Rationale and Standards of Evidence in Evidence-Based Practice
OLIVER C. MUDFORD, ROB MCNEILL, LISA WALTON
AND KATRINA J. PHILLIPS
What is the purpose of collecting evidence to inform clinical practice in psychology concerning the effects of psychological or other interventions? To quote Paul’s (1967) article that has been cited 330 times before November 4, 2008, it is to determine the answer to the question: “What treatment, by whom, is most effective for this individual with that specific problem, under which set of circumstances?” (p. 111). Another answer is pitched at a systemic level, rather than concerning individuals. That is, research evidence can inform health-care professionals and consumers about psychological and behavioral interventions that are more effective than pharmacological treatments, and to improve the overall quality and cost-effectiveness of psychological health service provision (American Psychological Association [APA] Presidential Task Force on Evidence-Based Practice, 2006). The most general answer is that research evidence can be used to improve outcomes for clients, service providers, and society in general. The debate about what counts as evidence of effectiveness in answering this question has attracted considerable controversy (Goodheart, Kazdin, & Sternberg, 2006; Norcross, Beutler, & Levant, 2005). At one end of a spectrum, evidence from research on psychological treatments can be emphasized. Research-oriented psychologists have promoted the importance of scientific evidence in the concept of empirically supported treatment. Empirically supported treatments (ESTs) are those that have been sufficiently subjected to scientific research and have been shown to produce beneficial effects in wellcontrolled studies (i.e., efficacious), in more natural clinical environments (i.e., effective), and are the most cost-effective (i.e., efficient) (Chambless & Hollon, 1998). The effective and efficient criteria of Chambless and Hollon (1998) have been amalgamated under the term “clinical utility” (APA Presidential Task Force on Evidence-Based Practice, 2006; Barlow, Levitt, & Bufka, 1999). At the other end of the spectrum are psychologists who value clinical expertise as the source of evidence more highly, and they can rate subjective impressions and skills acquired in practice as providing personal evidence for guiding treatment (Hunsberger, 2007). Kazdin (2008) has asserted that the schism between clinical researchers and practitioners on the issue of evidence is deepening. Part of the problem, which suggests at least part of the solution, is that research had concentrated on empirical evidence of treatment efficacy, but more needs c01 20 April 2012; 12:43:29 3 Hersen, Michel, and Peter Sturmey. Handbook of Evidence-Based Practice in Clinical Psychology, Child and Adolescent Disorders, John Wiley & Sons, Incorporated, 2012. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ashford-ebooks/detail.action?docID= ...
Expanding the Lens of EBP: A Common Factors in AgreementScott Miller
The authors explore the limitations of the traditional view of evidence-based practice with its emphasis on specific methods and diagnosis. An alternative is proposed based on the common factors.
Of Dodo birds and common factors: A scoping review of direct comparison trial...Will Dobud
Background: Adventure therapy (AT) is a term that includes therapies such as wilderness therapy and adventure-based counseling. With growing empirical support for AT, the diversity of studies make it difficult to attribute outcomes to specific treatment factors.
Objectives: Researchers explored whether AT, often perceived as an alternative therapy, works because of AT's unique components, or whether factors shared by all therapies were responsible.
Methods: A scoping review was undertaken utilizing a search of major databases, unpublished disser- tations, and a hand search for direct comparison trials matching AT with another therapeutic intervention.
Results: 881 publications were identified. 105 quantitative studies were included following a title and abstract review. Only 13 met the full inclusion criteria. Little to no differences were found to isolate specific therapeutic factors.
Conclusions: We discuss the implications of these results considering the movement toward evidence- based practice and recommend future research to eclipse our current understanding of AT.
Whether you are preparing for an upcoming nursing exam or struggling with a specific topic, our service is designed to cater to your unique needs. We offer personalized tutoring and support to help you overcome your challenges and achieve your academic goals. With our take my nursing exam, you can improve your nursing knowledge and skills and feel confident when taking your nursing exams. For more information visit us at https://www.liveexamhelper.com/take-my-nursing-exam.html or email support@liveexamhelper.com. You can also call +1 (315) 557-6473 for assistance with nursing exams.
Expanding the Lens of EBP: A Common Factors in AgreementScott Miller
The authors explore the limitations of the traditional view of evidence-based practice with its emphasis on specific methods and diagnosis. An alternative is proposed based on the common factors.
Of Dodo birds and common factors: A scoping review of direct comparison trial...Will Dobud
Background: Adventure therapy (AT) is a term that includes therapies such as wilderness therapy and adventure-based counseling. With growing empirical support for AT, the diversity of studies make it difficult to attribute outcomes to specific treatment factors.
Objectives: Researchers explored whether AT, often perceived as an alternative therapy, works because of AT's unique components, or whether factors shared by all therapies were responsible.
Methods: A scoping review was undertaken utilizing a search of major databases, unpublished disser- tations, and a hand search for direct comparison trials matching AT with another therapeutic intervention.
Results: 881 publications were identified. 105 quantitative studies were included following a title and abstract review. Only 13 met the full inclusion criteria. Little to no differences were found to isolate specific therapeutic factors.
Conclusions: We discuss the implications of these results considering the movement toward evidence- based practice and recommend future research to eclipse our current understanding of AT.
Whether you are preparing for an upcoming nursing exam or struggling with a specific topic, our service is designed to cater to your unique needs. We offer personalized tutoring and support to help you overcome your challenges and achieve your academic goals. With our take my nursing exam, you can improve your nursing knowledge and skills and feel confident when taking your nursing exams. For more information visit us at https://www.liveexamhelper.com/take-my-nursing-exam.html or email support@liveexamhelper.com. You can also call +1 (315) 557-6473 for assistance with nursing exams.
Evidence based nursing practice is one of most important for perfect and accurate in terms of saving a life.this presentation covers almost all aspect of EBD
EBSCO Publishing Citation Format APA (American Psychologica.docxtidwellveronique
EBSCO Publishing Citation Format: APA (American Psychological Assoc.):
NOTE: Review the instructions at http://support.ebsco.com.library.capella.edu/help/?int=ehost&lang=&feature_id=APA and make any
necessary corrections before using. Pay special attention to personal names, capitalization, and dates. Always consult your library
resources for the exact formatting and punctuation guidelines.
References
Brossart, D. F., Meythaler, J. M., Parker, R. I., McNamara, J., & Elliott, T. R. (2008). Advanced regression methods for single-
case designs: Studying propranolol in the treatment for agitation associated with traumatic brain injury. Rehabilitation
Psychology, 53(3), 357–369. https://doi-org.library.capella.edu/10.1037/a0012973
<!--Additional Information:
Persistent link to this record (Permalink): http://library.capella.edu/login?url=http://search.ebscohost.com
/login.aspx?direct=true&db=pdh&AN=2008-11210-010&site=ehost-live&scope=site
End of citation-->
Advanced Regression Methods for Single-Case Designs: Studying Propranolol in the Treatment for Agitation
Associated With Traumatic Brain Injury
By: Daniel F. Brossart
Department of Educational Psychology, Texas A&M University;
Jay M. Meythaler
Department of Physical Medicine and Rehabilitation, Wayne State University;
Rehabilitation Institute of Michigan, Detroit, Michigan
Richard I. Parker
Department of Educational Psychology, Texas A&M University
James McNamara
Department of Educational Psychology, Texas A&M University
Timothy R. Elliott
Department of Educational Psychology, Texas A&M University
Acknowledgement: This study was funded in part by National Institute of Disability Research and Rehabilitation
Grant H 133G000072 awarded to Jay M. Meythaler. Appreciation is expressed to Michael E. Dunn for sharing
information and opinions about the history of single-case designs in rehabilitation psychology research. Graphs of
participant data not presented in this article are available upon request from Daniel F. Brossart.
In a thoughtful commentary, Aeschleman (1991) observed a decreasing interest in single-case research (SCR)
designs in the rehabilitation psychology literature: Between 1985 and 1989, Aeschleman found only 6 out of 402
empirical papers published in Rehabilitation Psychology, Archives of Physical Medicine and Rehabilitation, and
Rehabilitation Counseling Bulletin used a single-subject design (<1.5% of the total; Aeschleman, 1991, p. 43). A brief
examination of the past 15 years of Rehabilitation Psychology reveals one article that offered an innovative way to
analyze single-case data (Callahan & Barisa, 2005) and another that was a true single-case study (Pijnenborg,
Withaar, Evans, van den Bosch, & Brouwer, 2007).
We disagree with Aeschleman's bleak conclusion that SCR designs “… have not made a methodological impact on
research in reh.
Protection of human subjects,Phenomenon ,Methodology,Study design,Theoretical model,Significance of the study,Research problem,
WHAT IS THE IMPACT OF COMFORT CARE VERSES ALTERNATIVE CARE FOR THE CHRONIC DYING PATIENT FAMILY AND THE HEALTH CARE TEAM
Understanding Oncology Nurses’ Grief: A Qualitative Meta-AnalysisLisa Barbour
Barbour, L. C. (2016, September 16-18). Understanding oncology nurses’ grief: A qualitative meta-analysis. A presentation at the Athabasca University 2016 Graduate Student Conference, Edmonton, AB.
Running head RESEARCH PROPOSAL ON COUPLES COUNSELING RESEA.docxtoltonkendal
Running head: RESEARCH PROPOSAL ON COUPLES COUNSELING
RESEARCH PROPOSAL ON COUPLES COUNSELING 5
Research Proposal on Couples Counseling
Social Work Practice Research I (SOCW - 6301 - 3)
Introduction
This research proposal is about undertaking research to find the best therapy method for couples between individual, group, and couples therapy. The proposal will detail the findings of past researchers and will occasionally focus on the therapy methods in the context of a couple that is experiencing conflict mainly based on the rejection of their same-sex marriage by their respective families. It will also detail the methodologies used by other researchers in investigating the therapy methods. The study will reveal the most recommended therapy method and the variations of the method.
Research Problem and Question
Many couples quarrel because their respective families reject their union or relationship or marriage. Most of the affected couples are those whose respective families are deeply divided on the basis of religion, race/ethnicity and socio-economic status. However, some families just oppose relationships because they threaten their traditions, which are mostly rooted on religion. Some families oppose gay or lesbian relationships or marriages. Even when a family member reveals that he or she may attracted to a member of the opposite sex, the other family members may rise up against that family member. It may make teenagers and young adults hide about their sexual orientation. The stigmatization may be too unbearable for the affected individuals, who may choose to go into seclusion and engage in suicidal actions. There are couples like Kathleen and Lisa who courageously seek the help of therapists. Upon setting a stage for positive development, couples can ease the tension in the mind. They can open up to people and feel ready to solve problems together. The question that comes in mind in light of these facts is: What it the true impact of sexual orientation-based rejection by family members on a relationship? How can a social worker help couples overcome sexual orientation-based rejection by family members on a relationship? The research question of the study is: which between individual, group, and couples therapy is the best therapy method for couples?
Literature Review on Individual, Group, and Couples Therapy
The therapeutic alliance concept is mainly associated with individual psychotherapy, particularly in literature. Yet, the concept is increasingly used together within the marital and family therapy domains. According to Pinsof and Catherall (1986), “a systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework”. The authors examined family, couple and individual therapy and used some methodologies and deve ...
