Madonna Fernandez-Frackelton, MD, FACEP
Effects of moderate caffeine in take on the calcium economy of premenopausal women herbs cooking discount 30 caps npxl fast delivery. Milk-alkali syndrome associated with calcium carbon ate consumption: Report of 7 patients with parathyroid hormone levels and an estimate of prevalence among patients hospitalized with hypercalcemia herbals in tamilnadu buy cheap npxl 30caps. Evidence that bone resportion of young men is not increased by high dietary phosphorus obtained from milk and cheese herbs life is feudal buy npxl online from canada. Metabolic alkalosis with hypertonic dehydration in a patient with diarrhoea and magnesium oxide ingestion herbals stores purchase 30 caps npxl free shipping. Influence of the vitamin D-binding protein on the serum concentration of 1,25-dihy droxyvitamin D3. Markers of bone remodeling in the elderly subject: Effects of vitamin D insufficiency and its correction. Vitamin D supplementation in the eld erly: Review of safety and effectiveness of different regimes. Increased skeletal uptake of Tc-99m Methylene Disphosphonate in Milk-Alkali Syndrome. Requirements and upper limits of vitamin D intake in the term neonate, infant, and older child. Exercise and mineral status of athletes: Calcium, magnesium, phosphorus, and iron. Selective gastric hypersensi tivity and reflex hyporeactivity in functional dyspepsia. Calcium homeosta sis and bone metabolism during pregnancy, lactation, and postweaning: A longitudinal study. Calcium intake and fracture risk: Results from the study of osteoporotic fractures. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Calcium retention and hormone levels in black and white women on high and low calcium diets. Rates of bone loss in postmenopausal women randomly assigned to one of two dosages of vitamin D. The vitamin D story: A collaborative effort of basic science and clinical medicine. Magnesium homeostasis: Conser vation mechanism in lactating women consuming a controlled-magnesium diet. Dobnig H, Kainer F, Stepan V, Winter R, Lipp R, Schaffer M, Kahr A, Nocnik S, Patterer G, Leb G. Correlation between magnesium and potassium con tents in muscle: Role of Na(+)-K+ pump. Changes in dental fluorosis following an adjustment to the fluo ride concentration of Hong Kongs water supplies. Effect of estrogen on calcium absorp tion and serum vitamin D metabolites in postmenopausal osteoporosis. Geographic variation in breast cancer mortality in the United States: A hypothesis involving exposure to solar radiation. Effects of increased calcium, phosphorus, and vitamin D intake on bone mineralization in very low-birth-weight infants fed formulas with polycose and medium-chain triglycerides. Lifetime calcium intake and physical activity habits: Independent and combined effects on the radial bone of healthy premeno pausal Caucasian women. The level and timing of systemic exposure to fluoride with respect to caries resistance. Mineral and vitamin D adequacy in infants fed human milk or formula between 6 and 12 months of age. The photoproduction of 1, 25-dihydroxyvitamin D3 in skin: An approach to the therapy of vitamin-D-resistant syndromes. The relationship of adequate and excessive intake of vitamin D to health and disease. Report of the Sub committee on Nutritional Status and Weight Gain During Pregnancy, Sub committee on Dietary Intake and Nutrient Supplements During Pregnancy, Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board. The efficiency of intestinal calcium absorption is increased in late pregnancy but not in established lactation. Epithelial cell proliferation in the sigmoid colon of patients with adenomatous polyps increases during oral calcium supplementation. A longitudi nal study of urinary calcium, magnesium, and zinc excretion in lactating and nonlactating postpartum women. Hypercalcemic crisis in pregnancy associated with excessive ingestion of calcium carbonate antacid (milk-alkali syndrome): Successful treatment with hemodialysis. Effects of dietary lactose and a lactase preparation on the intestinal absorption of calcium and magnesium in normal infants. Vitamin D status and concentrations of serum vitamin D metabolites and osteocalcin in elderly pa tients with femoral neck fracture: A follow-up study. Low serum 25 hydroxyvitamin D concentrations and secondary hyperparathyroidism in middle-aged white strict vegetarians. Double-blind, controlled calcium supplementation and bone mineral accretion in children accustomed to a low-calcium diet. A randomized double-blind controlled calcium supplementation trial, and bone and height acquisition in children. Randomized clinical trial of the effect of prenatal fluoride supplements in preventing den tal caries. Bone mineral content in relation to lactation history in pre and postmenopausal women. Effects of milk and milk components on calcium, magnesium, and