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Conclusions: Meta-analysis and literature analysis showed that the results after laparoscopic varicocelectomy are comparable to other surgical procedures. The laparoscopic approach has the advantage to treat simultaneously bilateral varicocele. Varicocele is generally considered the most common correctable cause of male infertility [1, 2]. It is indicated as a factor in about one third of infertile males, being associated Corresponding author. Several treatment options have been used, including spermatic vein sclerotherapy or embolization, open inguinal ligation of the spermatic vein, subinguinal microscopic varicocelectomy, and, most recently, laparoscopy, but the ideal method for varicocele treatment is still controversial Laparoscopic vs open varicocelectomy in children and adolescents [6-8]. The ideal procedure should perform a varicocelectomy with a low rate of recurrence, hydrocele formation, and testicular atrophy. The indication for varicocelectomy includes testicular volume discrepancy, chronic scrotal pain, and infertility. Meta-analysis is a useful statistical tool that can be used to compare and integrate different studies in both a qualitative and quantitative way, considering variations in characteristics that can influence the overall estimate of the outcome of interest. To our knowledge, there is no meta-analysis that compares the various techniques for varicocele treatment in children. The aim of our study is to identify clinical evidence on the reliability of the laparoscopic technique compared to the open techniques, with the end points of recurrence rate and hydrocele formation. Results Eleven studies published between 2000 and 2009 matched the inclusion criteria, comparing varicocele treatments in the pediatric population, and reporting the incidence of complications. Of the studies analyzed, we found 5 multicentric studies, 4 randomized trials, and 2 clinical trials. We first considered all studies that showed a population of 1443 children and adolescents (age, 6-17 years; mean age, 14. Similar results were obtained analyzing the recurrence of postoperative hydrocele. Because of nonhomogeneous studies, we could not apply the meta-analysis method to all studies simultaneously, but we analyzed different meta-analysis grouping studies with similar features. Finally, the metaanalysis shows a lower rate of postoperative hydrocele in patients undergoing dye injection before laparoscopic ligation for lymphatic identification with an odds ratio of 0. Material and methods A literature search was performed, using Medline and Pubmed database, on all articles published during the last 10 years (2000-2009), reporting on varicocele treatments. Articles with data regarding recurrence, complications (hydrocele, hypotrophy, atrophy), and, if available, semen parameters after treatment were analyzed. We recorded 37 studies, but 26 of these were excluded from our analysis using the following criteria: (1) studies that were not relevant, in which outcome of interest were not reported or were impossible to calculate from the results; and (2) studies not concerning an adolescent population. Eleven studies published between 2000 and 2009 matched the inclusion criteria, comparing varicocele treatments in the adolescent population and reporting the incidence of complications. We separated these studies into multicentric studies, randomized trials, and clinical trials. Statistical analysis for categorical variables was carried out using the odds ratio as the summary statistic. This ratio represents the odds of an adverse event occurring in a treatment compared with the reference group. Discussion Varicocele has an adverse effect on the histologic, endocrine, and biochemical testis function . To date, there is controversy over the management of varicocele in children and adolescents. The laparoscopic approach for varicocelectomy was introduced into clinical practice in early 1990s , and during the last decade, this procedure has gained popularity especially in children because it is a minimally invasive simple and safe technique. The main reason is the possibility to perform the operation under local anesthesia, whereas each surgical approach in children requires general anesthesia. Another advantage of the laparoscopic approach is the possibility of simultaneously treating bilateral varicocele. The major complications after varicocelectomy are postoperative hydrocele and recurrence. In a recent randomized clinical trial comparing open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy, Al-Kandari et al  demonstrated that the subinguinal microsurgical technique offers the best outcome in hydrocele formation and varicocele recurrence, but the duration of the operation is usually longer. Podkamenev et al  in a randomized controlled trial compared laparoscopic varicocelectomy, performed in 434 patients, to open varicocelectomy, performed in 220 patients, both after injection of methylene blue under the tunica albuginea.