Respond to at least two colleagues by explaining how they could use .docxcarlstromcurtis
Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
Somatic symptom disorders are mental disorders that manifest with physical symptoms that are not always clear to explain with medical diagnosis (APA, 2013). One specific example of such a disorder is the Illness Anxiety Disorder (F45.21). This disorder is diagnosed when there is a pervasive and impacting preoccupation with having a serious medical condition in circumstances when no predisposition or existing symptomatology indicate there should be medical concern (APA, 2013). The diagnosed individual will exhibit heightened anxiety regarding their perceived condition. Furthermore, the diagnosis is classified as either “care-seeking type,” whereby the individual frequently seeks out medical guidance from professionals or “care-avoidant type: whereby the individual avoids medical care despite their ongoing concerns (APA, 2013).
This can present a unique challenge for guiding professionals, as the client is potentially in need of both medical and mental health care. Therefore, a biopsychosocial assessment is recommended to gain the most thorough, comprehensive picture of the client and their current set of circumstances. This multi aspect evaluation serves to understand the biological, or physical, contributors to the individual’s somatic diagnosis, while also delving into their perceptions and beliefs (psychological) and their social environment and experiences. When this information is gathered from these varied perspectives, intervention can be designed to target specific areas of need, with the understanding that medical care may be required, concurrently, with mental health support (Dimsdale, Patel, Xin and Kleinman, 2007).
Because of the complexity of such diagnoses, a multidisciplinary approach is deemed most effective when working with such clients. Because of the psychological involvement in this disorder, psychotherapy aimed at modifying existing thought patterns would be considered sound practice (Kirmayer and Sartorius, 2007). To expand, cognitive behavioral therapy (CBT) can be applied, increasing the client's awareness of their current thought patterns, possible triggers and strategies to combat negative thinking. Additionally, the prescription of medication to address the co-occurring anxiety or other resulting physical symptoms would be provided by a medical professional, such as a psychiatrist. This approach, widely accepted, allows for the client’s case to be viewed through different lenses.
While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can b ...
According to Davenport (2014) social media and health care are c.docxmakdul
According to Davenport (2014) social media and health care are collaborating in meeting the needs of health care providers and patients. Social media is taking a step towards focusing on an analytic model to evaluate the value of social media in healthcare. For this assignment you research and investigate the areas of social media that might embrace and benefit from an analytic model combining acquired data and value-based analytics. You will then evaluate the resource addressing the following points:
· Five major stakeholder roles of social media—patients, physicians (and other outpatient care), hospitals, payers (employers, health plans), and health information technology (IT)
· Will social media improve a practice? How so? Provide a thorough rationale.
· Provide a conclusion with the main points .
format:
· Must be two to four
· Must use at least three scholarly sources
.
According to (Fatehi, Gordon & Florida, N.D.) theoretical orient.docxmakdul
According to (Fatehi, Gordon & Florida, N.D.) theoretical orientation represent styles of mind for understanding reality. This theoretical orientation can be organized as a continuum from theoretical constructs that are independent and concrete as with the Behavioral/ CBT theories, to theoretical constructs that are interdependent and abstract as with the Psychodynamic theories (Fatehi, Gordon & Florida, N.D.). Family systems and Humanistic/Existential are theoretical midpoints (Fatehi, Gordon & Florida, N.D.). Trait theory tends to focus on the premise that we are born with traits or characteristics that make us unique and explain our behaviors (Cervone& Pervin, 2019). For example, introversion, extroversion, shyness, agreeableness, kindness, etc. all these innate characteristics that we are born help to explain why we behave in a certain manner according to the situations we face, (Cervone& Pervin, 2019). Psychoanalytic perspective on the other hand focuses on childhood experiences and the unconscious mind which plays a role in our personality development, (Cervone& Pervin, 2019).
According to Freud, (Cervone& Pervin, 2019) our unconscious mind includes all our hidden desires and conflicts which form the root cause of our mental health issues or maladaptive behaviors. The main difference between these two perspectives is that trait theory helps to explain why we behave in a certain manner, whereas psychoanalytic theory only describes the personality and predicting behavior and not really explaining why we behave the way we do. There is no such evident similarity between the two perspectives, but kind of rely on underlying mechanisms to explain personality. Also, there is some degree of subjectivity present in both the perspectives. Trait theories involve subjectivity regarding interpretations of which can be considered as important traits that explain our behaviors, and psychoanalytic theory is subjective and vague in the concepts been used like the unconscious mind. My opinions accord with the visible contrasts between the two, one focused on internal features describing our behaviors in clearer words, whilst other concentrating on unconscious mind in anticipating behavior which is ambiguous and harder to grasp.
References
Cervone, D., & Pervin, L. A. (2019). Personality: Theory and research (14th ed.). Wiley.
Fatehi, M., Gordon, R. M., & Florida, O. A Meta-Theoretical Integration of Psychotherapy Orientations.
.
More Related Content
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Evidence based nursing practice is one of most important for perfect and accurate in terms of saving a life.this presentation covers almost all aspect of EBD
EBSCO Publishing Citation Format APA (American Psychologica.docxtidwellveronique
EBSCO Publishing Citation Format: APA (American Psychological Assoc.):
NOTE: Review the instructions at http://support.ebsco.com.library.capella.edu/help/?int=ehost&lang=&feature_id=APA and make any
necessary corrections before using. Pay special attention to personal names, capitalization, and dates. Always consult your library
resources for the exact formatting and punctuation guidelines.
References
Brossart, D. F., Meythaler, J. M., Parker, R. I., McNamara, J., & Elliott, T. R. (2008). Advanced regression methods for single-
case designs: Studying propranolol in the treatment for agitation associated with traumatic brain injury. Rehabilitation
Psychology, 53(3), 357–369. https://doi-org.library.capella.edu/10.1037/a0012973
<!--Additional Information:
Persistent link to this record (Permalink): http://library.capella.edu/login?url=http://search.ebscohost.com
/login.aspx?direct=true&db=pdh&AN=2008-11210-010&site=ehost-live&scope=site
End of citation-->
Advanced Regression Methods for Single-Case Designs: Studying Propranolol in the Treatment for Agitation
Associated With Traumatic Brain Injury
By: Daniel F. Brossart
Department of Educational Psychology, Texas A&M University;
Jay M. Meythaler
Department of Physical Medicine and Rehabilitation, Wayne State University;
Rehabilitation Institute of Michigan, Detroit, Michigan
Richard I. Parker
Department of Educational Psychology, Texas A&M University
James McNamara
Department of Educational Psychology, Texas A&M University
Timothy R. Elliott
Department of Educational Psychology, Texas A&M University
Acknowledgement: This study was funded in part by National Institute of Disability Research and Rehabilitation
Grant H 133G000072 awarded to Jay M. Meythaler. Appreciation is expressed to Michael E. Dunn for sharing
information and opinions about the history of single-case designs in rehabilitation psychology research. Graphs of
participant data not presented in this article are available upon request from Daniel F. Brossart.
In a thoughtful commentary, Aeschleman (1991) observed a decreasing interest in single-case research (SCR)
designs in the rehabilitation psychology literature: Between 1985 and 1989, Aeschleman found only 6 out of 402
empirical papers published in Rehabilitation Psychology, Archives of Physical Medicine and Rehabilitation, and
Rehabilitation Counseling Bulletin used a single-subject design (<1.5% of the total; Aeschleman, 1991, p. 43). A brief
examination of the past 15 years of Rehabilitation Psychology reveals one article that offered an innovative way to
analyze single-case data (Callahan & Barisa, 2005) and another that was a true single-case study (Pijnenborg,
Withaar, Evans, van den Bosch, & Brouwer, 2007).
We disagree with Aeschleman's bleak conclusion that SCR designs “… have not made a methodological impact on
research in reh.
Protection of human subjects,Phenomenon ,Methodology,Study design,Theoretical model,Significance of the study,Research problem,
WHAT IS THE IMPACT OF COMFORT CARE VERSES ALTERNATIVE CARE FOR THE CHRONIC DYING PATIENT FAMILY AND THE HEALTH CARE TEAM
Understanding Oncology Nurses’ Grief: A Qualitative Meta-AnalysisLisa Barbour
Barbour, L. C. (2016, September 16-18). Understanding oncology nurses’ grief: A qualitative meta-analysis. A presentation at the Athabasca University 2016 Graduate Student Conference, Edmonton, AB.
Running head RESEARCH PROPOSAL ON COUPLES COUNSELING RESEA.docxtoltonkendal
Running head: RESEARCH PROPOSAL ON COUPLES COUNSELING
RESEARCH PROPOSAL ON COUPLES COUNSELING 5
Research Proposal on Couples Counseling
Social Work Practice Research I (SOCW - 6301 - 3)
Introduction
This research proposal is about undertaking research to find the best therapy method for couples between individual, group, and couples therapy. The proposal will detail the findings of past researchers and will occasionally focus on the therapy methods in the context of a couple that is experiencing conflict mainly based on the rejection of their same-sex marriage by their respective families. It will also detail the methodologies used by other researchers in investigating the therapy methods. The study will reveal the most recommended therapy method and the variations of the method.
Research Problem and Question
Many couples quarrel because their respective families reject their union or relationship or marriage. Most of the affected couples are those whose respective families are deeply divided on the basis of religion, race/ethnicity and socio-economic status. However, some families just oppose relationships because they threaten their traditions, which are mostly rooted on religion. Some families oppose gay or lesbian relationships or marriages. Even when a family member reveals that he or she may attracted to a member of the opposite sex, the other family members may rise up against that family member. It may make teenagers and young adults hide about their sexual orientation. The stigmatization may be too unbearable for the affected individuals, who may choose to go into seclusion and engage in suicidal actions. There are couples like Kathleen and Lisa who courageously seek the help of therapists. Upon setting a stage for positive development, couples can ease the tension in the mind. They can open up to people and feel ready to solve problems together. The question that comes in mind in light of these facts is: What it the true impact of sexual orientation-based rejection by family members on a relationship? How can a social worker help couples overcome sexual orientation-based rejection by family members on a relationship? The research question of the study is: which between individual, group, and couples therapy is the best therapy method for couples?
Literature Review on Individual, Group, and Couples Therapy
The therapeutic alliance concept is mainly associated with individual psychotherapy, particularly in literature. Yet, the concept is increasingly used together within the marital and family therapy domains. According to Pinsof and Catherall (1986), “a systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework”. The authors examined family, couple and individual therapy and used some methodologies and deve ...
Respond to at least two colleagues by explaining how they could use .docxcarlstromcurtis
Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
Somatic symptom disorders are mental disorders that manifest with physical symptoms that are not always clear to explain with medical diagnosis (APA, 2013). One specific example of such a disorder is the Illness Anxiety Disorder (F45.21). This disorder is diagnosed when there is a pervasive and impacting preoccupation with having a serious medical condition in circumstances when no predisposition or existing symptomatology indicate there should be medical concern (APA, 2013). The diagnosed individual will exhibit heightened anxiety regarding their perceived condition. Furthermore, the diagnosis is classified as either “care-seeking type,” whereby the individual frequently seeks out medical guidance from professionals or “care-avoidant type: whereby the individual avoids medical care despite their ongoing concerns (APA, 2013).
This can present a unique challenge for guiding professionals, as the client is potentially in need of both medical and mental health care. Therefore, a biopsychosocial assessment is recommended to gain the most thorough, comprehensive picture of the client and their current set of circumstances. This multi aspect evaluation serves to understand the biological, or physical, contributors to the individual’s somatic diagnosis, while also delving into their perceptions and beliefs (psychological) and their social environment and experiences. When this information is gathered from these varied perspectives, intervention can be designed to target specific areas of need, with the understanding that medical care may be required, concurrently, with mental health support (Dimsdale, Patel, Xin and Kleinman, 2007).