trace element absorption during infancy. Hormone-sensitive magnesium transport and magnesium regu lation of adenylate cyclase. Effect of dietary oxalate and cal cium on urinary oxalate and risk of formation of calcium oxalate kidney stones. Calcium metabolism and calcium requirements during skeletal modeling and consolidation of bone mass. Fluoride content of infant formulas: Soy-based formulas as a potential factor in dental fluorosis. Long term fracture prediction by bone mineral assessed at different skeletal sites. The ion-selective magnesium electrode: A new tool for clini cians and investigators. Bone mineralization in the first year of life in infants fed human milk, cow-milk formula, or soy-based formula. Calcium and magnesium dietary intakes and plasma and milk concentrations of Nepalese lactating women. Effects of aging, chronic disease, and multiple supple ments on magnesium requirements. Magnesium deficiency produces insulin resistance and increased thrombox ane synthesis. Effects of skin thickness, age, body fat, and sunlight on serum 25-hydroxyvitamin D. Report of the Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences. Pre vention of bone loss by vitamin D supplementation in elderly women: A ran domized double-blind trial. Bone remodeling: Relationship to the amount and structure of bone, and the pathogenesis and prevention of fractures. Serum cal cium, magnesium, phosphorus, alkaline phosphatase and 25-hydroxyvitamin D concentrations in children. The prenatal and postnatal effects of fluoride supplements on West Australian school children, aged 6, 7 and 8, Perth, 1967. A comparative study of ex ercise, calcium supplementation, and hormone-replacement therapy.
If you make a mistake or want to reuse the sheet herbals for hair loss discount generic npxl uk, erase the material with a damp tissue or cloth herbals dario order npxl 30caps. Letters one-inch high should be legible at a distance of thirty-two feet (Svinicki and Lewis herbals teas safe during pregnancy generic 30caps npxl amex, n lotus herbals 3 in 1 sunblock review buy generic npxl from india. Since the size of projected lettering decreases as the projec tor is moved closer to the screen, test out various sizes of lettering in your classroom under typical viewing conditions (Lewis, 1982). Use the same principles for writing on transparencies as you would use for the chalkboard. For example, write systematically, starting at the top left-hand corner and working across and then down to the next line; use titles, headings, and underlining or colors to emphasize key statements; give students time to copy what you have written; pass out complex diagrams or drawings. Place a sheet of lined paper underneath the transparency to serve as a guide as you write on the sheet. Use commercially available "presentation" software to prepare material for overhead transparencies. Software packages produce compelling renditions of even the most tedious material. The software also permits you to make two-per-page or six-per-page reduced format handouts of all trans parencies for distribution to students. Some photocopy machines also allow you to re produce a paper original onto a plastic transparency, and some laser printers can produce transparencies. Letters approximately one-quarter to one-half inch tall will project well in a small classroom. For easier viewing, leave a border around the body of the material: for a 10" x 10" projector, work within a 7Vi"x 9Vz" space, projecting the 9Vi" dimension horizontally. Using Prepared Transparencies Arrange your transparencies in the order you will be using them. Make a notation in the margin of your notes indicating when to put up the next transparency. To avoid exposing the light when you change transparen cies, hold the new one above and drop it as you remove the old one. Leave the trans parency up long enough for students to copy the material, but let them know if you are going to distribute a handout that duplicates the image. On the plastic overlay, you can highlight or emphasize key parts of the permanent transparency or add details to it. By stacking transparencies, you can show how a graph changes, how a plant grows, or how an equation is derived. You can also show several systems simultaneously (for example, the mechanical systems of a building). In preparation you will need to decide which elements belong on the base transparency (projected first) and which belong on each overlay. Make 324 Transparencies and Overhead Projectors separate masters for the base and each overlay; special kits can help you create multilayer transparencies. The chief disadvantage of showing slides is that the room must be darkened, which makes it hard for some students to take notes and easy for others to doze off. If most of your slides show graphs and charts, insert some slides of people, places, or things or use