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These requirements are subject to change as legislative, fiduciary and other aspects of the program change. The information is used for essential activities including legislative reporting, federal reporting requirements for the State, budgeting, funding allocations, and other aspects of financial management. In addition, this data provides statistical information needed for program evaluation, assessment of need, and other activities required of Title X Family Planning Projects. The following list summarizes the required Title X reports, their forms and due dates. This list is provided to sub-recipients as part of the contracting process and the required forms are provided to sub-recipients with instructions prior to their due dates. This document provides guidance on the submission requirements for the Annual Health Care Plan narrative and associated appendices. Highlight significant program achievements, milestones, or other notable accomplishments during this past fiscal year. Insert the below table into this narrative section and indicate the projected number of unduplicated users during calendar year 2020 for each table row. Develop project goals and objectives for next fiscal year that are specific, measurable, attainable, realistic, and time bound (S. Goals and objectives should reflect regional needs and engage priority populations. Include at least one project goal and objective for Community Education Activities (See Section 11. Include at least one project goal and objective for Community Promotion Activities (See Section 11. The roster should indicate what community populations/groups the member represents. Provide a brief description of how the member composition of the I&E Committee represents the population served in terms of demographic factors such as race, color, national origin, handicapped condition, sex, and age. Describe the process the I&E Committee will use to review and track previously approved materials. Previously approved materials must be reviewed every three years to ensure information is still relevant, factually accurate, and appealing to its target audience. Financial Management Audit Requirements Financial Management Audit Requirements Following are the Audits that are required of all Family Planning Title X sub-recipient agencies. This section applies to agencies designated as sub-recipients (health department & private nonprofit agencies). Required Audit or Exemption Notice Grantees must submit to the Department a Single Audit, or Exemption Notice as described below (A. The Single Audit must comply with the requirements of the Single Audit Act Amendments of 1996, and Title 2 Code of Federal Regulations, Subpart F. Audit Exemption Notice Grantees exempt from Single Audit must submit an Audit Exemption Notice that certifies the exemption. The template Audit Exemption Notice and further instructions are available at. Other Audits the Department or federal agencies may also conduct or arrange for additional audits to meet their needs. In addition to the above audits, comprehensive site reviews are performed every three years, and detailed fiscal reviews are performed every two to three years. Due Date and Where to Send the required audit and any other required submissions. The Department reserves the right to request a hard copy of the audit materials if for any reason the electronic submission process is not successful. The Department may retain the amount withheld if the Grantee is more than 120 days delinquent in meeting the filing requirements. The Department may terminate the current grant if the Grantee is more than 180 days delinquent in meeting the filing requirements. The management decision includes whether or not the audit finding is sustained; the reasons for the decision; and the expected Grantee action to repay disallowed costs, make financial adjustments, or take other action. Prior to issuing the management decision, the Department may request additional information or documentation from the Grantee, including a request for auditor verification of documentation, as a way of mitigating disallowed costs.
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Relationship - Compare: Myrtus Chekan (Chronic bronchitis with dense, yellowish sputum, difficult to detach. Naja tripudians (virus of the cobra) * Naja produces a typical bulbar paralysis (L. Head - Pain in left temple and in left orbital region, extending to occiput, with nausea and vomiting. Ears - Illusions of hearing; otalgia; chronic otorrhoea, black discharges; smells like herring brine. Sleep - Profound, like a log, with stertorous breathing, a typical reptilian state. Modalities - Worse, from use of stimulants; better, from walking or riding in open air. Naphthalinum (a chemical compound from coal-tar; tar camphor) * Coryza, hay-fever, phthisis pulmonalis, also gonorrhoea have been influenced favorably by this drug. Narcissus pseudonarcissus (daffodil) * Symptoms of nausea followed by violent vomiting and diarrhoea. Daffodil bulbs contain an alkaloid the action of which, according to authorities, varies as to whether the alkaloid is extracted from the flowering bulb or from the bulb after flowering. Thus in the former case the alkaloid produces dryness of the mouth, checks cutaneous secretions, dilates the pupil of the eye, quickens the pulse, and slows and weakens the heart contractions. On the other hand, the alkaloid from the bulbs after flowering produces copious salivation, increases cutaneous