as for monitoring the efficacy of legitimate gene therapy, in relation to the detection target, the type of sample required for analysis and detection methods. We examine the accumulated knowledge on responses of the body, at both cellular and systemic levels, to gene transfer and evaluate strategies for gene doping detection based on current knowledge of gene technology, immunology, transcriptomics, proteomics, biochemistry and physiology. Copyright © 2008 John Wiley & Sons, Ltd. [source] State of Research in High-consequence Hospital Surge CapacityACADEMIC EMERGENCY MEDICINE, Issue 11 2006Carl H. Schultz MD High-consequence surge research involves a systems approach that includes elements such as healthcare facilities, out-of-hospital systems, mortuary services, public health, and sheltering. This article focuses on one aspect of this research, hospital surge capacity, and discusses a definition for such capacity, its components, and future considerations. While conceptual definitions of surge capacity exist, evidence-based practical guidelines for hospitals require enhancement. The Health Resources and Services Administration's (HRSA) definition and benchmarks are extrapolated from those of other countries and rely mainly on trauma data. The most significant part of the HRSA target, the need to care for 500 victims stricken with an infectious disease per one million population in 24 hours, was not developed using a biological model. If HRSA's recommendation is applied to a sample metropolitan area such as Orange County, California, this translates to a goal of expanding hospital capacity by 20%,25% in the first 24 hours. Literature supporting this target is largely consensus based or anecdotal. There are no current objective measures defining hospital surge capacity. The literature identifying the components of surge capacity is fairly consistent and lists them as personnel, supplies and equipment, facilities, and a management system. Studies identifying strategies for hospitals to enhance these components and estimates of how long it will take are lacking. One system for augmenting hospital staff, the Emergency System for Advance Registration of Volunteer Health Professionals, is a consensus-derived plan that has never been tested. Future challenges include developing strategies to handle the two different types of high-consequence surge events: 1) a focal, time-limited event (such as an earthquake) where outside resources exist and can be mobilized to assist those in need and 2) a widespread, prolonged event (such as pandemic influenza) where all resources will be in use and rationing or triage is needed. [source] Using framing parameters to improve handling of uncertainties in water management practiceENVIRONMENTAL POLICY AND GOVERNANCE, Issue 2 2010Nicola Isendahl Abstract Management of water resources is afflicted with uncertainties. Nowadays it is facing more and new uncertainties since the pace and dimension of changes (e.g. climatic, demographic) are accelerating and are likely to increase even more in the future. Hence it is crucial to find pragmatic ways to deal with these uncertainties in water management. We argue for an analytical yet pragmatic approach to enable decision-makers to deal with uncertainties in a more explicit and systematic way and allow for better informed decisions. Our approach is based on the concept of framing, referring to the different ways in which people make sense of the world and of the uncertainties. We apply recently developed parameters of the framing of uncertainty in two sub-basins of the Rhine, the Dutch Kromme Rijn and the German Wupper. We present and discuss the results of a series of stakeholder interactions in the two basins aimed at developing strategies for improving dealing with uncertainties. The strategies are amended and synthesized in a check-list based on the uncertainty framing parameters as a hands-on tool for systematically identifying improvement options when dealing with uncertainty in water management practice. We conclude with suggestions for testing the developed check-list as a tool for decision aid in water management practice. Copyright © 2010 John Wiley & Sons, Ltd and ERP Environment. [source] The black,white "achievement gap" as a perennial challenge of urban science education: A sociocultural and historical overview with implications for research and practice,JOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 10 2001Obed Norman A perennial challenge for urban education in the United States is finding effective ways to address the academic achievement gap between African American and White students. There is widespread and justified concern about the persistence of this achievement gap. In fact, historical evidence suggests that this achievement gap has existed at various times for groups other than African Americans. What conditions prevailed when this achievement gap existed for these other groups? Conversely, under what conditions did the gap diminish and eventually disappear for these groups? This article explores how sociocultural factors involved in the manifestation and eventual disappearance of the gap for these groups may shed some light on how to address the achievement gap for African American students in urban science classrooms. Our conclusion is that the sociocultural position of groups is crucial to understanding and interpreting the scholastic performance of students from various backgrounds. We argue for a research framework and the exploration of research questions incorporating insights from Ogbu's cultural, ecological theory, as well as goal theory, and identity theory. We present these as theories that essentially focus on student responses to societal disparities. Our ultimate goal is to define the problem more clearly and contribute to the development of research-based classroom practices that will be effective in reducing and eventually eliminating the achievement gap. We identify the many gaps in society and the schools that need to be addressed in order to find effective solutions to the problem of the achievement gap. Finally, we propose that by understanding the genesis of the gap and developing strategies to harness the students' responses to societal disparities, learning can be maximized and the achievement gap can be significantly reduced, if not eliminated entirely, in urban science classrooms. © 2001 John Wiley & Sons, Inc. J Res Sci Teach 38: 1101,1114, 2001 [source] Population structure and geographical subdivision of the Leishmania major vector Phlebotomus papatasi as revealed by microsatellite variationMEDICAL AND VETERINARY ENTOMOLOGY, Issue 1 2009O. HAMARSHEH Abstract Multi-locus microsatellite typing (MLMT) has been employed to infer the population structure of Phlebotomus papatasi (Scopoli) (Diptera: Psychodidae) sandflies and assign individuals to populations. Phlebotomus papatasi sandflies were collected from 35 sites in 15 countries. A total of 188 P. papatasi individuals were typed using five microsatellite loci, resulting in 113 different genotypes. Unique microsatellite signatures were observed for some of the populations analysed. Comparable results were obtained when the data were analysed with Bayesian model and distance-based methods. Bayesian statistic-based analyses split the dataset into two distinct genetic clusters, A and B, with further substructuring within each. Population A consisted of five subpopulations representing large numbers of alleles that were correlated with the geographical origins of the sandflies. Cluster B comprised individuals collected in the Middle East and the northern Mediterranean area. The subpopulations B1 and B2 did not, however, show any further correlation to geographical origin. The genetic differentiation between subpopulations was supported by F statistics showing statistically significant (Bonferroni-corrected P < 0.005) values of 0.221 between B2 and B1 and 0.816 between A5 and A4. Identification of the genetic structure of P. papatasi populations is important for understanding the patterns of dispersal of this species and to developing strategies for sandfly control. [source] Decreasing household television time: a pilot study of a combined behavioral and environmental interventionBEHAVIORAL INTERVENTIONS, Issue 4 2006Amy Gorin Excessive TV viewing is associated with weight gain across the lifespan; thus developing strategies to decrease household viewing time may be an effective obesity prevention approach. This pilot study (n,=,6 families) examined the feasibility and short-term impact of a 2-pronged environmental plus behavioral approach designed to reduce TV time in the entire family. The environmental manipulation involved placing TV Allowances (programmed to turn off power after family members had watched 75% of their baseline hours) on all TVs in the home. A kit with behavioral strategies for reducing TV time was also sent to the home each week and family members self-monitored viewing time. Viewing was objectively assessed with the TV Allowances at baseline and at 8,weeks. A significant decrease in objectively measured TV viewing hours was observed, t(5),=,3.1, p,=,0.03, 29.8,±,10.3 versus 14.9,±,6.0,h (equivalent of decreasing from 7.5 to 3.7,h per day). Fifty percent of families reduced their viewing time by ,50%. The acceptability of the intervention was high, with 100% of families reporting they would recommend the TV Allowances to others. Further research is needed to test the long-term efficacy of the program and its impact on weight. Copyright © 2006 John Wiley & Sons, Ltd. [source] | ||||||||||||||||