title slides to announce a new topic. As a quick check, if you can read a 2" x 2" slide by holding it up to the light without a magnifier and without squinting, students will be able to see it in the classroom. The front side is sometimes hard to identify, but it is usually the side with a date. You can also identify the front side by holding up the slide against the light to see that it reads correctly left to right. If you only have fifteen minutes worth of slides, group them all together rather than dispersing them throughout a fifty-minute lecture. You can avoid having to look at the screen to know what image is on view or which is coming up next if you have photocopies of all the slides. Place copies of three or four slides along one side of an 8V2" x 11" page or photocopy and enlarge each slide to If you later repeat the same presentation, the photocopies will help you reconstruct the correct sequence for the slides. If the slides are detailed, consider distributing paper copies of them to the class. Since the images need not be on the screen for a long period of time, the production values can be somewhat rough. Newer technologies are making it easier to produce higher-quality slides (Head, 1992). Experienced photographers suggest using black paper around the borders to mask out portions that will not fit in the slide format and to eliminate white edges. For slides to be shown horizontally, limit text to five or six printed lines with five to six words per line. Keep in mind that while students are reading a slide, they are not listening to you speak. Be sure to define the variables, label each axis, and as necessary, label the units (for example, each tick mark represents ten thousand people). The fair-use provisions of the 1976 copyright law allow copyrighted materials to be copied for educational purposes. You can make one copy of a copyrighted image from a book or periodical without asking permission. However, keep track of the source of the slide in case you want to illustrate an article, essay, or monograph. Using Slides in the Classroom Use slides to emphasize the structure of your presentation. For example, show a title slide at the start of each major section and subsection. Use slides to reinforce your major points, using a new slide for each point you make. If a single tray will not hold all your slides, change trays at a logical breaking point rather than in the middle of a sequence. Project two images simultaneously to compare and contrast objects or to show two perspectives of the same object. Two-projector presentations are easy to do: lay out the slides in two col 328 Slides umns, side by side. In older carousels, you may need to insert blank cardboard whenever there are unmatched pairs. Most screens are designed to show horizontal slides; vertical slides tend to project past the top and bottom edges of the screen. If you want to show both horizontal and vertical slides in the same presentation, place a vertical slide at the very beginning of your tray so that you can correctly position and focus the projector. This technique directs the attention of students toward the front of the auditorium and makes it easier to call the class to order. Make certain that the slide on view corresponds to what you are saying at the moment. Otherwise students will be distracted by trying to puzzle out the relationship between your words and the image before them. Studies show that when a new image appears on a screen, most viewers spend no more than fifteen seconds actively exploring it. If you want to refer to one image at several points in your presentation, use duplicate slides. Students will try to imagine what is coming, and the slide will either reinforce or correct their expectations. Most remote devices have three buttons (forward, reverse, focus) and are easy to operate. To avoid a screenful of blinding brightness and also to protect your last slide from excessive heat, place a dark slide at the end of the set. The ventilating system of some brands may not be sufficient to cool the emulsion sandwiched between two pieces of glass. Keep in mind that students may not be able to take notes during your slide presentations.