secretion, contracts the pupil of the eye, produces slight relaxation of the pulse, and slight faintness and nausea. Skin - Erythema of a papular, vesicular and pustular type, aggravation in wet weather. Natrium arsenicosum (arseniate of sodium) * A remedy for nasal catarrh, with headache, pain at root of nose, dry and painful eyes. Natrium carbonicum (carbonate of sodium) * All the Natrums stimulate cellular activity and increase oxidation and metabolish. Head - Aches from slightest mental exertion, worse from sun or working under gas-light. Nose - All troubles of external nose which may attain a morbid size-pimples and puffiness. Modalities - Worse, sitting, from music, summer heat, mental exertion, thunderstorm. Relationship - Compare: Sodii bicarbonates (in vomiting of pregnancy with acetonuria, 30 grains in water spread over twenty-four hours); Nat. Mouth - Sore irritable spots along sides of tongue and throat, gums sore, tongue swollen; aphthous ulceration. Natrium muriaticum (chloride of sodium) * the prolonged taking of excessive salt causes profound nutritive changes to take place in the system, and there arise not only the symptoms of salt retention as evidenced by dropsies and oedemas, but also an alteration in the blood causing a condition of anaemia and leucocytosis. Stonham) * A great remedy for certain forms of intermittent fever, anaemia, chlorosis, many disturbances of the alimentary tract and skin. Nose - Violent, fluent coryza, lasting from one to three days, then changing into stoppage of nose, making breathing difficult. Respiratory - Cough from a tickling in the pit of stomach, accompanied by stitches in liver and spurting of urine? It appears likely to become a most useful remedy as an auxiliary, if not as a principal, in the treatment of diseases in patients of a strumous diathesis. Natrium phosphoricum (phosphate of sodium) * Natrium phosphoricum is the remedy for conditions arising from excess of lactic acid, often resulting from too much sugar. Mind - Imagines, on waking at night, that pieces of furniture are persons; that the hears footsteps in next room. Ears - One ear red, hot, frequently itchy, accompanied by gastric derangements and acidity. Cyanosis, fainting, copious liquid stools at night; throbbing and fullness; faintness, nervous pain in head, nausea, eructations, blue lips).
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Experimental data suggest that lipofuscin is the chromophore involved in the mediation of light-induced retinal damage following the exposure to blue light [70-73]. The second type of light-induced photochemical damage occurs with longer (1248 h) but less intense light exposure. This type of damage was initially observed in albino rats  but has also been observed in other species. Early studies [76-78] also provided evidence that the action spectrum for light-induced photoreceptor damage is similar to the absorption spectrum of rhodopsin, but later studies indicated that blue light (400440 nm) might be more damaging [79-81]. The exposure to blue light (max 474), green light (max 513), or fluorescent light at the intensity of 1Ч10-1 W/cm 2 for 4 h/day for 30 days did not produce a significant change in the number of cells in the photoreceptor layers of the Sprague-Dawley rats (n=6; see  for details about the methods used to quantify cells in the photoreceptor layer). The slides were incubated in a humidified container for 60 min at 37 °C in the dark. Photoreversal of bleaching augments the capability of rhodopsin molecules to absorb photons by several orders of magnitude, thus allowing the molecules to reach the critical number of photons required to induce damage in the retinal cells . The data from our laboratory indicate that in albino rats, exposure to blue light (max 474 65 nm, 1Ч10 -1 W/cm 2) acutely suppressed melatonin levels  while exposure to blue light for 4 h/day for 30 days did not produce significant effects on photoreceptor viability (Figure 3). These data support the idea that exposure to blue light in the range of 400470 nm (even at low levels) may damage photoreceptors and retinal pigment epithelium cells. Although most studies have focused on the acute effect of light exposure, several have also investigated the cumulative effect of light. For example, Noell  reported that a single 5 min exposure to light did not induce significant damage in photoreceptor cells, whereas a series of 5 min exposures led to significant photoreceptor damage. Furthermore, the time between exposures affects the cumulative effect of light [90-92]. In some cases, intermittent light exposure may produce even more pronounced damage than an equivalent amount of light in a single exposure . In addition, the type of illumination to which the animals had been exposed before the experimental treatment influenced Figure 4. The intensity of the light during the light phase of the 12 h:12 h light-dark cycle was about 400450 lux. After 30 days, the rats were killed, and the retinas were explanted, immediately frozen, and stored at -80 °C. For example, rats raised in complete darkness showed greater susceptibility to light-induced retinal damage , and rats raised in an 800 lux light-dark cycle were more resistant to light-induced retinal damage compared to animals raised in a 5 lux light-dark cycle . The exposure to light that might affect adult animals might not induce retinal damage in young animals . From that point of view, the protective function of lutein, or blueblocking pigment, on the retina is also considered. Finally, the