Transforming the Healthcare Response to Intimate Partner Violence and Taking Best Practices to Scale

BACKGROUND: Intimate partner violence (IPV) is prevalent among adolescent and adult women, with significant physical, sexual, and mental health consequences. In 2011, the Institute of Medicine\u27s Clinical Preventive Services for Women consensus report recommended universal screening for violence as a component of women\u27s preventive services; this policy has been adopted by the Health Resources and Services Administration (HRSA). These policy developments require that effective clinic-based interventions be identified, easily implemented, and taken to scale. METHODS: To foster dialogue about implementing effective interventions, we convened a symposium entitled Responding to Violence Against Women: Emerging Evidence, Implementation Science, and Innovative Interventions, on May 21, 2012. Drawing on multidisciplinary expertise, the agenda integrated data on the prevalence and health impact of IPV violence, with an overview of the implementation science framework, and a panel of innovative IPV screening interventions. Recommendations were generated for developing, testing, and implementing clinic-based interventions to reduce violence and mitigate its health impact. RESULTS: The strength of evidence supporting specific IPV screening interventions has improved, but the optimal implementation and dissemination strategies are not clear. Implementation science, which seeks to close the evidence to program gap, is a useful framework for improving screening and intervention uptake and ensuring the translation of research findings into routine practice. CONCLUSIONS: Findings have substantial relevance to the broader research, clinical, and practitioner community. Our conference proceedings fill a timely gap in knowledge by informing practitioners as they strive to implement universal IPV screening and guiding researchers as they evaluate the success of implementing IPV interventions to improve women\u27s health and well-being

Analysing key influences over actors' use of evidence in developing policies and strategies in Nigeria: a retrospective study of the Integrated Maternal Newborn and Child Health strategy

Background Evidence-informed policymaking has been promoted as a means of ensuring better outcomes. However, what counts as evidence in policymaking lies within a spectrum of expert knowledge and scientifically generated information. Since not all forms of evidence share an equal validity or weighting for policymakers, it is important to understand the key factors that influence their preferences for different types of evidence in policy and strategy development. Method A retrospective study was carried out at the national level in Nigeria using a case-study approach to examine the Nigerian Integrated Maternal Newborn and Child Health (IMNCH) strategy. Two frameworks were used for conceptualization and data analysis, namely (1) to analyse the role of evidence in policymaking and (2) the policy triangle. They were used to explore the key contextual and participatory influences on choice of evidence in developing the IMNCH strategy. Data was collected through review of relevant national documents and in-depth interviews of purposively selected key policy and strategic decision makers. Thematic analysis was applied to generate information from collected data. Results The breadth of evidence used was wide, ranging from expert opinions to systematic reviews. The choice of different types of evidence was found to overlap across actor categories. Key influences over actors’ choice of evidence were: (1) perceived robustness of evidence – comprehensive, representative, recent, scientifically sound; (2) roles in evidence process, i.e. their degree and level of participation in evidence generation and dissemination, with regards to their role in the policy process; and (3) contextual factors such as global agenda and influence, timeline for strategy development, availability of resources for evidence generation, and lessons learnt from previous unsuccessful policies/plans. Conclusion Actors’ preferences for different types of evidence for policy are influenced not only by the characteristics of evidence itself, but on actors’ roles in the evidence process, their power to influence the policy, and the context in which evidence is used

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Induction of Inducible Nitric Oxide Synthase by Lipopolysaccharide and the Influences of Cell Volume Changes, Stress Hormones and Oxidative Stress on Nitric Oxide Efflux from the Perfused Liver of Air-Breathing Catfish, Heteropneustes fossilis.