Therefore herbs like kratom discount npxl 30caps on-line, factors hindering the movement of these ossicles wicked x herbal order npxl canada, such as pus or fluid in the middle ear vedantika herbals order npxl in india, will adversely affect hearing wtf herbals purchase npxl 30 caps with amex. The eustachian tube allows for ventilation and clearance of fluid from the middle ear. Also, the angle of the tensor veli palatini muscle to the cartilage around the tube is variable, compared to being stable in the adult. The significance of these characteristics is that there is a greater likelihood that nasopharyngeal secretions can reflux or insufflate into the middle ear, and that clearance of the middle ear cavity of these secretions is decreased (2). These differences are the reason why there are more middle ear infections in the infant compared to the adult and older child. Otitis media is common in infants and young children with the peak age being between 6 to 18 months of age. This is due not only to anatomical factors, but immunologic as well since these children still lack many protective antibodies against viral and bacterial organisms. Also, babies are breast fed while in a vertical or semi-reclining position, compared to some babies who may be bottle-fed while in a horizontal position. The presence of cerumen and uncooperative and frightened patients complicate this. It should be noted, although controversial, that a tympanic membrane may become red in a crying child (4). This chapter will focus on two types of otitis media, namely acute otitis media and otitis media with effusion. Older children may complain of a "plugged" feeling or "popping" in their ears, which is usually bilateral. It is important to distinguish between the two diseases because the management of each is different, however, it is not easily done. If severe otalgia is present, then analgesia becomes a major therapeutic consideration. Although Auralgan otic is used for pain relief, one should be aware of allergic reactions and to make sure there is no perforation. The management of otitis media is one of many controversial subjects in pediatrics. The three most common organisms are Streptococcus pneumoniae, non-typable Haemophilus influenzae, and Moraxella catarrhalis. Other less common organisms are Streptococcus pyogenes, Staphylococcus aureus, gram negative enteric bacteria, and anaerobes (5). The choice of antibiotic is dependent on efficacy, palatability, side effects, convenience of dosing, and cost. For this reason, it is recommended that the dose of amoxicillin be increased from 40-50 mg/kg/day to 80-90 mg/kg/day in two to three divided doses. However, children who are at low risk for resistant organisms may be treated with the lower dose of amoxicillin, being 40-50 mg/kg/day. Risk factors include young age (less than 2 years), recent antibiotic use (within the last month), and day care attendance (4). In patients who are allergic to beta-lactam antibiotics, macrolides, like erythromycin plus sulfisoxazole, azithromycin, or clarithromycin, and trimethoprim-sulfamethoxazole may be used. The duration for treatment is 10 days, although azithromycin, cefpodoxime, and cefdinir are now approved for 5 days, and a single dose of intramuscular ceftriaxone is as effective as a 10-day course of amoxicillin. Also recently, azithromycin has been approved for a 30 mg/kg one time dose, or 10 mg/kg dose for three days. Other drugs that are recommended are cefprozil, ceftibuten, loracarbef, and clindamycin (6). Persistent otalgia, fever, and other systemic symptoms past 72 hours should be reevaluated. At times, tympanocentesis or myringotomy is necessary for resistant cases, at which time a culture can also be obtained. Follow-up visits are recommended 10-14 days later to determine the need for further antimicrobial treatment. Although a middle ear effusion may be present, an inflamed eardrum or persistent systemic symptoms at this follow-up visit may warrant changing the antibiotic therapy or performing a myringotomy/tympanocentesis. It is estimated that 30-70% of children will have a middle ear effusion 10-14 days later, and that without treatment, 6-26% will have a persistent middle ear effusion after 3 months, with the mean of resolution being about 23 days. Medications that have been studied are decongestants, antihistamines, oral corticosteroids, and antibiotics. The only drugs proved efficacious are oral corticosteroids and antibiotics; however, it is felt that the side effects from oral corticosteroids outweigh its benefits. Other antibiotics that have been recommended are cefaclor, erythromycin-sulfisoxazole, and ceftibuten, although these are either just as efficacious or less so than amoxicillin. If antibiotic therapy fails, then myringotomy with tympanostomy tube placement or myringotomy and adenoidectomy are recommended as the next step. Only ofloxacin otic solution is approved in children with acute otitis media with tympanostomy tubes or chronic suppurative otitis media with perforation (8). Not only do we treat otitis media for symptomatic relief, but also to prevent its complications. Fortunately, because we live in the antibiotic era, these complications are rarely seen. Only in a few children does medical therapy fail, and more aggressive measures are needed, such as myringotomy and tympanostomy tubes. As the humidity in the outer ear increases, the stratum corneum in the cartilaginous portion of the ear absorbs water, which results in edema. Edema blocks the pilosebaceous units in the ear, thereby