severity of light-induced retinal damage changes with the time of the day [98-102]. For example, rats are three to four times more susceptible to light damage at night (01:00) than during the day (09:00 and 17:00). Exposure to blue light during the night might have more negative effects compared to the same exposure during the daytime. However, in this case, this assumption is based on the experimental data obtained from nocturnal rodents. Thus, it is difficult to determine whether light-induced retinal damage has a daily rhythm in humans, and further studies on diurnal animal models. Although most studies on the effects of blue light have focused on the mechanisms responsible for the damage to the photoreceptors following an acute exposure to high intensity light, some studies have reported that sub-threshold exposure to blue light can also induce damage in photoreceptors [105-107]. The mechanism through which long-term exposure to blue light may induce photoreceptor damage is mostly unknown. Several studies have indicated lipofuscin (absorption peak around 450 nm) is a possible mediator of the risk associated with long-term exposure to blue lightinduced retinal damage [109, 110]. The number of reactive oxygen species produced by lipofuscin is directly related to the spectral composition of the light, and it steadily decreases from 400 to 490 nm . Finally, it has been reported that chronic exposure to blue light may accelerate photoreceptor degeneration in an animal model in the study of retinal degeneration . Thus, experimental evidence obtained from different experimental models indicates that exposure to blue light in the 470490 nm range may be less damaging to the eye compared to blue light in the 400460 nm range. However, the real risk from artificial light (white or blue) exposure in humans is difficult to assess, since light therapy has been in use for only a few years and in a small number of individuals.
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Personal insight replaces belief in God with the complete study of the laws of cause and effect (Karma). May include meditation or chanting according to the form of Buddhism the Buddhist follows. All rituals at death are aimed at promoting human rebirth in the next life, as well as preventing lower forms of rebirth taking place. Person`s state of mind at moment of death believed to influence rebirth, so they will want to be calm and peaceful. Imperative that a Buddhist representative be notified well in advance to see that appropriate person presides over the care of a dying person. Traditionally, there is a 3-5 day period when the body is not disturbed following death. Illness is a result of karma (law of cause and effect), therefore an inevitable consequence of actions in this or a previous life. Healing and recovery promoted by awakening to wisdom of Buddha, which is spiritual peace and freedom from anxiety. No restrictions on blood or blood products, surgical procedures, organ donation, autopsy. Medications acceptable if in great discomfort as long as they do not affect state of mind. While some celebrations are common to all Buddhists, many are unique to particular schools. Daily Practices Dying and Death Facilitating Practices Food Health Holy Days and Festivals © HealthCare Chaplaincy Network 2014 Page 22 Pregnancy and birth Rituals or ceremonies Spiritual instruments, social structure and symbols Artificial insemination, sterility testing and birth control acceptable. Buddhists do not condone taking a life; circumstances of patient determine whether abortion acceptable. The major rituals are around baby blessings, lay and monk ordination, marriage and death. Incense burning, flower and fruit offerings, altars/images/statues of Buddha, social and ancestors, prayer beads, chant boxes. Hinduism *3rd largest religion in the world *Large population in India, Nepal and Bangladesh Beliefs A wide variety of beliefs held together by an attitude of mutual tolerance and belief that all approaches to God are valid. Personal hygiene very important and bathing is required every day, but bathing after meal may be viewed as harmful. The last thoughts or words are of God; the Gita (scripture) is recited to strengthen the person`s mind and provide comfort. Religious chanting before and after death is continually offered by family, friends and priest. Prefer to die at home, as close to mother earth as possible (usually on the ground). Immediately after death priest may pour water into mouth of deceased and family may wash the body. Father/husband is primary spokesperson to whom questions should be directed - women may not request special care. According to dietary law, right hand is used for eating and left hand for toileting and hygiene. May fast on special holy days Prayer for health considered low form of prayer; stoicism is preferable. Various sacred writings Various objects for rituals- including sandalwood, incense, candle, symbols structure and or pictures, fresh flowers, prayer beads. Holy Days and Festivals Pregnancy and Birth Rituals and Ceremonies Spiritual instruments, structure and symbols © HealthCare Chaplaincy Network 2014 Page 24 Sikhism *Mostly from Pakistani and Indian region of Punjab Beliefs God is formless, eternal, and unobserved. Salvation can be achieved through disciplined meditation and spiritual union with God. Fasting not accepted as a religious practice, although can be observed for medical reasons. Meet as a congregation for prayer service and common meal on six primary holidays.