The air-breathing singhi catfish (Heteropneustes fossilis) is frequently being challenged by bacterial contaminants, and different environmental insults like osmotic, hyper-ammonia, dehydration and oxidative stresses in its natural habitats throughout the year. The main objectives of the present investigation were to determine (a) the possible induction of inducible nitric oxide synthase (iNOS) gene with enhanced production of nitric oxide (NO) by intra-peritoneal injection of lipopolysaccharide (LPS) (a bacterial endotoxin), and (b) to determine the effects of hepatic cell volume changes due to anisotonicity or by infusion of certain metabolites, stress hormones and by induction of oxidative stress on production of NO from the iNOS-induced perfused liver of singhi catfish. Intra-peritoneal injection of LPS led to induction of iNOS gene and localized tissue specific expression of iNOS enzyme with more production and accumulation of NO in different tissues of singhi catfish. Further, changes of hydration status/cell volume, caused either by anisotonicity or by infusion of certain metabolites such as glutamine plus glycine and adenosine, affected the NO production from the perfused liver of iNOS-induced singhi catfish. In general, increase of hydration status/cell swelling due to hypotonicity caused decrease, and decrease of hydration status/cell shrinkage due to hypertonicity caused increase of NO efflux from the perfused liver, thus suggesting that changes in hydration status/cell volume of hepatic cells serve as a potent modulator for regulating the NO production. Significant increase of NO efflux from the perfused liver was also observed while infusing the liver with stress hormones like epinephrine and norepinephrine, accompanied with decrease of hydration status/cell volume of hepatic cells. Further, oxidative stress, caused due to infusion of t-butyl hydroperoxide and hydrogen peroxide separately, in the perfused liver of singhi catfish, resulted in significant increase of NO efflux accompanied with decrease of hydration status/cell volume of hepatic cells. However, the reasons for these cell volume-sensitive changes of NO efflux from the liver of singhi catfish are not fully understood with the available data. Nonetheless, enhanced or decreased production of NO from the perfused liver under osmotic stress, in presence of stress hormones and oxidative stress reflected its potential role in cellular homeostasis and also for better adaptations under environmental challenges. This is the first report of osmosensitive and oxidative stress-induced changes of NO production and efflux from the liver of any teleosts. Further, the level of expression of iNOS in this singhi catfish could also serve as an important indicator to determine the pathological status of the external environment

Effect of LiClO<SUB>4</SUB> and LiCl additives on the kinetics of anionic polymerization of methyl methacrylate in toluene-tetrahydrofuran mixed solvent

The kinetics of anionic polymerization of MMA has been studied at -78 &#176;C in toluene-THF (9:1 v/v) using 1,1'-diphenylhexyl lithium as initiator in the presence of lithium perchlorate and lithium chloride as Lewis acid additives. The control of the polymerization is lost in the absence of additives as evident from the non-linear first-order time-conversion plot and polymers with broad multimodal molecular weight distribution. The presence of LiClO4 and LiCl in 10:1 and 5:1 ratio, respectively, over the initiator brings about sufficient control, yielding polymers of narrow unimodal distribution throughout the polymerization. The reaction in the presence of the additives follows first-order kinetics free of termination and transfer. Moreover, the order with respect to the active centers is found to be almost unity, which signifies a probable disaggregation of ion-pairs to a single complexed propagating species

Zonal localization iNOS in LPS-treated fish.

<p>Immunocytochemical analysis showing the localized expression of iNOS in different tissues of <i>H</i>. <i>fossilis</i> after treatment with LPS. Representative pictures of five independent experiments are shown. Nucleus–blue; iNOS–red. Scale bar: 55 μm.</p

Synthesis of amphiphilic poly(methyl methacrylate- b-ethylene oxide) copolymers from monohydroxy telechelic poly(methyl methacrylate) as macroinitiator

The synthesis of well-defined poly(methyl methacrylate)-block-poly(ethylene oxide) (PMMA-b-PEO) dibock copolymer through anionic polymerization using monohydroxy telechelic PMMA as macroinitiator is described. Living anionic polymerization of methyl methacrylate was performed using initiators derived from the adduct of diphenylethylene and a suitable alkyllithium, either of which contains a hydroxyl group protected with tert-butyldimethylsilyl moiety in tetrahydrofuran (THF) at -78 °C in the presence of LiClO<SUB>4</SUB>. The synthesized telechelic PMMAs had good control of molecular weight with narrow molecular weight distribution (MWD). The <SUP>1</SUP>H NMR and MALDI-TOF MS analysis confirmed quantitative functionalization of chain-ends. Block copolymerization of ethylene oxide was carried out using the terminal hydroxyl group of PMMA as initiator in the presence of potassium counter ion in THF at 35 °C. The PMMA-b-PEO diblock copolymers had moderate control of molecular weight with narrow MWD. The <SUP>1</SUP>H NMR results confirm the absence of trans-esterification reaction of propagating PEO anions onto the ester pendants of PMMA. The micellation behavior of PMMA-b-PEO diblock copolymer was examined in water using <SUP>1</SUP>H NMR and dynamic light scattering

Activity of iNOS in LPS-treated fish.

<p>Changes in the activity of iNOS (units/g wet wt) in different tissues of <i>H</i>. <i>fossilis</i> after treatment with LPS. Values are plotted as mean ± SEM (n = 5). ^a,c: <i>P</i> values significant at <0.05 and <0.001 levels, respectively, compared to respective controls (Tukey’s post hoc test).</p