decreasing the excretion of cerumen. A decrease in cerumen causes an increase in the pH of the external ear, in addition to decreasing its water repelling covering. The exposed skin becomes susceptible to maceration and the higher pH becomes a favorable environment for bacteria such as Pseudomonas. Bacteria can then penetrate through the dermis after superficial breakdown or through minor trauma such as with cotton applicators. The most common organisms cultured in otitis externa are Pseudomonas and Staphylococcus aureus. Other organisms that can be cultured are Enterobacter aerogenes, Proteus mirabilis, Klebsiella pneumoniae, streptococci, coagulase-negative staphylococci, diphtheroids, and fungi such as Aspergillus and Candida. Symptoms initially include pruritus and aural fullness, which then progresses to ear pain that may be severe and out of proportion to its appearance. Purulent otorrhea and hearing loss from edema of the canal may be present as well. Examination shows an inflamed and erythematous cartilaginous canal, with variable involvement of the bony canal. Although the tympanic membrane is not affected, it and the medial portion of the canal can become involved and often look granular. When this happens, pneumatic otoscopy is needed to rule out concomitant otitis media. Tender and palpable lymph nodes may be present in the periauricular Page 183 and preauricular areas. Treatment includes the use of ototopical drops, such as a combination of polymyxin B, neomycin, and hydrocortisone (Cortisporin otic). Polymyxin B is active against gram negative bacilli such as Pseudomonas, neomycin is active against gram positive organisms and some gram negatives especially Proteus, and the corticosteroid reduces inflammation and edema. Fluoroquinolones are a new class of antibiotics for otitis externa; ofloxacin and ciprofloxacin are both currently available. If there is a lot of fluid drainage, it may be preferable to wick out most of the fluid prior to instilling the drops. If there is severe edema preventing effective instillation of drops, a wick can be placed in the membranous canal with otic drops applied several times a day, the wick can be replaced every 48 to 72 hours until the edema resolves (11). Cleaning the ear canal such as irrigating with 2% acetic acid to remove debris can be a useful adjunct to therapy.
The research on technology transfer (see especially Backer herbals shoppe hedgehog products buy npxl 30caps fast delivery, David herbs pool order npxl master card, and Soucy herbals india chennai proven npxl 30 caps, 1995a; Brown herbals bestellen npxl 30 caps with mastercard, 1995) has documented five fundamental conditions that must be met to facilitate the adoption of a new treatment or intervention program: Information describing effective, research-based programs must be disseminated in a way that is accessible and understandable to individuals and organizations so that they are aware that such interventions exist and can be replicated without excessive costs or undesirable side effects. The Blueprints initiative was designed to help prevention practitioners overcome these challenges, and strategies for doing so will be described in more detail below. The first component involved identifying programs that effectively reduced problem behaviors and disseminating this information to communities. The second phase of the initiative entailed assessing and enhancing sites readiness and ability to replicate a Blueprints program. This work was achieved through the following efforts: Creating applications that required applicants to specify their needs, resources, and commitment to the project. Communicating Information Regarding Effective, Research-Based Programs To successfully transfer technology, information must be credible and available in a language and format that are accessible to prevention practitioners (Backer, David, and Soucy, 1995a; Brown, 1995). Unfortunately, evidence regarding effective prevention programs is often not shared by researchers in a systematic way, is published in journals that are not available to those in the field, or is written in scholarly jargon and based on complicated statistical procedures that may be incomprehensible to prevention practitioners (Webster-Stratton and Taylor, 1998). Moreover, a recent trend has been the publication of numerous lists of best practice programs that typically vary from source to source, resulting in a plethora of information that is difficult for those in the field to assess. When faced with the obstacles of gaining access to and understanding research findings, practitioners often choose to continue current practices (Backer, David, and Soucy, 1995a). The team conducted oral presentations at workshops and conferences to outline strategies for effective intervention and to identify model programs most effective in reducing problem