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This metabolic pathway would result in the formation of the aniline metabolites as well as a 2-carbon fragment lost from the piperazine ring. In the mass balance studies, the 14C label was placed on one of the carbons that would be lost during oxidative cleavage of the piperazine ring. A similar peak (~17% of radioactivity) was present in the radio-chromatograms from the rat mass balance study following a single oral dose of [14C]-lumateperone. Although efforts to identify the constituents of this peak were unsuccessful, it is likely composed of highly polar compounds resulting from oxidative cleavage of the piperazine ring yielding a 2-carbon fragment containing the 14C label. The relative size of this early eluting peak indicates this is a major metabolic pathway in dogs and to a lesser extent in rats. However, there is no evidence directly supporting this concept because the anilines theoretically formed during this metabolic process are actually present at relatively low levels in plasma of both dogs and rats. The discrepancy between the levels of these anilines measured in the systemic circulation in the general toxicology studies and their theoretical formation based on results from the mass balance study could have been addressed by placing the [14C] label on a different carbon from the ones lost via piperazine ring cleavage. Although the Applicant has conducted no studies to directly assess the reasons for the apparent discrepancy in theoretical aniline formation based on the mass balance study and the circulating levels measured in the general toxicology studies, there is evidence that indicates aniline metabolites are present at significant levels in dogs and to a lesser extent in rats. As noted above, significant intracellular accumulation of pigmented material was reported in multiple organs in the dog and rat repeat dose toxicology studies. It is also possible that additional aniline metabolites that were not fully investigated using mass spectrometry were present. The metabolic pathway responsible for the formation of the aniline metabolites from lumateperone has not been definitively characterized; however, it likely involves oxidation of the piperazine ring resulting in scission as was observed with clonidine and as proposed in bioactivation pathway for 2-(3-chlorobenxyloxy)-6-(piperazin-1-yl)pyrazine (Baillie, Neill et al. Therefore, these animal findings need to be described in the label as the nonclinical studies could not definitively establish that they are of no clinical relevance. In conclusion, from a nonclinical perspective, the application is considered approvable pending the description of the relevant findings in animals in section 13. Genotoxicity and Carcinogenicity Lumateperone was not mutagenic in the in vitro bacterial reverse mutation assay (Ames test) or the mouse lymphoma test in the absence of metabolic activation. Oral administration of lumateperone did not cause any increase in tumors at doses approximately 3. Oral administration of lumateperone to rats and rabbits did not cause fetal malformations at doses approximately 14. In rats, fetal variations were observed; however, these occurred in the presence of maternal toxicity and, therefore, are of limited clinical relevance. Only the studies relevant to the potential mechanism of action of lumateperone and associated labeling claims proposed by the Applicant are reviewed here. Therefore, the Applicant asserts that lumateperone has a pharmacologic profile that differs from other antipsychotic agents and "is a first-in-class, small molecule, new molecular entity that selectively and simultaneously modulates serotonin, dopamine, and glutamate neurotransmission. In addition, the in vivo data, although somewhat supportive of presynaptic partial agonist activity at D2 receptors, is not sufficient to override the in vitro functional activity data demonstrating lumateperone is an antagonist at D2 receptors. Thus, it is not clear whether lumateperone is an antagonist or partial agonist at presynaptic D2 receptors from the data available at this time. Primary Pharmacology the in vitro receptor binding profile of lumateperone at targets thought to mediate the efficacy of atypical antipsychotic drugs (Arnt and Skarsfeldt 1998, Lieberman, Bymaster et al. Lumateperone is extensively metabolized to multiple pharmacologically active metabolites in humans and nonclinical species (Table 3). Lumateperone significantly inhibited serotonin-induced [3H]inositol phosphate accumulation at concentrations ranging from 50 to 200 nM (Figure 1). There is substantial evidence that the D2L isoform is expressed in structures targeted by dopaminergic fibers indicating a postsynaptic localization, whereas the D2S isoform is preferentially expressed in dopaminergic cell bodies and axons indicating a presynaptic localization (Khan, Mrzljak et al. Therefore, based on the in vitro functional assays conducted by the Applicant, lumateperone acts as an antagonist at both postsynaptic and presynaptic D2 receptors. The phosphorylation state of numerous phosphoproteins was altered by lumateperone and the other antipsychotic drugs assessed; however, there were differences between these drugs in their respective profiles. Lumateperone produced an increase in the phosphorylation state of numerous proteins thought to be downstream from receptors at which it displays in vitro binding affinity; however, these increases were consistently less significant relative to the other drugs studied (Figure 2). Reviewer Note: the Applicant proposes that these data support their assertion that lumateperone is a "dopamine receptor phosphoprotein modulator;" however, these results are not distinct from those observed with other antipsychotic drugs (Figure 2). Therefore, these data do not support labeling for lumateperone that would be distinct from other atypical antipsychotic drugs. Thus, the Applicant proposes that lumateperone is a partial agonist at presynaptic dopamine D2 receptors. This theory is based on the similar effects observed with aripiprazole (a partial agonist), in contrast to the robust increase in phosphorylation state observed with other antipsychotic drugs in this study (Figure 2).