Because of the complexity of such diagnoses, a multidisciplinary approach is deemed most effective when working with such clients. Because of the psychological involvement in this disorder, psychotherapy aimed at modifying existing thought patterns would be considered sound practice (Kirmayer and Sartorius, 2007). To expand, cognitive behavioral therapy (CBT) can be applied, increasing the client's awareness of their current thought patterns, possible triggers and strategies to combat negative thinking. Additionally, the prescription of medication to address the co-occurring anxiety or other resulting physical symptoms would be provided by a medical professional, such as a psychiatrist. This approach, widely accepted, allows for the client’s case to be viewed through different lenses.
While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can b ...
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According to Davenport (2014) social media and health care are c.docxmakdul
According to Davenport (2014) social media and health care are collaborating in meeting the needs of health care providers and patients. Social media is taking a step towards focusing on an analytic model to evaluate the value of social media in healthcare. For this assignment you research and investigate the areas of social media that might embrace and benefit from an analytic model combining acquired data and value-based analytics. You will then evaluate the resource addressing the following points:
· Five major stakeholder roles of social media—patients, physicians (and other outpatient care), hospitals, payers (employers, health plans), and health information technology (IT)
· Will social media improve a practice? How so? Provide a thorough rationale.
· Provide a conclusion with the main points .
format:
· Must be two to four
· Must use at least three scholarly sources
.
According to (Fatehi, Gordon & Florida, N.D.) theoretical orient.docxmakdul
According to (Fatehi, Gordon & Florida, N.D.) theoretical orientation represent styles of mind for understanding reality. This theoretical orientation can be organized as a continuum from theoretical constructs that are independent and concrete as with the Behavioral/ CBT theories, to theoretical constructs that are interdependent and abstract as with the Psychodynamic theories (Fatehi, Gordon & Florida, N.D.). Family systems and Humanistic/Existential are theoretical midpoints (Fatehi, Gordon & Florida, N.D.). Trait theory tends to focus on the premise that we are born with traits or characteristics that make us unique and explain our behaviors (Cervone& Pervin, 2019). For example, introversion, extroversion, shyness, agreeableness, kindness, etc. all these innate characteristics that we are born help to explain why we behave in a certain manner according to the situations we face, (Cervone& Pervin, 2019). Psychoanalytic perspective on the other hand focuses on childhood experiences and the unconscious mind which plays a role in our personality development, (Cervone& Pervin, 2019).
According to Freud, (Cervone& Pervin, 2019) our unconscious mind includes all our hidden desires and conflicts which form the root cause of our mental health issues or maladaptive behaviors. The main difference between these two perspectives is that trait theory helps to explain why we behave in a certain manner, whereas psychoanalytic theory only describes the personality and predicting behavior and not really explaining why we behave the way we do. There is no such evident similarity between the two perspectives, but kind of rely on underlying mechanisms to explain personality. Also, there is some degree of subjectivity present in both the perspectives. Trait theories involve subjectivity regarding interpretations of which can be considered as important traits that explain our behaviors, and psychoanalytic theory is subjective and vague in the concepts been used like the unconscious mind. My opinions accord with the visible contrasts between the two, one focused on internal features describing our behaviors in clearer words, whilst other concentrating on unconscious mind in anticipating behavior which is ambiguous and harder to grasp.
References
Cervone, D., & Pervin, L. A. (2019). Personality: Theory and research (14th ed.). Wiley.
Fatehi, M., Gordon, R. M., & Florida, O. A Meta-Theoretical Integration of Psychotherapy Orientations.
.
According to Libertarianism, there is no right to any social service.docxmakdul
According to Libertarianism, there is no right to any social services besides those of a night-watchman state, protecting citizens from harming each other via courts, police, and military.
Consider this town
that decided to remove fire rescue as a basic social service. To benefit from it, one had to pay a yearly fee. Do you think libertarians would generally have to support such a policy in order to be consistent? Why or why not? Also, can you think of any other social services that might no longer exist in a libertarian society? (Btw, none has ever existed).
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According to Kirk (2016), most of your time will be spent working wi.docxmakdul
According to Kirk (2016), most of your time will be spent working with your data. The four following group actions were mentioned by Kirk (2016):
Data acquisition: Gathering the raw material
Data examination: Identifying physical properties and meaning
Data transformation: Enhancing your data through modification and consolidation
Data exploration: Using exploratory analysis and research techniques to learn
Select 1 data action and elaborate on the actions performed in that action group.
.
According to cultural deviance theorists like Cohen, deviant sub.docxmakdul
According to cultural deviance theorists like Cohen, deviant subcultures have their own value system that often opposes those of society at large. These contradictory "values" have been embraced by generations within that culture—and as a way to act out against the majority value system from which they feel excluded. Write an essay of 750-1,000 words that addresses the following:
How has rap culture perpetuated subcultural values, and promoted violence and crime among young men?
Given its sharp deviation from conventional values and norms, how and why would theorists explain the persistence and popularity of this subculture? (See examples Tupac Shakur page 109-110 and 50 Cent page 135).
Be sure to cite three to five relevant scholarly sources in support of your content
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According to Gray et al, (2017) critical appraisal is the proce.docxmakdul
According to Gray et al, (2017) “critical appraisal is the process of carefully and systematically assessing the outcome of all aspects of a study, judging the strengths, limitation, trustworthiness, meaning, and its applicability to practice”. The steps involved in critical appraisal include “identifying the study's elements or processes, determining the strengths and weaknesses, and evaluating the credibility and trustworthiness of the study” (Gray et al., 2017). The journal article chosen is
“change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: a result of a before/after survey study”
by Niederhauser, Zullig, Marschall, Schweiger, John, Kuster, and Schwappach. (2019).
Identifying the study's elements or processes
A significant issue addressed by the study is the nursing “staffs’ perspective towards indwelling urinary catheter (IUC) and evaluation of changes in their perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project” (Niederhauser et al, 2019). the process of the research was conducted in “seven acute care hospitals in Switzerland” (Niederhauser et al, 2019). With a “sample size of 1579 staff members participated in the baseline survey and 1527 participated in the follow-up survey. The survey captures all nursing and medical staff members working at the participating hospitals at the time of survey distribution, using a multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter needs, and staff training were implemented over the course of 9 months” (Niederhauser et al, 2019).
Determining the strengths and weaknesses
A great strength of the study is a large sample size of over 1000 and the use of well-constructed and easy-to-read heading for better understanding. Also, the use of figures, graphs, and tables make the article less cumbersome to read. Another strength is the implementation of the ethical principles of research by enabling informed consent and voluntary participation as well as confidentiality and anonymity of information.
On the other hand, the study has several weaknesses such as the use of “the theory of planned behavior to model intentions to reduce catheter use, but it is not possible to know if changes observed in staff perception led to a true change in practice” (Niederhauser et al, 2019). Another weakness of the study is the repeated survey design which allows assessment of changes in staff perspectives after implementation of a quality improvement intervention but the sustainability of the effects over time could not be evaluated.
Evaluating the credibility and trustworthiness of the study
Although the study used a larger sample size of over 1000, the “use of a single-group design and no control group weakens its credibility and trustworthiness because there are no causal inferences abou.
According to article Insecure Policing Under Racial Capitalism by.docxmakdul
According to article "Insecure: Policing Under Racial Capitalism" by Robin D.G. Kelley and the article "Yes, We Mean Literally Abolish the Police" by Mariame Kaba, the police are no longer an attribute of safety and security. The facts that are given in the articles are similar within the meaning of the content. The police do not serve for the benefit of the whole community. Racial and class division according to social status became the basis of lawlessness and injustice on the part of the police. Kaaba in his article cites several stories confirming the racial hatred that led to the murder of African Americans. After that, people massively took to the streets of many cities in several countries, demanding an end to racial discrimination and the murder of African Americans. Kelley's article describes numerous manifestos where demands for police abolition have been raised, but all have been rejected. In the protests, people suggested that they themselves would take care of each other, which the police could not do. I understand that the police system is far from ideal and the permissiveness of police representatives should be limited. Ruth Wilson Gilmore says that "capitalism is never racial." I think that this phrase she wants to say that the stronger people take away from the weak people and use them for their own well-being. And since the roots of history go back to slavery, then African Americans are the weak link. In this regard, a huge number of prisons and police power appeared. The common and small class do not feel protected, on the contrary; they expect a threat from people who must protect them. The police take an oath to respect and protect human and civil rights and freedoms, regardless of skin color and social status. If this does not happen, then you need to change the system.
.
Abstract In this experiment, examining the equivalence poi.docxmakdul
Abstract:
In this experiment, examining the equivalence point in a titration with NaOH identified an
unknown diprotic acid. The molar mass of the unknown was found to be 100.78 g/mol with pKa
values of 2.6 and 6.6. The closest diprotic acid to this molar mass is malonic acid with a percent
error of 3.48%.
Introduction:
The purpose of the experiment was to determine the identity of an unknown diprotic acid. The
equivalence and half-equivalence points on the titration curve give important information, which
can then be used to calculate the molecular weight of the acid. The equivalence point is the
moment when there is an equal amount of acid and NaOH. Knowing the concentration and
volume of added NaOH at that moment, the amount of moles of NaOH can be determined. The
amount of moles of NaOH is then equivalent to the amount of acid present. Dividing the original
mass of the acid by the moles present gave the molar mass of the acid.
In this particular titration, there were two equivalence points as the acid is diprotic.
Consequently, the titration curve had two inflection points. The acid dissociated in a two-step
process with the net reaction being:
H2X + 2 NaOH Na2X + 2 H2O
This was important to take into consideration when calculating the molar mass of the diprotic
acid. If the first equivalence point was to be used, the ratio of acid to NaOH was 1:1. If the
second equivalence point was used in the calculations, the ratio became 1:2 as now a second
set of NaOH molecules reacted with the acid to dissociate the second hydrogen ion. The
titration curve also showed the pKa values of the acid. This happened at the half-equivalence
point where half of the acid was dissociated to its conjugate base (again, because of the diprotic
properties of the acid, this happens twice on the curve). The Henderson Hasselbalch equation
pH = pKa+log(A-/HA)
shows that at the half-equivalence point, the pKa value equaled the pH and was visually
represented by the flattest part of the graphs.
Discussion:
The titration graph showed that the data was consistent with the methodology and proved to be
an precise execution of the procedure and followed the expected shape. One possible source of
error was the actual mass of the acid solid. While transferring the dust from the weigh boat to
the solution, some remained in the weigh boat this could have altered the molar mass
calculations and shifted the final the final mass lighter than actual.
The Vernier pH method was definitely a much more concrete method of interpreting the results.
It was possible to see which addition of NaOH gave the greatest increase in pH ( greatest 1st
derivative of the titration graph). The relying solely on the indicator color would make it very
difficult to judge at which precise point the color shifted most, as the shift was a lot more gradual
compared to the precise numbers. This may have been a more reliable method if there was a
de.
ACC 403- ASSIGNMENT 2 RUBRIC!!!
Points: 280
Assignment 2: Audit Planning and Control
Criteria
UnacceptableBelow 60% F
Meets Minimum Expectations60-69% D
Fair70-79% C
Proficient80-89% B
Exemplary90-100% A
1. Outline the critical steps inherent in planning an audit and designing an effective audit program. Based upon the type of company selected, provide specific details of the actions that the company should undertake during planning and designing the audit program.