behavior. Next, the team created brief overviews of each program that were available on the Blueprints Web site and distributed to interested parties. Working with program developers, Blueprints staff designed comprehensive books (Blueprints) describing each program in detail. These volumes were specifically designed to translate the scientific rationale and research conducted on each program into an easy-to-read, practical handbook that could be used by prevention practitioners. Brief descriptions of the Blueprints programs were also published in trade magazines that are commonly read by the practitioner community. A videotape in which Blueprints program designers briefly described their programs was also produced and disseminated to the practitioner community. Enhancing Local Support for Empirically Based Programs and Readiness To Adopt New Initiatives Becoming more aware of the availability and effectiveness of research-based interventions is the first step in creating an environment that supports best practice programs. However, for such attitudes to become widespread takes time, and practitioners must be ready to exert considerable effort to enhance organizational and individual commitment to scientifically valid programs and show a readiness to adopt new initiatives (Backer, 1995; Webster-Stratton et al. Although community leaders may realize the importance of supporting empirically valid programs (especially when funding is contingent on adopting such practices), this attitude is not always shared by program administrators or the front-line staff charged with delivering the service. It is especially difficult to persuade organizations to replace home-grown programs or interventions, which may not have been evaluated or that have not demonstrated effectiveness, with science-based programs (Everhart and Wandersman, 2000). In many cases, the former are adopted because they have been recommended by others, are easily accessible, and are considered easy, cheap, and convenient to implement. In comparison to such programs, research-based interventions, which tend to be long-lasting, comprehensive, and somewhat more difficult to implement (requiring, for example, that therapists spend many hours with clients or that teachers replace didactic strategies with behavioral rehearsal and demonstration), may not be immediately appealing to the individuals who will be charged with delivering them to a chosen population. Programs that are selected after a more extensive information search are more likely to incorporate research-based practices and be implemented in a higher quality fashion (Gottfredson and Gottfredson, 2002). One way to accomplish consensus about a prevention approach is to include key players in planning for program adoption, implement the program incrementally so that individuals slowly become more familiar with the rationale and techniques for using the innovation (Brown, 1995; Webster-Stratton et al. In many cases, prevention practitioners are satisfied with the status quo and do not wish to support new innovations, particularly if doing so will result in extra work. Because overcoming this resistance is not easy, some researchers advocate that organizations seek volunteers from within the agency to become early adopters of the innovations (Webster-Stratton and Taylor, 1998). However, many organizations cannot adopt this strategy, particularly if a program is meant to be implemented comprehensively by all individuals in the school or agency. Thus, a major challenge for implementing new strategies is ensuring that individuals be energized rather than overwhelmed when confronted with new programs (Backer, 1995; Brown, 1995). A lack of commitment can lead to resistance, limited implementation, and even program sabotage. For example, when teachers, who are typically working under enormous time pressures, are not involved in program planning and decisionmaking, they may refuse to implement new programs or may deliver them in an inconsistent or incomplete manner. When these agencies failed to develop full support for the program within the school, their adoption of the curriculum was often challenged. During the application process, the Blueprints team simultaneously assessed and enhanced sites readiness for change, although priority was given to sites that appeared most receptive to adopting the new program. The application asked sites to describe the groundwork conducted to prepare others for the introduction of a new initiative. For school-based interventions, applicants were asked whether or not they had informed school administrators, counselors, and teachers of the decision to implement a new curriculum and to describe how these individuals reacted to this initiative. If key participants had yet to be informed, applicants were urged to remedy this situation and were given information they could use to