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However, it is impossible to talk about quality of life without considering the need for policies to improve overall public health and to reduce health disparities among different segments of the population. A major factor in reducing health disparities is recognizing how place matters i. The physical, social, and economic environments of a community, including air and water quality, housing conditions, and access to resources and services, determine the daily advantages or disadvantages community members face in trying to survive and prosper. The key to success for these coalitions is realizing that community members must be full partners. In a democracy, all people have a right to participate meaningfully in policy making. The use of successful local projects to inform policy agendas acknowledges the authenticity of a community-centered approach to change. Everyone benefits when communities are organized, responsive to local needs, supportive of residents input to policy change, and active in creating policies to protect community members from harmful conditions. Unfortunately, significant barriers have existed and communities of color and low-income communities have frequently been excluded from discussions of the health-related policies that affect them. The development of successful health-related policies depends on the participation of a broad, representative coalition of community members so that the policies created represent the needs or experiences of all community members. Public health can support the use of innovative approaches with communities, to improve the health and quality of life. To create a strong, healthy, and equitable world, we must identify and replicate successful community-based projects that harness our collective wisdom and experience. Through a coordinated policy agenda and strengthened advocacy, partners focused on building public will to address the environmental factors that shape the lives of young children. Consider this an asset rather than a barrier, because it allows you to try a variety of approaches to find out what works best for your partnership and your community. If possible, use multiple approaches to increase the likelihood of reaching different groups in your community. There is no right or wrong approach, but there are several factors that might influence your decision about which approach to use to achieve your goals and objectives. Although these factors can help guide your decision-making process, it is important to trust the intuition and experience of your partners, particularly the community members. For many issues, it might be necessary to use more than one approach to create the changes desired. You may want to consider, for instance, the resources required, the extent to which one approach lays the groundwork for the other, and the readiness of the community to engage in these approaches. Remember to consider new partners who can support your use of different approaches. Interventions were designed to be population-based, with an emphasis on improving access to care, linking clients to social services, and addressing institutional policies and norms considered racist. Consider the experiences, resources, and other supports that exist in the partnership. You are now ready to learn from doing by developing and implementing an action plan. An action plan is important not only to keep your partnership on track toward meeting its goals but also to demonstrate to community members and other stakeholders that you are making tangible progress toward improving social, economic, and environmental conditions. Keep in mind, however, that you may need to modify your action plan to meet changing conditions in your community over time. Getting started Developing an action plan An action plan describes the specific steps necessary to meet clearly defined goals and objectives. After the planning group has been organized it should meet to determine what action steps are necessary. The group will need to estimate the time needed for each action step and be sure the times are reasonable for everyone involved. The group will need to identify existing resources first and then determine whether additional resources will be required. Will they be completed > Who else in the community should know about or can help with the plan? Meet regularly and use the set of questions in "Developing an action plan" (page 76) as the basis for a status report to be discussed at your meetings. The group can acknowledge and celebrate what has been completed, assess challenges, and revise the action plan accordingly.