Weight: 15%
Did not submit or incompletely outlined the critical steps inherent in planning an audit and designing an effective audit program. Did not submit or incompletely provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Insufficiently outlined the critical steps inherent in planning an audit and designing an effective audit program. Insufficiently provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Partially outlined the critical steps inherent in planning an audit and designing an effective audit program. Partially provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Satisfactorily outlined the critical steps inherent in planning an audit and designing an effective audit program. Satisfactorily provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Thoroughly outlined the critical steps inherent in planning an audit and designing an effective audit program. Thoroughly provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
2. Examine at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Identify the accounts that you would test, and select at least three (3) analytical procedures that you would use in your audit.
Weight: 15%
Did not submit or incompletely examined at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Did not submit or incompletely identified the accounts that you would test; did not submit or incompletely selected at least three (3) analytical procedures that you would use in your audit.
Insufficiently examined at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Insufficiently identified the accounts that you would test; insufficiently selected at least three (3) analytical procedures that you would use in your audit.
Partially examined at least two (2) performance ratios that you would use in order to determine which analytical tests .
ACC 601 Managerial Accounting Group Case 3 (160 points) .docxmakdul
ACC 601 Managerial Accounting
Group Case 3 (160 points)
Instructions:
1. As a group, complete the following activities in good form. Use excel or
word only. Provide all supporting calculations to show how you arrived at
your numbers
2. Add only the names of group members who participated in the completion
of this assignment.
3. Submit only one copy of your completed work via Moodle. Do not send it to
me by email.
4. Due: No later than the last day of Module 7. Please note that your professor
has the right to change the due date of this assignment.
Part A: Capital Budgeting Decisions
Chee Company has gathered the following data on a proposed investment project:
Investment required in equipment ............. $240,000
Annual cash inflows .................................. $50,000
Salvage value ............................................ $0
Life of the investment ............................... 8 years
Required rate of return .............................. 10%
Assets will be depreciated using straight
line depreciation method
Required:
Using the net present value and the internal rate of return methods, is this a good investment?
Part B: Master Budget
You have just been hired as a new management trainee by Earrings Unlimited, a distributor of
earrings to various retail outlets located in shopping malls across the country. In the past, the
company has done very little in the way of budgeting and at certain times of the year has
experienced a shortage of cash. Since you are well trained in budgeting, you have decided to
prepare a master budget for the upcoming second quarter. To this end, you have worked with
accounting and other areas to gather the information assembled below.
The company sells many styles of earrings, but all are sold for the same price—$10 per pair. Actual
sales of earrings for the last three months and budgeted sales for the next six months follow (in pairs
of earrings):
January (actual) 20,000 June (budget) 50,000
February (actual) 26,000 July (budget) 30,000
March (actual) 40,000 August (budget) 28,000
April (budget) 65,000 September (budget) 25,000
May (budget) 100,000
The concentration of sales before and during May is due to Mother’s Day. Sufficient inventory should
be on hand at the end of each month to supply 40% of the earrings sold in the following month.
Suppliers are paid $4 for a pair of earrings. One-half of a month’s purchases is paid for in the month
of purchase; the other half is paid for in the following month. All sales are on credit. Only 20% of a
month’s sales are collected in the month of sale. An additional 70% is collected in the following
month, and the remaining 10% is collected in the second month following sale. Bad debts have been
negligible.
Monthly operating expenses for the company are given below:
Variable:
Sales commissions 4 % of sales
.
Academic Integrity A Letter to My Students[1] Bill T.docxmakdul
Academic Integrity:
A Letter to My Students[1]
Bill Taylor
Professor of Political Science
Oakton Community College
Des Plaines, IL 60016
[email protected]
Here at the beginning of the semester I want to say something to you about academic integrity.[2]
I’m deeply convinced that integrity is an essential part of any true educational experience, integrity on
my part as a faculty member and integrity on your part as a student.
To take an easy example, would you want to be operated on by a doctor who cheated his way through
medical school? Or would you feel comfortable on a bridge designed by an engineer who cheated her
way through engineering school. Would you trust your tax return to an accountant who copied his
exam answers from his neighbor?
Those are easy examples, but what difference does it make if you as a student or I as a faculty member
violate the principles of academic integrity in a political science course, especially if it’s not in your
major?
For me, the answer is that integrity is important in this course precisely because integrity is important in
all areas of life. If we don’t have integrity in the small things, if we find it possible to justify plagiarism or
cheating or shoddy work in things that don’t seem important, how will we resist doing the same in areas
that really do matter, in areas where money might be at stake, or the possibility of advancement, or our
esteem in the eyes of others?
Personal integrity is not a quality we’re born to naturally. It’s a quality of character we need to nurture,
and this requires practice in both meanings of that word (as in practice the piano and practice a
profession). We can only be a person of integrity if we practice it every day.
What does that involve for each of us in this course? Let’s find out by going through each stage in the
course. As you’ll see, academic integrity basically requires the same things of you as a student as it
requires of me as a teacher.
I. Preparation for Class
What Academic Integrity Requires of Me in This Area
With regard to coming prepared for class, the principles of academic integrity require that I come having
done the things necessary to make the class a worthwhile educational experience for you. This requires
that I:
reread the text (even when I’ve written it myself),
clarify information I might not be clear about,
prepare the class with an eye toward what is current today (that is, not simply rely on past
notes), and
plan the session so that it will make it worth your while to be there.
What Academic Integrity Requires of You in This Area
With regard to coming prepared for class, the principles of academic integrity suggest that you have a
responsibility to yourself, to me, and to the other students to do the things necessary to put yourself in
a position to make fruitful contributions to class discussion. This will require you to:
read the text before.
Access the Center for Disease Control and Prevention’s (CDC’s) Nu.docxmakdul
Access the Center for Disease Control and Prevention’s (CDC’s)
“Nutrition, Physical Activity, and Obesity: Data, Trends and Maps”
database. Choose a state other than your home state and compare their health status and associated behaviors. What behaviors lead to the current obesity status?
Initial discussion post should be approximately 300 words. Any sources used should be cited in APA format.
.
According to DSM 5 This patient had very many symptoms that sugg.docxmakdul
According to DSM 5 This patient had very many symptoms that suggested Major Depressive Disorder.
Objective(s)
Analyze psychometric properties of assessment tools
Evaluate appropriate use of assessment tools in psychotherapy
Compare assessment tools used in psychotherapy
.
Acceptable concerts include professional orchestras, soloists, jazz,.docxmakdul
Acceptable concerts include professional orchestras, soloists, jazz, Broadway musicals and instrumental or vocal ensembles, and comparable college or community groups performing music relevant to the content of this class. (Optionally, either your concert report
or
your concert review - but not both unless advance permission is given - may be based on a concert of non-western music selected from events on the concert list.)
Acceptable concerts include the following:
• Symphony orchestras • Concert bands and wind ensembles • Chamber Music (string quartets, brass and woodwind quintets, etc.) • Solo recitals (piano, voice, etc.) • Choral concerts • Early music concerts • Non-western music • Some jazz concerts • Opera• Broadway Musicals• Flamenco• Ballet• Tango
Assignment Format
The following are required on the concert review assignment and, thus, may affect your grade.
• Must be typed• Must be double-spaced• Must be between
2 and 4 pages
in length
not including the cover sheet
.• Must use conventional size and formatting of text - e.g. 10-12 point serif or sans serif fonts with normal margins. • Must include the printed program from the concert and/or your ticket stubs. Photocopies are unacceptable. (Contact me at least 24 hours before due date if any materials are unavailable.)• All materials (text, program, ticket stub) must be
stapled
together securely. Folded corners, paper clips, etc. instead of staples will not be accepted.• Careful editing, proofreading, and spelling are expected, although minor errors will not affect your grade.
Papers that do not follow these format guidelines may be returned for resubmission, and late penalties will apply.
Concert Review Assignment Content
I. Cover Sheet:
Include the following on a cover sheet attached to the front of your review:
• Title or other description of the event/performers you heard, along with the date and location of the performance. For example:
New World Symphony Orchestra
1258 Lincoln Road
Saturday, June 5, 2013
Lincoln Road Theater, Miami Beach
• Your name, assignment submission date, course. For example:
Pat Romero
October 31, 2013
Humanities 1020 MWF 8:05 a.m.
II. Descriptions
The main body of the concert review should include brief discussions of
three of the
pieces
in the concert you attend. In most cases, a single paragraph for each piece should be sufficient, although you may wish to break descriptions of longer pieces into separate short paragraphs, one per movement.
Your description of each piece (song) should include:
• The title of the piece and the composer's name if possible, as listed in the concert program.• A brief description of your reaction to the piece. For example:
When the piece started I thought it was going to be slow and boring, but the faster section in the first movement made it more exciting. A really great flute solo full of fast and high notes in the third movement caught my attention. I'm not sure, but I thought that som.
ACA was passed in 2010, under the presidency of Barack Obama. Pr.docxmakdul
ACA was passed in 2010, under the presidency of Barack Obama. Prior to this new act, there were plenty of votes that did not agree with the notion of accessible insurance. Before 2010, The private sector had been given coverage in such a way that Milstead and Short (2019) called it sickness insurance; meaning companies will risk incurring medical expenses as long as it was balanced by healthy people. They were doing so by excluding people that had pre-existing conditions, becoming a very solvent business (Milstead & Short, 2019). After ACA was passed that was no longer the case. When President Trump came into term he did so by bringing his own healthcare agenda, which attempted to repeal ACA, but ultimately failed to come up with a replacement.
In 2016, the Republican's party platform was to repeal ACA, while continuing Medicare and Medicaid, but on the other hand, democrats put down that Obamacare is a step towards the goals of universal health care, and that this was just the beginning (Physicians for a National Health Program, n.d.). As for the cost analysis of repealing the Affordable Care Act, this would increase the number of uninsured people by 23 million, and it will cost about 350 billion through 2027, as well as creating costly coverage provisions to replace it (Committee for a Responsible Federal Budget, 2017).
(2 references required)
.
Access the FASB website. Once you login, click the FASB Accounting S.docxmakdul
Access the FASB website. Once you login, click the FASB Accounting Standards Codification link. Review the materials in the FASB Codification, especially the links on the left side column. Next, write a 1-page memo to a friend introducing and explaining this new accounting research resource that you have found. Provide at least one APA citation to the FASB Codification and reference that citation using the APA guidelines.
.
Academic Paper Overview This performance task was intended to asse.docxmakdul
Academic Paper Overview This performance task was intended to assess students’ ability to conduct scholarly and responsible research and articulate an evidence-based argument that clearly communicates the conclusion, solution, or answer to their stated research question. More specifically, this performance task was intended to assess students’ ability to: • Generate a focused research question that is situated within or connected to a larger scholarly context or community; • Explore relationships between and among multiple works representing multiple perspectives within the scholarly literature related to the topic of inquiry; • Articulate what approach, method, or process they have chosen to use to address their research question, why they have chosen that approach to answering their question, and how they employed it; • Develop and present their own argument, conclusion, or new understanding while acknowledging its limitations and discussing implications; • Support their conclusion through the compilation, use, and synthesis of relevant and significant evidence generated by their research; • Use organizational and design elements to effectively convey the paper’s message; • Consistently and accurately cite, attribute, and integrate the knowledge and work of others, while distinguishing between their voice and that of others; and • Generate a paper in which word choice and syntax enhance communication by adhering to established conventions of grammar, usage, and mechanics.
