Background: Recent reviews of the use and application of implementation frameworks in implementation efforts highlight the limited use of frameworks, despite the value in doing so. As such, this article aims to provide recommendations to enhance the application of implementation frameworks, for implementation researchers, intermediaries, and practitioners. Discussion: Ideally, an implementation framework, or multiple frameworks should be used prior to and throughout an implementation effort. This includes both in implementation science research studies and in real-world implementation projects. To guide this application, outlined are ten recommendations for using implementation frameworks across the implementation process. The recommendations have been written in the rough chronological order of an implementation effort; however, we understand these may vary depending on the project or context: (1) select a suitable framework(s), (2) establish and maintain community stakeholder engagement and partnerships, (3) define issue and develop research or evaluation questions and hypotheses, (4) develop an implementation mechanistic process model or logic model, (5) select research and evaluation methods (6) determine implementation factors/determinants, (7) select and tailor, or develop, implementation strategy(s), (8) specify implementation outcomes and evaluate implementation, (9) use a framework(s) at micro level to conduct and tailor implementation, and (10) write the proposal and report. Ideally, a framework(s) would be applied to each of the recommendations. For this article, we begin by discussing each recommendation within the context of frameworks broadly, followed by specific examples using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Summary: The use of conceptual and theoretical frameworks provides a foundation from which generalizable implementation knowledge can be advanced. On the contrary, superficial use of frameworks hinders being able to use, learn from, and work sequentially to progress the field. Following the provided ten recommendations, we hope to assist researchers, intermediaries, and practitioners to improve the use of implementation science frameworks.
The kisspeptin/Gpr54 signaling pathway plays a critical role in reproduction by stimulating the secretion of GnRH, yet mice carrying mutations in Kiss1 (which encodes kisspeptin) or Gpr54 exhibit partial sexual maturation. For instance, a proportion of female Kiss1−/− and Gpr54−/− mice exhibit vaginal oestrus, and some male Kiss1−/− and Gpr54−/− mice exhibit spermatogenesis. To characterise this partial sexual maturation, we examined the vaginal cytology of female Kiss1−/− and Gpr54−/− mice over time. Nearly all mutant mice eventually enter oestrus, then spontaneously transition from oestrus to dioestrus and back to oestrus again. These transitions are not associated with ovulation, and the frequency of these transitions increases with age. The oestrus exhibited by female Kiss1−/− and Gpr54−/− mice was disrupted by administration of the competitive GnRH antagonist acyline, which also resulted in lower uterine weights and, in Kiss1−/− mice, lower serum FSH and LH concentrations. Similarly, male Kiss1−/− and Gpr54−/− mice treated with acyline had smaller testicular sizes and absence of mature sperm. In addition to examining intact Kiss1−/− and Gpr54−/− mice, we also assessed the effects of acyline on gonadotrophin concentrations in gonadectomised mice. Gonadectomy resulted in a significant increase in serum FSH concentrations in male Gpr54−/− and Kiss1−/− mice. Acyline administration to gonadectomised Kiss1−/− and Gpr54−/− male mice lowered serum FSH and LH concentrations significantly. In contrast to males, gonadectomy did not result in significant gonadotrophin changes in female Kiss1−/− and Gpr54−/− mice, but acyline administration was followed by a decrease in LH concentrations. These results demonstrate that, while kisspeptin signaling is critical for the high levels of GnRH activity required for normal sexual maturation and for ovulation, Kiss1−/− and Gpr54−/− mice retain some degree of GnRH activity. This GnRH activity is sufficient to produce significant effects on vaginal cytology and uterine weights in female mice and on spermatogenesis and testicular weights in male mice.
In a population of children with ASDs, parents report a diverse range of needs while in the hospital. These data support the concept that a pragmatic assessment of individual communication and sensory differences is likely to be essential in the development of an appropriate inpatient care plan.
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