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However, importance will be given to critically reflect on these and develop appropriate strategies for each location where the fellows will intervene rather than blindly adopt methods that have been followed by others. Introduction Gender norms and categories are directly related to the distribution of power among genders, and hence to issues of social justice, equity and human rights. Hence, the study of feminine, masculine and trans-gender identities concerns the exploration of power relationships within the contemporary gender landscape, where certain dominant ideals of manhood impact on women, different ways of being men, as well those identities that may not fit either gender category. In order to stand in a relationship of superiority to feminine identity, masculinity must be represented as possessing characteristics that are the binary opposite of (actual or imagined) feminine identity. It is also for this reason that we speak of masculinities rather than masculinity (in the singular). Within this system, even those who may not approximate to the male ideal (such as homosexual men) still stand to benefit from the privileges attached to being a man. So, as a parallel, we might think of the situation on apartheid era South Africa where all whites those who supported apartheid and those who opposed it were potential beneficiaries of the institutionalised privileges of being white. There is an entire task of building and rebuilding, consolidation, representation, and enforcement; in other words we must think of gender identities as works in progress. A crucial task of this course is to foreground the social nature of gender identities and simultaneously explore possibilities of interventions. This approach moves away from the biologism that has historically been part of the study of gender and sexual identities. Biologism is the thinking that suggests that gender and sexual identities: are biologically derived have been historically stable. Masculinities have been defined and understood in different ways by scholars and activists. However, what is important for our purpose is to understand its relationship with power and violence. Men often feel that masculinities is something that they carry somewhere deep inside themselves and it manifests itself with biological maturation. In other words from boyhood to becoming men is a passage that includes besides biological growth and maturation, a logical and linear development of masculinities. However, masculinity is not an essence that all men carry but socially produced notions and ideas about how men should act and behave. This what we mean when we say that masculinities are socially produced but embodied, that is carried by men on their body, ways of being men. By posing masculinities as something that is superior, men are able to provide a logic and justification to support their practice of authority, control and sense of power. Therefore, men appropriate for themselves the position of being decision makers or controlling and restricting the mobility of women, which in turn creates and sets up systems of deprivation and discrimination. The experience of power is never absolute for men but at the same time because of their gender position the sense of entitlement to power remains intact. Therefore it is more useful to describe masculinities as a sense of entitlement to power that men carry because of their being men but ironically, however hard they may try, this entitlement never translates into an absolute experience. The only space where even men who occupy the lowest rungs of social hierarchy are most likely to experience power is vis a vis women and children in the domestic sphere. It has been pointed out that if masculinities is to be challenged then men need to understand these contradictory power flows that dictate the ways in which they act and behave. Plurality of Masculinities If we were to ask a group of men in a room to describe their experiences of masculinity, we are most likely to receive a wide range of response that demonstrates that men understand and experience masculinity in very different ways. Often we fall into the trap of seeing masculinities only through the lens of sex roles. To understand masculinities we have to look beyond sex roles and examine masculinities as a wide set of practices that reflect the gendered nature of power, which includes the economic and political spheres of our social life. The narratives of the experience of masculinities that will emerge from shared experiences will demonstrate that there is no single pattern to masculinities. Different cultures and different periods of history throw up different forms of masculinities. There are different kinds of masculinities based on class, caste, culture, religion, sexual orientation, etc. Even within one cultural setting we will find different practices of masculinities.