.
Academic Research Team Project PaperCOVID-19 Open Research Datas.docxmakdul
Academic Research Team Project Paper
COVID-19 Open Research Dataset Challenge (CORD-19)
An AI challenge with AI2, CZI, MSR, Georgetown, NIH & The White House
(1) FULL-LENGTH PROJECT
Dataset Description
In response to the COVID-19 pandemic, the White House and a coalition of leading research groups have prepared the COVID-19 Open Research Dataset (CORD-19). CORD-19 is a resource of over 44,000 scholarly articles, including over 29,000 with full text, about COVID-19, SARS-CoV-2, and related corona viruses. This freely available dataset is provided to the global research community to apply recent advances in natural language processing and other AI techniques to generate new insights in support of the ongoing fight against this infectious disease. There is a growing urgency for these approaches because of the rapid acceleration in new coronavirus literature, making it difficult for the medical research community to keep up.
Call to Action
We are issuing a call to action to the world's artificial intelligence experts to develop text and data mining tools that can help the medical community develop answers to high priority scientific questions. The CORD-19 dataset represents the most extensive machine-readable coronavirus literature collection available for data mining to date. This allows the worldwide AI research community the opportunity to apply text and data mining approaches to find answers to questions within, and connect insights across, this content in support of the ongoing COVID-19 response efforts worldwide. There is a growing urgency for these approaches because of the rapid increase in coronavirus literature, making it difficult for the medical community to keep up.
A list of our initial key questions can be found under the
Tasks
section of this dataset. These key scientific questions are drawn from the NASEM’s SCIED (National Academies of Sciences, Engineering, and Medicine’s Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats)
research topics
and the World Health Organization’s
R&D Blueprint
for COVID-19.
Many of these questions are suitable for text mining, and we encourage researchers to develop text mining tools to provide insights on these questions.
In this project, you will follow your own interests to create a portfolio worthy single-frame viz or multi-frame data story that will be shared in your presentation. You will use all the skills taught in this course to complete this project step-by-step, with guidance from your instructors along the way. You will first create a project proposal to identify your goals for the project, including the question you wish to answer or explore with data. You will then find data that will provide the information you are seeking. You will then import that data into Tableau and prepare it for analysis. Next, you will create a dashboard that will allow you to explore the data in-depth and identify meaningful insights. You will then give structure .
AbstractVoice over Internet Protocol (VoIP) is an advanced t.docxmakdul
Abstract
Voice over Internet Protocol (VoIP) is an advanced telecommunication technology which transfers the voice/video over
high speed network that provides advantages of flexibility, reliability and cost efficient advanced telecommunication
features. Still the issues related to security are averting many organizations to accept VoIP cloud environment due to
security threats, holes or vulnerabilities. So, the novel secured framework is absolutely necessary to prevent all kind of
VoIP security issues. This paper points out the existing VoIP cloud architecture and various security attacks and issues
in the existing framework. It also presents the defense mechanisms to prevent the attacks and proposes a new security
framework called Intrusion Prevention System (IPS) using video watermarking and extraction technique and Liveness
Voice Detection (LVD) technique with biometric features such as face and voice. IPSs updated with new LVD features
protect the VoIP services not only from attacks but also from misuses.
A Comprehensive Survey of Security Issues and
Defense Framework for VoIP Cloud
Ashutosh Satapathy* and L. M. Jenila Livingston
School of Computing Science and Engineering, VIT University, Chennai - 600127, Tamil Nadu, India;
[email protected], [email protected]
Keywords: Defense Mechanisms, Liveness Voice Detection, VoIP Cloud, Voice over Internet Protocol, VoIP Security Issues
1. Introduction
The rapid progress of VoIP over traditional services is
led to a situation that is common to many innovations
and new technologies such as VoIP cloud and peer to
peer services like Skype, Google Hangout etc. VoIP is the
technology that supports sending voice (and video) over
an Internet protocol-based network1,2. This is completely
different than the public circuit-switched telephone net-
work. Circuit switching network allocates resources to
each individual call and path is permanent throughout
the call from start to end. Traditional telephony services
are provided by the protocols/components such as SS7, T
carriers, Plain Old Telephone Service (POTS), the Public
Switch Telephone Network (PSTN), dial up, local loops
and anything under International Telecommunication
Union. IP networks are based on packet switching and
each packet follows different path, has its own header and
is forwarded separately by routers. VoIP network can be
constructed in various ways by using both proprietary
protocols and protocols based on open standards.
1.1 VoIP Layer Architecture
VoIP communication system typically consist of a front
end platform (soft-phone, PBX, gateway, call manager),
back end platform (server, CPU, storage, memory, net-
work) and intermediate platforms such as VoIP protocols,
database, authentication server, web server, operating sys-
tems etc. It is mainly divided into five layers as shown in
Figure1.
1.2 VoIP Cloud Architecture
VoIP cloud is the framework for delivering telephony
services in which resourc.
Abstract
Structure of Abstract
Background on the problem
purpose/objective of the study
Method used
Interpretation of results
Conclusion&Recommendation for future research
.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Instructions for Submissions thorugh G- Classroom.pptx
Rationale and Standards of Evidence in Evidence-Based Practice.docx
1. Rationale and Standards of Evidence in Evidence-Based
Practice
OLIVER C. MUDFORD, ROB MCNEILL, LISA WALTON
AND KATRINA J. PHILLIPS
What is the purpose of collecting evidence to inform clinical
practice in psychology concerning the effects of psychological
or other interventions? To quote Paul’s (1967) article that has
been cited 330 times before November 4, 2008, it is to
determine the answer to the question: “What treatment, by
whom, is most effective for this individual with that specific
problem, under which set of circumstances?” (p. 111). Another
answer is pitched at a systemic level, rather than concerning
individuals. That is, research evidence can inform health-care
professionals and consumers about psychological and behavioral
interventions that are more effective than pharmacological
treatments, and to improve the overall quality and cost-
effectiveness of psychological health service provision
(American Psychological Association [APA] Presidential Task
Force on Evidence-Based Practice, 2006). The most general
answer is that research evidence can be used to improve
outcomes for clients, service providers, and society in general.
The debate about what counts as evidence of effectiveness in
answering this question has attracted considerable controversy
(Goodheart, Kazdin, & Sternberg, 2006; Norcross, Beutler, &
Levant, 2005). At one end of a spectrum, evidence from
research on psychological treatments can be emphasized.
Research-oriented psychologists have promoted the importance
of scientific evidence in the concept of empirically supported
treatment. Empirically supported treatments (ESTs) are those
that have been sufficiently subjected to scientific research and
have been shown to produce beneficial effects in wellcontrolled
studies (i.e., efficacious), in more natural clinical environments
(i.e., effective), and are the most cost-effective (i.e., efficient)
3. recommendations with an individual client. Recognizing each of
these three factors as necessary considerations in intervention
selection, the APA Presidential Task Force on Evidence-Based
Practice (2006, p. 273) provided its definition: “Evidence-based
practice in psychology (EBPP) is the integration of the best
available research with clinical expertise in the context of
patient characteristics, culture, and preferences.” The task force
acknowledged the similarity of its definition to that of Sackett,
Straus, Richardson, Rosenberg, and Haynes (2000) when they
defined evidence-based practice in medicine as “the integration
of best research evidence with clinical expertise and patient
values” (p. 1). Available research evidence is the base or
starting point for EBPP. So, in recommending a particular
intervention from a number of available ESTs, the psychologist,
using clinical expertise with collaboration from the client,
weighs up the options so that the best treatment for that client
can be selected. As we understand it, clinical expertise is not to
be considered as an equal consideration to research evidence, as
some psychologists have implied (Hunsberger, 2007). Like
client preferences, the psychologist’s expertise plays an
essential part in sifting among ESTs the clinician has located
from searching the evidence. Best research evidence is
operationalized as ESTs. Treatment guidelines can be developed
following review of ESTs for particular populations and
diagnoses or problem behaviors. According to the APA (APA,
2002; Reed, McLaughlin, & Newman, 2002), treatment
guidelines should be developed to educate consumers (e.g.,
clients and health-care systems) and professionals (e.g., clinical
psychologists) about the existence and benefits of choosing
ESTs for specific disorders over alternative interventions with
unknown or adverse effects. Treatment guidelines are intended
to recommend ESTs, but not make their use mandatory as
enforceable professional standards (Reed et al., 2002). The
declared status, implications, misunderstanding, and misuse of
treatment guidelines based on ESTs continue to be sources of
controversy (Reed et al., 2002; Reed & Eisman, 2006). Our
5. is the desire or duty, through the Hippocratic Oath, to use the
optimal method to prevent or cure physical, mental, or social
ailments and promote optimal health in individuals and
populations (Jenicek, 2003). This section of the chapter
provides an overview of the history of evidence-based practice
in medicine (EBM), as well as a description of the current
methodology of EBM. A critical reflection on the process and
evidence used for EBM is also provided, leading to an
introduction of the relevance of evidence-based practice (EBP)
to other disciplines, including psychological interventions.
History of Evidence-Based Practice in Medicine The earliest
origins of EBM can be found in 19th-century Paris, with Pierre
Louis (1787– 1872). Louis sought truth and medical certainty
through systematic observation of patients and the statistical
analysis of observed phenomena; however, its modern origins
and popularity are found much more recently in the advances in
epidemiological methods in the 1970s and 1980s (Jenicek,
2003). One of the key people responsible for the emergence and
growth of EBM, the epidemiologist Archie Cochrane, proposed
that nothing should be introduced into clinical practice until it
was proven effective by research centers, and preferably
through double-blind randomized controlled trials (RCTs).
Cochrane criticized the medical profession for its lack of
rigorous reviews of the evidence to guide decision making. In
1972, Cochrane reported the results of the first systematic
review, his landmark method for systematically evaluating the
quality and quantity of RCT evidence for treatment approaches
in clinical practice. In an early demonstration of the value of
this methodology, Cochrane demonstrated that corticosteroid
therapy, given to halt premature labor in high-risk women,
could substantially reduce the risk of infant death (Reynolds,
2000). Over the past three decades, the methods and evidence
used for EBM have been extended, refined, and reformulated
many times. From the mid-1980s, a proliferation of articles has
instructed clinicians about the process of accessing, evaluating,
and interpreting medical evidence; however, it was not until
7. recognizing the unique characteristics of the individual’s
characteristics, situation, and context. It is not difficult to see
the inherent benefits of EBM, and health professionals have
been quick to recognize the potential benefit of adopting it as
standard practice. Citing a 1998 survey of UK general
practitioners (GPs), Sackett and colleagues (2000) wrote that
most reported using search techniques, with 74% accessing
evidence-based summaries generated by others, and 84%
seeking evidence-based practice guidelines or protocols. The
process of engaging in EBM requires some considerable
understanding of research and research methods, and there is
evidence that health professionals struggle to use EBM in their
actual practice. For example, Sackett et al. (2000) found that
GPs had trouble using the rules of evidence to interpret the
literature, with only 20% to 35% reporting that they understood
appraising tools described in the guidelines. Clinicians’ ability
to practice EBM also may be limited by lack of time to master
new skills and inadequate access to instant technologies
(Sackett et al., 2000). In addition to these practical difficulties,
there have also been some criticisms of EBM’s dominant
methodology. An early criticism of EBM, and nearly all EBP
approaches, is that it appears to give greatest weight to science
with little attention to the “art” that also underlies the practice
of medicine, nursing, and other allied health professions. For
example, Guyatt and colleagues cited attention to patients’
humanistic needs as a requirement for EBM (EvidenceBased
Medicine Working Group, 1992). Nursing and other health-care
disciplines note that EBP must be delivered within a context of
caring to achieve safe, effective, and holistic care that meets the
needs of patients (DiCenso, Cullum, Ciliska, & Guyatt, 2004).