improve participants knowledge of the program. Not surprising, when school administrations thoroughly explained their reasons for choosing a particular program, described evidence of its effectiveness, and asked teachers if they would be willing to implement such a curriculum, the innovation was more likely to succeed. For complex programs that required interagency linkages and support, representatives from all pertinent agencies were requested to attend the feasibility visits. This ensured that all viable parties had information about the program before its adoption, helped garner motivation for the program, and allowed everyone to understand their own roles and responsibilities in the new effort. Applicants were also asked to describe other programs that had been adopted in the past to determine whether the site had a history of adopting new initiatives and whether these previous attempts were successful (Backer, 1995; Gendreau, Goggin, and Smith, 1999). In some cases, applicants noted that previous efforts were often made half-heartedly, with some staff implementing the program but not others, or some delivering only parts of the intervention. Although preference was given to sites that did not have a history of failed innovations, sites with failures were sometimes included if it appeared past problems could be avoided. For example, several school administrators reported that staff had not received training for the earlier intervention, and, as a result, they had low motivation and few skills to teach the program. Because the Blueprints initiative included training for all participants, these were not insurmountable obstacles. Site visits were jointly conducted by members of the Blueprints team and the program designers to provide applicants with direct contact with those most knowledgeable about each program. The designers presentations of their programs and the ensuing discussions often created a stronger motivation within organizations to implement programs. In addition, they provided a deeper understanding of the program elements, decreased fear and resistance, and enhanced motivation to conduct the program with integrity to the design. For these reasons, all key participants were required to attend feasibility visits, and sites that could not comply with this requirement were rated lower. In fact, later experience confirmed that the most problematic sites, especially those that lacked strong commitment at either the organizational or individual level, were those without full attendance at feasibility visits. Conducting a Needs Assessment A critical step for communities preparing to adopt a science-based program is to conduct a thorough needs assessment that identifies protective and risk factors for problem behavior and prioritizes the most important areas for intervention (Arthur and Blitz, 2000; Wandersman et al. Such assessments must be comprehensive, analyzing strengths and weaknesses within neighborhoods, families, schools, and individuals. They should use multiple sources of information, including interviews with individuals and focus groups, self-report surveys of adolescents, and pre-collected data or records (Gendreau, Gaggin, and Smith, 1999; Wandersman et al. Encouraging community members to participate in this assessment is also important (Wandersman et al. In fact, many researchers have advocated the creation of community planning boards that include youth, parents, school administrators and teachers, healthcare and social services professionals, law enforcement agents, and business owners (Arthur and Blitz, 2000; Webster-Stratton and Taylor, 1998). This approach will result in a more accurate and broader assessment of the communitys problems and will ensure that new programs are consistent with the beliefs and values of the community. Moreover, it will foster a shared sense of responsibility for the communitys troubles. In fact, research has demonstrated that when communities take ownership of their problems and encourage members to be involved and active in addressing them, interventions have a greater likelihood for success (Arthur and Blitz, 2000; Everhart and Wandersman, 2000). Needs assessments must also include detailed analyses of programs already occurring in the community, and also evidence of their quality of implementation and effectiveness (Wandersman et al. This approach should help prevent duplication of services, which can drain resources and frustrate both the implementors and targets of the intervention. For example, one of the Blueprints Nurse-Family Partnership sites was competing for clients with a similar program offered by another agency, and this situation led to some frustration among the nurses, who were not able to achieve the targeted number of clients they had anticipated. Order npxl no prescription. Что такое аюрведическая косметика ("ТВой вечер" 24/05/2016). |