Evidence-based practice is also criticized as being “cookbook
care” that does not take the individual into account. Yet a
requirement of EBP is that incorporating research evidence into
practice should consistently take account of the patient’s unique
circumstances, preferences, and values. As noted by Sackett et
al. (2000), when these three elements are integrated to inform
9. most efficient one has the potential to impact on the likelihood
of having sufficient resources to deliver that treatment, or any
other, in the future. By treating one person with the most
effective treatment the clinician may be taking away the
opportunity to treat others, especially if that treatment is very
expensive in relation to its effectiveness compared to less
expensive treatment options. According to current EBM
methods, the weight that a piece of evidence brings to the
balance of information used to make a decision about whether a
treatment is supported by evidence can be summarized in Table
1.1. Although there are subtle variations in this hierarchy
between different EBM guidelines and other publications, they
all typically start with systematic reviews of RCTs at the top
and end with expert opinion at the bottom. Before discussing
systematic reviews, metaanalyses, and clinical guidelines, it is
important to understand the type of study that these sources of
evidence are typically based on: the RCT. RCTs are a research
design in which the participants are randomly assigned to
treatment or control groups. RCTs are really a family of
designs, with different components such as blinding
(participants and experimenter), different randomization
methods, and other differences in design. Analysis of RCTs is
quantitative, involving estimation of the statistical significance
or probability of the difference in outcomes observed between
the treatment and control groups in the study. The probabilities
obtained are an estimate of the likelihood of that size
difference, or something larger, existing in the population.
There are a number of international databases that store and
provide information from RCTs, including the Cochrane Central
Register of Controlled Trials (CENTRAL;
mrw.interscience.wiley.com/cochrane/cochrane
_clcentral_articles_fs.html), OTseeker (www .otseeker.com),
PEDro (www.pedro.fhs.usyd .edu.au), and the Turning Research
Into Practice (TRIP; www.tripdatabase.com) database. Another
effort to increase the ease with which clinicians can access and
use evidence from RCTs has come through efforts to
11. that they are relatively resource intensive and this leads to
increased pressure to get desired results or to suppress any
results that do not fit the desired outcome (Gluud, 2006; Simes,
1986). In social sciences, RCTs are not always possible or
advisable, so many systematic reviews and meta-analyses in
these areas have less restrictive inclusion criteria. Commonly,
these include studies that compare a treated clinical group with
an untreated or attention control group (Kazdin & Weisz, 1998;
Rosenthal, 1984). In these situations, a quasiexperimental
design is often adopted. There is also evidence that RCTs are
not necessarily any more accurate at estimating the effect of a
given treatment than quasi-experimental and observational
designs, such as cohort and case control studies (Concato, Shah,
& Horwitz, 2008). Systematic reviews provide a summary of
evidence from studies on a particular topic. For EBM this
typically involves the formation of an expert committee or
panel, followed by the systematic identification, appraisal, and
synthesis of evidence from relevant RCTs relating to the topic
(Melnyk & Fineout-Overholt, 2005). The result of the review is
usually some recommendation around the level of empirical
support from RCTs for a given diagnostic tool or treatment. The
RCT, therefore, is seen as the gold standard of evidence in
EBM. Systematic review and meta-analysis are closely related
EBP methods to evaluate evidence from a body of sometimes
contradictory research to assess treatment quality. There is a
great deal of overlap between methods, stemming in part from
their different origins. The systematic review arises from EBM
and the early work of Cochrane and more recently Sackett and
colleagues (2000). Metaanalysis originated in the 1970s, with
the contributions of Glass (1976) in education and Rosenthal
(1984) in psychology being central. Meta-analyses are a
particular type of systematic review. In a meta-analysis,
measures of the size of treatment effects are obtained from
individual studies. The effect sizes from multiple studies are
then combined using a variety of techniques to provide a
measure of the overall effect of the treatment across all of the
13. coding system used to analyze studies, how inclusive the study
selection process was, the outcome measures used or accepted,
and the use of raw effect sizes or adjusted sample sizes (Flather
et al., 1997). Some meta-analyses are conducted without using a
rigorous systematic review approach, and this is much more
likely to produce a mathematically valid but clinically invalid
conclusion (Kazdin & Weisz, 1998; Rosenthal, 1984). There are
also some criticisms of the meta-analysis approach, specifically
from child and adolescent psychology literature. Meta-analyses
can obscure qualitative differences in treatment execution such
as investigator allegiance (Chambless & Hollon, 1998; Kazdin
& Weisz, 1998) and are limited by confounding among
independent variables such as target problems, which tend to be
more evident with certain treatment methods (Kazdin & Weisz,
1998). Evidence-based clinical practice guidelines are also
included in this top level of evidence, with the caveat that they
must be primarily based on systematic reviews of RCTs. The
purpose of these practice guidelines is to provide an easy-to-
follow tool to assist clinicians in making decisions about the
treatment that is most appropriate for their patients (Straus,
Richardson, Glasziou, & Haynes, 2005). There are some issues
with the publication and use of evidence-based clinical practice
guidelines. One problem is that different groups of experts can
review the same data and arrive at different conclusions and
recommendations (Hadorn, Baker, Hodges, & Hicks, 1996).
Some guidelines are also criticized for not being translated into
tools for everyday use. One of the major drawbacks of clinical
guidelines is that they are often not updated frequently to
consider new evidence (Lohr, Eleazer, & Mauskopf, 1998). In
addition to individual researchers and groups of researchers,
there are a large number of organizations that conduct
systematic reviews, publish clinical practice guidelines, and
publish their findings in journals and in databases on the
Internet, including the Cochrane Collaboration
(www.cochrane.org/), the National Institute for Clinical
Evidence (NICE; www.nice.org.uk/), the Joanna Briggs Institute
15. other studies are usually not identical and this raises issues,
particularly in the use of meta-analyses, where the treatment
effects are being combined (Eysenck, 1994). The mixing of
populations can also cause problems, where the treatment may
only be effective in one or more specific populations but the
review has included studies from other populations where the
treatment is not effective. The overall effect of mixing these
populations is to diminish the apparent effectiveness of the
treatment under review (Eysenck, 1994). Other issues with this
top level of evidence relate to the information not included.
Once a review or guideline is completed it must be constantly
updated to check for new evidence that may change the
conclusions. There are also issues around the information not
included in the review process, including nonRCT studies, gray
literature, such as technical reports and commissioned reports,
and unpublished studies. Studies that do not get into peer-
reviewed journals, and therefore usually get excluded from the
review process, are often those that did not have significant
results. The effect of this is that reviews will often exaggerate
the effectiveness of a treatment through the exclusion of studies
where the treatment in question was found to be ineffective. For
this reason there has been a recent move to introduce what is
called the “failsafe N” statistic. This is the hypothetical number
of unpublished (or hidden) studies showing, on average, no
effect that would be required to overturn the statistically
significant effects found from review of the published (or
located) studies results (Becker, 2006). Quasi-experimental
designs are the same as RCTs but the groups are not randomly
assigned, there is no control group, or they lack one or more of
the other characteristics of an RCT. In many situations
randomization of participants or having a control group is not
practically and/or ethically possible. The strengths of quasi-
experimental designs come from the degree of control that the
research has over the groups in the study, and over possible
confounding variables. A well-designed quasiexperimental
design has the important characteristic of being able to infer
17. intervention and any subsequent changes in outcome variables,
making the establishment of causation possible, at least to some
degree. The limitations of cohort studies include the difficulty
in controlling extraneous variables, leading to a relatively
limited ability to infer causality. They are also extremely
resource intensive and are not good where there is a large gap
between treatment and outcome (Grimes & Schulz, 2002).
Descriptive studies involve the description of data obtained
relating to the characteristics of phenomena or variables of
interest in a particular sample from a population of interest
(Melnyk & Fineout-Overholt, 2005). Correlational studies are
descriptive studies where the relationship between variables is
explored. Qualitative studies collect nonnumeric data, such as
interviews and focus groups, with the analysis usually involving
some attempt at describing or summarizing certain phenomena
in a sample from a population of interest (Melnyk & Fineout-
Overholt, 2005). Descriptive studies in general sit low down on
the ladder of evidence quality due to their lack of control by the
researcher and therefore their inability to infer causation
between treatment and effect. On the other hand, much research
is only feasible to conduct using this methodology. Qualitative
research in health services mostly arose from a desire to get a
deeper understanding of what the quantitative research finding
meant for the patient and provider (Mays & Pope, 1996). It asks
questions such as “How do patients perceive . . . ?” and “How
do patients value the options that are offered?” Expert opinion
is material written by recognized authorities on a particular
topic. Evidence from these sources has the least weight in EBM,
although to many clinicians the views of experts in the field
may hold more weight than the higher level evidence outlined
above. Despite its criticisms and methodological complexity,
EBM is seen by most clinicians as a valid and novel way of
reasoning and decision making. Its methods are widely
disseminated through current clinical education programs at all
levels throughout the world. As proposed by Gordon Guyatt and
colleagues in 1992, EBM has led to a paradigm shift in clinical
19. & Sons, Incorporated. All rights reserved. empirical support for
their effectiveness, such as the adoption of known ineffective
substance abuse prevention programs (Ringwalt et al., 2002) or
programs that are harmful for some students and their families,
such as facilitated communication (Jacobson, Mulick, &
Schwartz, 1995). This leads not only to resource wastage, but an
even greater cost in lost opportunities for the students involved.
It seems like common sense for EBP to be adopted by other
disciplines, as it is difficult to understand why reputable
practitioners, service providers, and organizations would not
want to provide interventions that have been shown to be the
most effective and efficient. Yet, despite this commonsense
feeling, the codes of conduct and ethical requirements, and
mandated laws, many disciplines (including medicine) have
found it difficult to bridge the gap between traditional
knowledge-based practice and the EBP framework (Greenhalgh,
2001; Stout & Hayes, 2004). Professions such as social work
(Roberts & Yeager, 2006; Zlotnick & Solt, 2006), speech
language therapy (Enderby & Emerson, 1995, 1996),
occupational therapy (Bennett & Bennett, 2000), and education
(Shavelson & Towne, 2002; Thomas & Pring, 2004) have all
attempted to overcome the difficulties that have arisen as they
try to move EBP from a theoretical concept to an actual usable
tool for everyday practitioners. Although some of these
disciplines have unique challenges to face, many are common to
all. Many human services disciplines have reported that one of
the major barriers to the implementation of EBP is the lack of
sound research. For example, speech language therapy reports
difficulties with regard to the quality and dissemination of
research. A review of the status of speech language therapy
literature by Enderby and Emerson (1995, 1996) found that
there was insufficient quality research available in most areas of
speech language therapy; however, they did find that those
areas of speech therapy that were associated with the medical
profession (e.g., dysphasia and cleft palate) were more likely to
have research conducted than those associated with education
20. (e.g., children with speech and language disorders and
populations with learning disabilities). There continues to be a
lack of agreement on speech language therapies effectiveness
(Almost & Rosenbaum, 1998; Glogowska, Roulstone, Enderby,
& Peters, 2000; Robertson & Weismer, 1999). In addition to the
lack of research, Enderby and Emerson were also concerned
about the manner in which health resources were being
allocated for speech language therapists. They found that of the
resources allocated to speech language therapy approximately
70% were being used with children with language impairments,
despite there being limited quality evidence of the effectiveness
of speech language therapy with the population at that time.
They also identified that dysarthria was the most commonly
acquired disorder, but had very little research outside of the
Parkinson’s disease population. So, again, many resources have
been allocated to programs that have no evidence of
effectiveness. This questionable allocation of resources is seen
in other fields also. For example, a number of studies have
found that people seeking mental health treatments are unlikely
to receive an intervention that would be classified as EBP and
many will receive interventions that are ineffective (Addis &
Krasnow, 2000; Goisman, Warshaw, & Keller, 1999). A number
of organizations and government agencies within a variety of
fields try to facilitate the much-needed research. Examples in
education include the United States Department for Children,
Schools, and Families (previously Department for Education
and Skills), the National Research Council (United Kingdom),
and National Teacher Research Panel (United Kingdom).
Similarly, in social work the National Association of Social
Workers (United States) and the Society for Social Work and
Research (United States) both facilitate the gathering of
evidence to support the use of EBP within their field; 12
Overview and Foundational Issues c01 20 April 2012; 12:43:30
Hersen, Michel, and Peter Sturmey. Handbook of Evidence-
Based Practice in Clinical Psychology, Child and Adolescent
Disorders, John Wiley & Sons, Incorporated, 2012. ProQuest
22. practice. Reilly, Oates, and Douglas (2004) outlined a number
of areas that the National Health Service Research and
Development Center for Evidence-Based Medicine had
identified for future development. They suggest that there is a
need for a better understanding of how practitioners seek
information to inform their decisions, what factors influence the
inclusion of this evidence into their practice, and the value
placed, both by patients and practitioners, on EBP. In addition,
there is a need to develop information systems that facilitate the
integration of evidence into the decision-making processes for
practitioners and patients. They also suggest that there is a need
to provide effective and efficient training for frontline
professionals in evidence-based patient care. Finally, they
suggest that there is simply a need for more research.
EVIDENCE IN PSYCHOLOGY Although RCT research is still
held up as the gold standard of evidence in medical science, in
other clinical sciences, especially psychology, best research
evidence has been less focused on RCTs as being the only
scientifically valid approach. Randomized controlled trials are
still held in high regard in clinical psychology, but it has long
been recognized that alternative designs may be preferred and
still provide strong evidence, depending on the type of
intervention, population studied, and patient characteristics
(APA Presidential Task Force on Evidence-Based Practice,
2006; Chambless & Hollon, 1998). Research Methods
Contributing to Evidence-Based Practice in Psychology We
have described and discussed RCTs in the previous section on
EBM. The issues concerning RCTs and their contribution to the
clinical psychology evidence base are similar. The inclusion of
evidence of treatment efficacy and utility from research
paradigms other than RCT methods and approximations thereto
has Rationale and Standards of Evidence in Evidence-Based
Practice 13 c01 20 April 2012; 12:43:30 Hersen, Michel, and
Peter Sturmey. Handbook of Evidence-Based Practice in
Clinical Psychology, Child and Adolescent Disorders, John
Wiley & Sons, Incorporated, 2012. ProQuest Ebook Central,
24. however, external validity has often been viewed as
problematic. This is because participants in small-N studies are
not a randomly selected sample from the whole population of
interest. The generality of findings from smallN studies is
established by replication across more and more members of the
population of interest in further small-N studies. A hypothetical
example of the process of determining the generality of an
intervention goes like this: (a) A researcher shows that a
treatment works for a single individual with a particular type of
diagnosis or problem; (b) Either the same or another researcher
finds the same beneficial effects with three further individuals;
(c) Another researcher reports the same findings with another
small set of individuals; and so on. At some point, sufficient
numbers of individuals have been successfully treated using the
intervention that generality can be claimed. Within a field such
as a particular treatment for a particular disorder, small-N
studies can be designed so results can be pooled to contribute to
an evidence base larger than N ¼ 1 to 3 or 4 (Lord et al., 2005).
Even if there is an evidence base for an intervention from a
series of small-N studies, every time another individual receives
the same treatment, the clinician in scientistpractitioner role
evaluates the effects of the intervention using small-N design
methods. Thus, every new case is clinical research to determine
the efficacy and effectiveness of this treatment for that
individual. Clinical psychologists can be cautioned that
physicians and medical researchers have a similar-sounding
name for an experimental design with their “N of 1 trials.” The
definition of N of 1 trials can vary somewhat but typically they
are described as “randomised, double blind multiple crossover
comparisons of an active drug against placebo in a single
patient” (Mahon, Laupacis, Donner, & Wood, 1996, p. 1069).
These N of 1 trials are continued until the intervention, usually
a drug, in question shows consistently better effects than its
comparison treatment or control condition. 14 Overview and
Foundational Issues c01 20 April 2012; 12:43:30 Hersen,
Michel, and Peter Sturmey. Handbook of Evidence-Based
26. Elbert, and Johnson (1998) tabulated criteria for determining
whether an intervention for childhood disorders could be
considered well-established (i.e., efficacious) or probably
efficacious (i.e., promising). For the former, they recommended
at least two well-conducted RCT standard studies by
independent research teams or a series of independent well-
designed small-N studies with at least nine participants
carefully classified to the diagnostic category of interest
showing that the intervention was better than alternative
interventions. The availability of treatment manuals was
recommended. For “promising” treatments, the criteria were
relaxed to allow nonindependent RCTs, comparing treatment to
notreatment, or a minimum of three small-N studies. These
criteria followed those established at the time for psychological
therapies in general (Chambless & Hollon, 1998). We have
discussed the determination of empirical support from RCTs
already. The next sections will examine how evidence is derived
from small-N studies: First, how evidence is assessed from
individual research reports; and second, how the evidence can
be combined from a group of research articles addressing the
same topic of interest. Evaluating Evidence From Small-N
Research Designs How do those assessing the efficacy of a
treatment from small-N designs measure the strength of the
design for the research purpose and whether, or to what extent,
a beneficial effect has been demonstrated? Chambless and
Hollon (1998) recommended reviewers to rate single-case
studies on the stability of their baselines, use of acceptable
experimental designs, such as ABAB or multiple baseline
designs, and visually estimated effects. Baselines need not
always be stable to provide an adequate control phase; there are
other valid designs (e.g., changing criterion, multielement
experimental designs); and visual estimates of effects are not
necessarily reliable (Cooper, Heron, & Heward, 2007). Validity
Rationale and Standards of Evidence in Evidence-Based
Practice 15 c01 20 April 2012; 12:43:30 Hersen, Michel, and
Peter Sturmey. Handbook of Evidence-Based Practice in
28. every data point shown on published graphs from 117 research
articles on procedures to reduce problem behaviors among
persons with autism. Each point was measured by using dividers
to determine the distance between the point and zero on the
vertical axis. Campbell calculated effect sizes for three
variables: mean baseline reduction, percentage of zero data
points, and percentage of nonoverlapping data points. Use of
these statistical methods may have been appropriate considering
the types of data Campbell examined; nonzero baselines of
levels of problem behavior followed by intervention phases in
which the researchers’ goal was to produce reduction to zero
(see Jensen, Clark, Kircher, & Kristjansson, 2007, for critical
review of meta-analytic tools for small-N designs).
Nevertheless, the seemingly arduous nature of the task and the
lack of generalizability of the computational methods to
reviewing interventions designed to increase behaviors are
likely to mitigate wider acceptance of Campbell’s (2003)
method. A final example of methods to evaluate the strength of
an evidence base for interventions is that outlined by
Wilczynski and Christian (2008). They describe the National
Standards Project (NSP), which was designed to determine the
benefits or lack thereof of a wide range of approaches for
changing the behaviors of people with autism spectrum
disorders (ASD) aged up to 21 years. Their methods of
quantitative review enabled the evidence from group and small-
N studies to be integrated. Briefly, and to describe their method
for evaluating small-N studies only, their review rated research
articles based on their scientific merit first. Articles were
assessed to determine whether they were sufficiently
welldesigned in terms of experimental design, measurement of
the dependent variables, assessment of treatment fidelity, the
ability to detect generalization and maintenance effects, and the
quality of the ASD classifi- cation of participants. If the article
exceeded minimum criteria on scientific merit, the treatment
effects were assessed as being beneficial, ineffective, adverse,
or that the data were not sufficiently interpretable to decide on
30. first A-phase. To continue with the baseline to meet NASP or
NSP evaluative criteria would have been unnecessary to show
experimental control and dangerous for the participant. These
examples indicate why more detailed and codified methods for
reviewing small-N studies quantitatively are, as yet, not firmly
established. Although there may be satisfactory methods for
fitting RCTs’ scientific merit and size of effects into databases
for metaanalyses, that appears to be more problematic with
small-N designs, given their flexibility in use (Hayes et al.,
1999). Volume of Evidence From Small-N Studies Required to
Claim That an Intervention Is Evidence Based Having rated the
strength of evidence from individual research articles, the next
step is to determine whether a group of studies on the same
topic between them constitute sufficient evidence to declare that
an intervention is an empirically supported treatment or a
promising or emerging intervention. We discuss only
empirically supported treatment criteria here. Consensus on
what minimum criterion should apply has yet to be reached.
Chambless and Hollon (1998) originally recommended a
minimum of two independent studies with three or more
participants (N $ 3) showing good effects for a total of N $ 6
participants. Lonigan et al. (1998) required three studies with N
$ 3; that is, beneficial effects shown for N $ 9 participants.
Since then, the bar has been raised. For instance, Horner et al.
(2005) proposed that the criteria for determining that an
intervention is evidence-based included a minimum of five
small-N studies, from three or more separate research groups,
with at least 20 participants in total. Wilczynski and Christian
(2008) used similar criteria with $ 6 studies of strongest
scientific merit totaling N $ 18 participants with no conflicting
results from other studies of adequate design. Others have
recommended similar standards: Reichow, Volkmar, and
Cicchetti (2008) described a method for evaluating research
evidence from both group and small-N designs, as had
Wilczynski and Christian (2008). Finally, Reichow et al. (2008)
set the criterion for an established EBP at $ 10 small-N studies
32. different levels, although we have outlined only the highest
levels. Both groups have also reported algorithms for
determining ESTs from mixed methods (e.g., RCTs and small-
Ns). Wilczynski and Christian (2008) report rules for
incorporating conflicting results into the decision-making
process about overall strength of evidence (De Los Reyes &
Kazdin, 2008). Level of Specificity of Empirically Supported
Treatments The issue to be discussed next concerns the unit of
analysis of the research evidence. We illustrate by examining an
example provided by Horner et al. (2005) in which they
assessed the level of support for functional communication
training (FCT; Carr & Durand, 1985). Functional
communication training is an approach to reducing problem
behaviors that teaches an appropriate nonproblematic way for
individuals to access reinforcers for the problem behavior that
have been identified through functional assessment. Horner and
colleagues cited eight published research reports that included
42 participants who had benefited in FCT studies across five
research groups. The evidence was sufficient in quantity for it
to be concluded that FCT is an empirically supported treatment,
exceeding all criteria reviewed earlier except that two more
studies would have been needed to reach the number of studies
$ 10 by the criteria of Reichow et al. (2008). It might
reasonably be asked: “For which population is FCT beneficial?”
Perusal of the original papers cited by Horner et al. (2005)
shows that 21/42 participants’ data were reported in one of the
eight cited studies (Hagopian, Fisher, Sullivan, Acquisto, &
LeBlanc, 1998), with the oldest participant being 16 years old,
and none reported to have a diagnosis of autism. Thus, applying
Horner et al.’s criteria, it cannot be concluded from the studies
cited that FCT is an empirically supported treatment for
participants with autism or for participants older than 16,
regardless of diagnosis. As an aside, eight participants across
the other seven studies were reported to have autism, and three
participants in total were aged over 20 years; however, the
literature on FCT that Horner et al. (2005) included did not
34. and EBPP movements (see contributions by clinicians in
Goodheart et al., 2006; Norcross et al., 2005). General concerns
included that requirements to use only ESTs restrict
professionalism by reframing psychologists as technicians going
by the book mechanically; restricting client choice to effective
interventions that have been granted empirically supported
treatment status higher than others, only because they, like
drugs, are relatively easy to evaluate in the RCT format.
Prescription of one-size-fits-all ESTs may further disadvantage
minorities, and people with severe and multiple disorders for
whom there is scant evidence available. There were also
concerns that the acknowledged importance of clinical
expertise, such as interpersonal skills to engage the client
(child) and significant others (family) in a therapeutic
relationship, would be ignored. Contrary to the pronouncements
from the APA (2002, 2006), guidelines have been interpreted or
developed that “assume the force of law” in prescribing some
interventions and proscribing others (Barlow et al., 1999, p.
155). Compulsion of psychologists in practice to follow
treatment guidelines has been reported to occur in the United
States by giving immunity from malpractice lawsuits to those
who use only ESTs, and increasing the vulnerability of those
who do not to litigation and increased professional indemnity
insurance (Barlow et al., 1999; Reed et al., 2002). Some
guidelines, especially those produced by agencies or companies
employing psychologists, have been viewed as thinly veiled
cost-cutting devices justified with a scientistic gloss. Ethical
Requirements For many human service professional
organizations, EBP and ESTs have become an ethical
requirement. The APA’s Ethical Principles of Psychologists and
Code of Conduct document mentions the obligation to use some
elements of EBPP; for example, “Psychologists’ work is based
upon established scientific and professional knowledge of the
discipline” (American Psychological Association, 2010, p. 5).
Other professional groups appear to be more prescriptive with
regard to EBP. The BACB’s Code for Responsible Conduct, for
36. that research on therapies for young people is lacking relative to
adults. Further research with child and adolescent populations
has been prioritized by APA (APA Presidential Task Force on
Evidence-Based Practice, 2006). Researching the effects of
treatments for children brings special difficulties (Kazdin &
Weisz, 1998). Regarding practice, children do not typically
selfrefer for mental, psychological, or behavioral disorders, nor
are they active seekers of ESTs or preferred interventions.
Parents or guardians tend to take those roles, either
independently or following recommendations from family, or
health or education professionals. Children and youth cannot
legally provide informed consent for treatments or for
participation in research studies. These are among the
developmental, ethical, and legal factors that affect
consideration of EBPP with children. Lord et al. (2005)
discussed the challenges of acquiring rigorous evidence
regarding efficacy of treatments for children with complex,
potentially chronic behavioral/psychological disorders.
Contributors to the article were researchers from multiple
disciplines assembled by the National Institutes of Health in
2002. They wrote about autism spectrum disorders specifically,
but acknowledged that the issues may have relevance to other
child and youth problems. Parents may be unwilling to consent
to randomization studies in case their child is assigned to what
parents perceive to be a less preferred treatment alternative,
particularly when the intervention is long term and early
intervention is, or is perceived to be, critical, such as early
intensive behavioral intervention for pervasive developmental
disorders. Lord et al. (2005) noted that ethical concerns may
prohibit RCTs of promising interventions when randomization
to no treatment or treatment of unknown effects is required by
the evaluation protocol. Additional factors that reduce the
internal validity of group comparison studies of psychosocial
interventions include that parental blindness to the intervention
allocated to their children is nigh on impossible, diffusion of
treatment through parent support groups is likely, parents may
38. selection uninformed by research affects children with other
difficulties and their families. Some interventions for children
with developmental and other disabilities have been found
ineffective or harmful (Jacobson et al., 2005), and the same
occurs for children with ADHD (Waschbusch & Hill, 2003).
(See also Chapter 2 of this volume for a further discussion of
this point by Waschbush, Fabiano, and Pelham.) We believe that
clinical psychologists working with young people ought to have
a professional ethical obligation to inform themselves and
others about empirically unsupportable treatments as well as
ESTs for their clients. LIMITATIONS OF THE EVIDENCE
BASE REGARDING EVIDENCE-BASED PRACTICE IN
PSYCHOLOGY There is a relatively large body of evidence
concerning efficacy of treatments (Kazdin & Weisz, 1998,
2003), but far less on treatment utility, effectiveness, and
efficiency. There is evidence that the utility of some efficacious
treatments has been demonstrated, but further study is needed
before the general statements can be made about the similarity
or difference between outcomes from controlled research and
clinical practice (Barlow et al., 1999; Hunsley, 2007). There is
less evidence concerning dimensions of clinical expertise and
client characteristics, culture, and preferences that are relevant
to beneficial treatment outcomes (Kazdin, 2008). Employment
of qualitative research methods may help us to understand
clients’ experiences of psychological treatments. The APA Task
Force has suggested that clinical expertise is made up of at least
eight components, including assessment and treatment planning,
delivery, interpersonal skills, self-reflection, scientific skills in
evaluating research, awareness of individual and social factors,
the ability to seek additional resources where necessary, and
having a convincing rationale for treatment strategies (APA
Presidential Task Force on Evidence-Based Practice, 2006).
Qualitative methods may provide evidence regarding clinical
expertise also. Improvement of two-way communication
between psychologists who are primarily researchers and those
who identify more as practitioners would assist dissemination of
40. feel forced to adapt to employing EBPP, but willingness or
compulsion to do so is not the same as becoming immediately
competent to use an empirically supported treatment effectively.
The typical workshop format for introducing new techniques is
as ineffective for professionals (Gotham, 2006), as it is for
direct care staff (Reid, 2004). Skill-based training can be
effective when trainees practice an intervention method in the
natural clinical environment with differential feedback from the
trainer on their performance of the skill. This should occur after
workshops that introduce the rationale and method, and include
in vivo or videotaped demonstration of the skill by the trainer
(i.e., modeling). Frequent follow-up observations by the trainer,
again with objective feedback to the trainee, can facilitate
maintenance of the newly acquired skills (Reid, 2004). Gotham
(2006) identified barriers to implementation of EBPP, and
provided an example of how to implement an empirically
supported treatment statewide despite obstacles. McCabe (2004)
wrote quite optimistically for clinicians about the challenges of
EBPP, offering advice in a step-by-step form to psychologists.
Reorienting and training clinicians is an area for further
clinicianresearcher collaboration that requires emphasis. We
have not included discussion of an area of EBPP that has, to
date, received less attention than evidence-based treatment,
which is “evidence-based assessment” (Kazdin, 2005; Mash &
Hunsley, 2005). An initial assessment with clinical utility will
identify what is the disorder or problem behavior so that it
points the psychologist in the right direction for identifying the
range of available ESTs for this client. Evidence-based
assessment includes identifying reliable and valid ongoing
measures that show the effects of an intervention with the
individual client (Kazdin, 2005). Typically, empirically
supported treatment reviews identify treatments for DSM-type
classifications, the nosological approach; however, an
idiographic functional approach to assessment may lead to
better problem-EST match (Sturmey, 2007). It was mentioned
earlier that some professional groups are concerned at the lack
42. treatments may find they have no raison d’eˆtre (and also no
income!).
Limitations to Evidence Based Practice
THOMAS MAIER
The promotion of evidence-based medicine (EBM) or, more
generally, of evidence-based practice (EBP) has strongly
characterized most medical disciplines over the past 15 to 20
years. Evidence-based medicine has become a highly influential
concept in clinical practice, medical education, research, and
health policy. Although the evidence-based approach has also
been increasingly applied in related fields such as psychology,
education, social work, or economics, it was and still is
predominantly used in medicine and nursing. Evidence-based
practice is a general and nonspecific concept that aims to
improve and specify the way decision makers should make
decisions. For this purpose it delineates methods of how
professionals should retrieve, summarize, and evaluate the
available empirical evidence in order to identify the best
possible decision to be taken in a specific situation. So EBP is,
in a broader perspective, a method to analyze and evaluate large
amounts of statistical and empirical information to understand a
particular case. It is therefore not limited to specific areas of
science and is potentially applicable in any field of science
using statistical and empirical data. Many authors often cite
Sackett, Rosenberg, Muir Gray, Haynes, and Richardson’s
(1996) article entitled “Evidence-based medicine:What it is and
what it isn’t” as the founding deed of evidence-based practice.
David L. Sackett (born 1934), an American-born Canadian
clinical epidemiologist, was professor at the Department of
Clinical Epidemiology and Biostatistics of McMaster University
Medical School of Hamilton, Ontario, from 1967 to 1994.
During that time, he and his team developed and propagated
44. against the propagation of EBM is, “It’s nothing new, doctors
have done it all the time.” Rangachari, for example,
apostrophized EBM as “old French wine with a new Canadian
label” (Rangachari, 1997, p. 280) alluding to the French 19th
century epidemiology pioneer Pierre Louis, who was an
influencing medical teacher in Europe and North America, and
to David L. Sackett, the Canadian epidemiologist. Even though
the “conscientious, explicit and judicious use of the current best
evidence in making decisions about the care of individual
patients” (Sackett et al., 1996, p. 71) seemsto be a perfectly
reasonable and unassailable goal, EBM has been harshly
criticized from the very beginning of its promotion (Berk
&Miles Leigh, 1999; B. Cooper, 2003; Miles, Bentley,
Polychronis, Grey, and Price, 1999; Norman, 1999; Williams &
Garner, 2002). In 1995, for example, the editors of The Lancet
chose to publish a rebuking editorial against EBM entitled
“Evidence-based medicine, in its place” (The Lancet, 1995):
The voice of evidence-based medicine has grown over the past
25 years or so from a subversive whisper to a strident insistence
that it is improper to practise medicine of any other kind.
Revolutionaries notoriously exaggerate their claims;
nonetheless, demands to have evidence-based medicine
hallowed as the new orthodoxy have sometimes lacked finesse
and balance, and risked antagonising doctors who would
otherwise have taken many of its principles to heart. The Lancet
applauds practice based on the best available evidence–bringing
critically appraised news of such advances to the attention of
clinicians is part of what peer-reviewed medical journals do–but
we deplore attempts to foist evidencebased medicine on the
profession as a discipline in itself. (p. 785) This editorial
elicited a fervid debate carried on for months in the letter
columns of The Lancet. Indeed, there was a certain doggedness
on both sides at that time, astonishing neutral observers and
rendering the numerous critics even more suspicious. The
advocates of EBM on their part acted with great self-confidence
and claimed no less than to establish a new discipline and to put